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Chemotherapy Content Supplied by NHS Choices
Introduction

Chemotherapy is a type of cancer treatment, with medicine used to kill cancer cells.

It kills the cancer cells by damaging them, so they can't reproduce and spread.

Why chemotherapy is used

Chemotherapy is used if a cancer has spread or if there's a risk that it will. The main aim of treatment may be:

  • to try to cure cancer completely - this is known as curative chemotherapy
  • to help make other treatments more effective - for example, chemotherapy can be combined with radiotherapy (where radiation is used to kill cancerous cells), or it can be used before surgery
  • to reduce the risk of the cancer returning after radiotherapy or surgery
  • to relieve symptoms - a cure may not be possible for advanced cancer, but chemotherapy may be used to relieve the symptoms and slow it down; this is known as palliative chemotherapy

Less commonly, chemotherapy is used to treat non-cancerous conditions. For example, low doses have been used to treat lupus and rheumatoid arthritis.

How chemotherapy is used

There are many different types of chemotherapy medication, but they all work in much the same way. Depending on the type of cancer you have, you may be treated with one medicine (monotherapy) or with a combination of medicines (combination therapy).

There are several ways in which chemotherapy medication can be given, including tablets and injections directly into a vein.

The team caring for you will help come up with a treatment plan for your specific circumstances.

Read more about how chemotherapy is carried out and who can use chemotherapy.

Side effects

Even though chemotherapy is often effective at treating cancer or relieving its symptoms, it does cause side effects.

The medicines used in chemotherapy can't distinguish between fast-growing cancer cells and other types of fast-growing cells, such as blood cells, skin cells and the cells inside the stomach.

This means that most chemotherapy medications have a poisonous effect on the body's cells, causing problems including:

  • feeling tired and weak all the time
  • feeling and being sick
  • hair loss

Some people only have minimal side effects, but for most people, a course of chemotherapy can be unpleasant and upsetting.

Living with and adapting to the side effects of chemotherapy can be challenging. However, it's important to realise that most, if not all, side effects will disappear once the treatment is complete.

There is no risk of the side effects of chemotherapy being passed to other people, including children and pregnant women, if they are in close contact with someone having chemotherapy.

Read more about the possible side effects of chemotherapy.



Who can use chemotherapy

As chemotherapy is a potentially life-saving treatment, it's usually recommended for most people with cancer, even if they're in poor health and it's likely the treatment will make them feel worse.

Delaying treatment, or in some cases not having chemotherapy, may be recommended if you:

  • are in the first three months of pregnancy - using chemotherapy during this time has a very high risk of causing birth defects
  • have low levels of blood cells - chemotherapy can lower your blood cell count further, so it could make you feel very ill and vulnerable to infection (medication and sometimes a blood transfusion may be needed to raise your blood cell count)
  • have severe kidney or liver disease - most chemotherapy medications are processed by your liver and kidneys, so this could have a very harmful effect if your liver and kidneys are already damaged
  • have had recent surgery or a wound - chemotherapy can disrupt the body's ability to heal wounds, so it's usually recommended that the wound heals before treatment begins
  • have an ongoing infection - chemotherapy can make you more vulnerable to the effects of infection, increasing your risk of developing serious complications


Side effects of chemotherapy

It's difficult to predict exactly what side effects you'll experience while having chemotherapy. Different people react to treatment in different ways.

A small number of people have very few or even no side effects.

Many of the common side effects of chemotherapy are listed below, although it's unlikely that you'll experience them all.

Your care team is there to help you cope with the physical and psychological side effects.

When to get urgent medical advice

While the side effects of chemotherapy can be distressing, most don't pose a serious threat to your health.

However, occasionally, some side effects can be very serious. For example, if you have a rapid fall in white blood cells, you may be vulnerable to a serious infection.

People having chemotherapy for cancer of the blood cells or bone marrow are most at risk of developing serious infections. This is because this type of cancer will already have caused a reduction in the number of white blood cells.

