TREATMENT

Understanding
Chemotherapy
A guide for people with cancer, their families and friends

For information & support, call 13 11 20

Understanding Chemotherapy
A guide for people with cancer, their families and friends

First published May 2002. This edition August 2022.

© Cancer Council Australia 2022. ISBN 978 0 6452848 0 5

Understanding Chemotherapy is reviewed approximately every two years.

Check the publication date above to ensure this copy is up to date.

Editor: Nicole MacKee. Designer: Eleonora Pelosi. Printer: IVE Group.

Acknowledgements
This edition has been developed by Cancer Council NSW on behalf of all other state and territory
Cancer Councils as part of a National Cancer Information Subcommittee initiative. We thank the reviewers of this
booklet: Prof Timothy Price, Medical Oncologist, The Queen Elizabeth Hospital, SA; Graham Borgas, Consumer:
Dr Joanna Dewar, Medical Oncologist and Clinical Professor, Sir Charles Gairdner Hospital and The University of
Western Australia, WA; Justin Hargreaves, Medical Oncology Nurse Practitioner, Bendigo Health Cancer Centre,
VIC; Angela Kritikos, Senior Oncology Dietitian, Dietetic Department, Liverpool Hospital, NSW; Dr Kate Mahon,
Director of Medical Oncology, Chris O’Brien Lifehouse, NSW; Georgie Pearson, Consumer; Chris Rivett, 13 11 20
Consultant, Cancer Council SA; Marissa Ryan, Acting Consultant Pharmacist (Cancer Services), Pharmacy
Department, Princess Alexandra Hospital, QLD. We also thank the health professionals, consumers and editorial
teams who have worked on previous editions of this title.

Note to reader
Always consult your doctor about matters that affect your health. This booklet is intended as a general
introduction to the topic and should not be seen as a substitute for medical, legal or financial advice. You
should obtain independent advice relevant to your specific situation from appropriate professionals, and
you may wish to discuss issues raised in this book with them.

All care is taken to ensure that the information in this booklet is accurate at the time of publication. Please
note that information on cancer, including the diagnosis, treatment and prevention of cancer, is constantly
being updated and revised by medical professionals and the research community. Cancer Council Australia
and its members exclude all liability for any injury, loss or damage incurred by use of or reliance on the
information provided in this booklet.

Cancer Council
Cancer Council is Australia’s peak non-government cancer control organisation. Through the eight state and
territory Cancer Councils, we provide a broad range of programs and services to help improve the quality of
life of people living with cancer, their families and friends. Cancer Councils also invest heavily in research and
prevention. To make a donation and help us beat cancer, visit cancer.org.au or call your local Cancer Council.

Cancer Council acknowledges Traditional Custodians of Country throughout Australia and

recognises the continuing connection to lands, waters and communities. We pay our respects
to Aboriginal and Torres Strait Islander cultures and to Elders past, present and emerging.

Cancer Council Australia Level 14, 477 Pitt Street, Sydney NSW 2000 ABN 91 130 793 725
Telephone 02 8256 4100 Email [email protected] Website cancer.org.au
About this booklet
This booklet has been prepared to help you understand more about
chemotherapy, one of the main treatments for cancer. Chemotherapy
uses a range of drugs to kill cancer cells or slow their growth.

We cannot give advice about the best treatment for you. You need to
discuss this with your doctors. However, this information may answer
some of your questions and help you think about what to ask your
treatment team (see page 60). It may also be helpful to read the
Cancer Council booklet about the type of cancer you have.

Many people feel concerned about the side effects of chemotherapy,

but most side effects are temporary. We have included information
about ways to manage the most common side effects.

This booklet does not need to be read from cover to cover – just read the
parts that are useful to you. Some medical terms that may be unfamiliar
are explained in the glossary (see page 61). You may also like to pass
this booklet to your family and friends for their information.

How this booklet was developed – This information was developed

with help from a range of health professionals and people affected by
cancer who have had chemotherapy.

If you or your family have any questions or concerns, call

Cancer Council 13 11 20. We can send you more information
and connect you with support services in your area. You can
also visit your local Cancer Council website (see back cover).
Contents What is cancer? 4

How cancer is treated 6

Your treatments 7

Key questions 8
What is chemotherapy? 8
How does it work? 8
How is chemotherapy used? 8
Why have chemotherapy? 9
How is chemotherapy given? 10
Why does chemotherapy cause side effects? 10
Does chemotherapy hurt? 11
How much does chemotherapy treatment cost? 11
Can I have chemotherapy if I’m pregnant? 12
How long does chemotherapy treatment last? 13
Where will I have chemotherapy? 13
How do I prepare for chemotherapy? 14
Which health professionals will I see? 16

Making treatment decisions 18

Chemotherapy treatment 20
The treatment course 20
Having intravenous (IV) chemotherapy 22
Other ways of having chemotherapy 24
Waiting for chemotherapy 26
Safety precautions 27
Is the chemotherapy treatment working? 30
Managing side effects 32 Key to icons
Preparing for side effects 32 Icons are used
throughout this
Blood-related side effects 34 booklet to indicate:
Feeling tired and lacking energy 38
Hair loss 40
More information
Appetite changes, nausea or vomiting 42
Constipation or diarrhoea 44 Personal story
Nerve and muscle effects 46
Thinking and memory changes 47 Tips
Mouth sores 48
Skin and nail changes 49
Sexuality, intimacy and fertility issues 50
Other side effects 52

Life after treatment 55

Follow-up appointments 56
Support from Cancer Council 57
Useful websites 58

Caring for someone with cancer 59

Question checklist 60

Glossary 61

How you can help 64

 What is cancer?
Cancer is a disease of the cells. Cells are the body’s basic building
blocks – they make up tissues and organs. The body constantly makes
new cells to help us grow, replace worn-out tissue and heal injuries.

Normally, cells multiply and die in an orderly way, so that each new
cell replaces one lost. Sometimes, however, cells become abnormal
and keep growing. These abnormal cells may turn into cancer.

In solid cancers, such as breast or prostate cancer, the abnormal

cells form a mass or lump called a tumour. In some cancers, such as
leukaemia, the abnormal cells build up in the blood.

How cancer starts

Normal cells Abnormal cells Abnormal cells multiply

4 Understanding Chemotherapy
 Not all tumours are cancer. Benign tumours tend to grow slowly
and usually don’t move into other parts of the body or turn into
cancer. Cancerous tumours, also known as malignant tumours, have
the potential to spread. They may invade nearby tissue, destroying
normal cells. The cancer cells can break away and travel through the
bloodstream or lymph vessels to other parts of the body.

The cancer that first develops in a tissue or organ is called the primary
cancer. It is considered localised cancer if it has not spread to other
parts of the body. If the primary cancer cells grow and form another
tumour at a new site, it is called a secondary cancer or metastasis. A
metastasis keeps the name of the original cancer. For example, bowel
cancer that has spread to the liver is called metastatic bowel cancer,
even though the main symptoms may be coming from the liver.

How cancer spreads

Malignant cancer

Cancer cells
break away

Cancer cells
travel to lymph
nodes and
other parts
of the body
(metastasis)

Grows own Invades

blood vessels surrounding
(angiogenesis) tissue
Lymph vessel
Blood vessel

What is cancer? 5
 How cancer is treated
Cancers are usually treated with surgery, drug therapy and radiation
therapy (radiotherapy). The types of drugs (medicines) used for the
treatment of cancer include chemotherapy, hormone therapy, targeted
therapy and immunotherapy. These treatments may be used on their
own, in combination (for example, you may have chemotherapy
together with radiation therapy) or one after the other (for example,
chemotherapy first, then surgery).

Types of cancer treatments

An operation to remove cancer or repair a part of

surgery
the body affected by cancer.

Drugs can travel throughout the body. This is called

systemic treatment. Drug therapies include:
• chemotherapy – the use of drugs to kill cancer
cells or slow their growth (see page 8)
• hormone therapy – treatment that blocks the
effects of the body’s natural hormones on some
drug therapies
types of cancer
• immunotherapy – treatment that uses the body’s
own immune system to fight cancer
• targeted therapy – the use of drugs to attack
specific features of cancer cells to stop the
cancer growing or spreading.

The use of a controlled dose of radiation to kill or

radiation therapy damage cancer cells so they cannot grow, multiply
or spread.

6 Understanding Chemotherapy
Your treatments
Because cancer treatment is becoming more tailored to individuals,
the treatment you have may be different to the treatment other
people have, even when the cancer type is the same. The treatment
recommended by your doctor will depend on:
• the type of cancer you have
• where the cancer began (the primary site)
• whether the cancer has spread to other parts of your body (metastatic
or secondary cancer)
• specific features of the cancer cell
• your general health, age and treatment preferences
• what treatments are currently available and whether there are any
clinical trials suitable for you (see page 19).

Call Cancer Council 13 11 20 for free booklets and information about

different cancer types and their treatments.

Chemotherapy for children

The information in this booklet is for adults having chemotherapy, although
much of it will also be relevant for children. Talk to your treatment team for
specific information about chemotherapy for children, and check out:
• Cancer Australia • Canteen – supports young
Children’s Cancer – for people aged 12–25 who have
information about children’s been affected by cancer.
cancers, visit childrenscancer. Call 1800 226 833 or visit
canceraustralia.gov.au. canteen.org.au.
• Camp Quality – supports • Cancer Council – for a copy
children aged 0–15 and their of Talking to Kids About Cancer,
families. Call 1300 662 267 or call 13 11 20 or visit your local
visit campquality.org.au. Cancer Council website.

How cancer is treated 7

 Key questions
Q: What is chemotherapy?
A: Chemotherapy (sometimes just called “chemo”) is the use of drugs
to kill or slow the growth of cancer cells. The drugs are also called
cytotoxics, which means toxic to cells (cyto).

Q: How does it work?

A: All cells in the body grow by splitting or dividing into 2 cells.
Cancer cells are cells that divide rapidly and grow out of
control. Chemotherapy damages cells that are dividing rapidly.
Most chemotherapy drugs enter the bloodstream and travel
throughout the body to target rapidly dividing cancer cells in
the organs and tissues. This is known as systemic treatment.
Occasionally, chemotherapy is delivered directly to the cancer.
This is known as local chemotherapy.

Q: How is chemotherapy used?

A: There are many different types of chemotherapy drugs, and each
type destroys or shrinks cancer cells in a different way. You might
have treatment with a single chemotherapy drug or several drugs.
When more than one drug is given, this is called combination
chemotherapy and it aims to attack cancer cells in several ways.

The chemotherapy drugs you have depend on the type of cancer.

This is because different drugs work on different cancer types.
Sometimes chemotherapy is the only treatment used to treat cancer,
but you may also have other treatments (see page 25).

8 Understanding Chemotherapy
Q: Why have chemotherapy?
A: Chemotherapy can be used for different reasons:

To achieve remission or cure (curative chemotherapy) –

Chemotherapy may be given as the main treatment with the aim
of reducing or ending the signs and symptoms of cancer (often
referred to as remission or complete response).

