Chemotherapy

1. What is chemotherapy?
2. When is chemotherapy used?
3. Chemotherapy drugs
4. Benefits of chemotherapy
5. Side effects of chemotherapy
6. How long does treatment take?
7. How chemotherapy is given
8. Starting chemotherapy
9. Things to be aware of during treatment

1. What is chemotherapy?

Chemotherapy is a treatment that uses anti-cancer drugs to destroy cancer cells. It works by interfering with the cancer cells’ ability to divide and grow.

Different chemotherapy drugs work in different ways and a combination of drugs is often used.

Chemotherapy affects cells throughout the body and can cause side effects.Back to top


2. When is chemotherapy used?

After surgery

Chemotherapy is given after surgery for primary breast cancer to reduce the risk of cancer coming back in the future. When used after surgery, it’s known as adjuvant chemotherapy.

Before surgery

Chemotherapy may be given before surgery to slow the growth of rapidly growing breast cancer. Or it might be given to shrink a larger breast cancer before surgery (this may mean breast-conserving surgery is an option, rather than a mastectomy).

People with certain types of breast cancer, such as triple negative or inflammatory breast cancer, or whose breast cancer is HER2 positive, may be more likely to have chemotherapy before surgery.

Chemotherapy given before surgery is called primary or neo-adjuvant chemotherapy.

Secondary breast cancer

Chemotherapy can be given to people with secondary breast cancer, when breast cancer cells have spread to another part of the body.

Chemotherapy can shrink or slow the growth of secondary breast cancer. It can also help reduce some symptoms. Back to top


3. Chemotherapy drugs

Find out about the drugs used for chemotherapy.

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4. Benefits of chemotherapy

The benefit of chemotherapy might be clear for some people but less clear in other cases.

Your cancer specialist may use an online program to help estimate the benefit you might expect to get from chemotherapy. They may be able to show you a graph of this information, or explain the benefit as a percentage.

Genomic assays (also called gene expression profiling or gene assays)

When the benefit of chemotherapy is less certain your specialist team may suggest a test called a genomic assay.

These tests look at groups of genes found in the breast cancer. They help identify who is most likely to benefit from chemotherapy and how likely the cancer is to return (recurrence). 

The tests are carried out on breast tissue removed during surgery, usually in a laboratory away from your hospital. Genomic assays are not suitable for everyone and sometimes don’t provide a clear answer. You can ask your specialist team whether this type of test would be suitable for you. Not all of the tests are available on the NHS.

Examples of genomic assay tests include the following.

Oncotype DX

This test predicts how likely the cancer is to return and the likely benefit of having chemotherapy. The result, called the recurrence score, is reported as a number between 0 and 100. The higher the score, the greater the risk of recurrence of an invasive breast cancer, and the more likely it is chemotherapy will be recommended.

EndoPredict

This test predicts how likely the cancer is to spread within ten years. The result, called the EPclin score, is reported as high risk or low risk. 

Prosigna Breast Cancer Prognostic Gene Signature Assay

This test predicts how likely the cancer is to spread within ten years. The result is reported as low, intermediate or high risk.

Making decisions

You may be asked to decide if you want to have chemotherapy. The decision is a personal one and you’ll need to weigh up the likely benefits against the potential side effects.

You can talk it through with your cancer specialist or breast care nurse, who can answer your questions and support you with your decision. You can also call us on 0808 800 6000 to talk about your options.Back to top


5. Side effects of chemotherapy

Find out about the side effects of chemotherapy.

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6. How long does treatment take?

Unless you’re having chemotherapy as tablets, you’ll normally be given your treatment at hospital as an outpatient or day case, which means you’ll be able to go home on the same day. With some types of chemotherapy you may be given your first treatment as an inpatient and will need to stay in hospital overnight.

You may be at the hospital for a short time only. However, because of tests, waiting times and how long it takes to prepare and give the chemotherapy drugs, some people are there for most of the day.

You might find it helpful to take things to help pass the time as well as snacks and drinks. You could ask someone to go with you to keep you company.

Cycles and regimes

Chemotherapy is commonly given as a series of treatments with a break between each treatment to give your body time to recover from any short-term side effects. The treatment and period of time before the next one starts is called a cycle.

You may have treatment weekly or every two or three weeks.

You may have one drug or a combination of two or three drugs. The exact type and dose of chemotherapy will be tailored to your individual situation. The drugs used, the dose, how often they’re given and the number of cycles may be called your chemotherapy regime or regimen.

