Abstract

Chemotherapy is the use of drugs to treat cancer. There are many different types of chemotherapy, different ways to take it, and different side effects that may occur. The type of chemotherapy you will receive depends on your specific type of cancer, so be sure to ask your health care provider any questions you may have about your treatment.

Name
chemotherapy

Also Called
anticancer drugs

What It Is For
Chemotherapy is any drug or combination of drugs used to treat a disease. However, the term is most often used to describe drugs that kill cancer cells. Normal cells grow and then die in a controlled way. But cancer cells continue growing and multiplying and take longer to die. Chemotherapy drugs kill cancer cells or stop them from growing and reproducing. These drugs may cure cancer, keep it from spreading, slow its growth, or relieve symptoms that you may have because of your cancer.

The type of chemotherapy you may receive depends on several factors, including the type of cancer you have, how advanced your cancer is, and your overall health. Likewise, the way you receive your chemotherapy and the effects it may have on your body depend on which drug or combination of drugs you receive. Sometimes more than one drug is necessary. Some drugs work better together than either drug alone. Chemotherapy may be the only form of treatment your health care provider decides to give you, or he or she may combine it with another form of treatment, such as surgery or radiation therapy.

An important thing to remember about chemotherapy is that there is no one way to give it. You may receive a different drug than someone else who has a cancer similar to yours. Likewise you may react differently than someone else to a particular drug. Everyone is different, and the chemotherapy experience will be different from patient to patient. Before, during, and after your treatment, please do not hesitate to ask your health care provider any questions you may have so he or she can address your needs and concerns.

How To Take It

You can receive your chemotherapy in one of the following ways:
- by mouth (orally), in pill, capsule, or liquid form.
- by being applied to your skin (topically).
- by an injection into one of your muscles (intramuscular injection) or under your skin (subcutaneous injection)
- into a vein (intravenously)
- through a pump, which can be stationery, portable, or implanted under the skin

The type of cancer you have will determine how often and for how long you'll need your chemotherapy. Some people get it every day, others every week, and still others only once a month. The treatments can last from 3 months to 3 years. Your health care provider will probably give your chemotherapy in on-and-off cycles, allowing your body to rest and recover between treatments.

Be sure to ask your health care provider how you will take your chemotherapy. Also ask him or her how often you will need to take your chemotherapy, and how long he or she thinks the full treatment may last.

Cautions
If you are already taking other medicines, be sure to give a list of them to your health care provider before you start chemotherapy. Some drugs may interfere with the effects of chemotherapy, so it is important for your health care provider to know what other medicines you are taking.

Chemotherapy can lessen your body's ability to fight infection. Therefore, it is very important to contact your health care provider immediately if you have one or more of the following symptoms:

- fever more than 100 degrees F
- chills
- sweating 
- loose bowels
- a burning feeling when you urinate (may indicate a urinary infection)
- a severe cough or sore throat
- unusual vaginal discharge or itching (may indicate a vaginal infection)
- redness or swelling of your skin, especially around a wound, sore, pimple, or boil

There are also special precautions you can take to avoid infection, such as:

- washing your hands regularly
- being careful not to nick or cut yourself 
- staying away from people with an illness you may catch (such as a cold or flu)

Some chemotherapy drugs may cause birth defects. Therefore, your health care provider may advise you to use birth control during the course of your treatment. Please speak to your provider about any concerns you may have regarding birth control.

It is also very important to eat a balanced, nutritious diet during your course of treatment. You need vitamins and nutrients to keep your body strong during this time. If you have questions about how to follow a healthy diet, please speak to your health care provider. Your health care provider may also advise you to drink plenty of fluids during your treatment. Be sure to ask your provider if it is okay for you to drink alcoholic beverages, if you wish to do so.

Side Effects
When you heard you needed chemotherapy, perhaps the first thing that you thought of was the side effects. That's perfectly normal. There have been several side effects associated with chemotherapy for cancer. Fortunately, researchers have developed some new drugs to lessen these effects and to help you to feel better during your course of chemotherapy.

Not everyone on chemotherapy gets side effects. And among those who do, some people only get a few. The way your body reacts to your chemotherapy depends on which drug you receive and how much of it you need to take. Throughout your chemotherapy, be sure to ask your health care provider any questions you may have about any aspect of your treatment. Some questions you might consider are:
- Which side effects might occur with my treatment?
- How long will these side effects last?
- How serious could these side effects be?
- Is there anything I can take to feel better if I get side effects?
- How should I take care of myself if I get these side effects?

