What to Expect with Chemotherapy

Just as there are different goals of chemotherapy, there are also different methods of administering chemo drugs.

Oral

Some chemotherapy drugs are available in pill, capsule, or liquid form that you take at home.

Not having to go in for infusions is an advantage, but oral chemotherapy requires strict precautions and adherence to your treatment plan.

Topical

Certain skin cancers can be treated with topical chemotherapy in the form of gels, creams, or ointments. These are powerful drugs, so you’ll need to take special safety measures.

Intravenous

Many chemotherapy drugs are given intravenously. For an IV infusion, a catheter is placed in a vein. The drug slowly drips from a plastic bag, through a tube, and into the catheter where it enters the bloodstream.

When a drug needs to get into the bloodstream quickly, it’s injected directly into the catheter. This is called an IV push. When a slower speed is necessary, the infusion is controlled by a pump you carry with you. That’s called a continuous infusion.

Chemo infusions and injections can also be administered other ways, including:

• into muscles or skin
• into spinal fluid, arteries, or organs
• directly into a tumor

Unless your oncology team says otherwise, you should block out several hours for a chemotherapy infusion.

Before the infusion can begin, a few other things must happen. First, your oncology nurse will check your vital signs, blood, and ask how you’re feeling. Some appointments will involve meeting with your oncologist.

Many chemotherapy drugs must be mixed just prior to use, so you might have a short wait.

How long a single infusion lasts depends on:

• the type of cancer and other health conditions
• the specific drug or combination of drugs
• the overall treatment plan

In general, it takes a few minutes for an IV push, while an IV infusion can take 30 minutes to several hours or more. A continuous infusion can last 1 to 3 days.

In some cases, especially when you’re getting a drug for the first time, you may need to stay a little longer for observation. You’ll be monitored to make sure you don’t have any serious side effects.

Chemotherapy usually takes more than one treatment and is typically given in cycles. Your oncologist will base this plan on:

• the type and stage of cancer
• the goal of treatment
• which drugs are being used

A dose takes a few minutes to a few days. It’s also called a “round” of treatment.

Once your infusion is done, it’s followed by a rest period to allow your body to recover from the chemo drugs. This rest period is typically 2 to 3 weeks, but it can be shorter or longer. A new cycle begins with your next infusion.

Your oncologist will plan for you to have a set number of cycles. For example, your plan might call for 4 infusions with one chemo drug at 2-week intervals, followed by 3 infusions with a different drug combination at 1-week intervals. Chemotherapy would last about 4 months in this case.

A lot depends on how your body responds to the chemotherapy drugs. A blood test before each treatment will show if your white blood cell count or platelet count is low. If so, it’s typically not safe to get more chemo. Your next treatment may be delayed by a week or two. If chemo dose adjustments are needed, that could also affect the number of cycles.

Chemo is sometimes used to shrink a tumor before surgery. How long that takes involves many factors, such as:

• the type of cancer, which is where the cancer cells originated
• the stage, including how far the cancer cells have progressed
• the tumor grade, which indicates how abnormal the cancer cells are; the higher the grade, the faster the cells grow and spread

It’s best to go in with the understanding that the timetable is subject to change.

Chemo drugs generally stay in your body for a few hours to a few days.

Most chemotherapy drugs are broken down by your liver and kidneys. The drug is excreted with urine, stool, and sweat. How long it takes to leave your body depends on:

• the specific drug
• your kidney and liver health
• other medications in your system
• your age

If your treatment plan calls for lengthy chemotherapy treatment, your oncologist may recommend a central venous catheter, or chemo port.

This device is implanted into a large vein, typically in your upper chest, during minor outpatient surgery. The port allows for easier access to your veins so you won’t have to deal with repeated needle sticks each time you have chemotherapy.

During each treatment, the IV with the chemo drugs will be inserted directly into your port. The port can also be used for blood tests and other medications.

Before your first chemo infusion, the treatment center will provide you with specifics about what to expect.

It’s important to arrange for transportation because you might not feel up to driving after treatment. Some clinics allow you to bring someone to sit with you during treatment. It’s up to you if you want someone with you, or if you’d prefer to be alone during your infusion.

Since you might be in treatment for several hours, it’s best to eat first unless your doctor says otherwise. Some infusion centers provide snacks and drinks. Some have refrigerators and microwaves so you can bring your own snacks.

Prepare a “go bag” for chemo treatment and include anything that will help you feel comfortable and pass the time. Some items you may want to take with you include:

• a water bottle and snacks
• books or magazines
• electronic devices and headphones
• a cozy blanket and socks
• a warm hat

After your first infusion, you’ll have a better idea of what items were helpful and if there are other things you want to take along for your next infusion.

A few things must happen before your first infusion can begin, such as:

• blood tests
• a check of vital signs
• a review of symptoms and side effects
• ordering and mixing the medication

If you have a chemo port, it’ll be flushed out. If you don’t have a port, a catheter will be inserted into a large vein, typically in your arm. Chemo drugs and medications given with chemo can cause immediate symptoms such as:

• a stinging sensation at the point of entry
• sleepiness
• metallic taste

If your infusion is expected to last an hour or longer, you’ll likely be offered a reclining chair. It’s OK to close your eyes and shut out the world during treatment. Lots of people nap right through it. You can pass the time with conversation, reading, or working on your laptop.

You’ll be able to get up and use the bathroom as needed during your infusion.

Some people feel the effects of chemo right away, but for others, it takes a day or two. Not all chemo drugs have the same side effects. For example, they don’t all cause hair loss.

Side effects do tend to increase with each cycle and may include:

• fatigue
• nausea
• altered taste and smell
• lack of appetite, weight loss
• diarrhea or constipation
• changes to nails and skin, such as a rash
• bruising, bleeding
• mouth sores
• nerve damage (neuropathy)
• mood changes
• brain fog (chemo brain)
• changes in sex drive

Keep your oncology team in the loop. Many side effects are treatable and some may signal serious complications.

Your oncology team is your best source of information. You might also find it helpful to download these free booklets about chemotherapy:

Chemotherapy is an effective treatment for many types of cancer. When it comes to which drugs you’ll get and what side effects you’ll have, many variables come into play. Your experience with chemo may be very different than someone else’s.

Chemo is given in cycles, with a typical infusion time of several hours, although it can be a day or longer in some cases. How long you’ll need chemotherapy depends on your treatment goals and how your body responds. Your treatment plan may need to be adjusted along the way.

Before starting chemotherapy, your oncology team will give you an overview of what to expect. These healthcare professionals are trained to answer all your questions and help you understand your treatment. No question is too minor, so don’t hesitate to ask them anything about your treatment or your diagnosis.