A quick guide to chemotherapy

18.12.2020
A lady who had chemotherapy

Every four minutes someone in Australia is diagnosed with cancer. The disease is characterised by abnormal cells that grow and reproduce rapidly and uncontrollably. Chemotherapy is one of the main treatments for cancer.

How does chemotherapy work?

Chemotherapy uses drugs to destroy abnormal cells that are rapidly dividing. Cancer cells generally grow faster and divide more quickly than normal cells, so chemotherapy kills more cancer cells than healthy cells.

Most normal cells in the human body don’t divide unless they are damaged and need repair, but there are exceptions. Some cells (for example in our hair) regularly divide and chemotherapy drugs can also kill rapidly dividing normal cells. This is why people who have chemotherapy might lose their hair. Thankfully, normal cells can generally repair the damage and recover once treatment is over (unlike cancer cells).

What sort of drugs are used?

There are around 100 different chemotherapy drugs (known as cytotoxic drugs) and each works in a slightly differently way. Some drugs might interfere with the genetic make-up of cells; others might block access to the nutrients that cells need to divide and multiply.

Chemotherapy can be used as a treatment on its own, or it can be used in conjunction with other treatments such as surgery or radiotherapy. Depending on the type of cancer, and how far it might have spread, it’s not unusual for a combination of drugs to be used to improve the chance of successful treatment.

An oncologist (cancer specialist) can advise on the most suitable form of treatment.

How is chemotherapy administered?

Chemotherapy can be administered intravenously (as liquid through a thin tube into a vein), orally (swallowing tablets or capsules), by direct injection or topically (for example using a cream for skin cancer).

Most chemotherapy treatments are administered intravenously in hospital as an outpatient service. However, it is possible to have some chemotherapy treatments delivered through a portable pump that you can use at home. Chemo@home, one of our chemotherapy at home providers, reports that one of the benefits to having chemotherapy at home is that there is less risk of the patient developing a fever or an infection while white blood cell count is low.

Chemotherapy drugs are powerful, so if you’re taking them at home you should always keep them in a safe, secure place, out of reach of children. People without cancer should avoid direct contact with cytotoxic drugs, so if you’re receiving chemotherapy, talk to your treatment team about any further precautions you might need to take at home.

Is chemotherapy successful?

Chemotherapy is often used in conjunction with other forms of treatment, so it’s hard for researchers to provide success rates for chemotherapy alone.

Successful treatment rates for various forms of cancer treatment have increased in the past three decades. Figures from 30 years ago show five in 10 people survived for at least five years after a cancer diagnosis. That figure has risen now to around seven in 10 people.

Chemotherapy can be used for a variety of reasons:

  • To cure cancer. Doctors often call this remission, rather than cure. This means signs or symptoms of cancer are no longer present.
  • To support other treatments. Chemotherapy can shrink tumours which in turn can help make other treatments, such as surgery, more effective.
  • To control cancer. In cases where chemotherapy can’t achieve a ‘cure’ it may control the growth and spread of a cancer.
  • To relieve symptoms. Chemotherapy can improve quality of life by shrinking a cancer that causes pain or other symptoms.
  • To prevent recurrence. Maintenance chemotherapy, sometimes given with other drug therapies, aims to prevent or delay the return of cancer.

How long does treatment last?

A course of chemotherapy treatment is usually given in cycles, to allow periods of rest in between treatments. This gives healthy cells time to recover.

A single session of chemotherapy given intravenously (through a ‘drip’) could take from 20 minutes to several hours.

Treatments might be delivered every 3-4 weeks, although each treatment plan differs depending on the individual. A full course of treatment could last between three and six months, or it may be shorter or longer.

Maintenance chemotherapy or palliative chemotherapy can continue for months or in some cases years.

Why does chemotherapy cause side effects?

Many people experience side effects from chemotherapy, which is the result of damage to healthy cells.

Chemotherapy drugs that circulate in the bloodstream can reach abnormal cells almost anywhere in the body. The drugs work by targeting cells as they divide, and since cancer cells divide faster and more often than normal cells, chemotherapy is more likely to find and kill them. 

