Chemotherapy

Understanding Chemotherapy

Chemotherapy is the most commonly known, but there are a number of other systemic therapies including:

• Monoclonal antibody therapy and small molecules—attack various targets within the cancer cell or its blood supply.
• Immune stimulant therapies—promote the body’s own immune system to fight the cancer cells.
• Clinical trials—making novel therapies available to patients.
• Hormonal therapies: treatments to adjust the body’s hormone levels to bring about a response in cancer cells. Hormone sensitive cancers include breast cancer, uterine cancer, and prostate cancer.

Chemotherapy works by disrupting cancer cells’ DNA or reproductive abilities. Many different chemotherapy drugs are available, and may be used alone or in combination to treat a wide variety of cancers.

Chemotherapy may be used:

• To kill cancer cells. Chemotherapy can be used as the primary or sole treatment for cancer. In some cases, chemotherapy is used with the goal of curing your cancer. In other cases, chemotherapy may be used with the aim that it will slow the cancer's growth.
• After other treatments to kill hidden cancer cells. Chemotherapy can be used after other treatments, such as surgery, to kill any cancer cells that might remain in the body. Doctors call this adjuvant therapy.
• To prepare you for other treatments. Chemotherapy can be used to shrink a tumor so that other treatments, such as radiation and surgery, are possible. You may hear your Wellstar doctor refer to this as neoadjuvant therapy.
• To ease signs and symptoms. Chemotherapy may help relieve signs and symptoms of advanced cancer, such as pain. This is called palliative chemotherapy. Some chemotherapy drugs have proved useful in treating other conditions, such as:
  • Stem cell transplants. In a stem cell transplant, very high doses of chemotherapy are administered and a person’s own stem cells are then given back to them to replenish their bone marrow.
  • Auto-immune disorders. Lower doses of chemotherapy drugs can help control the immune system in certain diseases, such as lupus and rheumatoid arthritis.

The most common way for drugs to be administered is intravenously, or through a vein. Some chemotherapy drugs are can be administered in a pill. Other drug delivery systems are placed directly into a body cavity. In some cases, a special venous access device is surgically inserted into the patient so that cytotoxic drugs can be administered directly into a major vein.

Regardless of how they are administered, the drugs typically work throughout the body, attacking cancer cells by in the primary tumor site as well as those that may be lurking microscopically in another part of the body.

Chemotherapy drugs are typically administered according to a protocol that has been established to be safe and effective to treat a specific type of cancer. You likely will receive chemotherapy on an outpatient basis in an infusion center of your Wellstar hospital.

Other patients may be receiving infusions at the same time. Wellstar oncology nurses are highly trained to help you through the process, and they are highly skilled in helping administer the drugs as comfortably as possible. They also know the side effects and what to look for, and they stand ready to answer any questions you may have.

Although chemotherapy is an effective way to treat many types of cancer, chemotherapy treatment also carries a risk of side effects. Some chemotherapy side effects are mild and treatable, others can cause serious complications. More common side effects of chemotherapy drugs that can occur during treatment include:

• Nausea
• Vomiting
• Diarrhea
• Hair loss
• Loss of appetite
• Numbness in fingers and toes
• Skin rashes
• Fatigue
• Fever
• Mouth sores
• Pain
• Constipation
• Easy bruising

Many of these side effects can be prevented or treated. Most side effects subside after treatment ends.

Chemotherapy drugs can also cause side effects that don't become evident until months or years after treatment. Late side effects vary depending on the chemotherapy drug, but can include:

• Damage to lung tissue
• Heart problems
• Infertility
• Kidney problems
• Nerve damage (peripheral neuropathy)
• Risk of a second cancer

Ask your doctor if you have a risk of any late side effects. Ask what signs and symptoms you should be alert for that may signal a problem.

Your doctor chooses which chemotherapy drugs you'll receive based on several factors, including:

• Type of cancer
• Stage of cancer
• Overall health
• Previous cancer treatments
• Your goals and preferences

Discuss your treatment options with your doctor. Together you can decide what's right for you.

How you prepare for chemotherapy depends on which drugs you'll receive and how they'll be administered. Your doctor will give you specific instructions to prepare for your chemotherapy treatments.

You may need to:

• Have a device surgically inserted before intravenous chemotherapy.
• Have your blood tested for certain genes.
• Make arrangements for help at home and at work.
• Plan ahead for side effects.
• See your dentist.
• Undergo tests and procedures to make sure you're healthy enough for chemotherapy.