To help other treatments – Chemotherapy can be given before

or after other treatments such as surgery or radiation therapy. If
used before (neoadjuvant therapy), the aim is to shrink the cancer
so that the other treatment (usually surgery) is more effective.
If given after (adjuvant therapy), the aim is to get rid of any
remaining cancer cells to try to cure the cancer. Chemotherapy is
often given with radiation therapy to make the radiation therapy
more effective (chemoradiation).

To control the cancer – Even if chemotherapy cannot achieve

remission or complete response (see above), it may be used to
control how the cancer is growing and stop it spreading for a period
of time. This is known as palliative chemotherapy. In rare cases,
palliative treatment can also achieve remission.

To relieve symptoms – By shrinking a cancer that is causing pain

and other symptoms, chemotherapy can improve quality of life.
This is also called palliative chemotherapy.

To stop cancer coming back – Chemotherapy might continue

for months or years after remission. Called maintenance
chemotherapy, it may be given with other drug therapies to stop
or delay the cancer returning.

Key questions 9
 “ When you’ve got to have chemo, it’s quite
frightening because you’ve only heard bad things
about it. But then I spoke to the oncologist and
he explained the benefits.” PHIL

Q: How is chemotherapy given?

A: Chemotherapy is most often given into a vein (intravenously).
It is sometimes given in other ways, such as tablets you swallow
(oral chemotherapy), a cream you apply to the skin, or injections
into different parts of the body. The choice depends on the type
of cancer being treated and the chemotherapy drugs being used.
Your treatment team will decide the most appropriate way to
deliver the drugs. For more information, see pages 22–25.

Q: Why does chemotherapy cause

side effects?
A: Chemotherapy damages cells that divide rapidly, such as cancer
cells. However, some normal cells – such as blood cells, hair
follicles and cells inside the mouth, bowel and reproductive
organs – also divide rapidly.

When these normal cells are damaged, side effects may occur.
Some people have few or mild side effects, while others may
feel more unwell. As the body constantly makes new cells, most
side effects are temporary. The drugs used for chemotherapy are
constantly being improved to give you the best possible outcomes
and to reduce potential side effects. See the chapter on managing
side effects (pages 32–55) for more information.

10 Understanding Chemotherapy
Q: Does chemotherapy hurt?
A: Having a needle inserted for intravenous chemotherapy may
feel like having blood taken. At first, it may be uncomfortable
to have the temporary tube (cannula) put into your hand or arm,
but it can then be used for the rest of the chemotherapy session.
If you have something more permanent, such as a central venous
access device (see page 23), it shouldn’t be painful.

Some chemotherapy drugs can cause inflamed veins (phlebitis),

which may be sore for a few days. It is important to let your
treatment team know if this is a problem because there may be
ways to reduce this discomfort or pain.

Q: How much does chemotherapy

treatment cost?
A: Chemotherapy drugs can be expensive. However, the Pharmaceutical
Benefits Scheme (PBS) subsidises the cost of many chemotherapy
drugs for people with a current Medicare card.

You usually have to contribute to the cost of oral chemotherapy

drugs you take at home. This cost is known as a co-payment.
Depending on the arrangements in your state or territory, and
whether you are treated as an inpatient or an outpatient, or in a
private or public hospital, you may have to contribute to the cost
of some intravenous chemotherapy drugs.

There may be other out-of-pocket expenses. For example, you will

usually have to pay part of the cost for any medicines that you take
at home to relieve the side effects of chemotherapy (such as anti-
nausea medicine). Remember to keep copies of your receipts if you

Key questions 11
 are getting your prescriptions filled at different pharmacies, or ask
your pharmacy to collate your prescription receipts. Once you have
spent a certain amount of money on drugs in a year, you will be
eligible for reduced cost or free drugs through the PBS Safety Net.

You have a right to know whether you will have to pay for treatment
and drugs and, if so, what the costs will be. This is called informed
financial consent. Ask your treatment centre for a written estimate
that shows what you will have to pay.
▶ See our Cancer Care and Your Rights booklet.

Q: Can I have chemotherapy if I’m pregnant?

A: Being diagnosed with cancer during pregnancy is rare – it is
estimated that 1 in every 1000 pregnant women are affected.

Having chemotherapy in the first trimester (12 weeks) may increase

the risk of miscarriage or birth defects, but there seems to be a
lower risk in the later stages of pregnancy. Chemotherapy drugs
may also cause premature delivery, and preterm babies often have
other health issues, such as respiratory problems.

If you are already pregnant, it may be possible to have some types

of chemotherapy. It’s best to discuss the potential risks and benefits
with your oncologist or haematologist before treatment begins.
If you have chemotherapy during pregnancy, you will probably be
advised to stop at least 3–4 weeks before your delivery date. This
is because the side effects of chemotherapy on your blood cells
increase your risk of bleeding or getting an infection during the
birth. Talk to your doctor about your specific situation and what
is best for your health and your unborn baby.

12 Understanding Chemotherapy
 In some cases, chemotherapy can be delayed until after the baby’s
birth. The treatment recommended will be based on the type of
cancer you have, its stage, other treatment options and protecting
your developing baby.

You will be advised not to breastfeed during chemotherapy as drugs

can pass through breastmilk and may harm the baby.
▶ See cancervic.org.au/living-with-cancer/pregnancy.

Q: How long does chemotherapy

treatment last?
A: How often and for how long you have chemotherapy depends on
the type of cancer you have, the reason for having treatment, the
drugs that are used and whether you have side effects.

Chemotherapy treatment before or after surgery is often given for

up to 6 months. Maintenance chemotherapy (to prevent the cancer
coming back) and palliative treatment (to control the cancer or
relieve symptoms) may continue for many months or years.
If you feel upset or anxious about how long treatment is taking or
the impact of side effects, let your treatment team know.

Q: Where will I have chemotherapy?

A: Most people have chemotherapy as an outpatient during day visits
to a hospital or treatment centre. In some cases, an overnight or
extended hospital stay may be needed. People who use a portable
pump (see page 23) or have oral chemotherapy can usually have
their treatment at home. Sometimes a visiting nurse can give you
chemotherapy intravenously or by injection in your home.

Key questions 13
 How do I prepare for chemotherapy?
Chemotherapy affects everyone differently, so it can be hard to know how
to prepare for treatment. However, there are some things you can think about

Ask about fertility Pack a chemo bag

Some types of chemotherapy can
affect male and female fertility. If you
think you may want to have children
in future, talk to your specialist about
your options before chemotherapy
begins (see pages 50-52).

Look after yourself Organise help

A bag for your chemo
sessions could include
warm clothing; healthy
snacks; lip balm; and
something to pass the
time, such as books,
headphones for listening
If you have children, you
to music, or a laptop.
may need to arrange
for someone to look
Try to stay as healthy after them when you
as you can before and have treatment. While Discuss your
during treatment. Eat you may be able to concerns
nourishing food, drink drive after treatment, If you are feeling anxious
lots of water, get enough it’s recommended that about the diagnosis and
sleep, and balance rest someone drive you on having chemotherapy,
and physical activity. the first day. A friend talk to a family member
Regular exercise and or family member may or friend, your health
good nutrition can help coordinate other offers of care team, or call Cancer
reduce some of the side help (e.g. with housework), Council 13 11 20. You could
effects of chemotherapy. or try online tools such also learn relaxation or
If you smoke, try to quit as candoapp.com.au or meditation strategies to
(see page 27). gathermycrew.org.au. help manage anxiety.

14 Understanding Chemotherapy
doing in advance to make it easier to cope with chemotherapy treatment
and any side effects that you may experience.

Freeze some meals Prepare for side effects

Talk to your treatment team about possible

You may not feel like cooking during your side effects. Ask whether you can take
treatment. Consider making some meals medicine to prevent nausea and vomiting.
ahead of time and freezing them or have Buy a thermometer so you can check your
ready-to-eat food available (e.g. tinned temperature during treatment. If hair loss is
fruit, yoghurt, soup). Sometimes, family and likely, think about having it cut or choosing a
friends will arrange a meal roster. wig before treatment starts.

Check your teeth Talk to your employer

It is a good idea to visit your dentist
before chemotherapy begins. Infection
(see page 35) and bleeding are more
likely during chemotherapy, so it is best
to have any tooth decay treated before
starting treatment. Dental problems
that arise during treatment may also
If you are working, talk to
interrupt your treatment schedule.
your employer about how
much time you are likely
to need off. It is hard to
Check other medicines predict how chemotherapy
Tell your doctor and pharmacist about any other medicines will affect you, so you
you are taking. Some over-the-counter medicines, could discuss the option
alternative and home remedies, herbs and vitamins can of flexible hours or taking
affect how chemotherapy works (see page 53). some leave.

Key questions 15
 Q: Which health professionals will I see?
A: During and after treatment, you will see a range of health
professionals who specialise in different aspects of your care.
The main specialist doctor you will see when having chemotherapy
is a medical oncologist (for tumours) or a haematologist (for
blood cancers). You may be referred to a medical oncologist or
a haematologist by your general practitioner (GP) or by another
specialist such as a surgeon.

Health professionals you may see

assists you with treatment decisions and works in

GP
partnership with your specialists in providing ongoing care

medical oncologist* treats cancer with drug therapies such as chemotherapy,

or haematologist* targeted therapy and immunotherapy (systemic treatment)

treats cancer by prescribing and overseeing a course

radiation oncologist*
of radiation therapy

surgically removes tumours and performs some biopsies;

surgeon*
specialist cancer surgeons are called surgical oncologists

coordinates your care, liaises with other members of

cancer care the MDT, and supports you and your family throughout
coordinator treatment; may also be a clinical nurse consultant (CNC)
or clinical nurse specialist (CNS)

administers drugs, including chemotherapy, and provides

nurse or nurse care, information and support throughout your treatment;
practitioner a nurse practitioner works in an advanced nursing role and
may prescribe some medicines and tests

16 Understanding Chemotherapy
 Treatment options will often be discussed with other health
professionals at what is known as a multidisciplinary team (MDT)
meeting. Ask your doctor if your case has been discussed at an
MDT meeting.

It is a good idea to build a relationship with a GP because they will

be involved in your ongoing care, particularly after your cancer
treatment ends.

dispenses medicines and gives advice about

pharmacist
dosage and side effects

palliative care specialist* work closely with the GP and cancer team to help
and nurses control symptoms and maintain quality of life

helps with nutrition concerns and recommends

dietitian
changes to diet during treatment and recovery

links you to support services and helps you with

social worker
emotional, practical and financial issues

assist with physical and practical problems,

occupational including restoring movement and mobility
therapist, physiotherapist after treatment, and recommending aids and
equipment

help you manage your emotional response

psychologist, counsellor
to diagnosis and treatment

* Specialist doctor

Key questions 17
 Making treatment
decisions
Sometimes it is difficult to decide on the type of treatment to have.
You may feel that everything is happening too fast, or you might be
anxious to get started.

