Chemotherapy and drug therapies

What does drug treatment for cancer mean?

In drug treatment, the medicine enters the body into a vein, by mouth or as an injection, and travels in the blood. Unlike surgery and radiotherapy, which treat one area, these medicines act throughout the body. For this reason they can target cancer cells in different places, but their side effects may also be in different parts of the body.

The four main groups:

Chemotherapy

Medicines that target cells that grow and divide quickly. Because healthy fast-dividing cells (such as hair, the mouth and bone marrow) are affected too, side effects occur. The aim of chemotherapy can be to treat the cancer, lower the chance of it coming back, slow its growth or ease symptoms.

How is it given? Mostly through a vein (a drip). Sometimes it is by mouth or by injection. It is often given through a catheter or port in a large vein of the chest or arm. It is usually given in courses (cycles): a few days of medicine and then a few weeks of rest so the body can rebuild. For example, one week of treatment and three weeks of rest make a four-week cycle. Several medicines may be given together, and sometimes chemotherapy is used before surgery (to shrink the tumour) or after it (to destroy remaining cells).

The choice of medicines depends on the type and stage of the cancer, whether you have had chemotherapy before and your other illnesses, such as diabetes and heart disease.

Hormone therapy

For cancers that grow with hormones, such as some breast and prostate cancers. This treatment either stops the making of the hormone or stops its effect. Its forms are tablets, injections and, in some cases, removal of the glands that make the hormone. Part of it can be taken at home.

Side effects may include hot flushes, vaginal dryness, changes in periods in women who have not yet reached menopause, mood changes, lower sex drive, nausea and tiredness. Their severity and type differ with the patient and the medicine. Ask your doctor how long treatment will last.

Targeted therapy

Medicines that target specific proteins that help a cancer cell grow and spread. There are two common types: small-molecule medicines (often tablets or capsules) and monoclonal antibodies (made in a laboratory, attaching to the target). Most of the time a biomarker test has to be done on a sample of the tumour to show whether the target is present in your tumour. For some cancers, such as chronic myeloid leukaemia, this target is almost always present.

More common side effects: diarrhoea and liver problems, high blood pressure, tiredness, mouth sores, nail changes and skin rashes or dryness. Some side effects can be prevented or treated with medicine. In some patients the cancer cell becomes resistant over time.

Immunotherapy

Treatment that helps the body’s immune system act against cancer. Its types include immune checkpoint inhibitors, monoclonal antibodies, treatment vaccines and cell transfer therapy (such as CAR T cell therapy in some blood diseases). It is mostly given through a vein and sometimes by mouth or on the skin.

Because an activated immune system may attack healthy tissues too, side effects may include diarrhoea, skin rashes, flu-like symptoms and inflammation of organs. Sources say some types of immunotherapy may cause severe allergic and inflammatory reactions, although these reactions are rare. Doctors and nurses cannot tell in advance which side effect will come, when, or how severe it will be. So tell the team about every new change, and report new diarrhoea, a rash or shortness of breath right now.

Who uses drug treatment?

Any patient whom the doctor judges suitable for it on the basis of the type and stage of the disease, tests of the tumour and general health. Some patients get only one type and some a combination of several. The decision is made for each patient separately.

Before and during treatment

• A blood test before every course: counts of white cells, red cells and platelets. The doctor adjusts the plan on the result.
• Regular visits to check side effects and the response to treatment, with tests and scans
• Ask the team for a number that is answered at night too. If there is no such number, ask which emergency department to go to at night. The fever guidance is on the page “When should I call for urgent help?”
• Give the doctor a list of all your medicines, supplements and herbs

Common side effects and what to do

The most common side effect of chemotherapy is tiredness. Other side effects depend on the medicine: nausea and vomiting, mouth sores, hair loss (which is usually temporary), low white cells and a higher risk of infection, anaemia, easy bruising and bleeding, constipation or diarrhoea, tingling in the hands and feet, trouble concentrating, clots and an effect on fertility. Many side effects get better after treatment ends.

There are measures for each. See the page “Common side effects at home”. The most important rule: tell the team about every side effect. Do not start or stop a medicine or supplement on your own.

Low white cells and fever

The lowest white cell count usually comes 7 to 12 days after each course of medicine and can last as long as a week. A fever at any point in treatment is an emergency, not only on these days. During this time infection can become serious fast. A fever of 38 degrees or higher during chemotherapy is an emergency. Tell the treatment team at once, and do not take a fever reducer before calling.

When should you get urgent help?

• A fever of 38 degrees or higher: this is an emergency. Tell the treatment team at once.
• Sudden shortness of breath, new or severe chest pain (sharp or pressing), coughing up blood: call 115 (the emergency number inside Iran).
• Bleeding that does not stop: call 115.
• Pain, swelling and warmth in one arm or leg: it may be a clot. Tell the team right now.
• Severe vomiting or diarrhoea and signs of dehydration (dizziness, weakness, confusion): tell the team right now.
• In immunotherapy: new diarrhoea, rash, shortness of breath: tell the team right now.

The full list is on the page “When should I call for urgent help?” The type of treatment, dose, number of courses and length are decided only by your treating doctor, taking account of your situation.