Chemotherapy - The National Lung Cancer Forum For Nurses

My doctor has told me that I need chemotherapy. What does this mean?
Chemotherapy is a general term for the treatment of cancer using drugs. Patients with different types of lung cancer are likely to
receive different combinations of chemotherapy drugs. After discussing your treatment options with you, your oncologist will decide which chemotherapy drugs are most suitable.

Chemotherapy can be used to:

• control the disease;
• shrink the cancer;
• help with symptom management;
• help extend length of life.

Chemotherapy for small cell lung cancer
If you have small cell lung cancer (SCLC), chemotherapy is usually the standard first line treatment. As previously mentioned, SCLC cells grow quickly and can spread early (metastasise). Chemotherapy travels, in the bloodstream, and throughout most of your body. This usually leads to relief of symptoms and longer survival. If the cancer responds very well to this treatment then radiotherapy maybe given as well to try and stop the cancer coming back. There are a variety of different types of chemotherapy drugs. Evidence shows that the chemotherapy which works best for people with SCLC contains platinum (cisplatin or carboplatin) mixed with one of the following drugs: Etoposide, Cyclophosphamide, Doxorubicin, Vincristine. You can find more information at http://www.cancerbackup.org.uk/Cancertype/Lung/Treatment/Chemotherapy

Chemotherapy for non-small cell lung cancer

Chemotherapy can also be used to treat non-small cell lung cancer (NSCLC). If you are not suitable for surgery you will be offered either chemotherapy (if you are fit enough) on its own or in combination with radiotherapy.

If you have had surgery for lung cancer and all of the cancer cells have been removed, you may be offered chemotherapy. However, if you have had surgery and cancer cells remain, your doctor will discuss the advantages and disadvantages of chemotherapy with you. There are a variety of different types of chemotherapy drugs. Evidence shows that the chemotherapy which works best for people with NSCLC contains platinum (cisplatin or carboplatin) mixed with one of the following drugs: Docetaxel, Etoposide, Gemcitabine, Paclitaxel and Vinorelbine. You can find more information at http://www.cancerbackup.org.uk/Cancertype/Lung/Treatment/Chemotherapy

I am frightened of needles and feel sick at the thought of treatment - what should I do?

It is not unusual to be frightened of needles and nursing staff have many ways of reducing your fears. Tell them if you are feeling nervous about needles before you start your treatment, as there are creams available to numb your skin. Some people feel sick at the thought of treatment, or perhaps the sight or smell of hospitals. This is called anticipatory nausea and vomiting and can be helped with a variety of methods including relaxation techniques, counselling and medication. Discuss your options with your treatment team.

What actually happens when I get my chemotherapy?

Some types of chemotherapy can be given at an out-patient clinic, whilst others require a short stay in hospital. Before receiving your chemotherapy the doctors have to make sure that you don't have a higher than normal risk of developing side-effects. A
blood sample will be taken to make sure that your blood, kidneys and liver are working normally. Nearly all chemotherapy for lung cancer is given into a vein (intravenously), usually on the back of your hand or forearm. A small plastic needle (cannula) is put into the vein and attached to a drip. You will be given anti-sickness medicines into the drip before starting the chemotherapy. Once the chemotherapy is finished you will be given tablets to take home to prevent any sickness over the next few days.

A few types of chemotherapy are available in tablet form. This still requires a visit to the out-patient clinic.

In general, the time in-between each treatment is three to four weeks. This is to allow your body to recover before giving more
chemotherapy drugs. The doctors will assess your side-effects after each treatment and make adjustments to the next treatment as required.

“I expected to have to lie still in bed for the whole day, but actually, even with the drip in, I was able to wander down to the day room and watch telly.”

I have heard that chemotherapy has very bad side-effects. Is this true and is there anything that can be done about them?
All forms of cancer treatment have side-effects of one sort or another. Chemotherapy drugs do have side-effects but these vary from one drug to another. Most chemotherapy drugs work by stopping cells dividing and growing. Cancer cells divide very quickly and can be destroyed by chemotherapy drugs. Your blood will be checked regularly, to see if your white cells (cells that fight infection), haemoglobin (cells that carry oxygen), and platelets (cells that clot the blood) are normal. Most cells in your body will be affected by chemotherapy.

The following table contains practical advice on all of the more common side-effects that you may experience. However, it is important to remember that different chemotherapy drugs produce different side-effects and it is unlikely that you will experience all of them.

Possible side-effects and practical advice

Tiredness
This is normal. Although it is important to rest, a small amount of regular exercise will also help reduce your tiredness. If you fell breathless, your legs ache or you are concerned that you feel too tired, ask your GP or hospital team for advice.