Check with your medical oncologist or haematologist how soon

treatment should begin, as it may not affect the success of the treatment
to wait a while. Ask them to explain the options and take as much time
as you can before making a decision.

Know your options – Understanding the disease, the available

treatments, possible side effects and any extra costs can help you
weigh up the options and make a well-informed decision. Check if
the specialist is part of a multidisciplinary team (see previous page) and
if the treatment centre is the most appropriate one for you – you may be
able to have treatment closer to home, or it might be worth travelling
to a centre that specialises in a particular treatment.

Record the details – When your doctor first says you have cancer,
you may not remember everything you are told. Taking notes can
help. If you would like to record the discussion, ask your doctor first.
It is a good idea to have a family member or friend go with you to
appointments to join in the discussion, write notes or simply listen.

Ask questions – If you are confused or want to check anything, it is

important to ask your specialist questions. Try to prepare a list before
appointments (see page 60 for suggestions). If you have a lot
of questions, you could talk to a cancer care coordinator or nurse.

18 Understanding Chemotherapy
Consider a second opinion – You may want to get a second opinion
from another specialist to confirm or clarify your specialist’s
recommendations or reassure you that you have explored all of your
options. Specialists are used to people doing this. Your GP or specialist
can refer you to another specialist and send your initial results to that
person. You can get a second opinion even if you have started treatment
or still want to be treated by your first doctor. You might decide you
would prefer to be treated by the second specialist.

It’s your decision – Adults have the right to accept or refuse any
treatment that they are offered. For example, some people with
advanced cancer choose treatment that has significant side effects
even if it gives only a small benefit for a short period of time. Others
decide to focus their treatment on quality of life. You may want to
discuss your decision with the treatment team, GP, family and friends.
▶ See our Cancer Care and Your Rights booklet.

Should I join a clinical trial?

Your doctor or nurse may suggest you led to better outcomes for people
take part in a clinical trial. Doctors run diagnosed with cancer.
clinical trials to test new or modified
treatments and ways of diagnosing You may find it helpful to talk to
disease to see if they are better your specialist, clinical trials nurse
than current methods. For example, or GP, or to get a second opinion.
if you join a randomised trial for a If you decide to take part in a
new treatment, you will be chosen clinical trial, you can withdraw at
at random to receive either the best any time. For more information, visit
existing treatment or the modified australiancancertrials.gov.au.
new treatment. Over the years, trials ▶ See our Understanding Clinical
have improved treatments and Trials and Research booklet.

Making treatment decisions 19

 Chemotherapy
treatment
Most cancers have treatment protocols that set out which drugs to have,
how much and how often. You can find information about protocols
for chemotherapy at eviq.org.au. Your specialist may need to tailor the
protocols to your individual situation.

You may have treatment with one chemotherapy drug or a combination

of 2 or more. The chemotherapy drugs given, the dose and the treatment
schedule (how often you have the drugs) will be recorded in a treatment
plan. You will have tests throughout treatment (see table opposite) to
monitor your response, and your treatment plan may be adjusted based
on the results and any side effects.

The treatment course

How often and for how long you have chemotherapy is known as a
treatment course. This will be determined by the type of cancer you
have, the reason for having treatment, the drugs used and whether
you have any side effects.

Chemotherapy is commonly given as a period of treatment followed

by a break. This is called a cycle. For example, you may have treatment
on days 1, 2 and 3, then a break until day 28. Then a new cycle will begin.
The length of the cycle depends on the chemotherapy drugs being given.
The break between cycles lets your body recover. If you need more time
to regain strength, the specialist may decide to delay your next cycle. If
you have any concerns about changes to your treatment or any delays,
talk to your specialist.

20 Understanding Chemotherapy
What to expect when having chemotherapy

This information will apply in most cases, but you may find that things are
done slightly differently depending on how you have chemotherapy and
where you have treatment.

Tests you may have Receiving the treatment

Before chemotherapy and between While receiving chemotherapy, you

cycles, you will have several tests to will usually be:
help plan treatment, including: • seated in a reclining chair in a
• weight and height measured to room with other patients; during
work out the right dose treatment it’s a good idea to shift
• blood tests to check how well your weight in the chair
your kidneys and liver are working • able to walk around the room
and the number of blood cells (e.g. if you need to go to the toilet)
(see page 34) • given anti-nausea (antiemetic)
• x-rays and scans to check that you medicine so you don’t feel sick
are fit for treatment and see how • given several glasses of water
the tumour is responding to drink to help flush the
to treatment. chemotherapy drugs through the
For some chemotherapy drugs, you kidneys and bladder
may also have: • monitored throughout the session;
• heart monitoring tests to see if the nurses will also talk to you about
drugs are affecting your heart ways to manage side effects
• lung function tests to check • able to have someone with you
whether the drugs are affecting to support you during treatment,
your lungs. depending on health guidelines
at the time
• able to travel to and from
treatment by yourself; it’s
recommended that someone
travels with you the first time in
case you feel unwell.

Chemotherapy treatment 21
 Having intravenous (IV) chemotherapy

Chemotherapy drugs are usually

given as a liquid through a drip
inserted into a vein (intravenous
infusion). To prepare for IV
chemotherapy, the treatment team
will insert a narrow tube into a vein.

The drugs may be injected through

a cannula or a type of central
venous access device (see opposite
page). The type of device used will
depend on how often you need
chemotherapy, how long it will take
to give each dose and how long the
device will need to stay in place.

Chemotherapy will usually be given

during day visits to your hospital or
treatment centre. In most cases, a
single session takes from 20 minutes
to several hours. For some types of
cancer, a treatment session may take
several days. A portable pump that
you can use at home can provide a “My chemo infusions
continuous dose of chemotherapy for
up to a week (see opposite page). took about 8 hours
because I had 2 drugs
The infusion process may cause
reactions (e.g. flushing, skin rashes, and a saline solution in
or difficulty breathing) during the between. It was a long
session or several hours afterwards.
You may be given medicines to help
day, sitting in the chair
prevent these reactions. having infusions.” CHERYL

22 Understanding Chemotherapy
How IV chemotherapy is delivered

Central venous Cannula Portable pump

access device (CVAD) A small plastic tube A device that gives a
A thin plastic tube that inserted into a vein in prescribed amount
remains in your vein your arm or the back of chemotherapy
throughout the treatment of your hand. Having a continuously for up to a
course, often for several cannula put in can be week. It is attached to
weeks or months. It uncomfortable, but it a CVAD and does not
allows medical staff to should only take a few need to be connected to
give chemotherapy and minutes. The cannula can a power point. Different
other drugs, fluid or blood be kept in place if you types of pumps are
transfusions, and draw need to stay in hospital used (pictured above is
blood. A CVAD is inserted for a few days. If you have an elastomeric infusion
under local anaesthetic day treatment every few pump). The pumps are
and it shouldn’t cause weeks, the cannula is small and can be carried
discomfort or pain. usually put in and taken in a bag and tucked under
Common types are: out each time you visit. a pillow when sleeping.
• Hickman line – inserted
into the chest
• peripherally inserted
central catheter (PICC) Caring for your CVAD
line – inserted into A nurse will show you how to look after your CVAD
the arm to prevent infection or blockage. You may visit the
• port-a-cath (port) – a clinic, or a nurse may visit you at home to help
device inserted under clean tubes or lines. Contact your health care team
the skin of the chest or immediately if there is pain, redness or swelling
arm (pictured above). around the line or port.

Chemotherapy treatment 23
 Other ways of having chemotherapy
There are other ways of having chemotherapy, depending on the
drugs being used and the type of cancer you have. You may have
oral chemotherapy, injections into various parts of the body or
creams you apply to the skin.

Oral chemotherapy – Some people are able to take chemotherapy as

tablets or capsules at home. Your doctor, nurse or pharmacist will tell
you how and when to take them, and how to handle the drugs safely.

Injections – Less commonly, chemotherapy can be injected using

a needle into different parts of the body:
• into a muscle, usually in your buttock or thigh (intramuscular)
• just under the skin (subcutaneous)
• into the fluid around the spine (intrathecal, also known as a
lumbar puncture)
• into an artery (intra-arterial)
• into your abdominal area (intraperitoneal)
• into the outer lining of the lungs (intrapleural)
• into the bladder (intravesical)
• into the tumour (intralesional; this method is rare).

Cream – Some skin cancers are treated using a chemotherapy cream

applied directly to the skin. This is called topical chemotherapy.

Transarterial chemoembolisation (TACE) – Used for primary liver

cancer or some types of cancer that have spread to the liver, TACE
involves injecting high doses of chemotherapy directly into the liver
tumours. The chemotherapy will either be mixed with an oily substance
or loaded onto tiny plastic beads. The blood vessels feeding the tumour
may also be blocked (embolisation).

24 Understanding Chemotherapy
Chemotherapy with other treatments
For some types of cancer, you may be given chemotherapy as part of another
treatment, such as a stem cell transplant or radiation therapy, or in combination
with other drug therapies.

Usually given as part of a stem cell transplant for

blood cancers, such as leukaemia or lymphoma.
high-dose
It kills off all the cancer cells before the new,
chemotherapy
healthy blood cells are given. The transplant
usually occurs 1-2 days later.

Also called chemoradiotherapy, this is when

chemotherapy is combined with radiation
therapy. The chemotherapy drugs make the
chemoradiation
cancer cells more sensitive to radiation therapy.
Chemoradiation is commonly used for brain,
bowel, cervical and oesophageal cancers.

May be used after chemotherapy. Some cancers,

such as breast and prostate cancer, can grow in
hormone therapy
response to hormones. Drugs that block these
hormones may be given as tablets or injections.

Often combined with chemotherapy, targeted

targeted therapy therapy drugs (see page 6) may be given through a
drip in a vein (intravenously), injections or tablets.

May be used in combination with chemotherapy.

immunotherapy Immunotherapy (see page 6) is usually given
through a drip in a vein (intravenously).

Often given with chemotherapy to ease or

prevent nausea, manage allergic reactions, make
chemotherapy more effective or directly treat the
steroids cancer. Steroids are usually given as tablets. Side
effects include indigestion, increased appetite,
mood swings, difficulty sleeping, increased blood
glucose levels and muscle weakness.

Chemotherapy treatment 25
 Waiting for chemotherapy
When you have chemotherapy, you may spend a lot of time waiting
for health professionals, blood tests, test results, and for the necessary
safety checks to be undertaken. It also takes time for your drugs to
be prepared, and for the drugs to be given.

While you are waiting, you may want to:

• read a book or magazine, or complete a crossword puzzle
• listen to music or a podcast, or write in a journal
• chat with a companion (if health guidelines allow a support person
to stay with you during treatment)
• meditate, practise relaxation techniques or just have a rest
• use a laptop, smartphone or ereader – check whether it is okay to use
devices and if power points are available
• knit, crochet or embroider.

