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Chemotherapy is the use of anti-cancer drugs to treat cancer. It can be used to treat cancer by stopping the growth of cancer and by killing cancer cells that have spread to other parts of the body. Chemotherapy is given after surgery (called adjuvant chemotherapy) or before surgery (known as neoadjuvant chemotherapy) to reduce the risk of breast cancer returning.
How is it given?
There are many different chemotherapy drugs used today. Some drugs work better in combination than alone, so your doctor may give you more than one to take. A few anti-cancer drugs are taken by mouth or injected into the muscle or fat tissue below the skin, but most are injected into a vein.
When is it given?
Chemotherapy usually starts within 4 to 12 weeks after surgery. Today it is commonly given on a 21-day or 28-day cycle. Drugs are generally given weekly or once every third week, with a rest period to allow your body to regain strength. Some studies are looking at a shorter schedule - giving chemotherapy more often along with drugs to control side effects. This may prove to be beneficial for some women.The length of the cycle will depend on the type of drugs used. The length of the treatment period will vary, but it typically lasts from 3 to 6 months.
Classes of chemotherapy drugs
Each chemotherapy drug belongs to a class of drugs. Each class has a different effect on cancer cells. That is why different anti-cancer drugs are often used in combination with each other. The major drug classes are described below.
Chemotherapy and You: A Guide to Self-Help
During Cancer Treatment. National Cancer Institute. http://www.nci.gov/cancertopics/chemotherapy-and-you
The Breast Cancer Survivor Manual, 3rd ed. by John Link. 2003 (Henry Holt and Company).
Susan G. Komen for the Cure
1-877 GO KOMEN
American Cancer Society
Related fact sheets in this series:
• Chemotherapy - Coping With Side Effects
• Making Treatment Decisions
• Getting the Support You Need
• New Drugs for Breast Cancer Treatment
• Clinical Trials
Questions and Answers About Chemotherapy
What is chemotherapy?
Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.
How does chemotherapy work?
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.
What does chemotherapy do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that are causing pain or pressure.
How is chemotherapy used?
Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:
Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
Help radiation therapy and biological therapy work better.
Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).
How does my doctor decide which chemotherapy drugs to use?
This choice depends on:
The type of cancer you have. Some types of chemotherapy drugs are used for many types of cancer. Other drugs are used for just one or two types of cancer.
Whether you have had chemotherapy before
Whether you have other health problems, such as diabetes or heart disease
Where do I go for chemotherapy?
You may receive chemotherapy during a hospital stay, at home, or in a doctor's office, clinic, or outpatient unit in a hospital (which means you do not have to stay overnight). No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and make any needed drug changes.
How often will I receive chemotherapy?
Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:
Your type of cancer and how advanced it is
The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
The type of chemotherapy
How your body reacts to chemotherapy
You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.
Can I miss a dose of chemotherapy?
It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.
How is chemotherapy given?
Chemotherapy may be given in many ways.
Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.
Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).
Intravenous (IV). The chemotherapy goes directly into a vein.
Topically. The chemotherapy comes in a cream that you rub onto your skin.
Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.
Things to know about getting chemotherapy through an IV
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.
IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.
Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter. For more information on infection, see Infection.
Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port. For more information on infection, see Infection.http://www.cancer.gov/images/Documents/0a8081a1-f3fa-487d-949e-864c5846e9a5/cty-s2-4.jpg
Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.http://www.cancer.gov/images/Documents/0a8081a1-f3fa-487d-949e-864c5846e9a5/cty-s2-5.jpg
How will I feel during chemotherapy?
Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy.
Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:
Asking someone to drive you to and from chemotherapy
Planning time to rest on the day of and day after chemotherapy
Getting help with meals and childcare the day of and at least 1 day after chemotherapy
There are many ways you can help manage chemotherapy side effects. For more information, see the Side Effects At-A-Glance section.
Can I work during chemotherapy?
Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.
Can I take over-the-counter and prescription drugs while I get chemotherapy?
This depends on the type of chemotherapy you get and the other types of drugs you plan to take. Take only drugs that are approved by your doctor or nurse. Tell your doctor or nurse about all the over-the-counter and prescription drugs you take, including laxatives, allergy medicines, cold medicines, pain relievers, aspirin, and ibuprofen.
One way to let your doctor or nurse know about these drugs is by bringing in all your pill bottles. Your doctor or nurse needs to know:
The name of each drug
The reason you take it
How much you take
How often you take it
Talk to your doctor or nurse before you take any over-the-counter or prescription drugs, vitamins, minerals, dietary supplements, or herbs.
Can I take vitamins, minerals, dietary supplements, or herbs while I get chemotherapy?
Some of these products can change how chemotherapy works. For this reason, it is important to tell your doctor or nurse about all the vitamins, minerals, dietary supplements, and herbs that you take before you start chemotherapy. During chemotherapy, talk with your doctor before you take any of these products.
How will I know if my chemotherapy is working?
Your doctor will give you physical exams and medical tests (such as blood tests and x-rays). He or she will also ask you how you feel.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well. Or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.
How much does chemotherapy cost?
It is hard to say how much chemotherapy will cost. It depends on:
The types and doses of chemotherapy used
How long and how often chemotherapy is given
Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
The part of the country where you live
Does my health insurance pay for chemotherapy?
Talk with your health insurance plan about what costs it will pay for. Questions to ask include:
What will my insurance pay for?
Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?
What do I have to pay for?
Can I see any doctor I want or do I need to choose from a list of preferred providers?
Do I need a written referral to see a specialist?
Is there a co-pay (money I have to pay) each time I have an appointment?
Is there a deductible (certain amount I need to pay) before my insurance pays?
Where should I get my prescription drugs?
Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?
How can I best work with my insurance plan?
Read your insurance policy before treatment starts to find out what your plan will and will not pay for.
Keep records of all your treatment costs and insurance claims.
Send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records.
As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.
If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.
What are clinical trials and are they an option for me?
Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:
Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug.
Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you.