The information below is provided to help patients understand some important information about chemotherapy. This information is not intended to replace the advice or recommendations of your physician. When you are undergoing chemotherapy, you should discuss any medications (prescription and over the counter), herbal or vitamin supplements, exercise routines, and other invasive procedures (surgery, dental work, acupressure) with your doctor or nurse. Please discuss questions you may have about the information provided with your treating physician.
The idea of cancer treatment can be frightening. We hope to ease some of the uncertainty that creates fear. Understanding possible side effects of treatment and feeling comfortable asking questions and voicing concerns is important for patients and their caregivers. Following are some of the most frequently asked questions many patients and family members have. Much of the information here is from America Cancer Society and National Cancer Institute/National Institute of Health publications.
Chemotherapy is the use of medicines (or drugs) to treat disease. Cancer chemotherapy (usually just called "chemotherapy" or "chemo") refers to medicines used to treat cancer. Because chemotherapy medicines travel throughout the body through the bloodstream the whole body can be affected. That is why it is important to understand the side effects of chemotherapy.
What are biotherapy and targeted therapies?
Biotherapy is a type of treatment that works with your immune system. It may also be called immunotherapy, biologic therapy, biological response modifier therapy, and BRM therapy. Biologic therapy can help fight cancer or help control side effects (how your body reacts to the drugs you are taking) from other cancer treatments like chemotherapy. It may boost or restore the ability of the immune system to fight cancer, infections, and other diseases. It is also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct anti-tumor effect.
Targeted therapies – Targeted cancer therapies use drugs that block the growth and spread of cancer. They interfere with specific molecules involved in carcinogenesis (the process by which normal cells become cancer cells) and tumor growth. Because scientists call these molecules “molecular targets,” these therapies are sometimes called “molecular-targeted drugs” or “molecularly targeted therapies”. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than other treatments and less harmful to normal cells.
What types of chemotherapy are available?
There are more than 90 different chemotherapy drugs in use today and all cancers are NOT treated with the same drugs. The treatment you receive will be based on your particular cancer and the potential side effects. Treatment for cancer will often include more than one drug, called combination therapy. In this way, drugs with different actions and different side effects can be used at the same time or in sequence. This is believed to decrease the chance that the cancer will become resistant to the treatment.
You should discuss with your doctor all the different types of chemotherapy drugs that are available to you. Your doctor may also talk with you about a clinical trial - a promising new drug or combination of drugs that are being tested for their effectiveness against the type of cancer you have. Standard chemotherapy protocols and clinical trials are both available at the NorthBay Cancer Center.
Will I have to be in the hospital for chemotherapy? Will someone have to drive me to my treatments?
Most of the time chemotherapy is administered as an outpatient procedure, such as in the infusion area of the NorthBay Cancer Center. Hospitalization is often reserved for chemotherapy treatments that require additional fluids, extended larger volume infusions, or for patients who are anticipated to experience side effects in which hospitalization is preferred for management. At the NorthBay Cancer Center, the majority of patients receive their therapy while relaxing on one of the recliners in the infusion center. The center also has a limited number of private rooms with hospital beds for full day treatments.
We encourage you to bring a friend or family member during your treatments to provide transportation, support and to help make your time with us more enjoyable for you. This is especially important the first time you receive treatment since some medications used to prevent or treat side effects may cause drowsiness. If you are continuing to need medications that cause drowsiness, decreased coordination or problems with concentration, having someone drive you to your appointments is best.
How is chemotherapy administered?
Chemotherapy medicines are often given intravenously or directly into a vein. Some medicines may be given by injection under the skin or into the muscle, and others may be taken by mouth.
For some patients, if their veins are weak or difficult to use or if long term treatment is anticipated, a vascular access device, or catheter, may be recommended. You can ask your doctor or nurse if this is an option for you.
The amount of time you will spend in the center receiving your treatment depends upon the chemotherapy drug used and the number of drugs you are receiving. Some drugs take only 5 to 10 minutes to deliver and others a few hours. In some cases, patients may be placed on a continuous delivery of medication over several days. In that case, the patient usually goes home with a small battery operated pump and a carrying pack. Before this type of equipment was available, patients were hospitalized for continuous chemotherapy.
In addition to the time spent receiving the chemotherapy drug, expect to be in the infusion center for additional care before and after your treatment. This care can include evaluation by your doctor or nurse before and after your treatment, starting of the I.V. (catheter to deliver intravenous therapy), and administration of any medications or fluids to prevent or treat the acute effects of therapy.
Will I get sick to my stomach (nauseated) after my treatments?
Many patients experience very little nausea during or after chemotherapy, while some have more severe side effects. One of the greatest advancements in cancer care over the past 10 years are the medications and other techniques now used to reduce the side effects of chemotherapy. In fact, patients may receive medications to help lessen or prevent nausea before the chemotherapy is administered. This is called "pre-medication". Additional medications are taken after the treatment if needed. Patients are instructed about how to take their nausea preventing medications at home.
Some other tips include:
How will I feel the day after my treatment?
Each person responds differently to chemotherapy, but we have found that most patients don’t experience many side effects the day after treatment. If you do experience any side effects, please call your doctor or nurse to discuss your symptoms. Most symptoms can be managed by a combination of medicinal and non-medicinal treatments.
Will my hair fall out?
Not all chemotherapy drugs cause hair loss, and some people only notice mild thinning. If you do lose hair, it will almost always grow back after the treatments are over. However, it might be a different color or texture.
