Chemotherapy: what to expect

Chemotherapy is a form of treatment used to either kill cancer cells or to slow their growth. It is often given as part of a treatment plan that may include surgery or radiation.

When cancer develops, the cancer cells reproduce and divide at a rapid rate and chemotherapy can stop these cells from dividing and spreading. There are a number of different chemotherapy drugs, however, they all work in a similar way — by targeting and damaging dividing cells. 

Chemotherapy can be used to:

• Make other cancer treatments more effective
• Reduce the risk of cancer returning
• Relieve cancer symptoms if a cure is not possible
• Shrink a tumour before surgery
• Try to cure cancer completely

What happens before treatment?

Before you start treatment, you’ll have a consultation with your oncologist and will undergo a series of tests to ensure you’re healthy enough for treatment and can cope with any side effects.

You’ll need to give consent before your chemotherapy starts. Your doctor will talk you through the risks and benefits and then ask you to sign a consent form.

It can be helpful to attend your first treatment with someone. They can provide support and help you recall any information you’ll be told on the day.

How will I receive my chemotherapy?

The type of chemotherapy you receive will depend on several factors, including the type of cancer you have. You may have one or a combination of different chemotherapy drugs.

Types of chemotherapy:

Oral chemotherapy 

This includes tablets, liquid or capsules which are taken by mouth. These are usually taken at home with regular check-ups at a hospital or clinic.

Intravenous chemotherapy (IV) 

This is given through a drip in your arm which administers the drugs straight into a vein, together with anti-sickness drugs. Some IV drugs are taken over a few days or weeks, and therefore are given via a small pump that you either wear or carry.

Topical chemotherapy

This is a cream you apply onto your skin at home — you can collect this cream from your pharmacy.

How long does chemotherapy take?

Everyone’s journey is different. Your doctor will put together your treatment plan outlining when and where your chemotherapy sessions will take place and how many sessions or cycles you will need.

You may have one dose of treatment on one set day every week or month, or a series of treatment periods. For example, one dose followed by a three-week rest, then another dose followed by another three-week rest and so on — this is called a treatment cycle.

How can I prepare for chemotherapy?

The drugs used in chemotherapy cause a variety of side effects; some can be severe so to prepare for your chemotherapy, think about: 

• Asking for help — chemotherapy will probably make you very tired; day to day tasks can seem draining so ask friends and family for help 
• Childcare — if you have children try to arrange childcare for treatment days and a few days after
• Hair loss — if your doctor tells you that hair loss is likely after treatment, you may find it helpful to invest in a wig beforehand
• Reducing your workload — consider reducing your hours at work or working from home during treatment periods
• Support — chemotherapy is an emotional journey too; talk to your friends and family and have an emotional support network in place before you start treatment 

Consider bringing someone with you on treatment days, as well as your phone, a blanket and something to read.

Questions to ask before your treatment

You are entitled to ask as many questions as you want.

Ask about your treatment plan, treatment timeline, where you’ll receive treatment and when.

Ask about side effects associated with the drugs being used, and about aftercare contact numbers and out-of-hours numbers for your doctor or nurse.

What are the side effects?

The drugs used in chemotherapy often affect healthy cells as well as the cancer cells. This can cause a variety of side effects.

Some side effects are more common than others. You may not experience them all and what you do experience will depend on the type of chemotherapy you have.

Most side effects slowly go away or stop when your chemotherapy is completed.

Side effects include:  

Fatigue after treatment

Fatigue may be constant or only after certain activities. Make sure you get plenty of rest, avoid tiring tasks and take breaks from activity often. If your fatigue becomes severe, contact your doctor. 

Nausea 

When a chemotherapy treatment is being used that is known to cause nausea or vomiting, an anti-sickness drug will be given with or before treatment.

If you experience nausea or vomiting after treatment, ask your doctor if they can prescribe some anti-sickness drugs. 

Increased risk of infection

Chemotherapy can reduce the number of white blood cells your body makes. White blood cells help your immune system fight infection. After chemotherapy, you therefore may have a weakened immune system. You are most susceptible to infection seven to 14 days after chemotherapy. After this, your white blood cell production will slowly increase.

Your chemotherapy nurse will talk to you about the risk of infection after treatment and tell you about signs of infection to watch out for. 

Constipation

Constipation can be a side effect of chemotherapy drugs, anti-sickness drugs or painkillers. It can normally be treated at home with gentle exercise, plenty of fluid and eating more fibre. 

Speak to a pharmacist or your doctor if diet and lifestyle changes are not helping your constipation.  

Diarrhoea 

Diarrhoea can occur in the first few days after treatment. If you experience diarrhoea contact your doctor or nurse as they can prescribe medication to help. 

Make sure you have lots of fluids to avoid dehydration and get plenty of rest. 

Hair loss

Some people experience partial hair loss or thinning while others experience hair loss from all over their body. Your doctor may be able to predict the risk of hair loss based on the drugs and doses that you are taking.

What happens after treatment?

Your nurse will check your pulse, blood pressure and temperature.

Your doctor will talk you through any side effects you may experience and can prescribe medication to help manage these. You may be told to avoid being around people with a cold or other infections depending on the drugs used in your chemotherapy.

Make sure you ask your doctor or nurse who to contact after you get home if you are concerned about any side effects from your treatment.