Chemotherapy

Chemotherapy is a systemic therapy that often forms part of the treatment regimen for cancer. It is generally used in conjunction with radiotherapy, surgery and/or hormone therapy.

What is systemic therapy?
Systemic therapy is treatment via the bloodstream and therefore reaches every part of the body, not just the tumour.

What is chemotherapy?
Chemotherapy is the term used for treatment (therapy) of a disease by means of chemical medication (anti-cancer drugs).

How does it work?
The medication is carried to the cancer cells via the bloodstream. The cancer cells are attacked and killed, including those that have spread to the rest of the body.

Why are drugs used in combination?
Different drugs attack the cells at different stages of cell division. By using a combination of drugs, the cancer cells are combated in different ways.

What is the goal of chemotherapy?
Chemotherapy has three main goals:

• cure
• control
• supporting radiotherapy or surgery.

When is chemotherapy used to cure cancer?
Chemotherapy, on its own or in conjunction with surgery, can cure certain types of cancer.

When is chemotherapy used to control cancer?
It is mostly used for cancer that has spread, because is works throughout the body. Chemotherapy can control the size and spread of a tumour, thereby extending the patient's life expectancy and improving quality of life.

When is chemotherapy used in conjunction with radiotherapy or surgery?
Surgery or radiotherapy is used to remove the tumour. Because chemotherapy can attack cancer cells throughout the body, it is used to ensure that all cancer cells are eradicated. It is also used before surgery to reduce the size of the tumour.

How is chemotherapy administered?
The most common method of administration is intravenous injection or infusion (drip).

How is an intravenous injection administered?
It can be administered directly into a vein by syringe, like an ordinary injection. It only takes a few seconds. It can also be administered over a longer period by means of an infusion – the medication flows from a plastic bag suspended from a stand via a plastic tube through the needle into the vein, at a regulated speed. The needle is kept in position with a sturdy plaster and the infusion may last from a few minutes to a few hours.

Is intravenous administration painful?
It is no more painful than an ordinary injection. Sometimes there might be a slight irritation of the vein or the skin at the site of injection.

How often is the medication given?
Treatment may last a few hours and is followed by a rest period of a few days or weeks, to give normal cells a chance to recover. The length of treatment is determined by the drugs used.

Who determines and monitors chemotherapy?
The treatment regimen is determined and monitored by an oncology team. An oncologist is a specialist in the diagnosis and treatment of cancer and is assisted by specialised nursing staff.

Where is chemotherapy administered?
Chemotherapy is usually given at a specialised clinic on an outpatient basis.

What happens at the first treatment session?

• The oncology team will discuss the goals of the treatment, the treatment regimen and possible side effects with you in detail.
• Various people may be involved in the treatment, so it can be confusing at first. Do ask questions at this stage, to remove all uncertainties.

Who should I consult if I have questions or problems?

• Although it’s good to be well informed, too much information from different sources can be confusing.
• It’s very important to talk to the oncologist and nursing staff at the clinic and to keep them informed about your reaction to the treatment.
• Keep a notebook and write down any side effects of the treatment and questions you might have. Take it with you to each treatment session and consult the oncology team. Keep asking until you feel reassured about your treatment. No question is too unimportant to ask.

How can I prepare myself for the treatment?

• It’s quite natural to feel apprehensive about an unfamiliar experience.
• Try to be positive about your therapy, particularly on the day of the treatment. Think about the effect the therapy will have on your disease.
• Set yourself small goals for each day, rather than thinking too far ahead.

How will I feel after the treatment?
After the treatment has started, your body will start excreting the waste products of dead cells. This could make you feel tired or listless.

Why is my blood count measured before each treatment?

• The drugs that attack cancer cells also inhibit division in body cells, particularly those that divide quickly, such as bone marrow cells.
• Bone marrow produces various cells that need to recover and increase to a certain level after chemotherapy. That is why chemotherapy is administered at intervals, to give normal cells a chance to recover.
• A blood count measures the levels of these cells in the blood.
• Further chemotherapy is postponed if the blood levels are not normal, because that means the body is not yet ready for the next treatment.

What can I do to regain my strength?

• Rest as much as possible.
• Go to bed early and rise later.
• Avoid strenuous physical labour or exercise.
• Allow your family or friends to take over tasks such as the children's lift club and shopping.
• Learn relaxation techniques.
• Eat a healthy diet.
• Avoid pent-up stress and anxiety – talk about your feelings.

What side effects can I expect?

• You won’t necessarily experience all the possible side effects. Side effects depend on what drugs are being used, on the dosage and on the patient's state of health.
• The oncology team will discuss possible side effects with you, in accordance with your treatment regimen.

Are the side effects permanent?
No, the effects of chemotherapy disappear after the treatment has been completed.

Possible side effects and hints on how to prevent or alleviate them:

Nausea and vomiting

• Try to relax and focus your thoughts on something else.
• Use positive visualising techniques: visualise how the anti-cancer drugs are moving throughout your body, finding and destroying each and every remaining cancer cell.
• Drink more water on the day before and after treatment – this helps to remove toxic waste.
• Avoid rich, fatty and spicy foods.
• Have small amounts of food throughout the day rather than large meals.
• Cold food and salads may be more digestible.
• Nibble a biscuit or suck a glucose sweet before you get up in the morning.
• Consult the oncology team for help if the nausea continues.

