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Chemotherapy FAQs

How is chemotherapy given?
Chemotherapy can be given:

• Intravenously (IV)

• By mouth in the form of a pill

• With a shot (injection)

Many types of chemotherapy can be given at home. Through instruction, you and your family members can learn how to administer chemotherapy in pill form or by injection with small syringes and needles similar to those that people with diabetes use to administer insulin. In other cases, a nurse will administer chemotherapy at one of our facilities. Chemotherapy is typically given in cycles, which is a treatment followed by a period of rest. A cycle can last one or more days, but is usually one, two, three, or four weeks long. A course of chemotherapy is comprised of multiple cycles. Each course is different, but generally consists of four to six cycles. It may take a relatively short period of time to receive some chemotherapy drugs, while others take hours. It all depends on the treatment regimen that your doctor recommends. If your chemotherapy is given through an IV, your doctor may suggest a Port. Ports are surgically placed in a large vein near the heart and can stay in place for long periods of time.

How often will I receive chemotherapy? 
Generally, treatments are given daily, weekly, or monthly. How often you receive chemotherapy depends on the type of cancer and which drug or combination of drugs you receive. Your doctor will help you determine the most effective treatment schedule for you.  Chemotherapy may be used in combination with surgery. When chemotherapy is given before surgery it is referred to as neoadjuvant chemotherapy. The goal of neoadjuvant chemotherapy is to shrink the cancer before it is surgically removed. If the chemotherapy is given after surgery, it is referred to as adjuvant chemotherapy. The goal of adjuvant chemotherapy is to kill any cancer cells left in the body after surgery. Regardless of whether it is given before or after surgery, chemotherapy will still be administered in cycles that depend on the type of cancer and which drug or combination of drugs.

What chemotherapy will I receive?
You will receive chemotherapy that is best suited to achieve your goals of therapy. When selecting a treatment or treatments, your doctor will consider:

• Your diagnosis

• How far along your cancer is in its development

• The expected behavior of the cancer

• Where the cancer originated

• Your age

• Other medical problems you may have

• Any potential side effects from the treatment

Why is my complete blood count (CBC) tested?
Chemotherapy destroys rapidly dividing cells, a characteristic of cancer cells. However, red blood cells, white blood cells, and platelets also divide rapidly and are frequently damaged by chemotherapy. Your red blood cell count, white blood cell count, and platelet count 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.

What are the side effects of chemotherapy?
Chemotherapy works by destroying cancer cells; unfortunately, it cannot tell the difference between a cancer cell and a healthy cell. The delivery of cancer therapy often affects the body’s normal tissues or organs that are not affected by cancer.  Side effects of treatment may cause inconvenience, discomfort, and occasionally even fatality to patients. Additionally,  side effects may prevent delivery of the full dose of chemotherapy on schedule. This is extremely important to understand since your expected outcome from chemotherapy is based on delivering treatment at the full dose and schedule prescribed in the treatment plan. Because the expected outcome from therapy is based on delivering treatment at the prescribed dose and schedule, a change from the treatment plan may reduce your chance of achieving an optimal outcome. Side effects not only cause discomfort and unpleasantness, but may also compromise your chance of cure by preventing the delivery of therapy at its optimal dose and time. The most common side effects of chemotherapy are low blood counts, nausea, vomiting, hair loss, and fatigue. Some side effects may be temporary and merely annoying. Others, such as infection or a low white blood count, can be life-threatening. For example, one of the most serious potential side effects of chemotherapy is a low white blood cell count known as neutropenia which can put you at risk for severe infections or treatment interruptions. Fortunately, there has been a great deal of progress in the development of treatments to help prevent and control the side effects of cancer therapy.

Why am I so tired? 
 Many people who receive chemotherapy experience fatigue. Fatigue has many causes but frequently occurs because of anemia caused by the chemotherapy. Your daily activities should be planned according to how you feel, and you should take rest periods throughout the day as often as you feel necessary. Anemia can be effectively treated.

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

What tests will be performed?
Your doctor determines what kinds of tests are needed. If you are receiving chemotherapy, you may have blood work done anywhere from the day of or up to 7 days before your scheduled treatment. This blood work will include a complete blood count (CBC) and any necessary cancer markers. A blood sample for a complete blood count (CBC) will also be collected seven to fourteen 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.

