- Chemotherapy Facts*
- Chemotherapy Overview
- Chemotherapy Uses
- Types of Chemotherapy Drugs
- Chemotherapy Treatment Centers
- Chemotherapy Treatment Frequency and Dosing
- Missing a Dose of Chemotherapy
- Administering Chemotherapy
- Chemotherapy and Your Daily Life
- Working During Chemotherapy Treatment
- Taking OTC or Prescription Medication While Undergoing Chemotherapy Treatment
- Body Changes During Chemotherapy
- Approximate Costs for Chemotherapy Treatment
- Chemotherapy Clinical Trials
- Tips for Meeting With Your Doctor or Nurse
- Your Feelings During Chemotherapy
- Chemotherapy Side Effects
- Chemotherapy Topic Guide
*Chemotherapy facts medically edited by: Charles Patrick Davis, MD, PhD
- Chemotherapy is a treatment that uses drugs to damage or kill cancer cells; chemotherapy may reduce cancer symptoms, keep cancer from spreading, and in some cases, cure cancer.
- Chemotherapy is used to make tumors smaller, destroy hidden cancer cells that may remain after surgery, help radiation therapy and biological therapy work better, and inhibit and/or destroy cancer cells that are recurrent or have spread to other areas of the body (metastatic cancer).
- There are many dozens of different chemotherapy drugs; the choice of the drug depends on the type of cancer and the patient's overall health situation.
- There are many types of chemotherapy treatment centers; you may be treated at home, in a doctor's office, in a clinic as an outpatient, in a hospital or during a hospital stay.
- Chemotherapy dosing and frequency of treatment depends on the type of cancer and how advanced it is, the type of chemotherapy drug, how your body reacts to chemotherapy and the goals of your treatment; chemotherapy often is administered in cycles (for example, one week of chemotherapy and three weeks of rest/recovery).
- Chemotherapy benefits may be compromised if the patient misses a dose of chemotherapy.
- Chemotherapy may be given in many ways such as injection into muscles, intra-arterial, intraperitoneal, intravenous, topically or orally; some chemotherapy may be administered through specialized ports and/or pumps.
- Chemotherapy affects people differently; patients may need help to carry out daily activities during and after some chemotherapy sessions.
- Patients may need to talk with their employers about how to adjust to working because many employers are required by law to change a chemotherapy patient's work schedule.
- It is important to tell your doctors and nurses about any over-the-counter drugs and/or prescription medication you take; these compounds may affect your chemotherapy treatment.
- Many patients experience body changes (side effects such as fatigue or hair loss) during chemotherapy treatment; concerns about body changes should be discussed with your physician.
- Approximate costs for chemotherapy vary widely; it is best to go over your insurance policies and keep a record of all your treatment costs and insurance claims; this will help you to understand all of the costs and provide records in case costs need to be appealed.
- Clinical trials of chemotherapy agents allow new treatments to be developed; benefits vary from none to good cancer treatments and the risk are that they may not be as good as standard treatments; some chemotherapy in clinical trials may not be covered by insurance so it is important to understand all of the details for before agreeing to participate in a clinical trial.
- You should prepare a list of questions (see text for question details) and take notes and ask for printed information about your cancer and the chemotherapy drugs you may receive; also, it is wise to find out how to contact a physician or nurse in an emergency or after normal office hours.
- Chemotherapy can be stressful for some patients; the stress can be reduced by joining support groups, talking with others about chemotherapy, exercise and using relaxation techniques.
- Some common side effects of chemotherapy are fatigue, nausea, vomiting, decreased blood cell count, hair loss, mouth sores, and pain.
- Some side effects can be reduced by medications, others may resolve during or after the chemotherapy session; everyone is different so it is difficult to predict the side effects and the length of time they will occur - however, if fever and chills occur, the patient should be seen and evaluated by a medical professional quickly.
- The National Cancer Institute is a good source to answer many questions about chemotherapy.
Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to damage and ultimately destroy cancer cells.
How Does Chemotherapy Work?
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over. Chemotherapy works best if the cancer cells do not recover as well as the normal cells. Exploiting the difference in the sensitivity of cancer cells as opposed to normal cells is central to effective chemotherapy treatments.
What Does Chemotherapy Do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
- Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
- Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
- Ease cancer symptoms (also called palliation of symptoms) - when chemotherapy shrinks tumors that are causing pain or pressure - such as by lessening a cough, or pain by affecting the cancer cells causing such symptoms..
Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:
- Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
- Destroy either hidder or obvious deposits of cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy, and it attempts to improve upon the results of the other treatment previously given.
- Help radiation therapy and biological therapy work better.
- Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).
Types of Chemotherapy Drugs
There are many dozens of different drugs used for cancer chemotherapy. Each is different and yet all may be called chemotherapy drugs. The process of treating a cancer with these drugs is properly called chemotherapy treatment.
This choice of drug or drugs depends on:
- The type of cancer you have. Some types of chemotherapy drugs are used for many types of cancer. Other drugs are used for just one or two types of cancer.
- Whether you have had chemotherapy before and how it worked, and if so, for how long.
