Chemotherapy (for medical oncology patients)
Chemotherapy is a term for a large number of drugs with different methods of working and different side effects.
This information applies to medical oncology patients only. For haematology conditions (leukaemia, lymphoma or myeloma) refer to the chemotherapy for haematology patients page.
About chemotherapy
Chemotherapy works by damaging rapidly dividing cells such as cancer cells. It can also affect your normal cells. Usually the effect on normal cells is temporary and they are able to recover.
It is used to improve the chance of cure or to control the growth of cancer cells.
Chemotherapy may be used alone or in combination with other treatments such as radiation therapy or surgery to improve the overall effectiveness of treatment.
Sometimes it is given to reduce the symptoms of cancer and to improve quality of life, this is known as palliation.
You will receive chemotherapy:
- in tablet or capsule form (do not crush or open capsule, avoid touching tablets/capsules)
- into the vein (intravenously by inserting a needle into the vein or a central venous access device)
- into your abdominal cavity (intraperitoneal)
- injectioned into tissue under the skin (subcutaneous)
- injectioned into the muscle (intramuscular)
- applied to your skin (topical).
Important: If you experience any pain/swelling/redness around the injection site, tell your nurse or doctor IMMEDIATELY.
When administering chemotherapy your nurse will wear a gown, goggles, gloves and a mask.
Looking after yourself during chemotherapy treatment
Nutrition
It is important to eat a well-balanced diet to help you stay well nourished. Good nutrition can help you cope better with the side effects of treatment, help wounds and damaged tissues heal, improve your immune system, and help maintain your weight and muscle strength. Treatment side effects may occur that make eating and drinking difficult for you.
A Dietitian is available should you have any concerns with your eating or weight loss or gain during treatment.
Nutrition resources
- Nutrition Education Material Online (NEMO)
- Memorial Sloan Kettering Cancer Centre – Herbs, botanicals and Other products
Hydration
It is important to:
- maintain your daily fluid intake at 2 litres/day
- always carry a water bottle with you
- take small sips frequently
Emotional support
A diagnosis of cancer can be a difficult and challenging time for you and the people who care for you. It may affect your physical, emotional and financial wellbeing. It can be helpful to talk to someone.We have put together a list of resources to support patients, carers and families.
Managing side effects of chemotherapy
Side effects
The main areas of your body that may be affected by chemotherapy are those where normal cells grow quickly. These cells are found in:
- bone marrow (where blood cells are made)
- digestive tract (this includes the mouth, throat or oesophagus, small and large bowel and the rectum)
- skin
- hair
- reproductive organs.
Most side effects are temporary and differ for each person. Precautions are taken to prevent or reduce these effects and your side effects do not indicate whether treatment is working.
Effect on the cells of the body
- Red cells – which carry oxygen to all the body’s cells. If your red blood cell count is low you can feel tired, dizzy and breathless and/or have heart palpitations. If this happens your doctor may suggest a blood transfusion.
- Platelets – which help to clot blood. Low levels of these cells may cause an increased risk of bleeding or bruising.
- White cells – protect against infection. If your white blood count is low, you are more likely to pick up a cold or other infection. It is especially important to prevent and treat infection during your treatment with chemotherapy.
Precautions to take when your platelets are low
- Use a soft toothbrush
- Be careful when using sharp objects
- If you do cut yourself, apply cold compress and pressure using a clean cloth for several minutes. If bleeding does not stop or the area swells, seek medical attention.
Take your temperature daily and more often if you are feeling unwell.
DO NOT take paracetamol if you have a temperature 38°C or above BEFORE you go to the Emergency Department
Paracetamol may mask (hide) an underlying infection by lowering the temperature and make you feel better. It will not correct or treat the infection.
If your temperature is 38°C or higher or if you have any other signs of infection you must either:
- During working hours – call the Medical Oncology Clinic
- After hours – go to your nearest emergency department
- Chills especially shaking chills
- Sores in or around your mouth and throat
- Feeling feverish, hot or sweaty
- Burning on pain passing urine
- Cough or flu-symptoms
- Loose or watery bowel motions
- Redness, swelling, ooze or tender area on your body
- Unusual vaginal discharge
If your temperature is 38°C or higher or if you have any other signs of infection you must either:
- During working hours – call the Medical Oncology Clinic
- After hours – present to your nearest emergency department
Suggestions to reduce your risk of infection
- Good hand washing is very important.
- Take care when shaving or using sharp objects to prevent injury/bleeding.
- Take care and wear gloves when gardening and when your blood counts are low.
