Chemotherapy

It varies. Not everyone experiences the same side effects, nor do they occur at the same time. Some individuals may experience side effects after one cycle, others after two or more cycles. Side effects may get worse as the cycles progress.

Your doctor determines what tests are needed. If you are receiving chemotherapy, you may have blood work done anywhere from the day of or up to seven days before your scheduled treatment. The blood work will include a complete blood cell count (CBC), chemistry profile and any necessary cancer markers. A blood sample for a CBC will also be collected seven to 14 days following your chemotherapy. It is important to be aware of possible symptoms of reduced red blood cell (RBC), white blood cell (WBC) or platelet (PLT) production. Chemotherapy destroys rapidly dividing cells, a characteristic of cancer cells. However, RBC, WBC and PLTs also divide rapidly and are frequently damaged by chemotherapy. Your RBC, WBC and PLT counts may all go down. Your doctor monitors these counts to determine the toxicity of treatment and to predict your risk for complications, as well as to plan future therapy.

Without receiving special anti-nausea medications, most patients will experience some nausea after treatment with chemotherapy. Nausea and vomiting may last 24 to 48 hours. The severity mainly depends on which chemotherapy drugs were used. A number of very effective medications called anti-emetics or anti-nausea drugs are available to help lessen or prevent nausea or vomiting. These medications may be given to you intravenously during your chemotherapy, or you may be given a prescription medication to take at home.

Where you go for treatment depends on your specific chemo regimen, the drug doses, your hospital's policies, your insurance coverage, what you prefer and what your doctor recommends. You may be treated with chemo at home, in your doctor's office, in a clinic, in a hospital's outpatient department or elsewhere in a hospital. Some of these settings may have private treatment rooms, while others treat many patients together in one large room. Talk to your doctor or nurse ahead of time so you know what to expect your first day.

The chemotherapy itself may take five to six hours, depending on the drug combination. That does not include the time required to perform blood tests and a physical exam that are often necessary prior to receiving chemotherapy.

Since chemo may dehydrate you, it is best to get hydrated before treatments start.

Your oncologist will monitor your progress at each chemotherapy appointment. After the successful completion of chemotherapy, you usually will see your oncologist every two to four months for the first two years, every three to six months for the next three years, and then once a year after that.

It is important to distinguish the direct effects of chemotherapy as it circulates in the body from the long-term effect that can continue after the body has eliminated the chemotherapy through normal metabolic pathways. Most chemotherapy is eliminated from the body fairly quickly, and the fatigue that patients experience after treatment is a prolonged effect that continues long after the chemotherapy is gone. A person should not assume that feeling fatigued means that the chemotherapy is still in the body. Fatigue has many possible causes and severe fatigue should be evaluated so that these causes can be identified and treated.

Not all chemotherapy drugs cause hair loss. Your doctor will be able to tell you if the medication you are taking is likely to make your hair fall out. If you do lose your hair, it will grow back after the treatments are over.

Chemotherapy is usually administered in a doctor's office, clinic or outpatient unit at a hospital. Chemotherapy follows a standard protocol, so your care should not vary greatly from place to place. You may decide to travel to an academic hospital, especially if you are interested in participating in clinical trials.

Neulasta (pegfilgrastim) is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection. Neulasta is used to prevent neutropenia, a lack of certain white blood cells caused by receiving chemotherapy.