How is Chemotherapy Given?
Most chemotherapy is given intravenously as an outpatient, usually in an infusion center. The treatment is given under the supervision of a medical oncologist by a registered nurse. At Torrance Memorial Physician Network Cancer Care all nurses are experienced and chemotherapy certified RNs.
Chemotherapy treatment is empiric. That means that the drug selection for each individual patient is determined scientifically by clinical trials that report the success rate of the drug combinations based upon cancer type and stage. The results of these trials are reviewed at national meetings and reported in peer review journals so that the same treatments are given by cancer specialists throughout the United States and much of the rest of the world. At one time, about 20 years ago, it was thought that oncologists could individualize treatments for each cancer patient based upon chemotherapy assays of a patient’s cancer, very much like antibiotic sensitivity testing in patients with infection. Unfortunately that approach has not been proven helpful due to the inaccuracy and unreliability of this type of testing, so chemotherapy assay which is now rarely used nor recommended by university cancer leaders or the National Cancer Institute. Instead, the national leaders in oncology have emphasized the use of scientific evidence-based medicine and reliance on well conducted clinical trials to guide oncologists when selecting appropriate chemotherapy. It may be that genetic and protein tests in the future will be valuable in helping pick the best chemotherapy and many studies are currently underway to look at this.
At Cancer Care, we only use chemotherapies that are FDA approved for the specific cancer being treated (with the exception of patients on clinical trials). This is a significant issue because use of chemotherapy in non-approved situations can lead to insurance denial of reimbursement which can be a huge problem given the large cost associated with some of the drugs.
Will Chemotherapy Make Me Feel Ill?
Depends on the specific chemotherapy drugs administered. Each drug has a way of working and unique specific common side effects. One of the major advances in chemotherapy is the use of new and effective anti-nausea medication. Many patients will have minimal nausea so it wouldn't be unusual if you notice some nausea for a day or so. Depending on the specific chemotherapy, you might also have vomiting but usually on the evening of treatment and part of the following day. Contrary to popular belief, many patients receiving modern-day chemotherapy feel well enough to maintain a near normal level of activity and employment.
Will I Lose My Hair From Chemotherapy?
That depends on the specific drugs used. Some cause hair loss and others don’t. When chemotherapy is finished hair regrowth occurs. Sometimes the new hair is thicker and curlier, but eventually hair returns to near normal in texture.
Will I Be More Likely to Get an Infection While Receiving Chemotherapy?
You are more likely to develop an infection while on chemotherapy because chemotherapy lowers the type of white blood cells called neutrophils which fight bacterial infection. Generally the lowest levels occur 10-14 days after a chemotherapy treatment and remain low for 3-7 days. During this time, you could develop a bacterial infection of your blood due to bacteria that has entered the bloodstream from the skin and intestines. The risk generally doesn’t occur until the absolute neutrophil count (ANC) is less than 500. This type of infection usually occurs less than 10% of the time for the entire treatment period (for some chemotherapies less than 2%) but is very important as this can lead to severe illness and very rarely death. Because of this risk, chemotherapy is not given when the ANC is very low except when using specific drugs that don’t lower the ANC.
How Can I Protect Myself When I Have a Greater Risk of Infection?
You are advised to take your temperature whenever you are feeling ill. If you have a fever greater than 100.5 F, you should begin an antibiotic and notify our office within a day so that the blood count can be checked. Effective treatment can usually be done as an outpatient but severely ill patients are hospitalized for IV antibiotics. It should be noted that because these infections are caused by bacteria not viruses, they are not contagious and your activities and diet are not typically altered while on most chemotherapies.
It is wise, however, while you are receiving chemotherapy, that you practice good hand hygiene and avoid close contact with other who have a cold or flu.
Is Chemotherapy Dangerous?
There is no denying that chemotherapy is a significant and serious form of treatment. When given under the guidance of expert oncologists and experienced chemotherapy nurses the risks of a catastrophic event, although never entirely eliminated, is very rare.
Do I Need to Alter My Lifestyle While on Chemotherapy?
You are encouraged to do as much as you can to lead a normal life. Some patients feel well enough to work and are encouraged to do so. Exercise is also permitted. Diet is not restricted, for most chemotherapies alcohol in moderation is permitted. Women of childbearing age should use a reliable birth control method (non-hormonal for breast cancer patients) to avoid pregnancy while undergoing any form of cancer treatment including chemotherapy, oral medications, and radiation. Men who are undergoing chemotherapy are advised that either they or their partner should use a reliable birth control method so that pregnancy during treatment is avoided.
Can I Take Vitamins While on Chemotherapy?
No. Vitamins should not be taken during chemotherapy unless specifically prescribed by your doctor. There is data research to indicate that even a daily multi-vitamin can lower the effectiveness of chemotherapy. Since chemotherapy leads to cancer destruction by processes leading to oxidation, large doses of vitamins and antioxidant supplements are especially discouraged because there is a potential to interfere with the effect of chemotherapy against cancer.