Chemotherapy FAQs

1. What is chemotherapy?

Chemotherapy is the terminology given to the form of medical treatment which is given to cancer patients. The drugs are called as chemotherapeutic agents/drugs.

2. What is Targeted Therapy?

Targeted therapy is a form of treatment in which drugs act by targeting specific receptors on cancer cells. This form of therapy is less toxic, but it has side effects too.

3. How is Chemotherapy given?

It is usually given in the form of Intravenous (blood administration), also given in the form of oral pills, intramuscular, spinal, peritoneal, directly into CSF. A single chemotherapeutic agent may be used or a combination of many drugs may be used at the same time or at different times. It can be given via intravenous line (through veins), or via Chemoport or PICC line (Peripherally Inserted Central Catheter).

4. What is Chemoport?

Chemoport, also called as Port-A-Cath, is an implantable device, which is used for venous access. It consists of the portal reservoir (with silicone bubble) & septum (for needle insertion) which is inserted under the skin. Portal is connected to the catheter which extends till the vein in the neck. It is inserted with a simple surgery of short duration. It makes the blood sampling & chemotherapy administration relatively easy. It can be kept in place for few years but needs flushing with heparin at regular intervals (discuss with your doctor).

5. What is PICC line?

PICC line, Peripherally Inserted Central Catheter, is long, flexible tube, which is inserted through a large vein in the arm & the other end of it reaches the large vein in the neck. The insertion is a simple procedure (similar to the insertion of IV cannula) & needs flushing with heparin at regular interval (discuss with your doctor).

6. Different types of chemotherapy?

Broadly chemotherapy may be classified based on if given before surgery or after surgery or along with radiation therapy.

1. Combined modality chemotherapy

• Neo-adjuvant Chemotherapy:

  Chemotherapy which is given before surgery. It is given with an intent to reduce the size of the tumor to make it surgical resectable.

• Adjuvant Chemotherapy

  Chemotherapy which is given after surgery. It is given with an intent to kill the cancer cells present in the blood circulation in the body.

• Concurrent Chemotherapy

  Chemotherapy which is given when the patient receives radiation therapy. It is usually given once in a week, while the patient receives radiation therapy on a daily basis.

2. Curative Chemotherapy

Chemotherapy, when given with a curative intent, is called as curative chemotherapy. It is usually given in the early stages of cancer.

3. Palliative chemotherapy

It is a chemotherapy given to the patient, when the disease is in stage IV, with an intent to improve the symptoms & improve the quality of life. The other kinds of chemotherapy are induction, consolidation and maintenance chemotherapy (in leukemia).

7. Do I need to get admitted for chemotherapy?

You may or may not be able to get admitted for chemotherapy. It is usually administered in day-care (where chemotherapy is administered for a few hours & then the patient is discharged) under the supervision of paramedical staff. Chemotherapy may be administered over few seconds, or minutes or hours. It may be given over a period of few days also, depending on the treatment protocols, for which you may have to get admitted.

8. Who decides which chemotherapy should be given to the patient?

Your doctor (medical oncologist) will decide which form of chemotherapy should be given to you based on age, cancer site, histological type, stage and other parameters. Some International organizations, such as NCCN (National Comprehensive Cancer Network), ASCO (American Society of Clinical Oncology), ESMO (European Society for Medical Oncology) publish guidelines & protocols specifying dosage, schedule, a method of administration of chemotherapy, duration of administration of chemotherapy etc. based on evidence-based medicine.

9. For how long will I get chemotherapy? 

You will receive chemotherapy according to the chemotherapy protocols. You may receive chemotherapy daily, on an alternate day, weekly, 2 weekly, 3 weekly, monthly or so on. It depends on the chemotherapy protocol (designed by the international organizations or personalized protocols).

10. What is the cost of chemotherapy?

Cost of chemotherapy is based on the type of chemotherapy, a brand of the medicine used, a dosage of the medicine (calculated according to the body weight) and chemotherapy protocol being used. It may vary from a few thousand to few lakh. You should discuss the approximate cost of chemotherapy in the respective cancer center.

11. What is BSA?

BSA, also called as Body Surface Area, is measured or calculated the surface area of the human body. It is a parameter used to calculate chemotherapy dosage. It is calculated with the help of various formulas, using two parameters, height & weight.

12. What are the side effects of chemotherapy?

Various types of chemotherapy agents have different side effects. The severity may vary from person to person. Few of the predictable side effects are:

• Fatigue - Weakness & tiredness
• Pain - Generalized body pain, muscle pain, stomach pain, nerve damage pain
• Nausea/Vomiting
• Loss of taste
• Loss of appetite
• Changes in the skin - Pigmentation, Dryness
• Oral ulcers
• Hair Loss
• Loose stools
• Constipation
• Neutropenia - Low white blood cell count (low immunity)
• Anaemia - Low hemoglobin
• Thrombocytopenia - Low platelet count
• Pancytopenia - Low white blood cell count, haemoglobin & platelet count
• Infections - especially during the phase of low white blood cell count
• Changes in fertility

13. Are side effects of chemotherapy manageable?

These days, chemotherapy is not as scary as before. New drugs are available which are safe and more effective. Majority of side effects of chemotherapy are manageable with the help of supportive treatment. For example:

• Neutropenia - Low white blood cell count - is managed with the injections (filgrastim/pegfilgrastim), which boost the white blood cell count.
• Anaemia - Low haemoglobin - is managed with the help of blood transfusion, erythropoiten stimulating agents & iron supplements, if required.
• Nausea/Vomiting - is managed with the help of intravenous medications before chemotherapy (called as pre-medication), & with the help of oral medications after chemotherapy is over. Various combination of medications is used in different dosages depending on the type of chemotherapy and severity of nausea/vomiting.
• Loose stools/constipation - can be managed with the help of supportive medications.
• Hair Loss - Currently it can't be managed with the help of medications. However, hair loss is not permanent. Hair starts growing again after the chemotherapy is over.

Similarly, there are other side effects of chemotherapy, which may or may not be managed with the help of supportive treatment.

14. Will I get all the side effects?

Different types of chemotherapeutic agents have different types of side effects. Not everybody suffers from all side effects & severity of side effects may vary.

15. Can I work during my chemotherapy?

Chemotherapy leads to a period of few days of low immunity (low white blood cell counts), when you should be careful about onset of fever. Also some patients feel much tried & weak after chemotherapy, the duration of which may vary. You should consult your doctor about working hours & also, you can discuss your work schedule with your employer. You can work during chemotherapy if you medically fit for the same.

16. Checklist before going for chemotherapy?

There is no special pre-requisite/requirement to get chemotherapy. It's like any other day, however, you can utilize the time in the chemotherapy day-care listening to the music, or read books, magazines, or anything else which interests you. You should eat & drink right & healthy during your chemotherapy sessions.

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