Sickness and Nausea
There are very powerful anti-sickness drugs, which can help reduce sickness in most patients. Remember to take the tablets for sickness that the hospital has given you. If they don't work let your doctor know, as there is usually an alternative. The type of food
that you eat or smell may make you feel worse. See diet section below.

Mouth Ulcers
Keep your mouth clean and fresh, with regular tooth/denture brushing. If your tongue becomes coated or you notice white spots or ulcers contact your GP or hospital for advice.

Hair Loss And Thinning
Although distressing, it is temporary and does not happen with all chemotherapy drugs. If you notice your hair starting to fall out, wear a hairnet at night and a hat/scarf during the day. Don't brush your hair too much or use hair colourants/rollers. Most hospitals will supply advice on how to get a good quality wig of your choice. Use a mild or baby shampoo to wash your hair. Damp dry your hair with a towel rather than blow drying with a hairdryer. You should shower and bath as normal.

Infection
It is important to realise that you are at higher risk than normal. Therefore, if anyone you know has an obvious infection (for example flu, chickenpox, shingles), it is best to stay away. Fever, feeling hot and cold flushes or starting to shake uncontrollably can all be signs of infection. Check your temperature with a thermometer and contact the number given to you by your hospital/GP for advice straight away.

Diarrhoea
There are a variety of reasons why you might have diarrhoea, including infection and bad diet. However, if you have it for more than 24 hours, you should get medical advice. If possible try and drink plenty of liquid to prevent dehydration.

Constipation
Try to drink more liquid (particularly fruit juice) and eat plenty of fruit, vegetables and fibre. If it becomes painful, contact your GP or hospital as they will be able to give you advice or medication that will help.

Bruising Or Bleeding
Try to avoid bumping yourself. If you notice bruises or your nose bleeds then contact your GP or hospital for advice.

Taste Change
Quite common. See diet section below.

Tingling In Fingers/Toes Or Ringing In Ears
You may feel pins and needles, a strange feeling in your fingers or toes, or notice a change in your hearing. This is not unusual, but you should tell your doctor on your next visit.

Do the side-effects ease with time?

Yes, usually they do ease with time, although in some patients they last longer or start later. If you are going to feel sick it is usually within the first week after treatment. White blood cells and platelets reach their lowest point 10-15 days after treatment. Often the only sign that this has happened is a feeling of tiredness when even the smallest task feels like a great chore. This is also the time when you are most at risk of picking up infections. In general side-effects usually begin to reduce by the third week after chemotherapy and you should start to feel better. This is your body recovering in time for the next treatment. Unfortunately, some side-effects, for example, tiredness, bad taste in the mouth and tingling in the fingers and toes, may continue for some time after treatment.

Should I change my diet while I'm having chemotherapy?
It is quite common to lose your appetite while having chemotherapy and your sense of taste may also be affected. You could find that you have a metallic taste in your mouth or perhaps no taste at all. However, if you are concerned that you are not eating or drinking enough tell your doctor, as there are dietary supplements available on prescription.

The following tips may help to make foods taste better:

• Only eat foods that you like the taste of and avoid the ones that you don't like.
• Try different new foods that you haven't had before.
• Herbs and seasonings will help to add flavour to your food.
• Marinating food before cooking may help improve flavour, as may pickles and sauces to cold meats.
• Sharp tasting foods such as fruit juices, pineapple and grapefruit will leave a refreshing taste in your mouth.
• Fizzy drinks or lemon (or fruit) teas may provide a pleasant tasting change from tea and coffee.
• Cold food sometimes tastes better than hot food.
• Avoid strong smelling and fried foods.
• Eat small meals and snacks regularly throughout the day, rather than large ones only at meal times.
• Avoid drinking too much liquid before eating, as this will fill you up.

How do the doctors know if the chemotherapy is working?
It can be difficult to measure exactly how well it is working, although usually an assessment will be made at some point during your treatment (usually after two-three courses of chemotherapy). Usually this will be done by chest x-ray, CT scan or bronchoscopy. If there is evidence that your cancer is responding to the chemotherapy then treatment will continue (as long as you are not having side-effects which are intolerable) usually upto 4 cycles of chemotherapy. There is no evidence to suggest having more than 4 cycles adds any benefit in controlling the disease. If there is evidence that your cancer is not responding then it is important to know this, so that a decision on an alternative treatment can be made. Sometimes there will be no change in the state of your tumour when the x-ray or scan has been done. This may seem disappointing but is a worthwhile response, especially if you feel better. Even if the chemotherapy has not changed the size of the tumour, it may well have delayed the growth.