Introduction

The word chemotherapy was once used to mean any medicine used to treat any disease. Even taking an aspirin was described as chemotherapy. Today, chemotherapy, or "chemo" for short, most often means taking certain types of medicines (drugs) to treat cancer. You might take these drugs before or after cancer surgery. You might take them with radiation (x-ray) treatment. Or you might take the medicines alone.

Cancer chemotherapy is not new. It has been helping people beat cancer since the early 1950s. The chemo drugs your doctor suggests have been tested again and again. Careful research shows they work. Partly because of chemo, many people with cancer can have full, healthy lives.

How chemo works

If your doctor wants you to have chemo, it means something can be done to try to control, or maybe even cure, your cancer.

Cancer is a group of cells that divide quickly and grow out of control. The word cancer is a broad name for many different diseases. Each type of cancer affects your body in different ways. But all types of cancer have one thing in common: they involve abnormal cells growing out of control. Everyone's cancer is different and so is the chemo that is given.

Your doctor usually decides what chemo is best for your situation and your type of cancer. Together, you will plan a treatment that works best for you.

How is chemo given?

Most chemo drugs are given in one of the following ways:

• You might simply swallow a pill. If your chemo is a pill or liquid, you can often take it at home, but you need to follow your doctor's directions carefully.

• Chemo can be given like a flu shot. The shots may be given in your doctor's office, a hospital, a clinic, or at home.

• Most often, chemo is given right into your veins through a needle or tiny plastic tube (called a catheter). This is called an IV (intravenous) injection.

You may take chemo once a day, once a week, or even once a month, depending on the type of cancer you have and the chemo you are taking. How long you take chemo also depends on the type of cancer, how you respond to the drugs, and what length of time led to the best treatment results in research studies.

How much does chemo cost?

The cost of chemo depends on a lot of things, such as the kinds of drugs used, how often you take them, and for how long. You can ask about the cost and where to get help in paying for chemo if you need it.

If you have health insurance, check to see if it pays for your chemo. You will want to keep your health insurance, even if you must be out of work for treatment. If your insurance is through your job, don't quit until you learn about options that can help you keep your insurance. Find out if you can take Family Medical Leave or if you are protected under the Americans with Disabilities Act. You can call the American Cancer Society at 1-800-ACS-2345 to learn more about this.

If you have no health insurance, you may want to ask a social worker at your local hospital to help you look into payment through government programs such as Medicare and Medicaid or other agencies. Cancer treatment can cost a lot. It is always good to know what kind of coverage you have and what kinds of financial help you may be able to get.

What are the side effects of chemo?

Some people have no side effects from chemo. But sometimes chemo will make you feel sick. This is because chemo drugs are very strong. They work best on any cell that is quickly dividing, whether it's a cancer cell or not. So, some of the normal, healthy cells in the body that divide quickly are also damaged. Here are some parts of the body that are often affected:

• cells that grow hair--this can cause hair loss on your whole body

• cells in your bone marrow--this can cause a tired feeling, easy bruising and bleeding, and a higher risk of infection

• cells of the skin and mouth--this can cause dryness and sores in your mouth and dry skin

• cells in your stomach and intestines--this can cause you to feel sick to your stomach, vomit, or have diarrhea

Other organs of the body can be affected by some chemo drugs. Your doctor may do blood tests to find out if you need a lower dose of chemo drugs, or if you need longer breaks between doses.

Bone marrow changes

Bone marrow is the thick, liquid inner part of some bones that makes your blood cells (red blood cells, white blood cells, and platelets). It is often affected by chemo in these ways:

• Red blood cells carry oxygen from the lungs to all parts of the body. During chemo treatment, the bone marrow may not be able to make enough red blood cells. Not having enough red blood cells is called anemia. It can make you feel short of breath, weak, and tired (fatigued). Anemia can also make your skin, mouth, or gums look pale.

• White blood cells fight infection. Chemo lowers your white blood cell count, which can lower how well you are able to fight infections. Your cancer care team may ask you to do certain things to avoid infection, such as:

• wearing a surgical mask when in crowds or public places
• staying away from people who have infections or fevers
• eating only cooked foods (no raw foods, even fruits and vegetables)
• washing your hands thoroughly and often

• Platelets are tiny fragments that form blood clots to plug up bleeding from cuts or bruises. If your bone marrow cannot make enough platelets, you may bleed too much, even from small cuts. If your platelet count is low, you will need to be very careful to avoid cuts, bruises, and other injuries. Even brushing your teeth with a hard bristle toothbrush could cause your gums to bleed. You may need a soft toothbrush or one made of a special foam. Check with your doctor or nurse about flossing.

Hair, skin, mouth, and stomach

Cells in your hair, skin, mouth, and stomach and intestines (gastrointestinal tract, or GI tract) can be affected by chemo. This can result in hair loss, sores in your mouth and throat, dry skin, nausea, vomiting, and diarrhea.