Symptoms of a serious problem include:

  • a high temperature of 38C (100.4F) or above
  • shivering
  • breathing difficulties
  • chest pain
  • flu-like symptoms - such as muscle aches and pain
  • bleeding gums or nose
  • bleeding from other parts of the body that doesn't stop after applying pressure for 10 minutes
  • mouth ulcers that stop you eating or drinking
  • vomiting that continues, despite taking anti-sickness medication
  • four or more bowel movements a day, or diarrhoea

Contact your care team immediately if you have any of these symptoms. Your care team should give you a card with 24-hour emergency phone numbers.

Call NHS 111 if you don't have a card or you can't find it.

Fatigue

Fatigue or tiredness is a common side effect of chemotherapy. Almost everyone who has chemotherapy will experience fatigue. You may feel generally tired or you may tire very easily after doing normal, everyday tasks.

While having chemotherapy, it's important to get plenty of rest. Don't carry out tasks or activities that you don't feel up to.

Light exercise, such as walking or yoga, can boost your energy levels, but be careful not to push yourself too hard.

If you're working, you may need to ask your employer to let you work part time until your chemotherapy has finished.

Read more about coping with the effects of tiredness and fatigue.

Contact your care team if you're suddenly significantly more tired than usual and you also feel out of breath. Extreme fatigue and shortness of breath can be a sign of anaemia (see below).

Nausea and vomiting

Nausea and vomiting are common side effects of chemotherapy. They affect around half of all people being treated.

If you experience nausea and vomiting, you'll be given medication to help control your symptoms. This type of medication is known as an anti-emetic.

Anti-emetics can be given in a number of different ways, including:

  • as a tablet or capsule - which can either be swallowed or placed under your tongue to dissolve
  • as an injection or drip
  • as a suppository - which is a capsule that you put into your bottom so that it can dissolve
  • through a patch that you place on your skin

Continue taking your anti-emetics even if you don't feel sick, because they'll help stop your symptoms returning.

Side effects of anti-emetics include constipation, indigestion, problems sleeping (insomnia) and headaches.

There are several different types of anti-emetics. Contact your care team if the one you're taking doesn't work or if it causes too many troublesome side effects. There may be an alternative anti-emetic that works better for you.

Hair loss

Hair loss is a common side effect of some types of chemotherapy. It usually begins one to three weeks after the first chemotherapy dose, and most people have significant hair loss after one to two months.

The scalp is most commonly affected, although hair loss can also occur on other parts of your body, including your arms, legs and face.

Hair loss can be very traumatic, particularly for women. Talk to your care team if you find losing your hair very difficult to cope with. They understand how distressing it can be and will be able to give you support and counselling.

You may also find it useful to read more about coping with hair loss.

You may decide that you want to wear a wig. For some people, synthetic wigs are available free of charge on the NHS. Read more about wigs on the NHS.

Hair loss due to chemotherapy is almost always temporary, and your hair should begin to grow back soon after your treatment has finished.

Around three-quarters of people no longer wear a wig or use a head covering six months after their chemotherapy treatment has finished.

Many people find that their newly-grown hair is different than before. For example, it may be a different colour or it may be curlier or straighter than it used to be.

Cold cap

While receiving chemotherapy, it may be possible to prevent hair loss by using a cold cap. A cold cap looks similar to a bicycle helmet and is designed to cool your scalp while you receive a dose of chemotherapy. Cooling the scalp reduces the amount of blood flow to it, which reduces the amount of chemotherapy medication that reaches it.

Whether or not you can use a cold cap during treatment will depend on the type of cancer you have.

For example, a cold cap can't be used if you have:

  • various types of leukaemia - such as acute lymphoblastic leukaemia, which is cancer of the blood cells and mainly affects children
  • multiple myeloma - which is a cancer that develops inside the bone marrow
  • non-Hodgkin lymphoma - which is a cancer that develops inside the lymphatic system (a series of glands and vessels that help to protect the body against infection)

With these types of cancers, there's a good chance that cancerous cells could have spread to your skull. Therefore, it would be too dangerous to cool your skull.

Cold caps work better with certain types of chemotherapy medications, and they may not always prevent hair loss.

