Chemotherapy, or “chemo” for short, is the term used to describe more than 100 medications used to kill cancer cells. The National Cancer Institute estimates there are more than 18 million cancer survivors in the United States today and many of them used chemotherapy as part of their cancer treatment.
“We have great success stories of people making it all the way through and going on to live long, great lives,” said Tara Wiggins, manager of oncology chemo and infusion at the Novant Health Zimmer Cancer Institute, located at New Hanover Regional Medical Center.
If chemotherapy is in your future, you’ll have a lot of questions about the duration and frequency of your treatments, and how to feel your best during that time. To help begin this conversation, here’s a guide to what you might expect.
Treatment tailored to you
Chemotherapy is not a one-size-fits all process. Treatments differ because every individual’s situation is unique. Recent advances in cancer research have created targeted therapies, including immunotherapy and gene therapy. In fact, the scope of chemotherapy is totally different than it was 30 years ago.
“In all the years I’ve been doing this, it’s really cool to see how it has changed,” Wiggins said. “Cancer can mutate. With these drugs, we’re able to target very specific things.”
Doctors can now prescribe medications based on a tumor’s genetic makeup, explained Camille Utter, manager of outpatient oncology at the Zimmer Cancer Institute.
“If a tumor is removed, it’s sent off to be tested for its genetic makeup and specific targets within the cells,” Utter said. This can help the medical team develop a plan that’s specialized for the individual patient with those types of cell targets and/or genes.
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While chemotherapy drugs may be prescribed in pill form, patients usually receive them intravenously (IV), through a needle into a vein. Some patients receive a port, a surgical implant about the size of a quarter that’s placed underneath the skin near the collarbone. The port connects to a vein and reduces the number of needle sticks for patients. That’s how most patients at Zimmer Cancer Institute receive the treatment, because it tends to be the safest, most efficient way to deliver chemo medication, Utter said.
Managing side effects
“Chemotherapy is a little tougher on the body than most other drugs,” Wiggins said. “Chemo doesn’t distinguish good from bad.” That means that while chemo medications are effective at killing cancer cells, it makes some of the other cells in your body vulnerable to the medication, too.
To help manage the side effect of nausea, Utter recommended eating a light meal before receiving treatment. “Nothing greasy or difficult to digest,” she said. “That does help settle your stomach as you’re coming in for treatment.”
That said, nausea is not nearly as common as it once was with chemo because pre- and post-treatment medications have drastically improved, Utter said. Some pre-treatment medications are taken orally, while others are administered via IV. Your doctor may also prescribe anti-nausea medication to take at home.
In many cases, there is no reason to suffer through vomiting. “With the medications we have, you should not be sick,” Wiggins said.
Some foods that you previously found comforting, like salty or heavy dishes, might not seem so delicious anymore. Embracing a creative approach and remaining flexible are two tips for eating well during chemotherapy. Using the “plate method” is a way to ensure you’re getting the nutrients your body needs for recovery. This means you aim to fill your plate with 50 percent fruits and vegetables, 25 percent lean protein and 25 percent whole grains.
All medications have side effect risks, including chemotherapy. Your doctor will carefully weigh the risks of your cancer diagnosis against the risks of your chemotherapy treatment and may recommend therapies like cardio-oncology rehabilitation or even acupuncture to help with side effects.
Chemo can take minutes, hours or days
Because chemotherapy is highly customized, your experience will differ from someone else’s. Swallowing a pill may only take a moment, while an IV treatment may take hours.
“There are treatments that last 30 minutes,” Utter said. “There are treatments that last several days. We have patients that go home with an infusion pump that lasts 48 hours. Typically, people are here for an average of two to three hours.”
The amount of time it takes to receive chemo is not determined by the severity of the cancer. Rather, it’s about targeting the cancer cells at specific points in their growth cycles. “There’s a cell cycle, and chemotherapy drugs act as part of the cell cycle,” Utter said. “There are different phases that each drug may act in, and that causes the cells to die. That’s what we’re trying to capture – the most cell-kill we can get.”
You may receive IV chemo in “cycles,” which is a period of treatment and then a period of rest. For example, a three-week cycle may be one week of treatment followed by two weeks of rest. Including a rest period is important because this allows your body to generate new, healthy cells. A single course of chemotherapy typically involves four to eight cycles. Your oncologist, or cancer physician, will determine the length of your cycles based on your individual needs and goals for treatment.
Before receiving an IV chemo treatment, you’ll first receive a blood test to help ensure you receive the exact right dose of medication. Several healthcare workers are involved in the process of measuring and re-checking your chemo medication. Your individualized medication is then stored securely in a special room, adjacent to the infusion room where you will receive treatment.
Blankets and light refreshments are available to patients in the infusion room. Wiggins recommends bringing comfort items from home, like a tablet, headphones, a book or your favorite snack. She also encourages patients to bring a companion, but only one is allowed.
“Bring someone with you, especially if it’s your first time,” she said. This allows you to relax while receiving treatment and ensures someone is there to take notes about any recommendations the nurses may have for you.
In the institute’s infusion room, Wiggins and her nursing team are passionate about helping everyone receive the best care. “Nurses here don’t look at cancer as just a disease,” she said. “People are more than their cancer diagnosis. I want to know about you. You’re like family when you come into this place. That’s how it should feel.”