Cancer Chemotherapy in Delhi, India

Once the cancer is diagnosed, it can be treated depending upon the stages. The cancer is generally rated with Roman numerals. If the number is higher; more serious is the nature of cancer. In some cases, doctors perform only one treatment, while in advanced stages, a combination of treatments is required. There are different types of cancer treatments and basis of diagnosis, the doctor might advise:

• Surgery: In this procedure, the doctor removes the cancerous tumor or tissues or organs from the body.
  
• Chemotherapy: Chemotherapy is a type of a therapy that helps in cancer treatment. In this process the drugs are used to kill cancer cells or keep these cells away from spreading or shrink the tumor. Chemotherapy can also be used in combination with surgery, radiation therapy and targeted therapy to destroy cancer cells. Chemotherapy treatment can be given in certain ways which may include injections, intra-arterial (drugs go directly into the artery), intravenous (drugs go into a vein), oral (drugs given with pills or liquid) and topical (rubbing cream onto the patient’s skin).
  
• Radiation Therapy: In this procedure, high doses of radiation are given to kill cancer cells and shrink tumor.
  
• Targeted Therapy: In this therapy drugs are used to treat cancer. However, in this case, the drugs are given to target caner’s specific genes, proteins or tissues that contribute to cancer growth and survival.
  

Max Healthcare is counted among the leading hospitals in India and is known for offering world-class healthcare services with extremely advanced equipment with the upgraded technology that help to diagnose and find a constructive cure for every disease and problem.

Max Institute of Cancer Care offers a state-of-the-art facility for cancer chemotherapy treatment in India. Max Healthcare provides wholesome care for patients with experts advise in Surgical Oncology, Radiation Oncology, and Medical Oncology. The facility is rated as the number one in Northern India to feature Novalis Tx for IMRT/IGRT, Radiosurgery, HIPEC and SRS/SRT.

Max super speciality hospital provides best cancer chemotherapy treatment in Delhi and one can visit different centres including Saket, Patparganj, Shalimar Bagh and Vaishali for specialised treatments in Breast, Head and Neck, Lung, Gastrointestinal and other cancers. 

Chemotherapy may be given in different ways, depending on the type of cancer you have and the chemotherapy drugs used.

1. Most often chemotherapy is given by injection into a vein (intravenously). This is known as intravenous chemotherapy.
2. Some drugs are given as tablets or capsules (oral chemotherapy).
3. Some are injected into a muscle (intramuscular injection).
4. Others may be injected just under the skin (subcutaneous injection).

Drugs given in the above ways are absorbed into the blood and carried around the body so they can reach all the cancer cells. For some types of cancer, chemotherapy may be injected into the fluid around the spine. This is known as intrathecal chemotherapy. Sometimes the chemotherapy may be injected into particular body cavities such as the pelvic cavity or bladder: this is known as intracavity chemotherapy.

Drugs given in this way tend to stay in the area in which they are given and do not affect cells in other parts of the body. Chemotherapy creams may be used for some cancers of the skin: they only affect the cells in the area of skin to which the cream is applied.

Intravenous Chemotherapy through Cannula

The nurse or doctor will put a short, thin tube (cannula) into a vein in the back of your hand or your forearm. You may find this a bit uncomfortable or painful, but it should not take long and the pain soon wears off. If you find it painful to have the cannula put in, an anesthetic cream can be used on the skin to numb the area beforehand. The cream takes 10–20 minutes to work.

Once the cannula has been put in, it will be taped securely to keep it in place. A clear bag of fluid (a drip) is then attached to the cannula by a tube. Some chemotherapy drugs are given by injection into a rubber bung in the tubing of the drip. This can take from a few minutes to about 20 minutes.

Some drugs will be given directly in the drip bag (by infusion). This can take from 20 minutes to several hours, or sometimes days. If you feel any discomfort or notice a change in sensation, redness or swelling around the area of the cannula (or along your arm) while the drug is being given, let your nurse or doctor know immediately.

Intravenous Chemotherapy through Central Lines (Tunnelled Central Venous Catheters)

A central line is a long, thin plastic tube put into a vein in your chest. Hickman®* or Groshong®* lines are common types. The doctor or chemotherapy nurse will explain the procedure to you. You will be given a general or local anesthetic before the central line is put in.