Increased risk of infection

Chemotherapy can reduce your body's ability to fight infection, so a course of antibiotics may be prescribed to reduce your risk of developing an infection.

You'll also need to take extra precautions to protect yourself against infection. For example, you should:

  • have good personal hygiene - take daily baths or showers and make sure that your clothes, towels and bed linen are washed regularly
  • avoid contact with people who have an infection - such as chickenpox or flu
  • wash your hands regularly with soap and hot water - particularly after going to the toilet and before preparing food and eating
  • take extra care not to cut or graze your skin - if you do, clean the area thoroughly with warm water, dry it and cover it with a sterile dressing

Regular blood tests are often carried out during chemotherapy to identify when you are most vulnerable to infection.

You may be advised to take extra precautions, such as avoiding crowded places and using public transport at busy times.

Anaemia

Chemotherapy lowers the amount of red blood cells. These cells carry oxygen around the body. If your red blood cell count drops too low, your body will be deprived of oxygen and you'll develop anaemia.

Symptoms of anaemia include:

  • tiredness - you'll feel much more tired than the general level of fatigue associated with chemotherapy
  • lack of energy
  • shortness of breath (dyspnoea)
  • irregular heartbeat

Contact your care team as soon as possible if you have any of these symptoms.

You may need to have a blood transfusion to help increase the number of red blood cells. Alternatively, a medication called erythropoietin (EPO) can stimulate the production of red blood cells.

It's important to include a high amount of iron in your diet. This is because iron helps red blood cells to carry more oxygen. Foods that are high in iron include:

  • dark green leafy vegetables
  • iron-fortified bread
  • beans
  • nuts
  • meat
  • apricots
  • prunes
  • raisins

Read more about treatment for anaemia.

Bruising and bleeding

Chemotherapy can make you more vulnerable to excessive bleeding and bruising. This can cause:

Report any of these symptoms to your care team, because you may need a blood transfusion to raise your platelet count.

Mucositis

In some cases, chemotherapy can cause pain and inflammation of the soft layer of tissue that lines the digestive system from the mouth to the anus (the mucous membrane). This is known as mucositis.

People having high-dose chemotherapy usually experience more severe symptoms.

The symptoms of mucositis usually begin 7 to 10 days after you start chemotherapy.

If you develop mucositis, the inside of your mouth may feel sore, as if you've burnt it by eating very hot food. You'll probably develop ulcers on the lining of your mouth and, in some cases, on your tongue or around your lips.

The ulcers can be very painful and make it difficult to eat, drink and talk. They may also bleed and become infected.

The symptoms of mucositis should clear up a few weeks after your chemotherapy finishes. Medication is available to relieve the symptoms.

Loss of appetite

If you lose your appetite, it's important to make an effort to eat healthily and drink plenty of liquids.

You may find eating smaller, more frequent meals better than eating three large meals a day. Try sipping drinks slowly through a straw, rather than drinking them straight from a glass.

If you have serious problems eating and drinking due to symptoms such as mouth ulcers, you may need to be admitted to hospital, so that you can be fed with a feeding tube.

Skin and nails

Some chemotherapy medications can cause your skin to become dry and sore, particularly on your hands or feet. Your nails may become brittle and flakier than usual, and white lines may develop across them.

During chemotherapy, and for some time after treatment has finished, your skin may become more sensitive to sunlight, so it's important to protect your skin from the sun.

Memory and concentration

Some people have problems with their short-term memory, concentration and attention span during chemotherapy. You may find that routine tasks take much longer than usual.

It's unclear why this happens, but the symptoms will usually improve after your treatment has finished.

Sleep problems

Sleep problems are a common side effect of chemotherapy. They're thought to affect around half of all people being treated with chemotherapy.

Sleep problems can include difficulty falling asleep (insomnia), and waking up in the middle of the night and being unable to get back to sleep.

The following advice may help to improve your sleep:

  • Go to bed only when you're sleepy.
  • If you can't sleep, leave the bedroom and only return when you feel sleepy.
  • Only use your bedroom for sleeping and having sex.
  • Avoid napping during the day; if this isn't possible, try to limit your naps to about half an hour.
  • Avoid stimulants, such as caffeine, for at least six hours before you plan to go to bed.