You will be able to sit in a comfortable chair and wear your own clothes
while receiving treatment. Many treatment centres will provide biscuits
and water, tea and coffee, but it’s a good idea to bring your own water
bottle and snacks in case of long delays.

At first, you may feel uncomfortable being around people who are sick
because of cancer or their treatment. You may not identify with them.
However, many people gain support from others who are receiving
chemotherapy at the same time. You may find it helpful to join a support
group to meet other people going through a similar experience.

“ I became good friends with a lady who

began chemotherapy on the same day as me.
The companionship was a great support.” TANIA
26 Understanding Chemotherapy
Safety precautions
While providing many benefits, chemotherapy is strong, cytotoxic
(toxic to cells) medicine, so it is safest for people without cancer to
avoid direct contact with the drugs. Cancer (oncology) nurses and
doctors often wear gloves, goggles, gowns or masks because they are
exposed to chemotherapy drugs every day. When the treatment session
is over, these items are disposed of in special bags or bins.

After each chemotherapy session, the drugs may remain in your

body for up to a week. During this time, very small amounts of
the drugs may be released from the body in your vomit, urine (wee),
faeces (poo), blood, saliva, sweat, semen or vaginal discharge,
and breastmilk.

You may worry about the safety of family and friends while you are
having chemotherapy. There is little risk to visitors (including children,
babies and pregnant women) because they aren’t likely to come into
contact with any chemotherapy drugs or body fluids.

The safety measures listed on pages 28–29 are recommended for

people who are providing care or have other close contact with you
during the recovery period at home. If you have questions, talk to your
treatment team or call Cancer Council 13 11 20.

Smoking may affect how well the treatment works and make
side effects worse so it's important to try to quit or cut down
before starting chemotherapy treatment. Quitting can be
difficult, especially if you’re feeling anxious about the cancer
diagnosis and treatment. For support and advice, talk to
your doctor, call the Quitline on 13 QUIT (13 7848) or download
the My QuitBuddy app.

Chemotherapy treatment 27
 Chemotherapy safety at home
There are simple and effective ways to reduce exposure to chemotherapy
drugs at home, both for you and your family and friends.

Clean up spills Use a plastic Wear disposable

bucket gloves

In the week after a

Keep a supply of cleaning If you need to vomit, use chemotherapy treatment
cloths, paper towels and a plastic bowl or bucket session, wear disposable
disposable waterproof (or a thick plastic bag waterproof gloves when
gloves handy. During the with no holes). Empty it handling containers,
week after a treatment into the toilet and flush clothing or bedsheets
session, clean up any body the toilet twice. Don’t soiled with vomit or other
fluids or chemotherapy use the bowl or bucket body fluids. After use,
drugs that spill onto for anything else and double-bag the gloves
household surfaces. Put throw it out after your final and put them in the
on waterproof gloves, soak chemotherapy session. household rubbish bin.
up the spill with paper
towel, clean around the
area with a disposable
cloth and soapy water, and Take care going to the toilet
rinse the area with water. For a week after a chemotherapy
Put used gloves, cloths treatment session, both men and
and paper towels into a women are encouraged to sit down
plastic bag, and then into to use the toilet. Put the lid down
a second plastic bag (this before flushing to avoid splashing.
is called double-bagging). Flush the toilet with a full flush,
This can then be put in the then wash your hands with soap
household rubbish bin. and water.

28 Understanding Chemotherapy
Safety precautions will vary depending on the drugs you receive, so ask your
treatment team what you need to do at home.

Keep tablets whole Handle laundry Keep medicines in

carefully a safe place

Don’t crush, chew or cut

chemotherapy tablets. If
you can’t swallow a tablet
whole, ask your oncologist
or pharmacist whether Store all tablets, capsules
the drug comes in other or injections as directed
forms, such as a liquid, or Wash items soiled with by your oncologist or
can be dissolved. body fluids – such as pharmacist. Medicines
clothing, bedsheets and often need special
towels – straightaway. storage to keep them
Use the longest washing effective and safe. Keep
Practise safe sex machine cycle (hot or them out of reach of
cold water can be used) children and do not store
and wash separately from them in a pill organiser
other laundry. with other medicines.

Pregnancy and breastfeeding

Your doctor may advise Avoid getting pregnant, or getting
you to use barrier your partner pregnant, while having
contraception, such as a chemotherapy (see page 51). If you are
condom, during any type of planning to have a baby, speak to your
sex for up to a week after doctor about the timing for pregnancy.
treatment. This protects If you already have a baby, you will
your partner while drugs not be able to breastfeed during
may be in your body fluids. treatment (see pages 12–13).

Chemotherapy treatment 29
 Is the chemotherapy treatment working?
You might wonder whether experiencing side effects is a sign that the
chemotherapy is working. However, whether or not you have side
effects does not indicate how successful the chemotherapy will be.

Throughout treatment, you will be closely monitored by your specialist.

You will have tests to check how well the chemotherapy drugs are
working, and whether the cancer has shrunk or disappeared after
chemotherapy. This is called the treatment response and it helps your
doctor decide whether to continue or change the chemotherapy plan.

If tests show that the cancer has shrunk and is unable to be detected,
this may be called remission or complete response, which means there
is no evidence of disease (NED). Depending on the guidelines for the
type of cancer you have, this may mean chemotherapy can stop or it
may continue for a period of time.

Once you’ve completed the course of chemotherapy, your doctor will

monitor you for several months or years (see page 56). This is because
cancer can sometimes come back in the same place or grow in another
part of the body.

Telehealth appointments
You may be able to have some Although telehealth can’t replace
appointments with your health all face-to-face appointments, you
professionals over the phone or can use it to talk about a range
a video link from home. This is of issues including test results,
known as telehealth and it can prescriptions and side effects.
reduce the number of times you For more information, talk to your
need to attend hospital. treatment team or call 13 11 20.

30 Understanding Chemotherapy
Key points about chemotherapy
What it is • Chemotherapy is the use of drugs to kill
or slow the growth of cancer cells.
• You may have one drug or a combination
of drugs depending on the cancer type.
• You may have chemotherapy on its own
or with other treatments.

How • A medical oncologist or haematologist

chemotherapy prescribes the course of chemotherapy.
is given • Chemotherapy is usually given as a liquid
through a thin tube into a vein (intravenously).
• Chemotherapy is sometimes given by mouth
as tablets or capsules (orally).
• For some types of cancer, chemotherapy is
given in other ways (e.g. a cream for skin
cancer or injections for liver cancer).

Safety of • It is safest for people without cancer to avoid

chemotherapy direct contact with chemotherapy drugs, so
nurses and doctors wear protective clothing
when giving chemotherapy.
• There is little risk to visitors during and after your
chemotherapy treatment.
• Your treatment team will advise you about taking
precautions at home so your family members
don’t come into contact with chemotherapy
drugs or your body fluids, such as urine (wee)
or vomit.
• Your family and friends should not handle
chemotherapy drugs unless it is absolutely
necessary to do so.

Chemotherapy treatment 31
 Managing side effects
Chemotherapy drugs can damage healthy, fast-growing cells, such as
the new blood cells in bone marrow or cells in the mouth, stomach,
skin, hair and reproductive organs. When healthy cells are damaged, it
causes side effects. This chapter provides information and tips to help
you manage some common side effects of chemotherapy.

Preparing for side effects

Everyone reacts to chemotherapy differently. Some people have no
side effects, others have many. Whether you experience side effects
and how severe they are depends on the type and dose of drugs you
are given and your reaction from one treatment cycle to the next.

If you have side effects, they may start during the first few weeks of
treatment and occasionally become more intense with each treatment
cycle. Before treatment begins, your doctor, pharmacist or nurse will
discuss the side effects to watch out for or report, how to help prevent
or manage them, and who to contact after hours if you need help.

Recording side effects

It can be useful to keep a record of your chemotherapy treatment
and any side effects you develop. This will help you recall details
about when you had side effects, how long they lasted and what
helped to make them better. Some people use a notebook or a diary,
while others prefer to use an app on a smartphone or tablet. Tell your
treatment team about all side effects. They will be able to suggest
ways to manage the side effects or, if appropriate, they may adjust
your treatment.

32 Understanding Chemotherapy
How long side effects may last
Most side effects are short term, but some may be permanent. Side
effects tend to gradually improve once treatment stops and the normal,
healthy cells recover. Most side effects can be managed.

Some side effects from chemotherapy may not show up for many
months or years. These are called late effects. Before treatment starts,
talk to your doctor about whether you are at risk of developing late
effects and what you can do to help prevent them.

Long-term and late effects of treatment

Permanent side effects of chemotherapy may include damage to your
heart, lungs, kidneys, nerve endings (see page 46) or reproductive
organs (see pages 50–52). If damage to your heart muscle or lungs is
a possibility, your doctor will monitor your heart and lung function
and adjust your chemotherapy if early changes are seen.

Occasionally, many years after having chemotherapy, some people

develop a new, unrelated cancer. The risk of this is very low, but factors
such as continuing to smoke or rare genetic conditions can increase this
risk. If any symptoms appear, even many years after treatment, ask your
GP whether they could be related to the cancer treatment you received.
Ask whether your hospital has a late effects clinic to help you manage
any side effects you may experience after treatment.
▶ See our Living Well After Cancer booklet.

Keep a list of the doses and names of your chemotherapy

drugs, along with the names of your specialists. This will
save time if you become ill and need to visit the emergency
department. Make sure you tell the hospital staff that you are
having chemotherapy.

Managing side effects 33

 Blood-related side effects
Blood cells are made in the bone marrow, which is the spongy part
in the centre of the bones. The bone marrow makes 3 main types
of blood cells, which have specific functions:
• red blood cells – carry oxygen around the body
• white blood cells – fight infection
• platelets – help blood to clot and prevent bruising.

New blood cells are constantly being made in the bone marrow. These
rapidly dividing cells can be damaged by chemotherapy, and the
number of blood cells (your blood count) will be reduced. Low numbers
of blood cells may cause anaemia or bleeding problems, and increase
the risk of infections.

You will have blood tests at the beginning of treatment and before each
chemotherapy cycle to check that your blood count is adequate before
you have chemotherapy. If your blood count has not recovered, your
doctor may delay treatment.

Anaemia
If your red blood cell count drops below normal, this is called anaemia.
A reduced amount of oxygen circulates through your body, which can
make you feel tired, lethargic, dizzy or breathless. The tips for coping
with fatigue on page 39 may be helpful. To minimise dizziness, take
your time when you get up from sitting or lying down.

Your treatment team will monitor your red blood cell levels. Let them
know if you have any symptoms of anaemia during your course of
chemotherapy. If the levels of red blood cells drop too low, you may
need a blood transfusion to build them up again.
▶ See our Fatigue and Cancer fact sheet.