Dose-dense chemotherapy

Dose-dense chemotherapy is being trialled and is not standard treatment. Dose-dense chemotherapy means the drugs are given with less time between treatments than in a standard treatment plan, although the same total dose of chemotherapy is given.Back to top


7. How chemotherapy is given

For breast cancer chemotherapy drugs are most commonly given:

  • into a vein (intravenously)
  • by mouth as tablets or capsules (orally)

Intravenous chemotherapy

There are various ways that intravenous chemotherapy can be given depending on factors such as how easy it is for chemotherapy staff to find suitable veins and your preferences.

Cannula

The most common way of giving chemotherapy involves inserting a small needle and plastic tube called a cannula into a vein, either in the back of the hand or lower arm. The needle is removed and the plastic tube left in place.

The diluted drugs are slowly injected into the vein. If a large volume of fluid is used it can be given as an infusion (drip) through the cannula over a fixed period of time.

The cannula is taken out after you have had the drugs and a new one is inserted before each cycle of chemotherapy.

Chemotherapy is usually given into a vein in the arm on the opposite side to where you had your surgery, as this may help reduce the risk of lymphoedema developing (swelling of the arm, hand or breast area caused by a build-up of lymph fluid). But if this isn’t possible the arm on the same side as your surgery may be used. This is also the case if you have had surgery on both sides. 

If you have lymphoedema the cannula will be placed in the arm on the opposite side to where you had surgery.

Other intravenous devices

Although a cannula is the most common way of giving chemotherapy, a central venous access device is sometimes used instead. This stays in place throughout the course of the treatment and the chemotherapy is given through it.

Various types of central venous access device are described below.

Skin-tunnelled catheter (Hickman or Groshong line)

A skin-tunnelled catheter is a fine silicone tube that’s inserted into a vein through a small cut in the chest.

It can stay in place for several months, which means you don’t need to have a cannula put into the vein each time you’re given the chemotherapy drugs. Blood samples can also be taken from the catheter.

The catheter is usually put in under a local anaesthetic but a general anaesthetic can be used if necessary.

Your chemotherapy nurse will explain how to take care of your catheter to minimise the risk of infection. After you’ve completed all your treatment the catheter will be removed under local anaesthetic.

Peripherally inserted central catheter (PICC)

A PICC is inserted into a vein in your arm, at or above the bend in your elbow, and extends into the large vein leading to your heart. It stays in place until your whole course of treatment is finished. It’s usually put in under local anaesthetic. Blood samples can also be taken from this device.

While you have a PICC it will be covered by a dressing and you’ll be given instructions on how to care for and change this. When it’s no longer needed, the PICC will be removed by a nurse or doctor.

Implanted port                                

An implanted port is a small device connected to a thin tube (catheter). It’s put under the skin, usually in the chest or arm. The other end of the tube goes into a large vein just above the heart. The port is hidden but can be felt under the skin.

An implanted port is usually put in using a local anaesthetic.

Chemotherapy drugs are given directly into the port by puncturing it each time with a special needle. It can also be used to take blood samples.

When it needs to be removed a small cut is made over the site of the port using local aneasthetic. The port is then removed and the catheter is taken out of the vein. The wound is stitched and covered with a dressing.

Blood clots

If you have a Hickman, Groshong or PICC line, it’s possible for a blood clot to form in your vein at the end of the line. You may be given medication to help prevent this from happening.

Contact your hospital doctor or nurse immediately if you have any of the following symptoms:

  • swelling, redness or tenderness in the arm, chest area or up into the neck
  • shortness of breath
  • tightness in your chest

If a blood clot forms, you’ll be given medication to dissolve it. Your line may need to be removed.

Oral chemotherapy

Oral chemotherapy is taken by mouth, either as tablets or capsules, usually at home.

The hospital pharmacist or chemotherapy nurse will give you instructions on how to handle and store the chemotherapy. They’ll also tell you when to take it, and you’ll be given other written instructions such as whether or not to take it with food.

If you can’t take your medicines for any reason or if you vomit after taking your tablets, contact your treatment team immediately.

The drugs you’re given by the hospital make up a complete course of treatment, and it’s important to take them exactly as they’ve been prescribed. Always read the labels on the boxes before you leave the hospital – if the instructions are unclear, ask your nurse or doctor before taking any of the drugs.

Electrochemotherapy

Electrochemotherapy, sometimes called ECT, is a treatment for breast cancer that has spread to the skin. Electrochemotherapy is a relatively new treatment and is not available everywhere.Back to top


8. Starting chemotherapy 

It’s common to feel anxious or frightened about having chemotherapy. Not knowing what to expect can be very distressing.

