Cancer Care: What You Need to Know About Chemotherapy

If your doctor has recommended chemotherapy as part of your cancer treatment, you might be nervous. Maybe you have had a family member who found the treatment grueling or a friend who experienced intense side effects.

“Chemotherapy looks really different for everyone,” says UNC medical oncologist Jacob Stein, MD. “If it was a tough experience for someone else, that doesn’t mean it will be your experience. There are different scenarios.”

Chemotherapy encompasses a wide range of medications used to treat cancer, and the specific drug you receive is based on your diagnosis and the goal of your treatment. Some chemotherapy drugs are known for more severe side effects, while others may have minimal effects, so discuss your treatment with your medical team.

Although your experience may vary, Dr. Stein explains what most people can expect from chemotherapy.

How Chemotherapy Works

Chemotherapy drugs are designed to stop the growth of cancer cells.

“The medications disrupt DNA replication and cause DNA damage in cancer cells that prevents them from growing,” Dr. Stein says. “The drugs focus on the fastest-growing cells in the body, which are typically cancer cells.”

Along with cancer cells, chemotherapy medications affect healthy cells that naturally grow quickly, which causes side effects. Because chemotherapy travels throughout the body, it’s considered a systemic treatment; in comparison, radiation therapy more precisely targets cancerous cells while sparing other healthy cells.

Your doctor may prescribe chemotherapy as your primary treatment, or it may be used in combination with other treatments, including radiation.

“The reasons for chemotherapy depend on the cancer,” Dr. Stein says. “It may be used to shrink cancer before surgery, to increase the chances of the surgery going well, or it may be used after surgery, to go after remaining cancer cells.”

Chemotherapy can also be used as a palliative treatment for people with advanced or metastatic (spreading) cancer. Although the goal with this treatment is not to cure the cancer, it can improve quality of life or prolong life.

The Chemotherapy Process

Chemotherapy is typically delivered intravenously, requiring regular visits to an infusion center.

“Some people’s appointments take just 15 minutes, while others might be there for three to five hours,” Dr. Stein says. “There is a wide range of how often or how long you might have treatment. If you’re receiving chemotherapy before or after surgery, the entire process typically takes three to six months, but if you’re receiving palliative chemotherapy, it can be continual, and you’ll go for as long as the treatment is working well.”

Before each chemotherapy infusion, you will have your blood drawn so that your care team can ensure your body is strong enough to receive the treatment. You may also be given medications before your treatment to prevent side effects.

As your treatment progresses, Dr. Stein says there may be a pattern you can anticipate. For example, you may feel fine in the days immediately following treatment and then experience side effects such as fatigue or nausea most severely about a week after the infusion. Then, there may be a week or two where symptoms improve, when you can focus on activities you enjoy before your next appointment.

During the process, Dr. Stein advises people to eat a healthy, balanced diet and to stay as active as possible with walks or other moderate forms of exercise.

“It’s also important to lean on social support,” he says. “Chemotherapy can be a challenging process, so connections with friends and family are really meaningful to getting through it.”

Chemotherapy Side Effects

The short-term side effects of chemotherapy are the result of the drugs disrupting the body’s most rapidly growing healthy cells in addition to fast-growing cancerous cells. For example, your hair follicle cells grow quickly, making them a target for most chemotherapy drugs, resulting in hair loss or thinning.

Blood cells constantly regenerate, and as they’re affected by chemotherapy, it can lead to a variety of concerns. Damage to white blood cells affects your ability to fight infection, which means you may have to wear a mask in public during your treatment, be extremely mindful about hand hygiene and avoid people who are sick. A loss of red blood cells leads to fatigue and anemia, while a loss of platelets can increase the risk for bleeding. Your medical team can determine your risk for certain issues and whether additional treatments, such as blood transfusions, may be necessary.

Cells in the stomach lining also regenerate quickly, so chemotherapy causes gastrointestinal symptoms including nausea, diarrhea and constipation. Dr. Stein says that treatment of these symptoms can be much better managed with medication now than they were in the past.

Some people experience neuropathy, or nerve damage, during or after chemotherapy. It’s also possible to experience brain fog or memory issues during or after treatment.

Chemotherapy has several long-term side effects to consider.

“Some chemotherapy medications can affect the heart in the long term,” Dr. Stein says. “It’s a small risk percentage-wise, but it’s still a serious risk to be aware of.” If you have a personal or family history of heart problems, talk to your oncologist; you may require additional screenings or medications during treatment or adjustments to your chemotherapy dosage.

Some chemotherapy medications have been linked to causing a second cancer, so you may need additional cancer screenings in the years after treatment.

Chemotherapy drugs also may cause permanent impairments to fertility.

“There are options to preserve your fertility, so have that conversation with your medical team,” Dr. Stein says. “We want you to be able to consider your options and make a decision before treatment, rather than missing the opportunity.”

Your risk for side effects depends on a number of factors, so speak to your doctor about your particular case. Your medical team can help you weigh your potential risks and quality-of-life concerns against the efficacy of available treatments.

“In some cases, the studies are clear about a particular type of chemotherapy being the right treatment at a certain time, but often, we may need to have a conversation about which treatment is best for your specific goals,” Dr. Stein says. “Modern cancer care has improved so much, and there may be non-chemo options such as immunotherapy or a targeted drug therapy. Before any treatment, you should understand your options and make a choice you’re comfortable with.”

If you have questions about chemotherapy as an appropriate cancer treatment for you, talk to your doctor. Need a doctor? Find one near you.