A cycle of chemotherapy is defined as the administration the chemotherapy and the time it takes to recover from that treatment.

You'll meet with your Wellstar doctor regularly during chemotherapy treatment. Your oncologist will ask about any side effects you're experiencing, since many can be controlled.

Depending on your situation, you may also undergo scans and other tests to monitor your cancer during chemotherapy treatment. These tests can give your doctor an idea of how your cancer is responding to treatment and your treatment may be adjusted accordingly.

Because the drugs are very powerful, the body needs time to rest between doses. During the weeks that you are not having chemotherapy treatment, it is important to rest, to eat well and to take good care of yourself. Don’t be afraid to ask for help. If you do not feel capable of preparing dinner, ask a family member or friend. If you feel like taking a nap, take a nap. It is important to keep your strength up. You may want to ask your Wellstar health team about supportive palliative care, or comfort care, that can help you feel better and address any physical, emotional and even spiritual issues you may experience.

Make sure you talk to your Wellstar physician and members of your treatment team about side effects and how to look for them before you begin chemotherapy. Your Wellstar team of experts is dedicated to your health and your overall well-being, and they want to help you in any way they can.

Procedures

Intravenous Infusion

Before the Procedure

• Limit your exposure to people who have infectious or contagious diseases.
• Have a family member or spouse drive you to treatment and be prepared to stay with you during the treatment should you desire company or need assistance.
• Plan your schedule so that you can rest and limit activities for several days after your infusion.

During the Procedure

• Chemotherapy infusion must be done in a clinic or hospital, where Wellstar nurses and doctors can closely monitor you.
• A needle will be inserted, usually into your arm, and an IV drip will begin to send the cancer-killing drugs into your body.
• You will sit in a comfortable chair that can lean backward and that has a foot rest. Wellstar nurses will bring you a blanket, reading material and other things to make you as comfortable as possible.
• A family member or friend usually can stay with you to keep you company. Many patients find that they make good friends—some call them “chemo buddies”—with others in the infusion area.

After the Procedure

• Because the cytotoxic drugs are so potent, your body can handle these drugs on a limited basis. Thus, you will have a break from treatment for a week up to four weeks, depending on the type of cancer you have and other variables.
• Most patients want to take things easy for a few days. Nausea and vomiting are common side effects, but new anti-nausea drugs have lessened these side effects in recent years. Talk to your Wellstar physician about your side effects.
• It is important to monitor for side effects of chemotherapy. Many can interfere with your chemotherapy schedule, and some can even be life threatening. Low blood cell counts can be particularly problematic. These can be characterized by fatigue (low red cell count); infection and fever (low white cell count); and bruising and bleeding (low platelet count). Other side effects can include pain, depression, nausea, vomiting, and mouth sores. It is important to talk to your Wellstar physician about any side effect you experience.

Venous Access Device (VAD) Infusion

VAD comes in two forms—one is completely internal and below the skin, which is called a portacath. The others, a Hickman or PICC line, are external. Both types of devices are often placed in the operating room under sterile conditions since infection is one of the rare side effects. The benefits of a VAD is it allows easy access to the blood vessels without having to start an IV every treatment and allows for blood to drawn without having to do a venapucture. It also guarantees that the chemotherapy, which can be irritating to the skin and tissues, goes directly into a vein and doesn’t leak into the body. Many people on longer courses of chemotherapy are appreciative of VAD. Discuss with your WellStar physician whether this is appropriate for you.

Before the Procedure

• Plan to have a family member or friend accompany you, and drive you home after the procedure.
• Avoid exposure to people with colds or other infections.
• Plan your schedule so that you can rest for several days after the procedure.

During the Procedure

• Chemotherapy infusion will be done in a clinic or hospital setting.
• Depending on what type of VAD you have, the chemotherapy will be administered into the device.

After the Procedure

• Your VAD will need to be flushed after each infusion. This is done by inserting a blood thinner known as Heparin into the VAD. This typically is done immediately after the infusion. If you are no longer receiving chemotherapy but still have the device inserted, you will need to make an appointment to have the VAD flushed once every four to six weeks.
• As with IV chemotherapy, you likely will feel tired and perhaps nauseated. Rest as much as you can, and tell your Wellstar physician if you are nauseated and vomiting.
• Watch for other side effects that can be serious, including: infections, fatigue, fevers, nose bleeds, bruising and bleeding.