Contact your care team if this advice doesn't work, as you may need additional treatment. A type of therapy called cognitive behavioural therapy (CBT) has been shown to be effective in treating insomnia associated with chemotherapy.

Sexuality and fertility

Many people find that they lose interest in sex during chemotherapy. However, this is usually temporary and your interest in sex should gradually return after your treatment has finished.

Some chemotherapy medicines can stop women being able to conceive and can prevent men from producing healthy sperm. Loss of fertility is usually temporary, although it can be permanent in some cases.

If you're at risk of becoming permanently infertile, your care team can discuss this with you before treatment.

A number of options are available. Women can have their eggs frozen to be used later in IVF (in vitro fertilisation). Men can have a sample of their sperm frozen, to be used at a later date for artificial insemination.

Diarrhoea and constipation

You may have diarrhoea or constipation a few days after you begin chemotherapy. Your care team can recommend suitable medication to help control the symptoms.

Read more about treatment for diarrhoea and treatment for constipation.

Depression

Living with the effects of chemotherapy can be frustrating, stressful and traumatic. It's natural to feel ongoing anxiety and concern about whether your treatment will be successful.

Stress and anxiety can increase your risk of getting depression.

Contact your care team if you have psychological and emotional difficulties. They'll be able to recommend treatments to help improve the symptoms of stress, anxiety and depression.

Joining a support group for people who are having chemotherapy may also help. Talking to other people in a similar situation can often reduce feelings of isolation and stress.

The charity Macmillan Cancer Support has an online directory of cancer information and support centres in England. You can search the directory to find a centre in your area. You can also call the Macmillan Support Line free on 0808 808 00 00 (Monday to Friday, 9am-8pm).

Refusing or withdrawing treatment

In some circumstances, you may think that the benefits of chemotherapy aren't worth the poor quality of life, due to the side effects.

For example, if chemotherapy offers no hope of a cure and can only extend your life by a few months, you may feel that the extra few months aren't worth undergoing treatment.

However, if you are looking forward to an event such as the birth of a grandchild or the wedding of a son or daughter, you may want to extend your life, whatever the cost to your wellbeing.

There's no right answer or recommendation about when chemotherapy should be refused or withdrawn. Your care team can give you advice about the likely benefit of continuing with treatment, but the final decision will be yours.

This is obviously a very sensitive topic that you should discuss fully with your care team, family, friends and loved ones. You always have the right to refuse a particular treatment or to ask for the treatment to be stopped if you don't feel it's benefiting you.

Stopping chemotherapy doesn't mean that any symptoms you have will go untreated. Your care team will still provide support and pain relief. This type of care is known as palliative care.

If it's thought that you don't have long to live, it may be recommended that you're admitted to a hospice. Hospices provide care for people from the point at which their illness is diagnosed as terminal to the end of their life, however long that may be.

Read more about end of life care.



What happens during chemotherapy

Chemotherapy can be carried out in many different ways, depending on your specific circumstances.

Your care team

Many hospitals use multidisciplinary teams (MDTs), consisting of a number of specialists working together to give chemotherapy treatment. This may include:

  • medical oncologist - a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy
  • pathologist - a specialist in diseased tissue
  • haematologist - a blood specialist
  • psychologist - who can provide support and advice about the psychological and emotional impact of chemotherapy
  • clinical nurse specialist (CNS) - who will offer you support throughout your treatment

You may also be assigned a key worker (this is often the CNS) who you can contact at any point during your treatment.

Deciding what treatment is best for you can often be confusing. Your care team will recommend what they think is the best treatment option, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the doctor in charge of your care.

For example, you may want to find out:

  • what the purpose of your chemotherapy is - for example, whether it's being used to cure your cancer, relieve your symptoms or make other treatments more effective
  • what side effects you're likely to experience and whether anything can be done to prevent or relieve them
  • how effective the chemotherapy is likely to be at curing your cancer, or at least slowing it down
  • whether any alternative treatments can be used instead of chemotherapy

Tests

Before chemotherapy begins, you'll probably need tests to assess your health to make sure you can cope with any side effects. Tests may also be carried out during treatment to monitor your progress.

