TREATMENT

CHEMOTHERAPY

Overview

What is chemotherapy?

The word ‘chemotherapy’ describes the use of chemicals or drugs used to treat cancer. These drugs can be used as follows:

  • To cure certain types of cancer.
  • To prevent certain types of cancer spreading.
  • To shrink tumours, prior to surgery or radiotherapy.
  • To relieve symptoms caused by cancer, such as pain.
  • To stop or slow down the growth of cancer tumours.
Understanding chemotherapy

Chemotherapy drugs stop or retard the growth of cancer cells. Cancer cells undergo rapid division and chemotherapy drugs interfere with their division. By virtue of this mechanism of action, they may in some cases also harm healthy body cells which undergo rapid divisions, causing certain side effects.

Chemotherapy is the treatment of cancer by means of chemical drugs. The chemotherapeutic drugs reach the cells via the bloodstream. Cancer cells divide very rapidly and consequently absorb most of the chemotherapy, therefore they will die off and not divide and grow any further. The abnormal cells die, while the normal cells recover. The damage to the normal cells may nevertheless cause temporary side effects. The effect of chemotherapy differs from one person to another and also according to the type of cancer being treated.

How are chemotherapeutic agents administered?

Chemotherapy is administered to kill cancer cells or to retard or prevent their growth. Sometimes a combination of more than one drug is given in order to fight the tumour cells in different ways.

Chemotherapy makes cancer cells more sensitive to the effect of irradiation; therefore, these two methods are often combined to obtain the best result for a specific condition.

Each treatment is followed by a rest period to give the normal cells time to recover. The schedule differs from one person to another, and the oncologist will explain it to you.

The chemotherapy is normally given at the oncologist's consulting rooms. If it requires an intravenous infusion over several days, however, there are two options that can be followed, namely:

  • Admission to the hospital, with a conventional infusion.
  • An infusion administration system that enables you to receive the chemotherapy at home over a period of 24 hours.

Use of the latter method is only possible if you are provided with a "port". A port is a small metal chamber (the size of a two-rand coin). It is implanted under the skin under local anaesthetic. A catheter runs from this small chamber into one of your main veins.

Access to this chamber (port) is gained through a special needle that is inserted vertically through the skin into the port. This needle will remain in position for the duration of the chemotherapy.

An elastomeric administration system ensures that the chemotherapeutic drug flows directly into your bloodstream at a specific rate per hour. When the chemotherapy has been completed, the needle is removed.

Chemotherapy is no more painful than any other injection, or blood tests and the agents are administered in the following ways:

  • Intravenously, in the form of direct injections or an infusion. This is the most common method of administration.
  • Intra-arterially directly into the supply artery of the affected organ.
  • Orally, in the form of tablets.
  • Intramuscularly, as an injection into the muscle.
  • Subcutaneous injection into the fatty tissue.

The nursing staff rinse the vein during and after administration of chemotherapeutic drugs to prevent the vein from burning or being damaged.

If the injection area becomes painful or burn, you must report this to the nursing staff immediately. If you take medication other than that prescribed to you, you must keep the oncologist and / or nursing staff informed of this at all times.

It is also very important that you make separate appointments for your weekly and monthly chemotherapy treatments.

These appointments can be made with the oncologist's receptionists.

Side effects of Chemotherapy

Of course, chemotherapy also affects the healthy cells and may cause a range of side-effects. The aim of the following information is to give you peace of mind so that you can know what to expect and avoid unnecessary anxiety and fear.

1Nausea and Vomiting
Some medication may cause nausea and vomiting, the severity of which varies from one person to another. Anti-emetic medication is always given together with chemotherapy. There are also a variety of tablets, injections and suppositories that can be used to combat nausea. Please ask the nursing staff to arrange a prescription for you and use this medication regularly.

Diet also plays a role, and the following is recommended:

  • Always eat before you receive chemotherapy
  • Eat lighter meals with less fat.
  • Eat smaller meals, but more often.
  • Drink a lot of fluids.
  • You must eat, even if you have no appetite for food.
  • Take anti-emetics regularly while you are receiving chemotherapy, and for a few days afterwards.
2Cystitis (Bladder infection)
Report irritation of the bladder to the oncologist so that, if any infection is present, it can be treated. Remember to increase your fluid intake.
3Discolouration of urine
Some of the medication may cause discolouration of your urine. It is recommended that you increase your fluid intake so that the kidneys are flushed through properly.
4Diarrhoea & Constipation
Diarrhoea: If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and ± two litres of water per day). Also, consult your general practitioner or oncologist immediately.

You must prevent your body from dehydrating. Eat a lot of bananas, carrots (cooked), grated apple (without the skin) and maizena porridge. If you want more information, please talk to the nursing staff or dietician to assist you with this.

Constipation: You could become constipated as a result of the chemotherapy. Drink a lot of fluids and follow a balanced diet rich in fibre. It is important that you take all types of fibre, so ask the dietician to advise you. Laxatives may be taken, but you must first obtain the oncologist's permission for their use.

