Chemotherapy 101: An Overview

Chemotherapy (commonly called "Chemo") is the use of drugs for any of the following purposes: 

• To cure cancer OR
• To control cancer if it cannot be cured OR
• To relieve pain from a cancer that cannot be cured or controlled ("Palliative" care).
• Chemo usually consists of a combination of drugs. 

Chemo works by attacking reproducing cells. Reproducing cells include healthy cells in addition to cancer cells. 

Chemo generally works throughout the body. Sometimes chemo is given just to a specific area of the body. Chemotherepay may be given by a regional method when there is a need to give high doses of chemotherapy to a specific area of the body.

Chemotherapy is not like it used to be. Side effects are more limited, and there are more medications to eliminate or reduce side effects.

Which chemotherapy to use depends on the following factors:  

• The type of cancer and stage (which includes whether it has spread and, if so, how far).
• How and where chemo is given.
• For how long chemo is given.
• How often chemo is given. 
• Your general health status, including other diseases if you have more than one.
• Patient preference. For example, the side effects you are willing to tolerate.

Methods for giving Chemotherapy

Chemotherapy can be given:

• Orally (generally in pills) 
• Through an I.V. (intravenous) drip (a needle sat the end of a flexible tube which is attached to a bag or bottle hanging on a pole)
• Through a Central Venous Catheter (CVC) (a port embedded in your skin).

Steps to take before agreeing to Chemotherapy

If a chemotherapy protocol is recommended, an informed consumer would:

• Ask questions including:
  • The purpose of the drug.
  • How well it has done for other people in your situation.
  • The side effects to anticipate, and for how long.
  • If you work, whether the chemo will interfere with your work schedule.
  • About alternatives.
  • Survivorship A to Z provides a tool to help you make a decision if more than one treatment is available to meet your needs. 
• Learn the appropriate medical terms (which will make discussions with your medical team more precise and faster).
• Get a second opinion before starting treatment.

Always ask your doctor and nurse any questions you have about your chemo. A general knowledge of the words used with respect to chemo will help make discussions with medical providers more accurate and faster, leaving more time to raise any questions or concerns you may have.

Once you agree to chemotherapy: 

• You will be asked to sign a Consent Form. Ask to see the form well before the date your chemo is supposed to start so you have time to review it. It may provide information you didn't ask about or it may contradict what you think about the particular chemotherapy.
• If you could lose your hair, plan ahead. For instance, start shopping for a wig or other head covering.
• If other side effects such as nausea and fatigue commonly accompany the chemo, get a prescription now "just in case." Learn what other steps you can take to decrease or eliminate the side effect.
• If you want to have children, take steps now to bank sperm and eggs. 
• Think through the effect on work during and after treatment. Negotiate for the necessary accommodations or time off.

 During chemotherapy

Chemotherapy is not painful. IV medicines should not hurt after the first needle stick to put in the catheter. 

• Follow the protocol including when you are supposed to take the drug and when you are supposed to visit a doctor.
• Know when to call the doctor (for instance, if you spike a fever over ___ degrees),
• Chemotherapy's attack on healthy cells can cause a variety of side effects ranging from nausea and vomiting to hair loss to so-called "chemo brain" to fatigue. There are drugs and other steps that can be taken to lessen the effect of side effects or eliminate them all together. How long the side effects continue after treatment depends on the treatment and your body.
• Use family, friends and caregivers for support.

If your cancer returns, chemotherapy may be used again.

If it does, you may be given different drugs, including to relieve symptoms or to slow the cancer's growth or spread. Side effects may be different, depending on the drug, the dose, and how it is given. 

Cutting Edge Drugs 

If drugs approved by the FDA are not available for use for your situation, cutting edge drugs may be available through clinical trials. Drugs may also be available outside the U.S. which are not approved or subject to controlled studies here.

Payment

Chemotherapy is generally paid for by health insurance (including Medicare and Medicaid).  If an insurer balks at paying, appeal - and keep appealing!  Many pharmaceutical companies will handle the discussions with the insurer for you. If you are uninsured, there are alternative means for payment.
 
Emotional Support

Emotional support is valuable before, during and after treatment. Consider joining a support group. At least make contact with another person going through what you are or who has recently going through it..

Open and honest talks between you, your family, and your cancer care team is the best way to understand what is happening to you, your body, and your cancer - and to get needed support.

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