Hair loss can occur on all parts of the body, not just the head. Hair loss may occur after the first treatment or may not happen until after a few treatments. The loss may be gradual or in clumps.
During chemotherapy, your hair and scalp will need special care. Here are some suggestions:
Will I feel tired?
Fatigue is a common side effect of chemotherapy. It can vary from mild tiredness to feeling completely wiped out. Different people experience different patterns of fatigue. Like most other side effects, it will get better once the treatment is stopped.
During chemotherapy, be sure to discuss the management of fatigue with your doctor or nurse. These general suggestions do not replace the medical advice of your doctor.
What are the effects on my blood: anemia, infection and bleeding?
Your bone marrow produces three important blood parts: red blood cells, white blood cells and platelets. Chemotherapy drugs may damage some of the bone marrow so that fewer of these cells are produced. Side effects may result if a drop in these cells occurs. Your doctor may request that you have blood tests performed a certain number of days after your treatment to check your blood cell counts. You should call your doctor or nurse if you experience any of the symptoms listed below.
Anemia occurs when your blood has too few red blood cells. Red blood cells carry oxygen to the tissues. Some of the symptoms of anemia are fatigue, dizziness, paleness, a tendency to feel cold, and even shortness of breath. Anemia is sometimes treated with red blood cell transfusions or by injection of a growth factor for red blood cells.
Low white blood cells can decrease a person’s ability to fight infections. One type of white cell, called neutrophil, is especially important in providing a first line of defense. If these cells are low it is called "neutropenia". Infections can begin anywhere in your body, but most often start in the mouth, skin, lungs, urinary tract, rectum and reproductive organs.
If your white cell count is too low, your treatment may need to be delayed. Sometimes a growth factor for white blood cells may be used. To reduce your risk of an infection, try the following suggestions:
Even if you are very careful, your body may not be able to fight an infection. These are symptoms to report to your doctor or nurse right away: Fever of 100.5 F or greater, chills, sweating, loose bowels, frequent urgency or burning when you urinate, a severe cough or sore throat, mouth or lip blisters or sores, sinus pain or pressure, unusual vaginal discharge or itching, abdominal pain, earaches, headaches, or stiff neck, and redness, swelling, or tenderness around a wound, sore, pimple, intravenous catheter site or vascular access device. If you have a fever, check with your doctor before taking any medications to bring your fever down.
Thrombocytopenia is when your platelet count is low. Platelets are used to plug up damaged blood vessels and help your blood to clot. If your platelet count is low you may experience an increased tendency to bruise or bleed. Let your doctor know if you have unexpected bruising, small red spots under the skin, reddish or pinkish urine, or black or bloody bowel movements. Also report any gum or nose bleeds, bad headaches, dizziness, increased weakness, or pain in joints or muscles. If the platelet count is too low, transfusions of platelets may be given.Here are some ways to avoid problems if your platelet count is low:
Can I exercise while I am on treatment?
Check with your doctor or nurse about exercising during therapy. There may be times during your treatment cycle when you will want to avoid exercising in crowded areas, gyms or pools. If you already have a regular exercise program you may need to make some adjustments. Certain types of exercises may be helpful for managing the fatigue many patients experience with chemotherapy treatments.
Is there anything I can eat to make my blood counts come up faster? What should I eat or drink during therapy?
No special foods or vitamins are recommended during treatment. In fact, certain vitamins may interfere with your treatment or may cause an increase in side effects. In general, patients receiving chemotherapy should eat a balanced and varied diet. People who eat a nutritious diet are better able to handle side effects, fight infection and rebuild healthy body tissues. In addition to eating food from each food group (fruits and vegetables; poultry, fish, and meat; cereals and breads; and dairy products), patients should eat enough calories to keep his/her weight stable. Protein in the diet is especially important for building and repairing the body tissues.
Fluids are also important. In general it is best to avoid alcoholic beverages during treatment, although your doctor may permit a small amount. Caffeinated beverages should be avoided close to bedtime to decrease problems with sleep. Other fluids that can provide nutrients along with liquid value are juices, milk drinks and supplement drinks.
How will treatment affect intimate relations with my partner?
Patients receiving treatment may experience little change in their desire or pleasure with intimate relations. Others may experience difficulties due to treatment or disease related side effects. Sharing your concerns with your partner and sometimes a counselor can be helpful. These concerns should also be brought to your doctor or nurse, as some treatments may cause sexual dysfunction. It is also important to remember that intimacy includes hugging, touching, holding and cuddling.
A woman who is pregnant or breast-feeding should not take chemotherapy. Reliable birth control should be practiced by men and women undergoing chemotherapy because of the potential damage these drugs may have on the production of sperm and an unborn child.
Are there other potential complications from chemotherapy?
As with any other medical procedure, chemotherapy does pose some risks, depending on the type of medication used. Most patients experience only mild problems related to therapy. Most side effects are temporary and resolve when treatment ends. Few medicines cause permanent problems. The most common side effects of chemotherapy are a compromised immune system, hair loss and fatigue. You should discuss any concerns you have about the complications of chemotherapy with your doctor or nurse.
Where can I go for more information about chemotherapy?
The links below are excellent sources of information. The local American Cancer Society office, listed below, also offers a wealth of information.
The American Cancer Society1-800-ACS-2345Solano County Unit: 744 Empire Street, Suite 206 Fairfield, CA 94533www.cancer.org
NorthBay Medical Center: 707-646-5000 NorthBay VacaValley Hospital 707-624-7000
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