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Cytotoxic Chemotherapy

What is chemotherapy?

Chemotherapy, or chemo, is most commonly associated with the use of cytotoxic or “cell killing” chemical agents to destroy rapidly dividing cancer cells. Unlike localized forms of cancer treatment, such as radiation or surgery, chemotherapy eliminates cancer cells throughout the entire body which is why it is often referred to as systemic therapy.

Chemo can be delivered with one drug as a single agent or in combination with other drugs. As well, chemotherapy may be used in conjunction with other treatment modalities such as radiation therapy or surgery.

Why is chemotherapy used?

The exact goals of chemotherapy will depend on the type and stage of the cancer and overall health of the patient. Chemo can be used for the following reasons.

To reduce the size of a tumor before surgery (neoadjuvant chemo)
To prevent the cancer from coming back after surgery (adjuvant chemo)
To make the cancer cells more susceptible to the damage caused by radiation therapy (radio-sensitizing chemo)
To treat disease that has metastasized or spread to distant sites
To maintain a patient who has stable disease or is in remission
To re-treat cancer if it returns
To manage symptoms and improve quality of life
To extend life


How should a patient prepare for chemotherapy?

Prior to the first chemotherapy appointment and every three to four weeks thereafter, the patient will meet with the treating physician. If possible, a patient should bring someone to the physician visits to help listen to the facts and keep the information in context. Taking notes may also help the patient to remember and understand all of the information and prepare for treatments.

Prior to starting chemo, a list of all current medications should be provided to the physician to ensure there will be no interactions with the prescribed chemotherapy. Once treatment begins, the patient should inform the physician of any new medications, vitamins or herbal supplements.

For each chemotherapy appointment, the patient should plan to spend approximately 2-4 hours at the center. He/she should wear warm, comfortable clothes, and try to get a lot of rest prior to the appointment. If the patient is having trouble sleeping, the treatment team should be notified, and an anti-anxiety medication or a mild sedative may be prescribed.

Upon arrival, if a patient does not have a port or a catheter in place, a nurse will start an IV in order to infuse the chemotherapy. Our nurses are the most skilled nurses in the industry, so patients experience minimal discomfort. The chemotherapy will be delivered over the next few hours. Many patients find that they are able to nap through their treatments at the center. Following treatment, the patient will want to continue to get a lot of rest. If any redness, pain, burning, swelling or discomfort at the injection site is observed following the appointment, it should be reported immediately.

What are the side effects of Chemotherapy?

The most common side effects associated with chemo stem from the fact that chemotherapy drugs are not able to differentiate between cancer cells and otherwise healthy cells. They target all rapidly dividing cells meaning that in addition to the cancer cells, they may damage some normal cells including hair follicles, the lining of the gastrointestinal tract and blood cells. Not all chemotherapies cause all side effects, and some chemotherapies may have side effects that are unique to that particular drug. It is important to consult with the physician to learn more about any side effects associated with a particular chemo combination.

Fatigue:

Patients may experience mild to moderate fatigue while undergoing chemotherapy. Getting plenty of rest and eating a well-balanced diet are important for maintaining strength.

Hair Loss:

While not all chemotherapy leads to hair loss, some drugs will damage the hair follicles causing this side effect. The hair loss usually takes place approximately two weeks after the initiation of chemotherapy and may be accompanied by scalp tenderness. To prepare for this side effect, it may be helpful to get wigs, hats and/or scarves prior to beginning treatment. In the majority of cases, hair will re-grow following the completion of treatment and may return with a different texture or color than before.

Nausea/Vomiting/GI Upset:

While chemotherapy drugs can potentially cause some nausea and vomiting, today these side effects can generally be managed with medication. Diet does not contribute to these side effects, therefore it is not necessary to go on a bland diet when starting chemotherapy. In fact, many patients prefer strongly flavored food while they are in treatment.

Blood Related Side Effects/Myelosuppression:

Chemotherapies can frequently reduce the number of blood cells in the patient’s body. This can add to fatigue and can also make patients more susceptible to bleeding and infection. Blood draws will be scheduled regularly to closely monitor blood counts. Today, there are several drugs which have been developed to help compensate for the loss in blood cells. It is important for patients who are undergoing chemotherapy to avoid people who are sick and might be contagious.

Mouth or Throat Sores/Mucositis:

Sometimes chemotherapy can cause damage to the mucosal membranes that line the upper digestive tract. This can cause sores in the mouth and throat. Using a soft toothbrush and avoiding mouthwash containing alcohol will help to avoid further irritation of the tissues. As well, there are treatments available to help manage this side effect.

When Should a Patient Call the Doctor About a Side Effect?

A patient experiencing any fever, pain or any side effect that is worrisome should call 307.235.5433 immediately, day or night. A member of the patient’s treatment team who knows the details of his/her case will offer further direction.

Do Patients Undergoing Chemotherapy Need to Quit Work?

No. It is important while patients are undergoing chemotherapy for them to behave as normally as possible. Patients may experience mild to moderate fatigue, but many are able to work throughout their treatments. We will work to accommodate patients’ work schedules when setting up appointments.

How is Chemotherapy Delivered?

Chemotherapy is most often delivered into a vein (intravenous or IV infusion), but it can also be administered with a pill, capsule or liquid by mouth or with an infusion into a specific area of the body. Most treatments, with the exception of oral chemotherapy, will be delivered at the cancer center. While the time varies for each drug delivered, most patients receive their treatments over 2-4 hours.

Many chemotherapy drugs work best during a specific time during a cell’s growth and division process. Because of this, chemotherapy agents are not generally administered like other medications. Instead, each chemotherapy drug is delivered in a manner designed to eliminate the greatest number of cancer cells at the time of drug delivery. Chemotherapy is usually prescribed with intervals of active drug alternated with resting periods which allow the healthy tissues in the body to recover. The time from the first day of delivery of the drug(s) through the end of the rest period is referred to as a cycle. The time off of the drug(s) may last as long as 2-3 weeks. Once a cycle is completed, it will be repeated a number of times as prescribed by the physician. An entire course of chemotherapy consists of multiple, sequential cycles of treatment.

Because patients may receive multiple drugs, each of which may be delivered on a different timetable, the physician and patient care coordinators will help to set up a schedule so that patients know exactly when to come in for treatments. Drugs work the best when they are taken on schedule, so it is important for patients to try to stay on track and not miss appointments.