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Chemotherapy Treatment Centers
You may receive chemotherapy during a hospital stay, at home, or in a doctor's office, clinic, or outpatient unit in a hospital (which means you do not have to stay overnight). No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and make any needed drug changes.
Chemotherapy Treatment Dosing and Frequency
Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:
- Your type of cancer and how advanced it is
- The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
- The type of chemotherapy drug or drugs
- How your body reacts to chemotherapy
You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to rebuild new healthy cells to replace those damaged by treatment.
Missing a Dose of Chemotherapy?
In general, it is not good to skip a chemotherapy treatment. Previous reported benefits to a chemotherapy schedule may not be achieved if the patient cannot stay on schedule. Sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.
Chemotherapy may be given in many ways.
- Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
- Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.
- Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).
- Intravenous (IV). The chemotherapy goes directly into a vein.
- Topically. The chemotherapy comes in a cream that you rub onto your skin.
- Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.
Things to know about getting chemotherapy through an IV
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.
IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.
Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter.
Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port.
Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps connected to implanted catheters are placed under your skin during surgery.
Chemotherapy and Your Daily Life
Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy. They should inform you of the common side effects of the proposed treatment before you agree to take the treatment.
Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:
- Asking someone to drive you to and from chemotherapy
- Planning time to rest on the day of and day after chemotherapy
- Getting help with meals and child care the day of and at least 1 day after chemotherapy
Working During Chemotherapy Treatment
Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.
Taking OTC or Prescription Medication While Undergoing Chemotherapy Treatment
This depends on the type of chemotherapy you get and the other types of drugs you plan to take. Take only drugs that are approved by your doctor or nurse. Tell your doctor or nurse about all the over-the-counter and prescription drugs you take, including laxatives, allergy medicines, cold medicines, pain relievers, aspirin, and ibuprofen.
One way to let your doctor or nurse know about these drugs is by bringing in all your pill bottles. Your doctor or nurse needs to know:
- The name of each drug
- The reason you take it
- How much you take
- How often you take it
Can I take vitamins, minerals, dietary supplements, or herbs while I get chemotherapy?
Some of these products can change how chemotherapy works. For this reason, it is important to tell your doctor or nurse about all the vitamins, minerals, dietary supplements, and herbs that you take before you start chemotherapy. During chemotherapy, talk with your doctor before you take any of these products.
Body Changes During Chemotherapy
Your doctor will give you physical exams and medical tests (such as blood tests and X-rays). He or she will also ask you how you feel.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well. Or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer. Patients without side effects nmay still get real benefit from the treatments. Patients with side effects may or may not get benefit from their treatment.
Approximate Costs for Chemotherapy Treatment
It is hard to say how much chemotherapy will cost. It depends on:
- The types and doses of chemotherapy used
- How long and how often chemotherapy is given
- Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
- The part of the country where you live
Does my health insurance pay for chemotherapy?
Talk with your health insurance plan about what costs it will pay for. Questions to ask include:
- What will my insurance pay for?
- Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?
- What do I have to pay for?
- Can I see any doctor I want or do I need to choose from a list of preferred providers?
- Do I need a written referral to see a specialist?
- Is there a co-pay (money I have to pay) each time I have an appointment?
- Is there a deductible (certain amount I need to pay) before my insurance pays?
- What is my co-insurance? If the insurance pays for 80% of the cost, you may have to pay the other 20% unless you have supplemental insurance which covers that.
- Where should I get my prescription drugs?
- Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?
How can I best work with my insurance plan?
- Read your insurance policy before treatment starts to find out what your plan will and will not pay for.
- Keep records of all your treatment costs and insurance claims.
- You and your doctor must send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records. Clarify with your doctor what they will submit and what you may have to submit, and how to do it.
- As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.
- If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.
Chemotherapy Clinical Trials
Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine established treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:
- Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug. You may be receiving a treatment on a study which has been underway for sometime and which is already being given to many others with your condition.
- Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you. There is a guarantee under the principle of Equipoise that you will not be given a treatment expected to be worse than the standard chemotherapy, if there is one, for your condition.
- Payment. Your insurance company may or may not pay for treatment that is part of a clinical trial. Before you agree to be in a trial, you or your doctor's office should check with your insurance company to make sure it will pay for this treatment. This is called pre-approval or pre-authorization. It is best obtained in writing prior to beginning treatment if possible.
Contact the NCI's Cancer Information Service if you are interested in learning more about clinical trials.
Tips for Meeting With Your Doctor or Nurse
- Make a list of your questions before each appointment. Some people keep a running list and write down new questions as they think of them. Make sure to have space on this list to write down the answers from your doctor or nurse.
- Bring a family member or trusted friend to your medical visits. This person can help you understand what the doctor or nurse says and can talk with you about it after the visit is over.
- Ask all your questions. There is no such thing as a stupid question. If you do not understand an answer, keep asking until you do. If the doctor uses terms that you do not understand, then say so and ask that it be explained in other terms that you can understand.
- Take notes. You can write them down or use a tape recorder. Inform your doctor if you are recording the visit. The doctor should not object but it is polite to inform them. Later, you can review your notes and the recording so that you can remember what was said.