34 Understanding Chemotherapy
Infections
Chemotherapy can reduce your white blood cell level, making it
harder for your body to fight bacterial infections. Bacterial infections
that cause sickness may come from somewhere in your body (e.g. the
bowel) and are not necessarily caught from other people. Viruses such
as colds, flu and COVID-19 may be easier to catch and harder to shake
off, and scratches or cuts may get infected more easily. Your doctor
may recommend antibiotics as a precaution against infection. See the
table on page 36 for other ways to reduce your infection risk.

There are many types of white blood cells. One type, called a
neutrophil, protects you against infection by destroying harmful
bacteria and yeasts that enter the body. During chemotherapy, some
people have low levels of neutrophils. This is known as neutropenia.

To boost production of new white blood cells and protect you from
infection, your doctor may give you injections of a growth factor drug
called granulocyte-colony stimulating factor (G-CSF). Your doctor or
nurse will speak to you about possible side effects. Some people may
experience bone pain or tenderness at the injection site. Let your doctor
know if you have any of these side effects.

Vaccinations
Some vaccinations are safe to have During chemotherapy and for at least
during chemotherapy treatment and 6 months afterwards, you should
others are not. It is safe to have the not have vaccinations that contain
flu vaccine and the COVID-19 a live vaccine. These include:
vaccines available as at July 2022, the varicella (chickenpox), zoster
but speak to your doctor before (shingles), and MMR (measles,
having these vaccinations. mumps, rubella) vaccines.

Managing side effects 35

 Taking care with infections during chemotherapy

Reduce your risk When to seek help

To prevent the spread of infection: Contact your doctor or go to

• check your temperature daily and the nearest hospital emergency
any time you feel unwell department immediately if you
• avoid touching your eyes, nose experience one or more of the
and mouth with your hands following symptoms:
• check with your doctor about • a temperature of 38°C or higher
having the flu and COVID-19 • chills or shivering
vaccines • sweating, especially at night
• ask people close to you to
• burning or stinging feeling when
consider having the flu and
urinating (weeing)
COVID-19 vaccines
• a severe cough or sore throat
• ask family and friends with a cold,
flu or other contagious infection • shortness of breath
(e.g. COVID-19 or a cold sore) not • vomiting that lasts more than
to visit while they have symptoms a few hours
• avoid shaking hands, hugging • severe abdominal (belly) pain,
and kissing other people constipation or diarrhoea
• try to avoid crowded places, such • unusual bleeding or bruising, such
as shopping centres; if this is not as heavy nosebleeds, blood in your
possible, wear a face mask urine (wee) or black faeces (poo)
• wash your hands with soap and
• prolonged faintness or dizziness
water before preparing food and
and a rapid heartbeat
eating, and after using the toilet
• any sudden deterioration in
• prepare and store food properly
your health.
to avoid foodborne illness and
food poisoning
• eat freshly cooked foods; avoid
raw foods (fish, seafood, meat
and eggs) and soft cheeses;
wash fruits and vegetables well
before eating.

36 Understanding Chemotherapy
Bleeding problems
A low level of platelets (thrombocytopenia) can cause problems. You
may bleed for longer than normal after minor cuts, have nosebleeds
or bleeding gums, or bruise easily. Periods may be longer or heavier.
Your treatment team will monitor your platelet levels. If chemotherapy
causes severe thrombocytopenia, you may need a platelet transfusion.
Ask your specialist to explain the risks and benefits of this procedure.

Contact your treatment team or call Triple Zero (000) if you have
any persistent bleeding, such as a nosebleed that doesn’t stop within
30 minutes.

How to manage a low platelet count

• Be careful when using • When brushing your
knives, scissors or needles, teeth, use a soft-bristled
as you may bleed easily toothbrush to avoid
from small cuts or nicks. irritating your gums.
• Use an electric razor when • Wear comfortable, well-
shaving your face or body fitting shoes indoors and
to reduce the chance of outdoors to avoid cuts on
nicking yourself. your feet.
• Wear thick gloves when • Blow your nose with care.
gardening to avoid injury.
• If you bleed, apply
This will also prevent
pressure to the area for
infection from soil, which
about 10 minutes and
contains bacteria.
bandage as needed.
• Avoid contact sports and
• If you have problems with
high-impact activities, as
bleeding, talk to your doctor.
these could cause bruising
or bleeding if you get
knocked or fall over.

Managing side effects 37

 Feeling tired and lacking energy
Many people feel very tired, weak, drained and become quickly
worn out while they are having chemotherapy. This is called fatigue
and it is the most common side effect of chemotherapy.

You may also:

• develop muscle aches and pains
• have difficulty concentrating
• find it difficult to do daily activities.

Fatigue can affect you suddenly and it doesn’t always go away with
rest or sleep. For some people, it may be hard to do everyday things,
creating feelings of frustration and isolation.

Fatigue caused by chemotherapy may last for some weeks or months

after a treatment cycle ends. Many people find that their energy levels
return to normal within 6–12 months of treatment ending.

While fatigue is a common side effect of chemotherapy, it can also

be a symptom of depression (see page 55). For more information on
depression, visit beyondblue.org.au and talk to your health care team.
▶ See our Fatigue and Cancer fact sheet and listen to The Thing About
Cancer podcast episodes on fatigue and sleep.

“ I had no idea that I would still be feeling tired

5 months after finishing treatment. I didn’t know
how to make it better and I was scared that’s how it
would be: that I wouldn’t go back to normal, that I
would never go back to having energy again.” JUDY
38 Understanding Chemotherapy
How to manage fatigue
• Allow your body to recover your sleep or boost your
from treatment by taking energy levels. Listen to the
regular breaks, resting or relaxation and meditation
having a short sleep. tracks in Cancer Council’s
Finding Calm During Cancer
• Plan activities for the time
podcast or call 13 11 20 to
of day when you tend to feel
request CDs.
most energetic.
• Talk to your doctor about
• Do some regular exercise,
trying acupuncture –
such as walking. Moderate
some studies suggest
intensity exercise can
this may help reduce
boost energy levels and
physical tiredness after
make you feel less tired.
chemotherapy.
Your treatment team may
be able to suggest suitable • Check with your doctor
activities for you. whether your fatigue
is related to low levels of
• Ask for, and accept,
red blood cells (anaemia).
offers of support from
Anaemia can be treated
family, friends and
(see page 34).
neighbours. They can help
with shopping, driving, • Discuss the impact of
housework or gardening. the treatment with your
employer. You may be able
• If you have children, ask
to take a few weeks off,
trusted family and friends to
reduce your hours or work
look after them during your
from home.
chemotherapy sessions
and to be on call in case you • Eat a healthy, well-balanced
become unwell afterwards. diet and don’t skip meals.
Try to limit the amount of
• Find ways to manage
alcohol you drink.
anxiety or sleeping
difficulties as these can ▶ See our Exercise for People
increase fatigue. Relaxation Living with Cancer and
or meditation exercises may Cancer, Work & You booklets
help improve the quality of for more information.

Managing side effects 39

 Hair loss
Many people having chemotherapy worry about hair loss (alopecia).
Whether you lose your hair will depend on the drugs prescribed. Some
people lose all their hair quickly; others may lose only a little hair or
none at all. Although losing hair from the head is most common, you
may find your eyebrows and eyelashes fall out, and you may lose hair
from your underarms, legs, chest, beard and pubic area.

When hair loss does occur, it usually starts 2–3 weeks after the first
treatment. Before and while your hair is falling out, your scalp may
feel hot, itchy, tender or tingly. Some people find that the skin on their
head is extra sensitive, and they may develop pimples on their scalp.
After chemotherapy ends, it takes 4–12 months to grow back a full head
of hair. When your hair first grows back, it may be a different colour
or curly (even if you have always had straight hair). In time, your hair
usually returns to its original condition.

Coping with hair loss – Many people find losing their hair difficult.
Hair loss can affect your self-confidence and make you feel sad or
vulnerable. For many people, it’s a public sign of the cancer diagnosis.
It may help to talk to your treatment team about how you feel.

Scalp cooling – Some treatment centres provide cold caps, which may
reduce head hair loss. Cold caps can only be used with certain drugs
and some types of cancer, and they don’t always stop hair loss.

Worn while chemotherapy is being given, the cap is attached to a cooling

unit. This reduces blood flow and the amount of chemotherapy drug that
reaches the scalp. Some people find the cold cap uncomfortable, and
the cold temperature may be painful. If you are interested in trying a
cold cap, ask your treatment centre if it is an option for you.

40 Understanding Chemotherapy
Ways to manage hair loss
• Keep your hair and • Some treatment centres
scalp very clean. Use a have wig loan services; call
mild shampoo like baby Cancer Council 13 11 20
shampoo. If you want to use for information about
moisturiser on your head, wig services.
use sorbolene. Check with
• You could try a silk or satin
your nurse before using
pillowcase as these smooth
any other hair or skin care
fabrics can decrease
products on the scalp.
hair tangles.
• Comb or brush your hair
• Avoid dyeing your hair during
gently with a wide tooth
chemotherapy or for about
comb or a hairbrush with
6 months afterwards, or
soft bristles.
consider using vegetable-
• Explain to family and based dyes.
friends, especially children,
• If your eyelashes fall out,
that the chemotherapy may
wear sunglasses outside to
make your hair fall out.
protect your eyes from dust
• Consider cutting your hair and sunlight.
before it falls out. Some
• If your eyebrows fall out,
people say this gives them
you may wish to wear
a sense of control.
reusable eyebrow wigs
• Wear a wig, hat, turban or or transfers until your
scarf, or go bare-headed – eyebrows grow back.
whatever feels best to you.
• Contact Look Good Feel
If you prefer to leave your
Better – this program
head bare, protect it against
helps people manage the
sunburn and the cold.
appearance-related effects
• If you plan to wear a wig, of cancer treatment.
choose it before treatment Call 1800 650 960 or
starts so you can match your visit lgfb.org.au.
own hair colour and style.
▶ See our Hair Loss
Or consider a new style or
fact sheet.
colour for a bit of fun.

Managing side effects 41

 Appetite changes, nausea or vomiting
It's common for your appetite to change during chemotherapy.
Sometimes you may not feel hungry or you may prefer different types
of food. The drugs may also temporarily change how food tastes.

Chemotherapy can make you feel sick (nauseated) or make you vomit.
Not everyone feels sick during or after chemotherapy, but if nausea
affects you, it often starts a few days after your first treatment. Nausea
may last a short time or for many hours and it may be accompanied
by vomiting or retching (when you feel the need to vomit but can’t).
Sometimes nausea lasts for days after treatment.

Often the best way to manage nausea is to prevent it from starting,

so you will usually be given anti-nausea (antiemetic) medicine before,
during and after chemotherapy sessions. Anti-nausea medicine helps
most people, but finding the right one can take time.