You could try the following remedy for constipation (it is not habit-forming): One sachet of Duphalac dry = ½ teaspoon of Epsom salts, dissolved in a glass of water. You may request a prescription for this.
5Hair Loss (Alopecia)
Some of the drugs will cause your hair to fall out, but it will grow back after the treatment has been stopped or completed.

In some cases, a scalp-cooling device (ice bonnet) is used to limit hair loss as far as possible. For a small donation, you could also obtain a wig from your nearest branch of the Cancer Association.
6Stomatitis (Sores in the mouth or throat)
If you develop sores in your mouth or throat, you must report this immediately. If necessary, your oncologist can prescribe medication for you. You can also do the following to provide relief:

  • Use a mouth wash (one teaspoon of bicarbonate of soda in a cup of lukewarm water) after each meal and at bedtime, or four times a day.
  • Avoid food containing a lot of spices or herbs.
  • Do not smoke.
  • Avoid food that contains a lot of acids, for example, lemons, grapefruit and tomatoes.

Certain vitamins provide relief for sores in the mouth. Consult our dietician for more information.

If you can no longer eat, or have difficulty in swallowing, you must contact the dietician immediately so that a nutritional supplement can be prescribed.
7Bone Marrow Suppression
The bone marrow forms new blood cells in the body.
Each of the different types of blood cells plays an important role, namely:
  • White blood cells fight infection.
  • Red blood cells carry oxygen to all the parts of the body.
  • Blood platelets help with the clotting of blood.
Because bone marrow cells grow more rapidly, they also absorb more of the chemotherapy; therefore, it is necessary that a blood count is taken before each treatment. If the white blood cell count is too low, you will be very susceptible to infections. It is therefore advisable that you avoid, as far as possible, people who are suffering from colds or other infections. If you experience a fever or cold fever, you must contact your general practitioner or oncologist immediately.

It could happen that your treatment is postponed or that the dose is decreased because your blood count is low. This only shows that your body is not yet ready to withstand the next chemotherapy session and does not influence the effect of the treatment of the disease.
1Before Treatment
Please arrive 45 minutes early for your first appointment and report to the receptionist.

You will need to arrive only 15 minutes early for the rest of your appointments.

Patients who arrive more than 30 minutes after their scheduled appointment may have to reschedule for a later appointment or for another day.

After signing in, you may need to have a blood specimen taken, after which you will return to reception to wait for your appointment.

It is often better to have the blood taken a day before your visit.

If you live quite far away, it is better to have your blood taken before the visit and to phone the nursing staff to make sure that your blood results are within limits before you drive all the way to the oncology unit.
2During Treatment
Each patient is treated in a recliner; however in most cases, you are free to get up and walk around with the intravenous equipment. Visitors are allowed only one at a time during treatment.

Counsellors and social workers are available during visits if required.

Your nurse will monitor your treatment and answer any questions and discuss possible side effects.

The length of each session depends on your treatment plan and how you are feeling during treatment.
3After Treatment
Certain medications may make you sleepy following treatment.

Should you feel drowsy, you will not be allowed to leave unless someone else is driving or you wait for several hours before driving yourself.

For this reason, patients may want to arrange for a relative or friend to drive them home.

All future doctors’ visits, blood draws and treatments require an appointment.

At the end of the first treatment, please schedule your next appointment.

Please enquire from the nursing staff if you need to see the doctor at your next visit to ensure you make the right appointments.
Diet & nutrition during treatment

It is a known fact that 50% of cancer patients experience weight loss even before diagnosis. Even small weight loss before treatment is started (less than 5% of body mass) may have an adverse effect on the outcome of treatment. A common secondary diagnosis in patients with advanced cancer is protein-energy malnutrition (PEM).

The overall goals of the nutritional care of the oncology patient are:

  • Preventing or correcting nutritional deficiencies.
  • Minimising weight loss and maintaining a sound nutritional status through early nutritional assessment and intervention as a preventative measure; therefore, screening for risk of nutritional problems should occur at diagnosis and continue throughout treatment.
  • Providing guidelines regarding nutritional problems that may be experienced during treatment, e.g. guidelines for diet modifications and food selection and preparation.
  • Counselling individual patients and their families on general nutritional principles, the basic rules for a healthy diet and healthy eating habits, and nutritional monitoring.

There are many myths about foods that are allowed and foods to be avoided when you have cancer. These myths cause confusion and may ultimately lead to unhealthy food choices that could be detrimental to your wellbeing in the long run. The value of sound nutritional advice must, therefore, not be underestimated.

You may not have control over your disease, but you do have control over your food choices. Making smart nutritional choices can make your journey through cancer treatment a little easier. The right nutrition before, during, and after treatment, will get you on track for more rapid healing and long-term wellness. Maintaining your weight can also help you finish your treatments on time, recover sooner and feel better.

This service is available free of charge to patients and their families. Please contact the dietician for enquiries or an appointment.