Cancer cells grow and divide very quickly. Therefore, anticancer drugs are made to kill cells that grow quickly. However, since certain healthy cells also divide quickly, they, too, might be injured by the chemotherapy. These normal cells include blood cells, hair follicles (where your hair grows from), some skin cells, cells in your digestive system, and cells in your reproductive system. Therefore, you may experience one or several of the following symptoms:
- nausea and vomiting, although there are some relatively new drugs available to reduce these side effects
- hair loss
- fatigue (feeling tired) and anemia. Chemotherapy can reduce the number of red blood cells in your body. Red blood cells carry oxygen to your body's tissues. So when there are less of them, you may feel tired.
- infection. Chemotherapy may reduce the number of white blood cells in your body. White blood cells are important for fighting infection. There is a drug available now that helps your body recover from the effects of chemotherapy on your white blood cells. You should ask your health care provider if you need to take it. IMPORTANT: If you develop any signs of infection during your treatment, such as a fever or flu-like symptoms, please contact your provider immediately.
- your blood may have problems clotting. Chemotherapy may reduce the number of platelets in your blood. Platelets are the blood cells that help our blood to clot. Therefore, you may find you bruise more easily than usual during chemotherapy.
- mouth, gum, and throat problems. See your health care provider if you develop sores in these areas.
- diarrhea
- constipation
- nerve problems, such as tingling, numbness, or loss of balance
- muscle weakness or soreness
- skin and nail problems, such as redness, itching, peeling, dryness, or acne
- kidney and bladder problems. Be sure to ask your health care provider if your chemotherapy can cause these problems. If so, you should drink plenty of fluids to help you urinate regularly.
- flu-like symptoms. These may be a symptom of infection. IMPORTANT: If you develop flu-like symptoms, please call your health care provider immediately.
- retaining water (fluid retention). You may need to avoid salty foods. In some cases, your health care provider can give you another drug to help your body get rid of the excess fluid.
- sexual problems. These are perfectly normal, and can be physical or emotional. In men, some chemotherapy drugs may cause infertility, but will not affect the ability to have sexual intercourse. In women, menstrual periods may become irregular or stop during chemotherapy. Some chemotherapy drugs may damage the ovaries and cause infertility. Such infertility is not always permanent, however. Also, some women experience dryness of the vagina during chemotherapy and find intercourse to be uncomfortable. If you experience vaginal dryness, try using a water-based lubricant to make you more comfortable. Speak to your health care provider about any physical or emotional concerns you may have about your sexuality during chemotherapy.

Keep In Mind
Chemotherapy isn't easy for anyone. You may be feeling frustrated, angry, depressed, or anxious during this time. This is perfectly normal. Your day-to-day schedule may be disrupted, and your relationships with those around you may feel strained. Please keep in mind that you are not alone.

Here are some suggestions to help you through this difficult time:
- Consult your health care provider about any questions and concerns you may have about your cancer, its treatment, and how you are faring during your treatment. - Learn as much as you want to know about your cancer and its treatment. Knowledge helps many patients feel more in control.
- Talk to the people closest to you -- your spouse, your family, and your friends.
- Don't be afraid to seek counseling to deal with your emotions during the course of your treatment.
- Don't be too hard on yourself. You may not have as much energy as you usually have, and that's okay. Set realistic goals for yourself.
- You may also consider joining a support group consisting of others going through the same experience. Ask your health care provider about how to find such a group.
- Find ways to cope with the stress of cancer and its treatment. There are a number of techniques available to help you feel more relaxed. Ask your health care provider which technique might be best for you.

For more information on chemotherapy, you can call the Cancer Information Service of the National Cancer Institute at 1-800-4CANCER (1-800-422-6237). They have a variety of booklets they can send to you, including:
- "Chemotherapy and You", a comprehensive guide to dealing with various aspects of chemotherapy
- "Eating Hints", which offers tips on making eating easier and more enjoyable while you are on chemotherapy
- "Taking Time", which provides advice on helping cancer patients and their friends and family members to communicate better with each other.

Sources
1. "Chemotherapy and You: A Guide to Self-Help During Treatment," produced by the National Cancer Institute, 1991.
2. "Frequently Asked Questions About Neupogen (Filgrastim)" Produced by Amgen. Revised 1994.

(Copyright 1997 Mosby Consumer Health.)

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