If nausea or vomiting continues after using the prescribed medicine, let

your nurse or doctor know early so that another medicine can be tried.
Steroids may also be used to manage nausea (see page 25).

Being unable to keep liquids down because of vomiting can make

you dehydrated. Signs of dehydration include a dry mouth and skin,
dark urine (wee), dizziness and confusion. It is not safe to be left alone
if you are vomiting a lot, as the confusion may make it difficult to
realise you have become seriously dehydrated.

“ Once I started chemotherapy, I went off my food.

My mouth felt very dry, which made food taste
unappetising. Adding extra sauce helped.” HELEN
42 Understanding Chemotherapy
How to manage appetite changes
Appetite loss Nausea
• Eat what you feel like, when • Have a light, bland meal
you feel like it. before your treatment (e.g.
soup with dry biscuits).
• Try eating frequent snacks
rather than large meals. • Sip water or other fluids
• Avoid strong odours and throughout the day so that
cooking smells that may put you don’t get dehydrated.
you off eating. It might help Sucking on ice cubes or
to prepare meals ahead and iceblocks, or eating jelly
freeze them for days you can also increase your
don’t feel like cooking. fluid intake. If water tastes
unpleasant, flavour it with
• If the taste of certain foods ginger cordial or syrup.
has changed, don’t force
yourself to eat them. After • If your stomach is upset, try
treatment finishes, your drinking fizzy drinks such as
sense of taste should soda water or dry ginger ale.
return to normal. • If you wake up feeling sick,
• If you don’t feel like eating eat a dry biscuit or slice of
solid foods, try enriching toast rather than skipping
your drinks with powdered a meal.
milk, yoghurt or honey. Or • If you can’t keep fluids down,
try easy-to-swallow foods contact your doctor or
such as scrambled eggs. hospital immediately. They
• Don’t use nutritional may be able to treat the
supplements or medicines vomiting, or you may need
without your doctor’s to have fluids through an
advice, as some products intravenous drip in hospital.
could affect how your
▶ See our Nutrition for People
treatment works.
Living with Cancer booklet
• Ask a dietitian for advice on and listen to our “Appetite
the best foods to eat during Loss and Nausea” podcast
treatment and recovery. episode for more tips.

Managing side effects 43

 Karen’s story

I’d been feeling unwell – eating During the week I had treatment,
made me feel nauseated and I would feel okay as the nurses would
I couldn’t stand to have anything give me medicine. The next week,
tight around my stomach. My GP I would get side effects like
booked me in for some scans and diarrhoea, vomiting and constipation.
then I was referred to an oncologist I took ginger to help with the nausea,
and I had a biopsy. and I tried to live my normal life
whenever I felt well enough.
After that, the diagnosis of
non-Hodgkin lymphoma was I had good support from work, my
confirmed. I received the standard family and friends, and the hospital
chemotherapy drugs for the first few staff were brilliant. I still have regular
months of treatment, and then check-ups and I’m back to living my
I took part in a clinical trial. usual active life.

Constipation or diarrhoea
Some chemotherapy drugs, pain medicines and anti-nausea medicines
can cause constipation or diarrhoea. Tell your doctor, pharmacist or
nurse if your bowel habits have changed.

Some people experience ongoing bowel problems after cancer

treatment. If you find that dietary fibre makes any bowel problems
worse, you may need to eat low-fibre foods. For ways to manage bowel
issues at home, see the opposite page.
▶ Our Nutrition for People Living with Cancer booklet has more
information on staying well nourished and includes meal ideas.

44 Understanding Chemotherapy
How to manage bowel changes
Diarrhoea Constipation
• Choose bland foods such • Eat more high-fibre foods,
as clear broth, boiled rice or such as wholegrain bread
dry toast. Avoid spicy foods, and pasta, fruits and
wholegrain products, fatty vegetables, bran, nuts and
or fried foods, rich sauces, legumes (e.g. baked beans
and raw fruits or vegetables or lentils).
with skins or seeds.
• If you are having treatment
• It may help to eat foods for bowel cancer, ask your
that are high in soluble fibre treatment team if there
such as oats, white bread, are any foods you should
white rice, bananas or shouldn’t eat to help
and pasta. avoid constipation.
• Limit alcohol, fruit juice, soft • Drink plenty of fluids,
drinks, strong tea or coffee, both warm and cold.
and foods containing Prune, apple or pear juice
artificial sweeteners, as can work well.
these stimulate the bowel.
• Do some light exercise,
• Drink plenty of water to such as walking.
help replace fluids lost
• Ask your doctor about using
through diarrhoea.
a laxative, stool softener or
• Talk to your treatment fibre supplement.
team. They may change the
• Avoid using enemas or
drugs or doses or suggest
suppositories as they may
other solutions, such as
cause infection.
using over-the-counter
medicines. • Let your treatment
team know if you have
• If diarrhoea is severe or
constipation for more than
ongoing, let your treatment
a couple of days. They will
team know. It can cause
be able to help.
dehydration and you may
need to go to hospital.

Managing side effects 45

 Nerve and muscle effects
Some chemotherapy drugs can damage the nerves that send signals
between the central nervous system and the arms and legs. This is
called peripheral neuropathy. Symptoms include tingling (“pins and
needles”), numbness or pain in your hands and feet, and muscle
weakness in your legs.

For many people, peripheral neuropathy is a short-term issue, but for

others, it can last a long time or even be permanent. If you experience
numbness and tingling, tell your doctor or nurse before your next
treatment. Your treatment may need to be changed or the problem
carefully monitored.

Ways to manage numb hands or feet

• Take care when moving • Talk to an occupational
around; you may be more therapist about aids that
likely to trip if your feet are may help (e.g. posts to raise
numb or your legs are weak. the sheets off your feet
if they’re irritated by the
• Ask your treatment team
weight of the sheets).
about exercising. Moderate
exercise has been shown • Wear well-fitting shoes with
to reduce the symptoms of non-slippery soles.
peripheral neuropathy. • Clear walkways of hazards
• Wear gloves and socks and remove loose rugs.
to keep hands and feet • If your symptoms are
warm, or soak your hands severe, talk to your doctor
and feet in warm water to about medicines that may
relieve symptoms. offer relief.
• Use your elbow to check the ▶ See our Understanding
water temperature so you Peripheral Neuropathy and
don’t burn yourself. Cancer fact sheet.

46 Understanding Chemotherapy
Thinking and memory changes
Some people say they have difficulty concentrating, focusing and
remembering things after they have had chemotherapy. This is called
cancer-related cognitive impairment. Other terms used to describe this
include “chemo brain”, “cancer fog” and “brain fog”.

Thinking and memory changes may be caused by treatment or

medicines, fatigue and sleep problems, or emotional concerns,
such as stress or depression. These problems usually improve
with time, although some people experience issues for years.
Tell your doctor about any thinking and memory changes you are
having and if they are affecting your day-to-day life or your work.

Ways to improve concentration

• Use a calendar or set • Learn something new
a timer on your phone (e.g. take up a new hobby or
to keep track of tasks, do crosswords or puzzles).
medical appointments,
• Talk to your partner, family
when to take medicines,
or workplace about changes
social commitments,
to your memory and
birthdays, etc.
concentration – they may
• Write down anything you be able to give you more
need to remember support or assistance.
(e.g. to-do items, where ▶ See our Understanding
you parked the car). Changes in Thinking and
• Get plenty of sleep. Deep Memory fact sheet and
sleep is important for listen to our “Brain Fog and
memory and concentration. Cancer” podcast episode.

• Do light exercise every day

to help you be more alert
and sleep better.

Managing side effects 47

 Mouth sores
Some chemotherapy drugs can damage healthy cells in the mouth and
cause mouth sores, such as ulcers or infections.

Chemotherapy treatment may also reduce the amount of saliva (spit) in

your mouth, make your saliva thick or sticky, or make your mouth dry.
This is called xerostomia or dry mouth. If you notice any sores, ulcers
or thickened saliva, or if you find it difficult to swallow, tell your doctor.
▶ See our Mouth Health and Cancer Treatment and Understanding
Taste and Smell Changes fact sheets.

Looking after your mouth

• Discuss any dental issues • Sip fluids, especially water,
with your oncologist or and eat moist foods such as
haematologist before casseroles or soups if you
seeing the dentist. If you have a dry mouth.
need to have any dental
• Soothe tender gums or
work, tell your dentist you’re
mouth with plain yoghurt.
having chemotherapy.
• Try sucking on ice during
• Use a soft toothbrush to
chemotherapy sessions.
clean your teeth twice a day.
This may help to prevent
• Rinse your mouth often – mouth ulcers.
when you wake up, after you
• Blend foods to make them
eat or drink, and at bedtime.
easier to eat. Try smoothies
Ask your doctor or nurse
made of fruit and yoghurt.
what type of alcohol-free
mouthwash to use. They • Avoid smoking and alcoholic
may give you a recipe for drinks, as well as very hot
a homemade mouthwash. foods and spicy, acidic or
Talk to your doctor or nurse coarse foods (e.g. nuts or
about medicines to relieve grains). These can all make
pain and help with healing. mouth sores worse.

48 Understanding Chemotherapy
Skin and nail changes
Some chemotherapy drugs may cause your skin to peel, darken
or become dry and itchy. During treatment and for several months
afterwards, your skin is likely to be more sensitive to the sun.

You may find your nails also change and become darker than usual or
develop ridges or white lines across them. Your nails may also become
brittle and dry or lift off the nail bed. These changes usually grow
out. It is recommended that you avoid having your nails done at a nail
salon, as this can increase the risk of infection during chemotherapy.

Taking care of your skin

• Use a soap-free wash when • Protect your skin from
showering. Gently pat your the sun when UV levels
skin dry with a towel rather are 3 or above. Wear
than rubbing it. high-protection sunscreen
(SPF 50+), a broad-brimmed
• Use a good quality
hat, protective clothing
moisturising lotion or a
and sunglasses, and
cream containing the
try to stay in the shade.
ingredient urea to help
This advice applies to
with the dryness.
everyone, but is especially
• Wear loose, non-restricting important for people having
clothing. Choose clothes chemotherapy.
made from soft cotton
• Avoid chlorinated swimming
fabric instead of rough wool
pools as the water can
or synthetic fibres.
make skin changes worse.
• Use mild detergent to wash
• If your skin becomes red or
your clothing if you have
sore in the area where the
sensitive skin.
intravenous device went
• Don’t shave or wax until in, let your doctor or nurse
your skin is healed. know immediately.

Managing side effects 49

 Sexuality, intimacy and fertility issues
Chemotherapy can affect your sexuality and fertility in emotional and
physical ways. These changes are common. Some changes may be only
temporary while others can be permanent.

Changes in sexuality
You may notice a lack of interest in sex or a loss of desire (libido),
or you may feel too tired or unwell to want to be intimate. You may
also feel less confident about who you are and what you can do. There
may be a physical reason for not being able to have sex or interested
in having sex (e.g. vaginal dryness or erection difficulties). Changes in
appearance can also affect feelings of self-esteem and, in turn, sexuality.

