According to the American Cancer Society, about 231,800 women in the U.S. will be diagnosed with breast cancer this year. News of this diagnosis will start both a physical and emotional journey in these women’s lives. A journey also filled with making many tough decisions.
One of the first decisions is choosing which treatment option is best for you. Your cancer healthcare team will be there to help navigate you through these choices and support you and your family along the way. Your treatment team will likely include more than one doctor as well as other professionals who will play a role in your care.
Now that you and your cancer healthcare team have decided that chemotherapy is the best plan for you, a medical oncologist will lead your care. Your team may also include an oncology infusion nurse, nurse coordinator or case manager, social worker, recreation therapist, psychologist or psychiatrist, and a nutritionist.
Chemotherapy and Your Oncologist
You and your oncologist will work together to decide the next steps of your care. It’s important to build a good relationship with your oncologist. Feeling comfortable with asking questions and sharing your concerns can help ease some of your anxiety and stress as you begin treatment. Here are some questions you might consider asking:
- What should I do to get ready for my treatment?
- Will I need to change my diet or make any other lifestyle changes?
- What is the goal of my chemotherapy?
- What are the chances that chemotherapy will work?
- What happens during the treatment sessions? How long will they take?
- Will my treatment be in a hospital or clinic?
- Can a family member or friend sit with me during chemotherapy?
- Will there be other people getting treatment around me? Or is a private room available?
- How will I feel when I go home after chemotherapy? Will I be able to drive myself home? Will I be able to work the next day?
When talking about your cancer and chemotherapy, your oncologist may use medical words that are hard to understand. If you don’t understand something, ask them to say it again. And if you need more details, say so. It’s also a good idea to take notes or record what your oncologist says. Take a family member or friend with you to help listen and ask questions.
Before you begin treatment, your oncologist will explain how the cancer-killing drugs used for chemotherapy can be given intravenously (through the vein) or as a pill. Most chemotherapy drugs work better when given in combinations of more than one drug. Your oncologist will choose the drugs based on the stage of your cancer. The stage means how much cancer is in your body and where it’s found. Your treatment plan will include the type and amount of drugs you will need and for how long.
The most common drugs used for early breast cancer are anthracyclines (Adriamycin and Ellence) and taxances (Taxol and Taxotere). They’re often combined with other drugs like cyclophosphamide (Cytoxan), fluorouracil and carboplatin. Women with advanced stage breast cancer are often treated with drugs such as docetaxel, paclitaxel, and Capecitabine (Xeloda).
Side Effects of Treatment
Like any drug, chemotherapy can lead to side effects. Side effects are caused by the death of fast-growing cells. Fast-growing cells include the cancer cells as well as healthy cells found in the hair follicles, mouth, and blood.
Breast cancer chemotherapy affects everyone differently. While some have several side effects, you may only have a few. The most common side effects include:
- Hair loss and nail changes
- Loss of appetite or increased appetite
- Mouth sores
- Nausea and vomiting
- Low blood cell count
Chemotherapy can also affect the blood forming cells of the bone marrow, which can cause:
- Higher risk of infections
- Easy bruising or bleeding
Your side effects will depend on the type of drug, the amount you take, and how long you need treatment.
Easing the Symptoms
Your chemotherapy doctor can give you a complete list of possible side effects when you begin treatment. Ask if there’s anything you can do to prepare for these side effects. Also, ask if you can do anything to lower the chances of having them or minimize the severity of these potential side effects.
Let your healthcare team know when you first experience any side effect. There may be ways to help you feel better. For example, prescription medications, called anti-emetics, can prevent nausea and vomiting. Other ways to prevent nausea include:
- Eat several small meals during the day rather than three big ones.
- Pass on foods that are sweet, spicy, fried, or fatty.
- Drink plenty of fluids. Unsweetened fruit juices, tea, or flat ginger tea are good choices.
- Avoid strong, unpleasant smells.
Feeling really tired during treatment is also expected. But there are many reasons you may be feeling this way. It could be due to the chemotherapy drugs, the emotional toll of having cancer, as well as a condition called anemia. Anemia causes the levels of your red blood cells to drop. Red blood cells carry oxygen from the lungs to the muscles and other tissues in your body. They help give you energy.
A blood test can be done to check for anemia. Prescription drugs can help if your red blood cell count is low. Resting or taking short naps during the day can be helpful. Don’t hesitate to ask family or friends for help when you need.