Once it is in place, the central line is either stitched or taped firmly to your chest to prevent it being pulled out of the vein.

There is a small ‘cuff’ around the line which can be felt just under the skin. The cuff holds the line safely in place. A central line can stay in the vein for many months and means that you do not have to have cannulas put in when you have your intravenous chemotherapy. Blood can also be taken from it for testing.

You will be able to bathe or shower; although you should prevent water from getting to the area where the tube enters the skin – a plastic dressing can be used for this. Before you go home, make sure you are confident about looking after your central line. If you have any problems, contact the staff in the chemotherapy clinic or on the ward for advice.

Possible problems with central lines: Two potential problems with central lines are blockage and infection. Once or twice a week the line has to be flushed with saline (salt water), or heparin – a drug which prevents clotting. The nurses on the ward can teach you how to do this, or can arrange for a district nurse to visit your home and do it for you. Your doctor may also prescribe a low dose of warfarin, a drug to help prevent blood clots forming and blocking your line.

If you notice any swelling in your arm or neck, contact the hospital staff as your line may be blocked. If you notice any reddening, darkening or soreness of the skin around the central line, or if you have a high temperature, let your doctor know, as it could be a sign that you have an infection in the line. If this happens you will need to have antibiotics through the line to clear the infection.

Most hospitals consider a temperature above 38ºC (100.5ºF) to be high, but some hospitals use a lower or higher temperature. The doctors and nurses at your hospital will tell you which temperature they use.

Removing Your Central Line

When you no longer need the central line, it will be taken out. A doctor or nurse will do this for you, usually in the out patients department. Your chest will be cleaned with antiseptic, and the line will be gently but firmly pulled until it loosens and comes free. This does not usually take more than a few minutes, but can be uncomfortable. Sometimes a small cut in the skin is needed so that the cuff can be loosened. This is done under a local anesthetic. A dressing will be put over the area where the line has been removed, and you will be asked to remain lying down until it is certain that there is no bleeding.

Intravenous Chemotherapy Through PICC Lines

Your doctor may suggest that you have a long, thin tube put into a vein in the crook of your arm. This is called a peripherally inserted central venous catheter (PICC). Your doctor or chemotherapy nurse will explain the procedure to you. You will be given a local anesthetic before the line is put in.

Once it is in place, the PICC line is taped firmly to your arm to prevent it being pulled out of the vein. It can stay in the vein for many months. As with the central line, it means that you do not have to have cannulas put in when you have your intravenous chemotherapy. Blood can also be taken through the line for testing.

You will be able to bend your arm, bathe and shower, although you should avoid getting water on the area around the tube − a plastic dressing can be used for this. Before you go home, make sure that you are confident about looking after your line. A nurse can flush your line and change the dressing, or a friend or relative can be taught to do this for you. If you have any problems, contact the staff in the chemotherapy clinic or on the ward for advice.

The possible problems are the same as for central lines: blockage and infection.

Intravenous Chemotherapy Through Implantable Ports (Portacaths)

An implantable port is a thin, soft plastic tube that is put into a vein and ends in an opening (port) just under the skin on your chest or arm. The port has a thin rubber disc through which special needles can be passed to give medicines into the vein or take blood.

The tube is a long, thin hollow tube known as a catheter and the port is a disc about 2.5 to 4 cm in diameter. The catheter is usually inserted (tunneled) under the skin of your chest. The tip of the catheter lies in a large vein just above your heart and the other end connects with the port which sits under the skin on your upper chest. A small bump can be seen and felt underneath the skin, but nothing shows on the outside of your body.

The possible problems are the same as for central lines: blockage and infection.

Intravenous Chemotherapy Through Infusion Pumps

Infusion pumps may be used to give some types of chemotherapy. There are various types of portable pump. These give a controlled amount of chemotherapy into the bloodstream over a period of time (from a few days to a few weeks). The pump is connected to a central line or a PICC line. This means that you can go home with the pump and so you need fewer visits to hospital. The pumps are small enough to fit into a pocket and can be carried in a bag or belt holster.

The chemotherapy drugs are prepared at the hospital. You, and perhaps a family member or friend, will be taught how to look after the pump. Some pumps are battery-operated and care has to be taken not to get them wet when you are washing. Your nurses or pharmacy staff will give you full instructions and should also tell you who to contact if you have any problems or questions. Some pumps are disposable and are operated by a balloon mechanism or spring control.