If you have a partner, it may be helpful for them to understand the

reasons why your libido has changed and to know that people can have
a fulfilling sex life after cancer, but it often takes time. Some partners
may feel concerned about having sex – they might fear injuring the
person with cancer, feel uncomfortable with the changes in their
partner or worry about being exposed to chemotherapy drugs
(see opposite page).

Sexual intercourse may not always be possible, but closeness and

sharing can still be a part of your relationship. Talk with your
partner about how you’re feeling, and take time to adapt to any
changes. Try to see yourself as a whole person (body, mind and
personality) instead of focusing only on what has changed. If
you’re worried about changes to how you feel about yourself, your
relationships or sexual functioning, you may find talking to a
psychologist or counsellor helpful.
▶ See our Sexuality, Intimacy and Cancer booklet and listen to our
“Sex and Cancer” podcast episode.

50 Understanding Chemotherapy
“ All my life I wanted to be a father. I didn’t want
cancer to ruin my chances, so I stored my sperm
before treatment started. I think of this as a bit of
an insurance policy.” ZAC

Using contraception
In most cases, your doctor will advise you to use some form of
barrier contraception (condom, female condom or dental dam) after
each treatment session. This is to protect your partner from any
chemotherapy drugs that may still be in your body fluids.

As chemotherapy drugs can harm an unborn baby (see page 12), your
doctor may talk to you about using contraception for some months
after chemotherapy. Although chemotherapy often affects fertility,
it doesn’t always. If you are in a heterosexual relationship and sexually
active, you will need to use a reliable form of contraception to avoid
pregnancy while having treatment. Talk to your specialist immediately
if you or your partner become pregnant.

Changes in fertility
Chemotherapy can affect your ability to have children (fertility),
which may be temporary or permanent. If you may want to have
children in the future, talk to your doctor about how chemotherapy
might affect you and what options are available. Women may be able
to store eggs (ova), embryos or ovarian tissue for use at a later date,
and men may be able to store sperm. This needs to be done before
chemotherapy starts and requires careful consideration. In some cases,
hormone injections can reduce activity in the ovaries and protect eggs
from being damaged by chemotherapy.
▶ See our Fertility and Cancer booklet.

Managing side effects 51

 Effects of chemotherapy on ovaries – Chemotherapy can reduce
the levels of hormones produced by the ovaries. This can cause your
periods to become irregular or even stop for a while, but they often
return to normal within a year of finishing treatment. If your periods
do not return, the ovaries may have stopped working, causing early
menopause. After menopause, you can’t get pregnant naturally. Signs
of menopause include hot flushes, night sweats, aching joints and dry
or itchy skin. Menopause – particularly when it occurs under 40 – may,
in the long term, cause bones to become weaker and break more easily.
This is called osteoporosis. Talk to your doctor about ways to manage
menopause symptoms.

Effects of chemotherapy on sperm – Chemotherapy drugs may lower

the number of sperm produced and reduce their ability to move. This
can sometimes cause infertility, which may be temporary or permanent.
The ability to have and keep an erection (erectile dysfunction or
impotence) may also be affected, but this is usually temporary.
If impotence is ongoing, talk to your doctor.

Other side effects

Some other common side effects of chemotherapy may include hearing
problems, watery eyes and body odours.

Changes in hearing – Your doctor may recommend that you have

a hearing test before you start treatment, and this may be repeated
before each treatment cycle. You may be at risk of losing the ability
to hear high-pitched sounds. Sometimes, chemotherapy also causes
a continuous ringing noise in the ears known as tinnitus. These changes
can happen alone or together, and are usually temporary. Let your
doctor know if you notice any change in your hearing.

52 Understanding Chemotherapy
Complementary therapies and chemotherapy
Complementary therapies are you are using or thinking about
sometimes used with conventional trying, as some can interfere with
medical treatments. They may offer your treatment or make any side
physical, emotional and spiritual effects worse.
support, help manage side effects,
and improve quality of life. Complementary therapies are
different to alternative therapies,
Some therapies have been proven which are used instead of
to be safe and effective in scientific conventional medical treatments.
studies. For example, meditation,
relaxation, massage and counselling Alternative therapies are unlikely
can reduce anxiety, and acupuncture to be scientifically tested and may
has been shown to reduce prevent successful treatment of
chemotherapy-induced nausea. the cancer. Cancer Council does
Some studies suggest acupuncture not recommend the use of
may also reduce fatigue. alternative therapies.
▶ See our Understanding
It is important to talk to your doctors Complementary Therapies booklet
about any complementary therapies for more information.

Watery eyes – This can be a symptom of a blocked tear duct, which

can be caused by some chemotherapy drugs. Regularly massaging the
area and using eye drops can help clear blockages. Let your cancer care
team know if this issue is ongoing.

Body odours – Chemotherapy can affect your sense of smell and you
may notice unpleasant smells more. Talk to your cancer care team if
you are concerned about a change in body odour.

Managing side effects 53

 Key points about side effects
Why side effects • Many people have side effects from
occur chemotherapy. Side effects are caused when
the chemotherapy drugs damage healthy, fast-
growing cells.
• Most side effects are temporary and gradually
improve after you have finished treatment.

Common • Chemotherapy can affect the blood, causing

side effects anaemia. It can also increase the risk of
infections because chemotherapy can reduce
your levels of white blood cells, which help fight
infections. The level of platelets in the blood may
also be affected, causing bleeding problems.
• Chemotherapy can cause fatigue, hair loss,
changes in appetite, nausea and vomiting, and
bowel issues such as constipation or diarrhoea.
• You may have nerve or muscle problems, and
have trouble concentrating or remembering
things. You may also develop mouth sores and
have skin and nail changes.
• Chemotherapy can affect your sexuality and
fertility. If you may want to have children in the
future, talk to your doctor before treatment starts.

Managing • Your doctor or nurse will talk to you about how to

side effects manage any side effects. You may be prescribed
medicine or given suggestions for eating,
drinking and looking after yourself.
• If you have any side effects that weren’t
discussed with you before treatment, or if you
feel concerned, let your treatment team know.

54 Understanding Chemotherapy
Life after treatment
For most people, the cancer experience doesn’t end on the last day of
treatment. Life after cancer treatment can present its own challenges.
You may have mixed feelings when treatment ends, and worry that
every ache and pain means the cancer is coming back.

Some people say that they feel pressure to return to “normal life”.
It is important to allow yourself time to adjust to the physical and
emotional changes, and establish a new daily routine at your own pace.
Your family and friends may also need time to adjust.

Cancer Council 13 11 20 can help you connect with other people who
have had chemotherapy, and provide you with information about the
emotional and practical aspects of living well after cancer.
▶ See our Living Well After Cancer booklet.

Dealing with feelings of sadness

If you have continued feelings of get a Medicare rebate for sessions
sadness, have trouble getting up in with a psychologist. Cancer Council
the morning or have lost motivation may also run a counselling program
to do things that previously gave you in your area.
pleasure, you may be experiencing
depression. This is quite common For information about coping
among people who have had cancer. with depression and anxiety, call
Beyond Blue on 1300 22 4636 or
Talk to your GP, because counselling visit beyondblue.org.au. For 24-hour
or medication – even for a short crisis support, call Lifeline 13 11 14
time – may help. Some people can or visit lifeline.org.au.

Life after treatment 55

 Follow-up appointments
After chemotherapy ends, you will have regular appointments with
your oncologist or haematologist to monitor your health, manage
any long-term side effects, and check that the cancer hasn’t come
back or spread.

During these check-ups, you will usually have a physical examination

and you may have blood tests, x-rays or scans. You will also be able to
discuss how you’re feeling and mention any concerns you may have.

You may also have regular check-ups with other specialists who
have been involved in your treatment. If you need it, you will often
receive continued support from allied health professionals, such as
a physiotherapist or dietitian.

Check-ups will become less frequent if you have no further problems.

Between follow-up appointments, let your doctor know immediately
of any symptoms or health problems.

When a follow-up appointment or test is approaching, many people

find that they think more about the cancer and may feel anxious.
Talk to your treatment team or call Cancer Council 13 11 20 if you are
finding it hard to manage this anxiety.
▶ See our Emotions and Cancer booklet.

“ Once treatment was finished, it was quite

daunting and I was fearful that the cancer
would come back somewhere. Eight years later,
it hasn’t come back, which is fantastic.” PETE
56 Understanding Chemotherapy
Support from Cancer Council
Cancer Council offers a range of services to support people affected
by cancer, their families and friends. Services may vary by location.

Cancer Council 13 11 20 Information

resources
Our experienced health
professionals will answer any
questions you have about your
situation and link you to local
services (see inside back cover).

Cancer Council
produces booklets and
Legal and financial support fact sheets on more
than 25 types of cancer,
If you need advice on legal or as well as treatments,
financial issues, we can refer emotional and practical
you to qualified professionals. issues, and recovery. Call
These services are free 13 11 20 or visit your local
for people who can’t afford Cancer Council website.
to pay. Financial assistance
may also be available. Call
Cancer Council 13 11 20 to
ask if you are eligible.
Practical help

Peer support services

You might find it helpful to
share your thoughts and Cancer Council can help
experiences with other you find services or offer
people affected by cancer. guidance to manage
Cancer Council can link you the practical impacts of
with individuals or support cancer. This may include
groups by phone, in person, helping you access
or online. Call 13 11 20 or visit accommodation and
cancercouncil.com.au/OC. transport services.

Life after treatment 57

 Useful websites

You can find many useful resources online, but not all websites are reliable.
These websites are good sources of support and information.

Australian

Cancer Council Australia cancer.org.au

Cancer Council Online Community cancercouncil.com.au/OC

Cancer Council podcasts cancercouncil.com.au/podcasts

Guides to Best Cancer Care cancer.org.au/cancercareguides

Australian Cancer Trials australiancancertrials.gov.au

Cancer Australia canceraustralia.gov.au

Carer Gateway carergateway.gov.au

Carers Australia carersaustralia.com.au

Department of Health and Aged Care health.gov.au

eviQ Cancer Treatments Online eviq.org.au

Healthdirect Australia healthdirect.gov.au

Services Australia (including

servicesaustralia.gov.au
Centrelink and Medicare)

International

American Cancer Society cancer.org

Cancer Research UK cancerresearchuk.org

Chemocare (US) chemocare.com

Macmillan Cancer Support (UK) macmillan.org.uk

58 Understanding Chemotherapy
Caring for someone
with cancer
You may be reading this booklet because you are caring for someone
with cancer. What this means for you will vary depending on the
situation. Being a carer can bring a sense of satisfaction, but it can
also be challenging and stressful.