The side effects of chemotherapy usually go away after treatment. But new side effects, called late effects, sometimes appear post-treatment. Ask your doctor if you’re at risk for late effects and what symptoms you should watch for.
Is the Chemotherapy Working?
Chemotherapy is given in cycles. A treatment period is followed by a period of rest to give the body time to recover and build healthy new cells. Most cycles are two or three weeks long. For example, you may get chemo the first two weeks and then have a week off, making it a three-week cycle that starts again after your rest period. Depending on the drugs that are used, your total treatment schedule may take three to six months.
Your treatment team will do certain tests to check how well the chemotherapy is working. They may refer to this as “re-staging.” These tests may include physical exams, blood tests, x-rays, scans, and bone marrow biopsies.
How your body responds to treatment will determine how many cycles you’ll need. Your oncologist will explain the test results and what they show about your health. Discuss with them about happens next if tests show the chemotherapy isn’t working. Often, different treatment drugs will be used and another cycle of chemotherapy will be started.
Clinical Trials: Are they right for you?
While talking with your treatment team about your treatment, you may learn of a clinical trial being done for your type of cancer. Clinical trials are research studies that use patient volunteers to examine a new treatment or procedure.
If you think you may want to be part of a clinical trial, ask your oncologist if there’s one at your treatment center. You can also research open clinical trials online. Be aware that clinical trials aren’t available for everyone. Every trial has guidelines for who can join. These guidelines are called “eligibility criteria” and include your type of cancer, age, medical history, and your current health. If you are a candidate for a clinical trial, you will likely meet with a clinical trial coordinator or a research nurse and review a detailed consent.
Even if you do qualify, you may not be given the new treatment being studied. Patients are divided into groups by chance. This process is known as being “randomized.” One group receives the new treatment and the other group receives the standard treatment being used today. The doctors involved with the trial then compare how each group’s cancer responds to their treatment.
Joining a clinical trial has several benefits. You may have access to a promising, new cancer therapy. You may also help others with cancer. But clinical trials also have risks. The new treatment being studied may not help your condition. Being part of a trial can also require extra doctor visits, lab tests, and imaging tests. Check to see what medical expenses are included with the trial and whether the trial sponsor or your health plan will cover them.
Paying for Chemotherapy
Cancer treatment is costly. According to a recent National Cancer Institute (NCI) study, breast cancer care in the U.S. topped $16.5 billion in 2010 alone, and expenses have steadily increased since then. NCI also reported that breast cancer patients pay an average of about $23,000 a year for treatment. Even with health insurance, patients’ deductibles, co-pays, prescriptions, and other expenses can quickly add up.
Facing these financial costs can be stressful and even frightening for families. But there may be ways to lower the cost of your care. Talk to your healthcare team about how much your treatment is going to cost. Your healthcare facility may offer a financial counselor that can discuss specific treatment costs and financial responsibilities. Your oncology social worker can help you plan a budget, understand your health insurance coverage, and find additional financial support from other organizations. Financial aid is also available for patients without health coverage.
Several cancer organizations offer patients and their families resources for affording the costs of treatment and additional care. The American Cancer Society, for example, provides an online resource that lists ways to manage the expenses of medication, transportation, lodging costs away from home, and additional care.
Some of these resources include:
- Private health insurance. The Affordable Care Act requires that all health plans sold in the new insurance marketplace cover the costs of cancer screening, treatment, and follow-up care. But health insurance plans vary on how much they pay for medical services and prescription medications. Contact your plans Member Services department to find out what’s covered and to get help calculating your monthly out-of-pocket costs.
- Pharmaceutical companies. Many drug companies offer support to help patients manage the cost of their cancer prescriptions. Check the website of the drug’s maker to see if a patient drug assistance program is available. Each company has its own set of requirements for who qualifies for help.
- Medicare and Medicaid. Eligibility for these government health programs is different for each state. Contact your state office to see if you qualify.
- BenefitsCheckUp. The National Council on the Aging connects patients 55 or older with programs that help pay for medicine, health care, and other needs.
- Road To Recovery. The American Cancer Society’s program coordinates a network of volunteers who provide transportation for cancer patients who need a ride to treatment.
Remember, the members of your healthcare team are your partners to help face any challenges during and after treatment. Whether your needs are physical, emotional, or financial, you’re not alone.