Extravasation

Drugs given intravenously can occasionally leak into the tissues. This is called extravasation. It usually happens when a cannula dislodges and so is not positioned in the vein correctly. It very rarely happens with a central line.

If you notice any swelling, pain, stinging or redness when you are having your chemotherapy treatment, or after you get home, it is important to contact the hospital straight away. Some chemotherapy drugs can damage the tissues, so the sooner any extravasation is dealt with, the better. 

You may be given chemotherapy tablets or capsules to take at home as all or part of your treatment. You will be told when to take them and will be given other instructions such as whether or not to take them with food. If you cannot take your medicines for any reason you should contact your doctor immediately for advice.

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

If you need to have further supplies of the chemotherapy or other medicines, it is important to get these from your hospital specialist and not from any pharmacy.

Oral chemotherapy can cause side effects and it is important to be aware of these when taking your medicine.

Intramuscular Injection

Some chemotherapy drugs are given by injection into a muscle. The doctor or nurse will explain the procedure to you. The drug is injected into the muscle of the leg or buttock. You may feel some pain or discomfort for a short time.

Subcutaneous Injection

Some drugs can be given by injection just under the skin. A very fine needle is used and this may be uncomfortable for a short time.

Intrathecal Chemotherapy

In some conditions such as leukemia or lymphoma (cancer which starts in the lymph system) cancer cells can pass into the fluid which surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. To prevent this from happening, or to treat it if it occurs, chemotherapy may be given into the cerebrospinal fluid. For this treatment you will usually need to lie on your side with your legs drawn up. The doctor will then use local anesthetic to numb an area of skin over your spine. A needle is inserted into the space between two of the spinal bones and into the cerebrospinal fluid and the chemotherapy is injected. This procedure is called a lumbar puncture.

It takes from 15 to 30 minutes and you may need to lie flat afterwards for a few hours. It is important to drink plenty of fluids to reduce the chance of getting a headache. If you get a headache, it may last for a few hours. Painkillers can be given to help. Chemotherapy given in this way does not usually cause any other side effects.

Before you have any cancer chemotherapy, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the chemotherapy.

No medical treatment can be given without your consent, and before you are asked to sign the form, you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the leukemia chemotherapy
• any other treatments that may be available
• any significant risks or side effects of the treatment (both short and long term)
• what the treatment aims to achieve.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need things explained more than once.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

You can always ask for more time to decide about the treatment, if you feel that you can't make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Chemotherapy units are very specialized and not all hospitals have them, so you may need to travel for treatment. Chemotherapy drugs are usually prepared in a special area of the hospital pharmacy (admixture lab). All the drugs are carefully checked by the pharmacy staff to ensure that they are the right ones for you. Chemotherapy tablets, capsules or creams can be given to you to take home.

Most intravenous chemotherapy drugs can be given to you as a day patient at the hospital. This may take from half an hour to a few hours. However, some treatments, such as having chemotherapy into the abdominal cavity, will mean a short stay in hospital – perhaps overnight or for a couple of days. For some chemotherapy treatments – for example, high-dose chemotherapy – you will need to stay in hospital longer, perhaps for a few weeks. Your doctor or nurse will explain exactly what your treatment will involve before it starts.

If you are having chemotherapy by intramuscular injection, subcutaneous injection, intrathecal injection, or intracavity injection into the bladder, it is usually given in the outpatients department or the chemotherapy day unit at the hospital. It may also be given on certain wards within the hospital.

Sometimes, specialist chemotherapy nurses can visit you at home to give intravenous chemotherapy. You can ask your doctor whether it is possible to have your treatment at home.

Points to Remember When Having Chemotherapy at Home

• Chemotherapy tablets, capsules or injections may need to be stored in a particular way, such as in the fridge. Always follow the instructions given by your pharmacist.
• It is important not to touch some chemotherapy drugs with your fingers. You can check this with your pharmacist.
• All drugs must be stored out of the reach of children as they could cause serious harm if taken by accident.
• If you are having intravenous chemotherapy by pump and you notice any leakage of the drug from the pump or tube it is essential to let the nurse or doctor at the hospital know immediately.
• If you feel unwell at any time, phone the nurse or doctor at the hospital for advice.

