Getting a cancer diagnosis is one of the scariest things that can happen to a person. Not only would we worry about our survival, but many of us would also worry about what types of treatments we will face. Certainly, you know that doctors use chemotherapy treatments for cancer. But do you know how chemotherapy works, who it helps, and how you would receive treatments? How can you manage the side effects? Read on to learn important things about chemotherapy.
1. Important things to know about chemotherapy: When chemotherapy is used.
- To treat cancer: Chemotherapy can cure cancer, lessen the chance it will return, or stop or slow its growth.
- To ease cancer symptoms: Chemotherapy can shrink tumors that cause pain and other symptoms.
2. Important things to know about chemotherapy: Types of cancer it can help.
Doctors use chemotherapy on many types of cancer. Depending on your situation, you may receive chemotherapy on its own, or chemotherapy combined with other cancer treatments.
- Make a tumor smaller before surgery or radiation therapy (called neoadjuvant chemotherapy).
- Destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy).
- Help other treatments work better.
- Kill cancer cells that have returned or spread to other parts of your body.
3. Important things to know about chemotherapy: How chemotherapy medication is given.
Interestingly, chemotherapy may be given in many ways, including:
- Oral: pills, capsules, or liquids that you swallow.
- Intravenous (IV): goes directly into a vein through a needle or tube.
- Injection: a shot in a muscle in your arm, thigh, or hip, or a shot right under the skin in the fatty part of your arm, leg, or belly.
- Intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord.
- Intraperitoneal (IP): injected directly into the peritoneal cavity (the area in your body that contains organs such as your intestines, stomach, and liver).
- Intra-arterial (IA): injected directly into the artery that leads to your cancer.
- Topical: a cream that you rub onto your skin.
Chemotherapy is most often given with an IV, using a thin needle 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 your treatment is over.
Catheters, ports, and pumps.
You may receive IV chemotherapy through a catheter or port, sometimes administered with a pump. Here is a summary of what is involved:
- Catheter: Your doctor or nurse places one end of a catheter (a thin, soft tube) in a large vein, often in your chest area. The other end of the catheter stays outside your body. Generally, your catheter will stay in place until you finish your chemotherapy treatments. Nurses may also use catheters to give you other medications and to take blood samples. Since the area around a catheter can become infected, watch for signs of infection such as redness.
- Port: A port (a small, round disc) is placed under your skin – often in the chest – during minor surgery before you begin treatment. Your nurse will insert a needle into your port to give you chemotherapy and other medications, and to draw blood. The port stays in place until you finish your treatments. Similar to catheters, you must watch for signs of infection around your port.
- Pump: Pumps are often attached to catheters or ports to control the speed and quantity of chemotherapy given. Pumps can be internal (placed under your skin during surgery) or external (outside your body). Interestingly, with a pump, you may be able to get your chemotherapy outside of the hospital.
Where will you go for your chemotherapy treatments?
You may get chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital.
How often will you receive chemotherapy?
How often and for how long you will get chemotherapy depends on the following factors:
- Your type of cancer and how advanced it is.
- The reason for your chemotherapy:
- Cure your cancer.
- Control cancer’s growth.
- Ease your symptoms.
- The type of chemotherapy.
- How your body responds to the medication.
Importantly, you may receive chemotherapy in cycles – with a period of treatment followed by a period of rest.
Try not to miss a chemotherapy appointment.
Certainly, sometimes things arise that make it difficult to attend medical appointments. However, try your best not to skip any chemotherapy treatment sessions.
However, your doctor may change your chemotherapy schedule if you have certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.
4. Important things to know about chemotherapy: How to know if it’s working.
While undergoing treatment, you will see your doctor often. During these visits, he/she will ask you how you feel and perform a physical exam. Additionally, he/she may order blood tests, an MRI, CT, or PET scan – all of which can provide insight on the impact of your chemotherapy.
One of the important things to know about chemotherapy is that you cannot tell if chemotherapy is working based on the side effects you experience. Therefore, don’t assume that a lack of side effects means the chemotherapy isn’t working!
5. Important things to know about chemotherapy: Side effects.
We’ve all heard the stories about terrible side effects from chemotherapy. Yes, you may feel crappy. But you might not feel as horrible as you expect.
Why? Because advancements have made chemotherapy easier to tolerate. For instance, new ways of delivering chemo drugs make it easier for patients. Additionally, anti-nausea medications and alternative therapies (such as acupuncture, meditation and yoga) make it easier for cancer patients.
Moreover, side effects often get better or go away once you finish treatment.