- Ask for printed information about your type of cancer and chemotherapy drugs you are to receive and the schedule on which you will receive them. Also request a schedule of follow up lab tests and other studies which may be needed prior to your seeing the doctor again.
- Let your doctor or nurse know how much information you want to know, when you want to learn it, and when you have learned enough. Some people want to learn everything they can about cancer and its treatment. Others only want a little information. The choice is yours.
- Find out how to contact your doctor or nurse in an emergency or after normal office hours. This includes who to call and where to go.
Questions to Ask Your Health Care Professional
About My Cancer
- What kind of cancer do I have?
- What is the stage of my cancer?
- Why do I need chemotherapy?
- What is the goal of this chemotherapy?
- What are the benefits of chemotherapy?
- What are the risks of chemotherapy?
- Are there other ways to treat my type of cancer?
- What is the standard care for my type of cancer?
- Are there any clinical trials for my type of cancer?
- Do you recommend that I participate in a clinical trial?
About My Treatment
- How many cycles of chemotherapy will I get? How long is each treatment? How long between treatments?
- What types of chemotherapy will I get?
- How will these drugs be given?
- Where do I go for this treatment?
- How long does each treatment last?
- Should someone drive me to and from treatments?
About Side Effects
- What side effects can I expect right away?
- What side effects can I expect later?
- How serious are these side effects?
- How long will these side effects last?
- Will all the side effects go away when treatment is over?
- What can I do to manage or ease these side effects?
- What can my doctor or nurse do to manage or ease these side effects? When should I call my doctor or nurse about these side effects?
Your Feelings During Chemotherapy
At some point during chemotherapy, you may feel:
It is normal to have a wide range of feelings while going through chemotherapy. After all, living with cancer and getting treatment can be stressful. You may also feel fatigue, which can make it harder to cope with your feelings.
How can I cope with my feelings during chemotherapy?
- Relax. Find some quiet time and think of yourself in a favorite place. Breathe slowly or listen to soothing music. This may help you feel calmer and less stressed.
- Exercise. Many people find that light exercise helps them feel better. There are many ways for you to exercise, such as walking, riding a bike, and doing yoga. Talk with your doctor or nurse about ways you can exercise.
- Talk with others. Talk about your feelings with someone you trust. Choose someone who can focus on you, such as a close friend, family member, chaplain, nurse, or social worker. You may also find it helpful to talk with someone else who is getting chemotherapy.
- Join a support group. Cancer support groups provide support for people with cancer. These groups allow you to meet others with the same problems. You will have a chance to talk about your feelings and listen to other people talk about theirs. You can find out how others cope with cancer, chemotherapy, and side effects. Your doctor, nurse, or social worker may know about support groups near where you live. Some support groups also meet online (over the Internet), which can be helpful if you cannot travel.
Talk to your doctor or nurse about things that worry or upset you. You may want to ask about seeing a counselor. Your doctor may also suggest that you take medication if you find it very hard to cope with your feelings.
It is normal to have a wide range of feelings while going through chemotherapy. After all, living with cancer and getting treatment can be stressful.
Chemotherapy Side Effects
What are side effects?
Side effects are problems caused by cancer treatment. Some common side effects from chemotherapy are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, mouth sores, and pain.
What causes side effects?
Chemotherapy is designed to kill fast-growing cancer cells. But it can also affect healthy cells that grow quickly. These include cells that line your mouth and intestines, cells in your bone marrow that make blood cells, and cells that make your hair grow. Chemotherapy causes side effects when it harms these healthy cells.
Will I get side effects from chemotherapy?
You may have a lot of side effects, some, or none at all. This depends on the type and amount of chemotherapy you get and how your body reacts. Before you start chemotherapy, talk with your doctor or nurse about which side effects to expect.
How long do side effects last?
How long side effects last depends on your health and the kind of chemotherapy you get. Most side effects go away after chemotherapy is over. But sometimes it can take months or even years for them to go away.
Sometimes, chemotherapy causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys, or reproductive organs. Some types of chemotherapy may cause a second cancer years later. Ask your doctor or nurse about your chance of having long-term side effects.
What can be done about side effects?
Doctors have many ways to prevent or treat chemotherapy side effects and help you heal after each treatment session. For example: drugs to prevent or control nausea and vomiting are much more effective now than they used to be. Talk with your doctor or nurse about which side effects to expect, when they are likely to occur, and what to do about them. Make sure to let your doctor or nurse know about any changes you notice - they may be signs of a side effect.
As another example: chemotherapy can lower your white blood cell count. White blood cells are an important way to fight infection. If you get a fever when your white blood cell count is low it can be very dangerous. Development of a fever after office hours should always be called about right away. Your doctor and staff should teach you what to watch for- such as chills or sweats, and the importance of having a thermometer on hand.
Doctors have many ways to prevent or treat chemotherapy side effects and help you heal after each treatment session. Talk with your doctor or nurse about which ones to expect and what to do about them. Make sure to let your doctor or nurse know about any changes you notice - they may be signs of a side effect.
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REFERENCE: National Cancer Institute. Questions and Answers About Chemotherapy. Last update: 7/2/2010