Planning Your Chemotherapy Treatment

Your treatment will depend on a number of factors including:

• the type of cancer you have
• where in the body the cancer is
• how far it has spread (if at all)
• your general health.

How often you have your treatment and how long the whole course of treatment takes will depend on:

• the type of cancer you have
• the particular chemotherapy drugs you are having
• how well the cancer responds to the drugs
• any side effects the drugs may cause.

Before starting chemotherapy treatment, you will have your height and weight checked. This is used to work out the right dose of chemotherapy for you.

Intravenous chemotherapy is usually given as several sessions of treatment, unless you are having continuous treatment by infusion pump. Depending on the drug, or drugs, each treatment can last from a few hours to a few days. Each treatment is generally followed by a rest period of a few weeks to allow your body to recover from any side effects and so that the number of cells in your blood can go back to normal. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on how well your cancer is responding to the chemotherapy.

Your doctor or chemotherapy nurse will explain your treatment plan to you. If you have any questions, don't be afraid to ask. It often helps to make a list of questions and to take a close relative or friend with you to remind you of things you want to know but may easily forget. You may need some tests before starting your course of treatment. These will include blood tests and perhaps urine tests or heart tests.

Before each cycle of chemotherapy, you will normally have blood tests and see the doctor or specialist chemotherapy nurse. This can take some time. If your blood is tested at another hospital, the results can be sent to the hospital where you are having your treatment. Sometimes, you may need to have x-rays or scans.

All chemotherapy drugs are prepared specially for you and you may have to wait while the hospital pharmacy department gets them ready. To help pass the time, it can be helpful to take a book, personal stereo, iPod, newspaper, crosswords or perhaps some letters to write.

It may take several months to have all the chemotherapy needed to treat your cancer. When chemotherapy is given by an infusion pump it can be given continuously over a time-varying from several days to several weeks. Some people have their chemotherapy as tablets or capsules take them daily for several weeks or months before they have a rest period.

Your doctors will use blood tests and sometimes urine tests to monitor the effect that the chemotherapy is having on your body.

If you have a tumor that can be seen on a scan or felt by the doctor, the hospital staff will regularly check the effects of the chemotherapy on cancer. The results from your blood tests and any scans or x-rays can show how much the cancer is responding to the treatment.

Depending on the results of the tests, your treatment plan may sometimes need to be changed. There can be many reasons for this and your doctor will tell you why your treatment needs to be changed if this is necessary. It may be because the drugs you are having are starting to cause damage to particular parts of the body, such as the bone marrow, kidneys, liver, or nerves in the hands or feet. Sometimes it can be because the chemotherapy is not shrinking cancer enough. If this is the case, then changing to different drugs may be more effective.

Sometimes, your treatment may need to be delayed because the chemotherapy drugs are stopping your bone marrow from working properly. Delaying the chemotherapy gives your bone marrow a chance to recover before the next session of drugs is given.

If there is a special occasion coming up, or you want to go on holiday, it may be possible to arrange the timing of your treatment to fit in with this. Your doctor can tell you whether this is possible.

After your chemotherapy has finished, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems, or notice any new symptoms in between your appointments, let your doctor know as soon as possible. Many people find that they get very anxious before their appointment. This is natural and it may help to get support from family, friends or an organization during this time.

When their treatment is finished, people often feel it is time to get back to normal. However, this can sometimes be one of the hardest times to cope with. Recovery times vary and no one can say for sure how long you should take to get over the treatment and its effects.

The end of the visits to hospital for treatment can leave you feeling alone and neglected. Many people find that they feel very low and emotional at this time, when they had expected to be able to put the cancer and the treatment behind them. This may be the time when you need most support. Support is available to you if you would like it.

For people whose treatment is over apart from regular check-ups, our section on adjusting to life after cancer gives useful advice.

The main areas of your body that may be affected by chemotherapy are those where normal cells rapidly divide and grow, such as the lining of your mouth, the digestive system, your skin, hair and bone marrow (the spongy material that fills the bones and produces new blood cells).

If you want to know more about the side effects that may be caused by your chemotherapy treatment, ask your doctor or chemotherapy nurse, as they will know the exact drugs you are taking. Although the side effects of chemotherapy can be unpleasant, they need to be weighed against the benefits of the treatment. It is important to tell your doctor or chemotherapy nurse if the treatment is making you feel unwell. You may be able to have medicines to help you, or changes can be made to your treatment to lessen any side effects.