Why do chemotherapy treatments have side effects? Because chemotherapy also kills or slows the growth of healthy cells that grow and divide quickly, which can lead to many different symptoms.
How will you react to your chemotherapy treatments?
One of the most important things to know about chemotherapy is that everyone responds differently to treatment. Chemotherapy affects people in different ways, even among patients with the same cancer taking the same medications. Therefore, your doctor and nurses cannot accurately predict how you will feel during your chemotherapy treatment period.
How you feel depends on the following factors:
- The type of chemotherapy you get.
- Your chemotherapy dosage.
- Your type of cancer.
- The stage of your cancer.
- How healthy you are before treatment.
What kinds of side effects can occur?
When most of us think about chemotherapy, we think about hair loss.
Scalp cooling caps can help!
Fortunately, scalp cooling caps may help save some or most of your hair during chemotherapy.
Since chemotherapy kills fast growing cells, it kills hair follicle cells along with cancer cells. However, scalp cooling prevents the chemotherapy medication from traveling to the hair follicles, which prevents the hair follicles from dying and falling out.
Note there are two kinds of caps – manual cold caps and scalp cooling machines.
Will scalp cooling help you?
Importantly, you need to understand what “success” looks like. Scalp cooling is deemed successful if more than 50% of your hair is present at the end of chemotherapy treatments.
The likelihood of scalp cooling helping you depends on the type of chemotherapy, the original condition of your hair, fit of the cooling cap, and how well you follow guidelines for hair care during and after chemotherapy.
Additionally, scalp cooling helps your hair grow back more quickly and fully after chemotherapy – even if it didn’t save at least 50% of your hair.
Is scalp cooling safe?
Could cooling caps allow cancer to spread to your scalp? Researchers evaluated over 3,000 patients and determined that using scalp cooling does not increase the likelihood of cancer spreading to the scalp.
What about frostbite? Experts report that following manufacturer’s directions prevents frostbite.
Can the caps cause other harm? There are some medical conditions that could make cooling caps riskier, including migraine headaches and spinal injuries. Talk to your doctor about any concerns.
Is scalp cooling uncomfortable?
Most patients find the caps uncomfortable for the first 20 minutes. However, after that initial cooling period, the scalp becomes numb. Additionally, taking a relaxing medication can make it more tolerable. Finally, a heated blanket and/or warm beverages can minimize discomfort.
Additionally, you may get a headache while using a cooling cap, due to its tightness and cold temperature.
How can you take advantage of scalp cooling?
Hopefully, your cancer center provides access to cooling caps. However, if they don’t, with your doctor’s approval (who may not be familiar with the technology), you can rent a set of manual caps from the manufacturer. Note that you must use dry ice to keep these adequately cold and you’ll need at least one other person to help you put it on properly.
Are cooling caps expensive to use?
Cooling caps can cost between $2,000 – $3,000. Fortunately, some insurance companies cover the cost, but you may have to persist to get coverage. If your insurance won’t cover the cost, you can use your health savings account or flexible spending account to pay for a cap. Additionally, you can try to get financial help from HairToStay, a national nonprofit dedicated to helping low-income cancer patients afford scalp cooling.
What else can you do to minimize hair loss?
Talk to your healthcare team for suggestions on how to manage hair loss. Your team may provide suggestions on how to treat your hair gently and how to protect and care for your scalp.
Nausea and vomiting.
Not only can nausea and vomiting make you feel terrible, it can also cause serious health problems such as malnutrition and dehydration. However, controlling nausea and vomiting can help you avoid complications and make you feel better.
- Ask your doctor about anti-nausea medications (called antiemetics). These medications can prevent or reduce many types of nausea and vomiting. However, you must take it at specific times, so make sure you follow your doctor’s orders. If your medication doesn’t help, ask your doctor if other medications might help instead.
- Ask your doctor for tips regarding food and beverages.
- Drink plenty of water and fluids.
- Avoid greasy, fried, sweet, or spicy foods if you feel sick after eating them. And you might find it easier to tolerate cold foods.
- On treatment days, try eating a small snack before treatment. Additionally, you may find it helpful to stop eating or drinking right before or after treatment.
- Try complementary medicine practices, such as acupuncture, deep breathing, guided imagery, hypnosis, and other relaxation techniques (such as listening to music, reading a book, or meditating).
If these tips don’t help, talk to your doctor and/or meet with a dietitian.
You may find that you’ve lost your appetite or that food tastes or smells different. Additionally, mouth and throat problems, nausea and vomiting can all make it hard to eat. Lastly, the fatigue of cancer treatment can lower your appetite.
You can address appetite issues by:
- Talking to your healthcare provider for suggestions.