The tests you require will depend on the type of cancer you have.

Blood tests

In most cases, a blood test is carried out to assess the health of your liver and kidneys. This is important, because chemotherapy medicines will be broken down in your liver and kidneys. The medication can harm the liver, so it may not be suitable for you if you have liver or kidney damage.

You'll also need a blood count to measure how many blood cells you have.

If you have a low blood count, treatment may be delayed until your blood count has returned to normal. This is because chemotherapy reduces the number of cells in your blood. In some cases, a blood transfusion may be required.

Regular blood tests may also be carried out during your treatment to monitor your liver, kidneys and blood count.

Scans

Scans can help to identify the best form of treatment and provide a reference point, so your progress can be checked during treatment.

Several different scans may be used, including:

Your treatment plan

You'll need regular chemotherapy over a set period of time for it to be effective.

Your care team will draw up a treatment plan detailing how many sessions you'll need, how long the course should last, and how much time should pass between each session. It's common for there to be a break after each session, to allow your body to recover.

The treatment plan is known as a chemotherapy protocol. Chemotherapy protocols vary, depending on the type of cancer you have and how advanced it is.

Types of chemotherapy

Chemotherapy is usually given in one of two ways:

  • as a tablet (oral chemotherapy)
  • injected directly into a vein (intravenous chemotherapy)

However, chemotherapy medicine can also be given in other ways. It can be injected into the spine (intrathecal chemotherapy) and it can come as a cream that's applied directly to the skin.

The type of chemotherapy used will depend on the type of cancer you have and how advanced it is.

Oral chemotherapy

If you're in good health, you may be able to take your tablets at home. However, you'll still need to go to hospital for regular check-ups.

It's important that you only take your tablets on the days specified in your chemotherapy protocol. If you forget to take a tablet, contact your care team for advice. You should also contact your care team if you're sick shortly after taking a tablet.

Intravenous chemotherapy

Chemotherapy medicines are slowly released into a vein over a period of time. The time it takes to give one dose can range from several hours to several days.

Some people need a continuous low dose of chemotherapy medication over several weeks or months. If this is the case, you may be given a small portable pump that you can take home with you.

Intravenous chemotherapy can be given in a number of ways. You may get a choice, although this isn't always possible.

Cannula

A cannula is a small tube that's placed into a vein on the back of your hand or lower arm. Chemotherapy medicine is slowly injected through the tube into your vein. Once the dose of medication has been delivered, the tube can be removed.

Central line

A central line, also known as a skin-tunnelled catheter, is a fine tube that's inserted into your chest and connected to one of the veins near your heart. The tube can be left in place for several weeks or months, so that you don't have to have repeated injections. It can also be used to carry out blood tests.

Peripherally inserted central catheter

A peripherally inserted central catheter (PICC) is similar to a central line, except the tube is connected to your arm rather than your chest.

Implanted port

An implanted port is a rubber chamber surgically inserted under your skin. It's connected to a vein with a soft plastic tube. Chemotherapy medication is given using a special needle placed through the skin into the chamber. The port is kept in place throughout the course of treatment.

Things to consider

During chemotherapy treatment, there are a number of important things you need to bear in mind.

Other medication

Check with your care team before you take any other medication, including over-the-counter medicines and herbal remedies. Other medication could react unpredictably with your chemotherapy medication.

Pregnancy

You should avoid becoming pregnant while having chemotherapy. This is because many medications used in chemotherapy can cause birth defects.

You'll need to use a barrier method of contraception, such as condoms, while having chemotherapy and for at least six months after your treatment has finished.

Contact your care team immediately if you think you may have become pregnant while having chemotherapy.

Side effects

Chemotherapy usually causes severe side effects, such as hair loss, fatigue, nausea and vomiting. Read more about the side effects of chemotherapy.



 
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