Hair loss (alopecia)
* The condition is temporary – your hair will grow again, possibly even during the treatment phase. Initially the new hair might have a different texture. * Hair loss is often the first visible sign of your disease and brings it to the attention of others. Be prepared for this, and for the effect it might have on your appearance and self-image. * The oncology team will warn you if you can expect hair loss as a side effect of your treatment, so that you can decide beforehand how you want to cope with it. There are various options: you could wear a wig or head covering, or even shave off your hair all in one go.

Care of the scalp and hair

• Comb and brush the hair very gently, and not too often.
• Use a mild shampoo and gently dab the hair dry.
• Avoid hair dryers, curlers and curling tongs.
• Do not colour or perm your hair during treatment.
• Massage the scalp with a conditioner or hair stimulant.
• Avoid elastic bands, tight hair bands and clips.

Head coverings

• Experiment with different kinds of head coverings: scarves, caps and hats.
• Wigs are available from special boutiques where qualified staff will assist you. The Cancer Association also has second-hand wigs available. Consult the list of useful information that your Reach for Recovery visitor gave you.
• Preferably select a wig before your hair starts falling out, to ensure that the wig matches your natural hair type and appearance.
• When new hair starts growing, leave the wig off as much as possible when you are at home, until the hair is long enough.

New hair
Your hair will definitely grow again, even before treatment has been completed, or 8-12 weeks after falling out. Within three months after new hair has started to grow, it should be long enough for a short hair style.

Affected sense of taste
This may be caused by medication or emotional and social factors. When your sense of taste is affected, loss of appetite may follow. You might experience the following:

• A strange taste in the mouth, such as a bitter taste, metal taste or medicine taste.
• Red meat and other food might have a strange taste.
• Familiar foods might have a strange taste; you might prefer new foods.

Preventive measures

• Visit the dentist before treatment starts.
• Prevent dryness of the mouth – avoid eating dry foods.
• Stimulate your sense of taste with pleasant flavours.
• Avoid all contact with foods that you find distasteful.

Cystitis (bladder infection)
This may be caused by certain drugs. The oncology staff will warn you and prescribe treatment. The urine may be discoloured – this is not harmful.

How to prevent cystitis:

• Drink more water.
• Inform the oncology team if you have a history of cystitis.
• Ask your doctor for an alkaliniser to control the acid level of the urine.

Stomatitis
This is a condition that causes inflammation of the mucous membranes of the mouth. Early signs are dryness and a burning sensation in the mouth. Symptoms start a few days after treatment and may last 7-10 days.

Preventive measures

• Rinse your mouth after each meal using a salt solution or a mouthwash that does not contain alcohol.
• Maintain good mouth hygiene: use a soft toothbrush. Visit your dentist beforehand to rule out mouth infections.
• Drink lots of fluids.
• Avoid acid, spicy foods; avoid alcoholic beverages.
• Soft foods with a fine texture can be chewed and swallowed more easily.
• You may find ice cream and iced drinks soothing.
• Have yoghurt regularly to restore the natural flora in the digestive system.
• Inform the oncology team if the condition becomes worse.

Constipation
Hints for coping with constipation:

• Eat more unrefined foods: raw vegetables and fruit, dried fruit, brown rice, wholewheat bread.
• Drink more fluids, particularly warm drinks – this stimulates bowel activity.
• Respond immediately when you have the urge for a bowel movement; make a habit of going at set times.
• Use purgatives as little as possible, and then only as prescribed.
• Inform the oncology team if you have problems with constipation.

Diarrhoea
Some drugs used in chemotherapy cause diarrhoea. The staff will inform you in advance.

Hints for coping with diarrhoea:

• Inform the oncology team. Diarrhoea can be controlled with medication.
• Keep the area around the rectum clean - Vaseline is good for protecting the skin.

Dietary adjustments:

• Eat more foods low in fibre but high in nutritional value (protein and calories).
• Eat smaller portions more often.
• Avoid gas-producing foods: cabbage, broccoli, onions, cauliflower.
• Avoid strongly spiced foods and caffeine.
• Avoid very hot or very cold food.
• Avoid alcohol and nicotine (cigarettes).

Skin
Chemotherapy does not affect the skin directly, but faint marks may occur where drugs have been administered intravenously. These marks will disappear eventually.

• Protect your skin against the harmful rays of the sun, particularly when the UV-factor is high.
• Care for the skin by using bath oils or moisturising creams.
• Treat cuts and abrasions with a disinfectant to prevent infection – particularly after a mastectomy with removal of the lymph nodes.
• Lymph drainage is important if swelling of the arms and fingers occurs. Consult the oncology team and also refer to the pamphlet on Lymphoedema.

Sexuality
Chemotherapy has certain implications for the patient's sexuality and fertility. It is advisable to discuss the issue of contraception with your doctor, because the effect of chemotherapy on the unborn baby is still unknown. If you suspect that you are pregnant, inform your doctor. Chemotherapy may also cause temporary (reversible) sterility. Refer to the pamphlet on Sexuality for more information.

Diminished appetite and weight loss
Various factors may cause weight loss during chemotherapy. The disease uses energy and the body's metabolism is affected. The patient may tend to eat less owing to anxiety and stress. The appetite may be suppressed as a side effect of the drugs. It is therefore extremely important to eat a well-balanced diet. If you want to follow an alternative diet therapy, consult your doctor to ensure that it does not interfere with the medication you are using. Consult the pamphlet on Diet and Healthy Lifestyle.

Reach for Recovery would like to thank Gretha Aalbers for compiling this pamphlet, and The Ralph Nussbaum Foundation for sponsoring the printing.