Chemotherapy
Chemotherapy refers to the use of medications to treat cancer. These medications fight cancer by interfering with DNA production. The cancer cells are then destroyed as they try to replicate. Chemotherapy works best for fast-growing cancers and is less effective when the cancer grows more slowly.
A key advantage of chemotherapy is that it is usually delivered intravenously or by pill so the treatment circulates throughout the body. There are over 50 chemotherapy medications and each type of cancer responds best to a certain combination and sequence of treatment that is established by clinical trials.
Though chemotherapy medications are given in a very controlled way, they can cause some common side effects that can vary from patient to patient. Some chemotherapy causes hair loss, others do not. Usually there are several days of fatigue with treatment and potential for lowering of blood counts which need monitoring.
Patients are advised to learn about their individual treatments and the more common side effects they might have by reviewing their teaching packet. Please don't hesitate to ask questions or share your concerns.
Preparing for Chemotherapy
As part of the pre-treatment education provided to each patient during the teaching session, we'll give you an overview of your treatment plan. You will receive information on each chemotherapy medication that will outline the most common side effects and precautions. Please read this information and share it with your family.
If you haven't received an information guide, please ask your treating nurse for one. Modern chemotherapy is very safe but you can contribute to your care by following our directions and being aware of things to watch for.
As part of your teaching session, insurance pre-authorization will be obtained. Many insurances require a chemotherapy copayment which we will request before treatment to allow us to purchase the drug with which you will be treated.
Many of our chemotherapy treatments require medication to be given prior to treatment to minimize side effects including allergic type reactions and nausea. Please pick up these medications from your pharmacy and bring them in with you so we can review them during your teaching session.
The large majority of our treatments are given with medications that are very effective preventing nausea. We suggest that you eat a light breakfast and then have light meals or snacks during the remainder of your first treatment day. Some chemotherapy drugs require extra fluid intake before treatment. Others require extra fluid intake after treatment. These types of instructions will be reviewed with you during your teaching session. If you have any questions or if you are uncertain about the directions, please don't hesitate to ask us for clarification.
It's generally recommended that you continue your usual prescription medications when taking chemotherapy. However, the National Cancer Institute recommends that vitamins and supplements be stopped since they can interfere with effectiveness of chemotherapy against cancer cells and also to limit side effects. There are a few chemotherapy treatments that require a vitamin or supplement and we will instruct you on those.
Please arrange transportation, especially for your first treatment. Some of our chemotherapy infusions require medications that can make you drowsy for several hours and you should not drive.
Frequently Asked Questions
How is chemotherapy given?
Most chemotherapy is given intravenously as an outpatient, usually in an infusion center. The treatment is given under the supervision of a medical oncologist by a registered nurse. At Torrance Memorial Physician Network Cancer Care all nurses are experienced and chemotherapy certified RNs.
What medication is used for Chemotherapy?
Chemotherapy treatment is empiric. That means that the drug selection for each individual patient is determined scientifically by clinical trials that report the success rate of the drug combinations based upon cancer type and stage. The results of these trials are reviewed at national meetings and reported in peer review journals so that the same treatments are given by cancer specialists throughout the United States and much of the rest of the world. At one time, about 20 years ago, it was thought that oncologists could individualize treatments for each cancer patient based upon chemotherapy assays of a patient’s cancer, very much like antibiotic sensitivity testing in patients with infection. Unfortunately, that approach has not been proven helpful due to the inaccuracy and unreliability of this type of testing, so chemotherapy assay which is now rarely used nor recommended by university cancer leaders or the National Cancer Institute. Instead, the national leaders in oncology have emphasized the use of scientific evidence-based medicine and reliance on well conducted clinical trials to guide oncologists when selecting appropriate chemotherapy. It may be that genetic and protein tests in the future will be valuable in helping pick the best chemotherapy and many studies are currently underway to look at this.
At Torrance Memorial, we only use chemotherapies that are FDA approved for the specific cancer being treated (with the exception of patients on clinical trials). This is a significant issue because use of chemotherapy in non-approved situations can lead to insurance denial of reimbursement which can be a huge problem given the large cost associated with some of the drugs.
Will chemotherapy make me feel ill?
Depends on the specific chemotherapy drugs administered. Each drug has a way of working and unique specific common side effects. One of the major advances in chemotherapy is the use of new and effective anti-nausea medication. Many patients will have minimal nausea so it wouldn't be unusual if you notice some nausea for a day or so. Depending on the specific chemotherapy, you might also have vomiting but usually on the evening of treatment and part of the following day. Contrary to popular belief, many patients receiving modern-day chemotherapy feel well enough to maintain a near normal level of activity and employment.
Will I lose my hair from chemotherapy?
That depends on the specific drugs used. Some cause hair loss and others don’t. When chemotherapy is finished, hair regrowth begins. Sometimes the new hair is thicker and curlier, but eventually hair returns to near normal in texture.
Will I be more likely to get an infection while receiving chemotherapy?
You are more likely to develop an infection while on chemotherapy because chemotherapy lowers the type of white blood cells called neutrophils which fight bacterial infection. Generally, the lowest levels occur 10-14 days after a chemotherapy treatment and remain low for 3-7 days. During this time, you could develop a bacterial infection of your blood due to bacteria that has entered the bloodstream from the skin and intestines. The risk generally doesn’t occur until the absolute neutrophil count (ANC) is less than 500. This type of infection usually occurs less than 10% of the time for the entire treatment period (for some chemotherapies less than 2%) but is very important as this can lead to severe illness and very rarely death. Because of this risk, chemotherapy is not given when the ANC is very low except when using specific drugs that don’t lower the ANC.
How can I protect myself when I have a greater risk of infection?
You are advised to take your temperature whenever you are feeling ill. If you have a fever greater than 100.5 F, you should begin an antibiotic and notify our office within a day so that the blood count can be checked. Effective treatment can usually be done as an outpatient but severely ill patients are hospitalized for IV antibiotics. It should be noted that because these infections are caused by bacteria not viruses, they are not contagious and your activities and diet are not typically altered while on most chemotherapies.
It is wise, however, while you are receiving chemotherapy, that you practice good hand hygiene and avoid close contact with other who have a cold or flu.
Is chemotherapy dangerous?
There is no denying that chemotherapy is a significant and serious form of treatment. When given under the guidance of expert oncologists and experienced chemotherapy nurses the risks of a catastrophic event, although never entirely eliminated, is very rare.
Do I need to alter my lifestyle while on chemotherapy?
You are encouraged to do as much as you can to lead a normal life. Some patients feel well enough to work and are encouraged to do so. Exercise is also permitted. Diet is not restricted, for most chemotherapies alcohol in moderation is permitted. Women of childbearing age should use a reliable birth control method (non-hormonal for breast cancer patients) to avoid pregnancy while undergoing any form of cancer treatment including chemotherapy, oral medications, and radiation. Men who are undergoing chemotherapy are advised that either they or their partner should use a reliable birth control method so that pregnancy during treatment is avoided.
Can I take vitamins while on chemotherapy?
No. Vitamins should not be taken during chemotherapy unless specifically prescribed by your doctor. There is data research to indicate that even a daily multi-vitamin can lower the effectiveness of chemotherapy. Since chemotherapy leads to cancer destruction by processes leading to oxidation, large doses of vitamins and antioxidant supplements are especially discouraged because there is a potential to interfere with the effect of chemotherapy against cancer.