- Avoid crowds and people who are unwell
- Care should be taken when handling body fluids such as urine, bowel motions and vomit for 7 days after receiving your chemotherapy.
- Family/carers should wear gloves when handling contaminated body fluids.
- Wash contaminated skin immediately with soapy water for 15 minutes.
- If clothes are soiled with body fluids, wash separately using 2 full wash cycles (cold or hot water). Unsoiled clothes can be washed as normal.
- Toilet – 1 full flush of the toilet with lid closed.
- Household garbage – contaminated items can be placed in the household garbage.
- Oral cytotoxic drugs – do not crush or open capsule, avoid touching tablets/capsules
Resources
Nausea and vomiting while having chemotherapy is usually well controlled. Some chemotherapy drugs may make you sicker than others.
- Take regular anti-nausea medication as prescribed by your doctor and let your doctor know if nausea/vomiting continues for greater than 24 hours or if medication is not working.
Suggestions that may help control your nausea and vomiting
- Take anti-nausea tablets 30 minutes before eating.
- Small frequent meals rather than large meals.
- Snack on dry biscuits, toast and crackers.
- Drink plenty of fluid
A Dietician is available for advice if required.
Diarrhoea is more than 2 loose watery bowel motions a day. There are several reasons why diarrhoea can occur.
If diarrhoea is a problem:
- Drink plenty of fluids to replace water lost with diarrhoea.
- Choose plain, bland food.
- Limit alcohol, fruit juice and milk products until diarrhoea settles.
If diarrhoea persists for longer than 24 hours report this to your doctor or nurse.
Constipation may be due to a number of causes. Constipation is very common and needs to be treated early. If bowels not opened for greater than 2 days or what is outside your normal routine let your doctor or nurse know.
For relief of constipation:
- Increase fluid intake
- Pear or prune juice may be helpful
- Gentle exercise where possible
- Increase your diet to high fibre including whole grains, fruit and vegetables until constipation settles
- Take laxatives as recommended by your doctor.
The cells in the digestive tract grow quickly and chemotherapy can affect the cells lining the mouth and throat causing soreness, ulcers, bleeding and difficulty swallowing. Difficulty with chewing or swallowing may lead to loss of weight and this may slow down your recovery. Tell your doctor or nurse if you are unable to eat and drink.
Suggestions for mouth care hygiene
- Regular mouth washes after meals and before going to bed using salty water, sodium bicarbonate (baking soda) or prescribed mouthwash.
- Use a soft toothbrush.
- Avoid flossing your teeth.
- Apply lip balm for dry lips.
- Inspect mouth daily and report mouth changes including coated tongue (thrush).
- Avoid foods or fluids that irritate your mouth if you have mouth ulcers.
If dental treatment is required please discuss this with your doctor first.
Chemotherapy may make your skin:
- more sensitive to sunlight
- discoloured or pigmented
- dry and flaky.
- red and itchy or a rash.
Strategies that may help skin issues
- Avoid direct sunlight.
- Wear protective clothing and hat, sun screen.
- Clean rectal area thoroughly after toileting (soft cloth for red, sore areas).
- Report skin changes or problematic conditions.
- Maintain good personal hygiene (shower/bath daily).
- Maintain good hand washing to avoid the spread of infection.
Cancer related fatigue is different to normal fatigue and 70-100% of patients with cancer experience fatigue. It may get worse as you progress through treatment and affect your normal everyday activities. Everyone may experience different levels of fatigue.
Strategies that may assist fatigue
- Plan your day around how much energy you have
- Rest between activities
- Gentle exercise/physical activity
- A referral to an Occupational Therapist can be organised.
Fatigue resources
Hair loss depends on the type of chemotherapy you are having. This may begin 2 – 3 weeks after your first treatment.
All body hair may be affected and new hair growth may change colour or texture. Usually, when all your treatment is over, the hair will start to grow back.
Use hats, wigs or turbans to protect scalp from the wind, cold and sun.
Cancer Council Queensland information booklets are available and Look Good Feel Better offers support programmes.
Chemotherapy can affect a person’s fertility and sex life. Your doctor will discuss this with you prior to commencing treatment. Some drugs used in chemotherapy may cause temporary or permanent infertility. Tiredness or feeling unwell may affect your desire for intimacy.
- It is important to use barrier contraception (condom) to avoid pregnancy.
- Inform your doctor immediately if you think you may be pregnant.
- Women may experience menstrual changes (irregular periods or cease causing menopausal symptoms).
Good communication and support will help during your treatment. If you have any concerns or questions discuss this with your doctor or nurse.