- Drinking plenty of liquids, including smoothies which may be easier to swallow than whole foods.
- Choosing healthy, high-nutrient foods.
- Eating a little, even if you’re not hungry.
- Adding physical activity to your day (talk to your doctor for guidelines).
Unfortunately, chemotherapy can damage healthy cells that line your mouth and intestines, making it hard to eat. If you have problems, talk to your doctor or nurse. If needed, a dietitian may provide helpful recommendations.
Read the National Cancer Institute’s booklet for tips on coping with eating issues during cancer treatments.
You may have hard or infrequent bowel movements. Additionally, you might experience stomach cramps, bloating, and nausea. Not only can chemotherapy (and other treatments) cause constipation, certain medications (such as pain killers), and diet and lifestyle changes can also cause constipation.
If left unaddressed, constipation can lead to more serious complications, such as a bowel obstruction.
- Eating high-fiber foods.
- Drinking plenty of liquids. You may find warm or hot liquids help you move your bowels.
- Participating in some physical activity daily (talk to your doctor for guidelines).
- Ask your doctor about medications to address your constipation.
Although you may find yourself constipated, you may also develop diarrhea. Unfortunately, your cancer and/or your treatments can cause diarrhea or make it worse. Additionally, some medications, infections, and stress can cause diarrhea.
Importantly diarrhea can lead to dehydration and a reduction in your salt and potassium levels – each of which can be serious and even life threatening.
If you have diarrhea or signs of dehydration, notify your doctor.
You may be able to prevent any complications from diarrhea by:
- Drinking plenty of fluid every day.
- Eating small meals that are easy on your stomach, including foods high in potassium and sodium.
- Ask your doctor what medications you can take to ease your symptoms.
- Keep your anal area clean and dry.
Symptoms of cancer fatigue include:
- Having no energy.
- Feeling extremely tired.
- Having difficulty moving.
- Having difficulty thinking, remembering, or paying attention.
- Feeling a sense of physical, emotional, and/or mental exhaustion.
You may be able to minimize your cancer fatigue by:
- Talking to your doctor for suggestions.
- Receiving treatments for side effects (such as anemia, diarrhea, and pain) that cause fatigue.
- Practicing good sleep habits.
- Planning time to rest.
- Participating in physical activity (consult your doctor for guidelines).
- Meeting with a dietitian to learn about what you should eat and drink.
- Participating in mind-body practices, such as qigong, tai chi, and yoga.
- Taking supplements (consult your doctor for guidelines).
- Seeking support from friends and family.
With anemia, your number of red blood cells is below normal. This can make you feel very tired, short of breath, and lightheaded. You may also experience headaches, a fast heartbeat, and/or pale skin.
To reduce your fatigue associated with anemia, try the following:
- Ask for help.
- Take short naps during the day but realize that staying in bed too long can make you feel weak.
- Eat and drink well.
Other side effects.
Unsurprisingly, there are too many side effects to cover in this blog post. Instead, visit the National Cancer Institute’s website for detailed information on these side effects:
- Bleeding and bruising.
- Edema (swelling).
- Fertility Issues in males and females.
- Flu-like symptoms.
- Infection and neutropenia.
- Memory or concentration problems.
- Nerve problems (peripheral neuropathy).
- Organ-related inflammation and immunotherapy.
- Sexual health issues in men and women.
- Skin and nail changes.
- Sleep problems.
- Urinary and bladder problems.
Support can help you cope with side effects.
Side effects can take their toll on cancer patients. You may find it helpful to discuss your concerns with other cancer patients (look for support groups online – including on Facebook – and in your community). Additionally, reach out to family, friends, and mental health professionals for support.
6. Important things to know about chemotherapy: Working during treatment.
You may be able to work during chemotherapy, but you might have to adjust your work schedule to accommodate your stamina. Talk with your employer about ways you can adjust your work during chemotherapy.
Interestingly, your employer has to provide a reasonable accommodation if you are eligible under the ADA or your state’s fair employment law. However, your employer does not have to accommodate you if they can show the accommodation you are requesting would create an undue hardship or pose a direct threat.
If you or a loved one have cancer, there are a lot of potentially complicated things to learn and important decisions to make. Read the following posts for tips:
- What Should You Do When You Get a Cancer Diagnosis?
- How to Choose a Hospital for Cancer Treatment.
- What You Need to Know About Clinical Trials Before You Sign the Dotted Line.
- Can Ethnicity and Race Impact Cancer Survival?
- Does Where You Live Impact Cancer Outcome? Sadly, Yes.
NOTE: I updated this post on 2-20-24.