Possible Side-Effects of Some Chemotherapy Drugs

Bone Marrow and Blood 

Chemotherapy can reduce the number of blood cells produced by the bone marrow. Bone marrow is a spongy material that fills the bones and produces the cells (called stem cells) which develop into the three different types of blood cells:

• red blood cells, which carry oxygen to all parts of the body.
• white blood cells, which are essential for fighting infection.
• platelets, which help the blood to clot and control bleeding.

Increased Chance of Infection 

If the number of white cells in your blood is low you are more likely to get infections as there are fewer white cells to fight off bacteria. If your temperature goes up, or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital straight away. Most hospitals consider a temperature above 38ºC (100.5ºF) to be high, although some hospitals use a lower or higher temperature. The doctors and nurses will advise you when you need to contact the hospital.

Your regular blood tests will show the number of white cells in your blood. If you get an infection when your white blood cell level is low, you will need to have antibiotics. These may be given as an injection at hospital or you may be given antibiotic capsules or tablets to take at home. You may need to be admitted to hospital for the antibiotic treatment.

Helpful Hints - Infection

Tell your doctor at once if you develop a temperature as you may need to have antibiotics. Keep clean. Always wash your hands thoroughly before preparing your food. Stay away from crowded places and from people who you know to have an infection such as a cold. Sometimes, after chemotherapy, a drug called G-CSF will be used to help your bone marrow make white blood cells more quickly and so reduce the risk of infection. G-CSF is a protein made naturally in the body that can now be produced in the laboratory.

Anemia

This means you may feel very tired and lethargic, and may also feel breathless as there is less oxygen being carried around your body. People with anemia can also feel dizzy and light-headed, and have aching muscles and joints.

The blood tests will measure your hemoglobin. If it is low you may be offered a blood transfusion. The extra red cells in the transfusion will pick up oxygen from your lungs and take it around the body. You will feel more energetic and any breathlessness will be eased.

Increased Bleeding and Bruising

Platelets are cells which are important in blood clotting. If you have a low number of platelets in your blood you may bruise very easily, and may have nosebleeds or bleed more heavily than usual from minor cuts or grazes. If you develop any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin (petechiae) or bleeding gums, you should contact your doctor or the hospital straight away. You may have to be admitted to hospital for a platelet transfusion. This is given by drip into your blood. The platelets will start to work immediately, to prevent bruising and bleeding.

Hair Fall

The amount of hair that falls out, if any, depends on the type of drug or combination of drugs used, the dose given and how the drug affects you personally.

Helpful Hint - Your Hair

• If your drugs are likely to make your hair fall out, it can help to have your hair cut quite short before treatment. The weight of long hair pulls on the scalp and may make your hair fall out earlier.
• Use gentle hair products.
• Avoid perming or colouring your hair if it is brittle or if your scalp is dry and itchy.
• If you colour your hair, use a mild vegetable-based colourant and ask your hairdresser or chemotherapy nurse for advice.
• Try not to brush or comb your hair too roughly – use a soft or baby's brush.
• Avoid using hair dryers, and other items like tongs and straighteners. Pat your hair dry gently after washing it.
• If it is likely that your hair will fall out, ask your doctor or nurse about wigs early on, so that the wig can be as close a match as possible to your normal hair.
• You may like to wear a hat or scarf when you go out. There are also turbans which can be worn in the house.

Your Digestive System 

Your digestive system can be affected in a number of ways by chemotherapy.

Nausea and Vomiting 

If you do feel sick, it may start from a few minutes to several hours after the chemotherapy is given, depending on the drugs you are having. How long the sickness lasts varies.

Helpful Hints - Eating and Digestion

• If you feel sick or are sick, tell your doctor as soon as possible. Anti-sickness drugs can be prescribed which usually work well.
• Avoid eating or preparing food when you feel sick.
• Avoid fried foods, fatty foods or foods with a strong smell.
• Eat cold or warm food if the smell of hot food makes you feel sick.
• Eat several small snacks and meals each day and chew the food well.
• Peppermints or peppermint tea may help.
• Have a small meal a few hours before treatment, but not just before it.
• Drink plenty of liquid slowly, taking lots of small sips.
• Ginger, either as ginger biscuits, ginger tea or ginger beer can reduce feelings of sickness.
• Avoid filling your stomach with fluid before you eat.

