Planning your chemotherapy treatment
Your treatment is planned by your cancer doctor (clinical or medical oncologist) who is an expert in treating people with cancer using chemotherapy, radiotherapy and other anti-cancer drugs.
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Other health professionals are also involved in your care.
You may be introduced to a chemotherapy nurse specialist who will give you information and support.
Your cancer specialist or your specialist nurse will explain the aims of your chemotherapy, possible side effects, and the benefits and disadvantages to you.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again.
Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
We have more information in our section on making treatment decisions.
Preparing for chemotherapy
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Your cancer specialist will tell you if you need any tests before your chemotherapy or if any other preparations are needed.
Before starting your treatment, a nurse will check your height and weight at the clinic. Your cancer doctor uses this information to work out the right dose of chemotherapy for you.
Some chemotherapy drugs can affect organs such as the heart or the kidneys. You may need tests to measure how well these organs are working before you have chemotherapy. For example, if you’re having drugs that can affect the heart you may have an echocardiogram (uses sound waves to create a picture of the heart).
Some people may need further scans or x-rays to find out more about the extent of the cancer (its stage) before chemotherapy.
You may be advised to have a dental check-up before chemotherapy. Having dental work during chemotherapy can be more complicated as you’re more at risk of an infection.
Your course of chemotherapy
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How often you have chemotherapy, how it’s given, and how long your whole course takes depends on:
the type of cancer you have
the chemotherapy drugs you’re having, and how the cancer responds to the drugs
how the side effects are affecting you.
Sometimes treatment involves having chemotherapy in more than one way. For example, you may have chemotherapy into a vein (intravenous) and chemotherapy tablets.
Chemotherapy is usually given as several sessions of treatment followed by a rest period of a few weeks. The rest period allows your body to recover from the side effects, and the number of cells in your blood to go back to normal.
Some people are given drugs a day or two before treatment to reduce the risk of an allergic reaction or sickness. This depends on the type of chemotherapy and your nurse will go over this with you.
Chemotherapy and the rest period make up a cycle of your treatment. Your cancer doctor will explain the number of cycles you need to treat the cancer. After your first cycle, you’ll have a better idea of what you can plan for, and how much you may or may not be able to do.
The complete course of all your chemotherapy may take several months.
Chemotherapy is sometimes given continuously by an infusion pump for several days or several weeks. If you’re having chemotherapy as tablets or capsules, you may have them daily for several weeks or months before a rest period.
You’ll have a blood test before your chemotherapy. To save time, your blood may be checked a day or two before chemotherapy. This can be done at the hospital where you’re having chemotherapy, or by your GP, practice nurse or a hospital closer to home. The results will be ready for you when you go to have your chemotherapy.
Other things to think about
Here are some other things to think about before you start chemotherapy.
Taking other drugs, vitamins or supplements
Always tell your cancer doctor about any prescription and over-the-counter drugs, vitamins or supplements you’re taking. Some vitamins or supplements may interact with chemotherapy drugs and make treatment less effective.
Some chemotherapy drugs affect fertility (the ability to get pregnant or father a child). If this is a concern for you, it’s very important to talk to your cancer doctor before treatment. Sperm or eggs that can be used to try to preserve your fertility should be stored before chemotherapy begins.
Getting a wig
If the chemotherapy drugs cause hair loss it’s best to have a wig fitted before your hair falls out. You can then match it to your own colour and style.
Help at home
Chemotherapy makes you tired so you may need help with day-to-day chores. Although it can be hard to ask for help, family and friends are usually keen to do whatever they can. If you live alone or are caring for someone else, you can ask to see the hospital social worker about getting help.
Help with children
If you have children you may need help with taking and picking them up from school or clubs. Family and friends can usually organise a rota of help.
It’s also useful to know who you can contact at short notice to look after your children. We have more information on childcare when you have cancer.
Work or further education
It’s a good idea to talk to your employer or tutors, so they can make arrangements to support you and organise your time off during treatment.
Changes to your treatment plan
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Sometimes people may need their chemotherapy treatment plan changed. If this happens, your cancer doctor or nurse will explain why it’s advised in your situation.
It may be because of the effects of the chemotherapy on your body or on the cancer itself. Sometimes changes can be made to suit your personal circumstances.
Effects on your body
Chemotherapy can affect organs, such as the bone marrow, kidneys and liver. You’ll have regular blood tests to monitor this. Some drugs can affect the nerves in your feet and hands (known as peripheral neuropathy) and others drugs may affect hearing.
Depending on the problem, your doctor may delay your chemotherapy for a short while, reduce the dose or put you on a different chemotherapy drug.
Delaying your chemotherapy
The most common reason for delaying chemotherapy is the number of white blood cells in the blood being too low. This isn’t unusual so try not to get too worried about it. Once your white blood cells are back up to a healthy level, you can start your next cycle of chemotherapy.
You may be able to delay your chemotherapy if you have a special social occasion coming up. A small delay won’t usually be a problem, but this does depend on the type of cancer you have. Your cancer doctor or specialist nurse will tell you if this is advisable.
Effects on the cancer
Your doctor may arrange tests or a physical examination to check the effects of chemotherapy on the cancer.
If the results show the cancer isn’t responding well enough, your doctor may change your treatment plan to different chemotherapy drugs.