Most normal cells in our bodies aren’t as active as cancer cells − they only divide if they’re damaged and need to repair. However, some cells such as those in hair, nails, bone marrow, skin and the lining of our digestive system are constantly growing and dividing, which is why chemotherapy drugs can damage these cells.

What are the most common side effects?

There are over 100 different chemotherapy drugs, and different drugs cause different side effects. It’s important to remember that you’re unlikely to experience every side effect listed here:

  • fatigue, loss of appetite, nausea and bowel changes such as constipation or diarrhoea
  • anaemia, hair loss, bleeding problems, mouth sores, dry eyes, skin and nail problems
  • trouble concentrating or forgetfulness
  • reduced levels of white blood cells which can lead to an increased risk of infection
  • chemotherapy can also have an impact on sexuality and fertility.

Sometimes chemotherapy can cause long term issues such as infertility and damage to the heart, kidneys, liver, lungs or brain. Speak to your oncologist if you want to have children in the future, so you can discuss your options before you start treatment.

Many side effects can be treated or managed, and most begin to go once treatment has finished. The occurrence of side effects is not related to the success of chemotherapy treatment.

Managing side effects

Some people find it useful to keep a diary to record specific details of any side effects during treatment – for example, how long they lasted and anything that helped alleviate them.

Most side effects (such as hair loss) are temporary and the damage is usually short-term. Normal cells can generally repair or replace cells damaged by chemotherapy once the drug treatment finishes.

Medications can reduce the impact of some side effects, such as pain and nausea.

Can you combine exercise with chemotherapy?

Many cancer organisations are calling for exercise to be prescribed to all cancer patients as part of their routine cancer care.

According to the Cancer Council, only one in ten people diagnosed with cancer will get enough exercise during or after their treatment, yet research has shown that cancer patients who get regular exercise have fewer and less severe side effects. Exercise can also counteract fatigue.

Exercise should always be appropriately prescribed and monitored if you’re having chemotherapy treatment, so talk to your oncologist before undertaking any new exercise routine. 

Can you have chemotherapy when you’re pregnant?

A cancer diagnosis during pregnancy is rare (the Cancer Council estimates only one in every 1000 women is affected).

Chemotherapy during the first 12 weeks of pregnancy may increase the risk of miscarriage or birth defects, and chemotherapy drugs may also cause premature delivery. Chemotherapy can also affect sperm, so you and your partner are advised to avoid pregnancy during chemotherapy treatments.

You’re also advised not to breastfeed during chemotherapy as drugs contained in breastmilk can pass to your baby.

Your oncologist can advise on treatment options if you are pregnant.

Is chemotherapy covered by my health insurance?

Depending on your policy and your level of Hospital cover, some chemotherapy treatments are covered by health insurance. Log into your Member Centre or mobile app to check your level of cover, or contact us and we’ll check for you.

It’s important to clarify what type of chemotherapy you receive. You’ll be considered an admitted patient if you receive chemotherapy daily, so long as the hospital has an agreement with CBHS and admits you as a day patient. You won’t be able to claim for services delivered as an outpatient.

Your CBHS Hospital cover might also mean you’re eligible to receive chemotherapy at home under our Hospital Substitute Treatment program. Ask your specialist about your suitability to have treatment this way.

With CBHS Hospital cover you may also be eligible for a home-based cancer support program. These programs can help improve your quality of life through support from psychologists, exercise physiologists and dietitians who are experienced in dealing with the complex needs of people undergoing cancer treatment. CBHS member Kristine benefited from cancer support at home after a hospital stay for cancer treatment.

Call our Member Care team on 1300 654 123 or email help@cbhs.com.au to find out more.

More information about chemotherapy

The Cancer Council produces a comprehensive guide to understanding chemotherapy and what to expect when you have treatment. You can download a copy here or call the Cancer Council on 13 11 20 for more information.

Sources

https://www.cancer.org.au/assets/pdf/understanding-chemotherapy-booklet#_ga=2.225750361.236007542.1606268913-1944269934.1603688455

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/how-chemotherapy-works

https://www.cosa.org.au/media/332739/cosa-position-statement-v3-oct2020-final.pdf

https://www.canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics

All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified healthcare professional.

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