How does chemotherapy work?
Chemotherapy kills rapidly-dividing cells in a variety of ways, depending on the drug. Since there are many different types of cancers that all grow differently, many chemotherapy drugs have been developed to target these various growth patterns. Each drug has a different way of working and is effective at a specific time in the life cycle of the cell it targets.

Why does it take so long to get my chemo treatment? 
 The primary consideration for your cancer treatment is accuracy and safety above speed. Remember that your pharmacy and your nursing staff have many built-in safety checks that ensure that the right patient gets the right drug at the right dose at the right time. We also include patient-specific education for every treatment. Most of our medications require special handling, both to protect the sterility of the product for patient safety and to protect the preparer and the facility from the toxicity of the product. There is a lot of care going into the preparation of your chemotherapy treatment behind the scenes.

Will I lose my hair because of my treatment?
Hair loss occurs with some, but not all, chemotherapy drugs. The amount of hair loss varies from a slight thinning to complete baldness and affects the scalp, eyelashes and eyebrows, legs, armpits, and pubic area. Hair loss will typically begin two or three weeks after your first treatment. The amount of hair that you lose will depend on the type of chemotherapy drug you are taking. Hair typically begins to grow back approximately 2-3 weeks after treatment is finished. The hair may grow back differently than it was before treatment. For example color or texture (curly or straight) may be different. Remember that hair loss associated with chemotherapy is temporary and the hair WILL grow back.

Research FAQs

Does insurance pay for care associated with participation in a research study?
Some insurance companies do refuse to pay for care associated with participation in research studies. Medicare has specific rules about what types of studies they will reimburse for. In Missouri there is a statute that requires insurance companies to cover the cost of participating in a clinical trial.  We recommend that you allow our nurses to review your insurance coverage or speak to your insurance carrier regarding any participation in a research study, rather than contacting the insurance carrier yourself.

Aren’t research studies mainly used as a last resort, when there is nothing else?
A large number of our research studies are looking for patients at the time of their initial cancer diagnosis and some studies are for patients later in their cancer journey. It is a myth that research is a last resort.  Participating in a clinical trial is the first step in fighting cancer not the last.  We encourage all of our patients to ask their doctor if there is a clinical trial available.

Why should I participate? 
Participating in a clinical trial allows patients access to the most cutting edge treatments available and ultimately, can lead to developing new standards of care that are safer and more effective. The health of millions has been improved because of advances in science and technology, and the willingness of thousands of individuals like you who are willing to participate in clinical research. Without your help, the research studies at St. Louis Cancer Care, LLP cannot be accomplished. 

What are clinical studies? 
A clinical trial is a research study designed to evaluate potential new treatment options.  They test the safety and effectiveness of new or modified cancer drugs, new drug doses or new indications.  Clinical trials lead to higher standards of care through a process that ensures an acceptable level of safety and demonstrates benefit to helping patients with a specific cancer before becoming commercially available. Some of the research studies at St. Louis Cancer Care, LLP involve promising new treatments that may directly benefit patients.

What is randomization? 
Randomization is a computerized process of determining which treatment option on the clinical trial the volunteer will receive. The treatment chosen is given with the highest level of professional care and expertise, by our staff at St. Louis Cancer Care, LLP. Analyses are done at intervals during a trial, by the scientists that created the study.  This ensures continuous oversight regarding the safety and quality of the trial for the volunteer.

Are there risks involved in participating in clinical research? 
Risks are involved in clinical research, as in routine medical care and activities of daily living. The specific risks associated with any research protocol are described in detail in the consent document, which you are asked to sign before taking part in research. In addition, the major risks of participating in a study will be explained to you by your treating physician and the research nurse.  All of your questions will be answered regarding your participation in the study.

What is placebo? 
Placebos are harmless, inactive substances made to look like the real medicine used in the clinical trial. Placebos allow the investigators to learn whether the medicine being given works better or no better than ordinary treatment. If a placebo is part of a study, you will always be informed in the consent form given to you before you agree to take part in the study. Placebos are never given to replace a known active drug for your cancer.