It is important to look after your own physical and emotional

wellbeing. Give yourself some time out and share your concerns with
somebody neutral such as a counsellor or your doctor, or try calling
Cancer Council 13 11 20. There is a wide range of support available to
help you with the practical and emotional aspects of your caring role.

Support services – Support services such as Meals on Wheels, home

help or visiting nurses can help you in your caring role. You can find
local services, as well as information and resources, through the Carer
Gateway. Call 1800 422 737 or visit carergateway.gov.au.

Support groups and programs – Many cancer support groups and

cancer education programs are open to carers as well as to people
with cancer. Support groups and programs offer the chance to share
experiences and ways of coping.

Carers Australia – Carers Australia provides information and

advocacy for carers. Visit carersaustralia.com.au.

Cancer Council – You can call Cancer Council 13 11 20 or visit your

local Cancer Council website to find out more about carers’ services.
▶ See our Caring for Someone with Cancer booklet.

Caring for someone with cancer 59

 Question checklist
Asking your doctor questions will help you make an informed choice. You
may want to include some of the questions below in your own list.

Treatment
• Why do I need chemotherapy?
• What are the advantages and disadvantages of chemotherapy for me?
• How successful is chemotherapy for the type of cancer I have?
• What is the goal of this chemotherapy?
• Are there any other treatments I can have instead?
• Will I have other treatments as well as chemotherapy?
• How much does treatment cost?
• What drugs will I be receiving? How will they be given?
• How often will I receive chemotherapy and for how long?
• How will you decide the dosage?
• Are there clinical guidelines you are following?
• How will I know if the treatment is working?
• Where will I have treatment? Can I have it close to where I live or at home?
• Do my family and friends need to follow any safety measures?
• Can I take my usual medicines during chemotherapy?

Side effects
• What are the risks and possible side effects of this type of chemotherapy?
• Will the side effects be long term or short term?
• What can I do to help manage any side effects?
• Will chemotherapy affect my sex life and fertility?
• Are there any complementary therapies that might help me?
• Should I change my diet or physical activity during or after treatment?
• Who should I contact for information or if I have a problem during
treatment? Who is my after-hours contact?

After treatment
• How often will I need check-ups after treatment?
• Am I at risk of developing late effects from chemotherapy? What might
these be? What can I do to prevent this?

60 Understanding Chemotherapy
Glossary
advanced cancer chemoradiation
Cancer that is unlikely to be cured. In most Treatment that combines chemotherapy
cases, the cancer has spread to other parts with radiation therapy. Also called
of the body (secondary or metastatic cancer). chemoradiotherapy.
Treatment can often still control the cancer chemotherapy
and manage symptoms. A cancer treatment that uses drugs to kill
anaemia cancer cells or slow their growth.
A reduction in the number or quality of red cold cap
blood cells in the body. A cap that is connected to a cooling system
antiemetic and worn on the head during chemotherapy
A drug that helps to control nausea and that may prevent hair loss.
vomiting. Also called an anti-nausea drug. complete response
The disappearance of all signs of cancer in
blood count response to treatment.
See full blood count. curative treatment
bone marrow Treatment given with the aim of causing the
The soft, spongy material inside bones. Bone signs and symptoms of cancer to reduce or
marrow produces stem cells that become red disappear. Also known as definitive treatment.
blood cells, white blood cells and platelets. cycle
A period of chemotherapy treatment that is
cannula repeated on a regular schedule with periods
A small plastic tube inserted into a vein or of rest in between.
narrow opening in the body so that fluids can cytotoxic
be introduced or removed. A substance (e.g. chemotherapy) that is
cells toxic to cells, so it can kill or slow the growth
The basic building blocks of the body. of cancer cells.
A human is made of billions of cells that
perform different functions. fertility
central line The ability to conceive a child.
A type of central venous access device full blood count (FBC)
used to give direct access to a vein in the A test that measures the number, size and
chest or neck. maturity of each type of cell in the blood.
central venous access device (CVAD) Sometimes called a complete blood count.
A type of thin plastic tube inserted into a vein.
The CVAD gives access to a vein so fluid or granulocyte-colony stimulating factor
chemotherapy can be given, and blood can (G-CSF)
be taken. Types of CVADs include peripherally A protein that helps the bone marrow
inserted central catheter (PICC) lines, produce more neutrophils to reduce the
Hickman lines and port-a-caths (ports). risk of infection.

Glossary 61
 This can happen naturally, from treatment,
haematologist or because the ovaries have been removed.
A doctor who specialises in studying and metastasis (plural: metastases)
treating diseases of the blood, bone marrow Cancer that has spread from a primary cancer
and lymphatic system. (original site) to another part of the body.
Hickman line Also called secondary or advanced cancer.
A type of central venous access device
inserted into a vein in the chest. neutropenia
hormone therapy A low level of neutrophils. Neutropenia can
A treatment that blocks the body's natural make you more prone to infections.
hormones, which sometimes help cancers neutrophil
to grow. It may be used when the cancer is A type of white blood cell that defends the
growing in response to hormones. body against bacteria and yeast.

immune system oncologist

A network of cells and organs that defends A doctor who specialises in the study and
the body against attacks by foreign invaders, treatment of cancer.
such as bacteria and viruses. Includes the oral chemotherapy
lymphatic system. Chemotherapy given by mouth as tablets
immunotherapy or capsules.
A type of drug treatment that use the body's outpatient
own immune system to fight cancer, A person who visits the hospital for medical
inpatient care without being admitted into hospital.
A person who stays in hospital while having
treatment. palliative treatment
intravenous chemotherapy Medical treatment for people with advanced
Chemotherapy delivered into a vein through cancer to help them manage pain and other
a drip or pump. physical and emotional symptoms. Treatment
may include chemotherapy, radiation therapy
lymphatic system or other therapies.
A network of vessels, nodes and organs that peripherally inserted central catheter
removes excess fluid from tissues, absorbs (PICC)
fatty acids, transports fat, and produces A type of central venous access device that
immune cells. Includes the bone marrow, is inserted into a vein in the arm.
spleen, thymus and lymph nodes. peripheral neuropathy
Weakness, numbness, tingling or pain,
maintenance chemotherapy usually in the hands and feet, caused
Chemotherapy given for months or years by damage to the nerves that are located
after the initial treatment to prevent the away from the brain and spinal cord
cancer coming back. (peripheral nerves).
menopause platelets
When periods (menstruation) stop. One of the 3 main types of cells

62 Understanding Chemotherapy
found in the blood. Platelets help the
blood to clot and stop bleeding. Also targeted therapy
called thrombocytes. Drugs that target specific features of
port-a-cath (port) cancer cells to stop the cancer growing
A type of central venous access device and spreading.
surgically inserted under the skin of the chest
or arm. A tube called a catheter connects the white blood cells
port to a vein so fluids can be passed into One of the three types of cells found in the
the body. blood. They help to fight infection. Types
portable pump of white blood cells include neutrophils,
A portable device that delivers a controlled lymphocytes and monocytes. Also called
amount of chemotherapy. It is usually leukocytes.
attached to a central line. It allows a person
to have chemotherapy at home.
Can’t find a word here?
radiation therapy For more cancer-related words, visit:
The use of targeted radiation to kill or • cancercouncil.com.au/words
damage cancer cells so they cannot grow, • cancervic.org.au/glossary.
multiply or spread. The radiation is usually
in the form of x-ray beams. Also called
radiotherapy.
red blood cells
One of the 3 main types of cells found in the
blood. They carry oxygen around the body.
Also called erythrocytes.
remission
When the signs and symptoms of the cancer
reduce or disappear.

side effect
Unintended effect of a drug or treatment.
Most side effects can be managed.
steroid
A class of drugs that may be used to reduce
inflammation; treat the cancer; relieve
nausea, pain and fatigue; and boost the
appetite. Also called corticosteroids.
systemic treatment
Cancer drugs that spread throughout
the whole body. Includes chemotherapy,
targeted therapy, immunotherapy and
hormone therapy.

Glossary 63
 How you
can help
At Cancer Council, we’re dedicated to improving cancer control. As
well as funding millions of dollars in cancer research every year, we
advocate for the highest quality care for cancer patients and their
families. We create cancer-smart communities by educating people
about cancer, its prevention and early detection. We offer a range of
practical and support services for people and families affected by
cancer. All these programs would not be possible without community
support, great and small.

Join a Cancer Council event: Join one of our community fundraising

events such as Daffodil Day, Australia’s Biggest Morning Tea, Relay
For Life, Girls’ Night In and other Pink events, or hold your own
fundraiser or become a volunteer.

Make a donation: Any gift, large or small, makes a meaningful

contribution to our work in supporting people with cancer and their
families now and in the future.

Buy Cancer Council sun protection products: Every purchase

helps you prevent cancer and contribute financially to our goals.

Help us speak out for a cancer-smart community: We are a

leading advocate for cancer prevention and improved patient
services. You can help us speak out on important cancer issues
and help us improve cancer awareness by living and promoting
a cancer-smart lifestyle.

Join a research study: Cancer Council funds and carries out

research investigating the causes, management, outcomes and
impacts of different cancers. You may be able to join a study.

To find out more about how you, your family and friends can help,
please call your local Cancer Council.

64 Understanding Chemotherapy
Cancer Council
13 11 20
Being diagnosed with cancer can be overwhelming. At
Cancer Council, we understand it isn’t just about the treatment
or prognosis. Having cancer affects the way you live, work and
think. It can also affect our most important relationships.

When disruption and change happen in our lives, talking

to someone who understands can make a big difference.
Cancer Council has been providing information and support
to people affected by cancer for over 50 years.

Calling 13 11 20 gives you access to trustworthy information that is

relevant to you. Our experienced health professionals are available
to answer your questions and link you to services in your area, such
as transport, accommodation and home help. We can also help
with other matters, such as legal and financial advice.

If you are finding it hard to navigate through the health care

system, or just need someone to listen to your immediate
concerns, call 13 11 20 and find out how we can support you,
your family and friends.

If you need information in a language other than English,

an interpreting service is available. Call 131 450.

If you are deaf, or have a hearing or speech impairment,

you can contact us through the National Relay Service.
communications.gov.au/accesshub/nrs

Cancer Council services and programs vary in each area.

13 11 20 is charged at a local call rate throughout Australia (except from mobiles).
 UNDERSTANDING CHEMOTHERAPY
For information & support
on cancer-related issues,
call Cancer Council 13 11 20

AUG 2022 CAN708

Visit your local Cancer Council website

Cancer Council ACT Cancer Council Queensland Cancer Council Victoria

actcancer.org cancerqld.org.au cancervic.org.au
Cancer Council NSW Cancer Council SA Cancer Council WA
cancercouncil.com.au cancersa.org.au cancerwa.asn.au
Cancer Council NT Cancer Council Tasmania Cancer Council Australia
cancer.org.au/nt cancer.org.au/tas cancer.org.au

This booklet is funded through the generosity of the people of Australia.

To support Cancer Council, call your local Cancer Council or visit your local website.