Sexuality

Chemo can affect sexuality in both men and women. Sometimes sexual desire is low or even gone for some time, but it comes back when treatment ends. Some drugs given during chemo treatment may affect a woman's hormones, causing hot flashes and dryness of the vagina. Most chemo can cause birth defects if there is pregnancy during treatment. Ask your doctor about what kinds of birth control you should use and for how long.

Some chemo can cause problems with fertility in those who hope for a child. Sometimes, this effect does not go away after treatment is over. If you think you may want to have children in the future, tell your doctor while you are planning treatment. To find out more about having children, see Fertility and Cancer: What are My Options?

To learn more about the sexual effects of cancer treatments, please see  Sexuality & Cancer: For the Man Who Has Cancer and His Partner or Sexuality & Cancer: For the Woman Who Has Cancer and Her Partner.

Preventing and treating side effects

The good news is that there are things you can do to lessen or to get rid of some of these side effects.

• You can take some medicines before and during the time you receive your chemo to keep you from vomiting or feeling sick to your stomach.

• New drugs called growth factors can be given IV or as injections to help the bone marrow recover from chemo and start taking new blood cells.

• Transfusions of red blood cells or platelets from blood donors help many people.

Remember that not everyone gets the same chemo drugs. Chemo for some cancers may be much stronger and cause more side effects than chemo for other cancers. Also, everybody is different. Your overall state of health and fitness will affect how your body reacts to chemo.

You may be able to go on with what you normally do while you are on chemo. You may not have to stop working or be on a special diet. On the other hand, some people need to be in the hospital so that doctors can watch them closely and treat certain side effects. Most people have to change their work schedules to get chemo. Ask your cancer care team what you will be able to do while you're being treated-- on chemo days and in between treatments. Your cancer care team should give you this information up front, but make sure you are clear about what you can and can't do safely.

Once your chemo starts, stay in touch with your cancer care team. If you have side effects that bother you, let them know. They will be able to help you with them.

Chemo and possible effects on your family

Cancer isn't "catching," so you can stay close to family and friends. Having chemo won't "rub off" and harm anybody else either. Depending on how your body reacts to the drugs, people may not notice you are on chemo at all. If you do get unpleasant side effects, your family and friends can do things to help. When someone asks, "How can I help?" have a few ideas ready.

• You may not feel like eating very much, so ask family members to take turns cooking foods that you feel you can eat.

• You might get tired after each treatment and need extra rest. Ask your family to do little jobs for you until you feel better.

Keep in mind that your family cares very much about you, and they may feel nervous about your chemo. Let your family and friends know how much their support means to you. Be honest about how you feel. Get into the habit of talking things over with your loved ones so they can share your ups and downs.

There will be times when the people closest to you feel tired or sad, too. You can help them feel better by reminding them how important they are to you. You can also point out how much you value their support and help.

You and your doctor

Because cancer is different for everyone, your chemo will be planned just for you. Work closely with your doctor to decide what's best for you.

• Ask questions. Ask the doctor, nurses, social workers, and other professionals on your team as many questions as you need to. They know the most about chemo and how it works.

• Come prepared. Write down your questions ahead of time. Don't be afraid to admit you are confused or that you need to ask the same questions over again. Nothing you say will sound "silly" or "strange" to your health care team, because they know you want to understand your chemo plan as much as possible. All patients getting chemo have questions.

Here are some questions you might want to ask:

• How long will I be getting chemo?

• How will we know if it’s working?

• What are the usual side effects of the chemo?

• Is there any way to make these side effects less severe?

• How long do the side effects last? Are any permanent?

• How will this chemo affect my outlook (prognosis) for cure or long-term survival?

• Will I still be able to work (go to school) during treatment?

• Is there anything I should do to prepare for chemo?

Additional resources

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. You can find these on our Web site or order them from our toll-free number (1-800-ACS-2345).

After Diagnosis: A Guide for Patients and Families (also available in Spanish)

Caring for the Patient With Cancer at Home: A Guide for Patients and Families

Choosing a Doctor and a Hospital (also available in Spanish)

Fertility and Cancer: What are My Options?

Health Insurance and Financial Assistance for the Cancer Patient

Oral Chemotherapy: What You Need to Know

Sexuality & Cancer: For the Man Who Has Cancer and His Partner (also available in Spanish)

Sexuality & Cancer: For the Woman Who Has Cancer and Her Partner (also available in Spanish)

Talking With Friends And Relatives About Your Cancer (also available in Spanish)

Questions That People Ask About Cancer (also available in Spanish)

Understanding Chemotherapy: A Guide for Patients and Families (also available in Spanish)

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.

Last Medical Review: 04/04/08
Last Revised: 04/04/08