Many people worry about the side effects they might get. But most side effects can be controlled. You should be told what side effects to report as well as details of who to contact, day or night, if you have any concerns or are unwell.

Your chemotherapy team and breast care nurse can help with any questions you have. You can also call us free on 0808 800 6000 for information and support.

On our online Forum, you can find people going through treatment at the same time as you on the chemotherapy monthly threads.

You can also speak to someone who has had chemotherapy through our Someone Like Me service.

Before you start

Many hospitals will arrange a chemotherapy information session. A nurse will discuss how and when your chemotherapy will be given and how side effects can be managed. You may have extra blood tests and some people might be given an ECG (electrocardiogram), a simple test that checks your heart rhythm. Your height and weight will also be measured.

You should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.

You will usually be asked to sign a consent form before you start chemotherapy. The benefits and risks of the treatment should be explained before you sign.

You’ll usually be given anti-sickness drugs before each chemotherapy treatment. The drugs you’re given will depend on the type of chemotherapy you’re having, but will often include a steroid drug called dexamethasone as well as other anti-sickness medication.

Shortly before each cycle of treatment, and sometimes in between, you’ll have a blood test. This is because if the number of blood cells in the body is too low, treatment may need to be delayed.Back to top


9. Things to be aware of during treatment

Sex, contraception and pregnancy

It’s thought that chemotherapy drugs can’t pass into vaginal fluids or semen, but this can’t be completely ruled.

For the first few days after chemotherapy, you may want to avoid unprotected intercourse, oral sex, or any contact that involves sharing body fluids to make sure your partner isn’t exposed to the chemotherapy drugs. Most hospital specialists advise using barrier protection such as condoms for a few days after treatment.

If you haven’t been through the menopause, it’s important to use contraception because chemotherapy drugs can harm a developing foetus in the first three months of pregnancy. It’s still possible to become pregnant even if your periods become irregular or stop completely.

Your specialist will usually recommend barrier methods of contraception, such as condoms. The contraceptive pill is not usually recommended because it contains hormones. Emergency contraception such as the morning after pill can still be used.

An interuterine device (IUD or coil) can be used as long as it’s not the type that releases hormones. If you have a coil in place that does release hormones, such as the Mirena or Jaydess, when you’re diagnosed, you’ll probably be advised to have this removed.

Find out more about sex and intimacy.

Complementary therapies

Check with your specialist team or GP before having any complementary therapies, and mention your breast cancer and treatment to any therapist you see. Doctors may advise avoiding some therapies (particularly herbal remedies) if there’s a chance they could affect how your breast cancer treatment works.

Some therapies are available in NHS hospitals.

Diet and supplements

You may be able to eat normally throughout chemotherapy or your eating habits may change because of side effects. It’s important to eat and drink what you feel able to, maintaining a healthy, well-balanced diet wherever possible.

Find out more about diet during treatment

Tell your specialist about any vitamin and mineral supplements you take or would like to start taking.

The evidence is conflicting about how safe it is to take vitamin supplements, particularly high-dose antioxidants (including vitamins A, C and E, Co-enzyme Q10 and selenium), during chemotherapy.

Some studies suggest they might make the chemotherapy less effective, while other studies point towards them helping reduce chemotherapy side effects. Because the safety evidence is not clear many specialists recommend not taking high-dose antioxidant supplements during chemotherapy.

Talk to your specialist about any herbal remedies or supplements you’re taking or thinking of taking.

Travel

If you’re planning a holiday or need to travel overseas, check with your specialist first.

Going abroad may not always be advisable, particularly if you have side effects or are going to a country where you’ll need live vaccine injections.

If you’re going somewhere hot, don’t stay in the sun for long periods as your skin can burn more easily when the chemotherapy drugs are still affecting your system.

Read our tips for travelling with breast cancer.

Vaccinations

You shouldn’t have any live vaccines while you’re having chemotherapy. Live vaccines include measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.

Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.

It’s safe to have these vaccines six months after your chemotherapy finishes. Talk to your GP or specialist before having any vaccinations.

If someone you live with needs to have a live vaccine speak to your specialist or GP. They can advise what precautions you may need to take depending on the vaccination.

Flu vaccination

Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have or already having chemotherapy.

The flu vaccine is not a live vaccine so doesn’t contain any active viruses. If you’re already having chemotherapy, talk to your chemotherapy specialist or breast care nurse about the best time to have your flu jab.Back to top


Last reviewed: February 2018
Next planned review begins 2020