Steroids are often given to reduce nausea and vomiting. They often give a sense of well-being, as well as helping to reduce feelings of sickness and loss of appetite.

Diarrhea and Constipation 

Some chemotherapy drugs can affect the lining of the digestive system and this may cause diarrhea for a few days. Some chemotherapy drugs (or anti-sickness drugs) can cause constipation.

• If you have diarrhea, eat less fiber, and avoid cereals, raw fruits and vegetables.
• Drink plenty of liquid (up to two liters a day) to replace the fluid lost with diarrhea.
• If you are constipated, eat more fiber, raw fruits (with peels on-for eg banana, apple etc – pls throw the peel away), cereals, and vegetables. Fruit juice and warm drinks can help.
• Try to take gentle exercise, if possible.

Loss of Appetite 

Some chemotherapy drugs can affect your appetite.

Changes to Your Sense of Taste

Chemotherapy can affect your sense of taste; food may taste more salty, bitter or metallic. Your normal sense of taste will come back after the chemotherapy treatment finishes.

Helpful hints – changes to sense of taste

• Eat only the foods that you like and ignore those that do not appeal to you.
• Use seasonings and herbs to flavor your cooking.
• Try marinating food, or using strongly flavored sauces to go with food.
• Sharp-tasting foods such as fresh fruit can be refreshing and leave a pleasant taste in the mouth.
• Some people find that cold foods taste better than hot foods.

Your Mouth

Some drugs can cause a sore mouth, which may lead to mouth ulcers. If this happens it is usually about 5–10 days after the drugs are given and will clear up within three to four weeks. You can be given mouthwashes to help.

Mouth ulcers can become infected. Your doctor or specialist nurse can give you treatment to help prevent or clear any infection. Cleaning your teeth regularly and gently with a soft toothbrush will help to keep your mouth clean. It may be helpful to see your dentist before you start your treatment. Dental treatment sometimes needs to be delayed when you are on chemotherapy because of the risk of infection and a sore mouth.

• You might find eating fresh pineapple helps keep your mouth fresh and moist.
• Clean your teeth or dentures gently every morning, evening and after each meal.
• Use a soft-bristled or child's toothbrush.
• If your toothpaste stings or brushing your teeth makes you feel sick, try using a mouthwash of one teaspoon of bicarbonate of soda dissolved in a mug of warm water.
• If your doctor prescribes a mouthwash for you, use it regularly as prescribed to prevent soreness.
• Rinse your mouth regularly with salt water.
• Gently use dental tape or floss each day.
• Keep your lips moist by using Vaseline, or a flavored lip balm.
• Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
• These may irritate your mouth.
• Keep your mouth and food moist. Add gravies and sauces to your food to make swallowing easier.
• Try to drink at least 1.5 liters of fluid a day (water, tea, weak coffee, and soft drinks).
• Avoid acidic drinks such as orange and grapefruit juice. Warm herbal teas may be more soothing.
• Let your doctor know if you have mouth ulcers, as you may need medicines to help heal the ulcers and clear any infection.
• Sucking crushed ice while the chemotherapy drugs are being given may help to prevent a sore mouth.

Tiredness

Some people feel very tired during chemotherapy. This is quite normal. For someone who normally has a lot of energy, feeling tired all the time can be very frustrating and difficult to cope with. The hardest time may be towards the end of the course of chemotherapy.

The tiredness will ease off gradually once the chemotherapy has ended, but it can often be three or four months until you feel back to normal. Some people find that they still feel tired a year or so afterwards.

Skin and Nail Changes 

Some drugs can affect your skin. Your skin may become dry or slightly discoloured, which may be made worse by swimming, especially if there is chlorine in the water. Any rashes should be reported to your doctor.

Your skin may also be more sensitive to sunlight, during and after the treatment. Protect your skin from the sun by wearing a hat, sunglasses, and loose clothing that covers your skin. Use sunscreen cream (at least factor 15) on any exposed areas.

• Avoid wet shaving − an electric razor is less likely to cause cuts. If your skin becomes dry or itchy, you can use some moisturizing cream.
• If you are also having radiotherapy, check with your doctor before using any moisturizers.
• Wear a hat, loose clothing and high-factor sun-cream if you are going out in the sun, to prevent your skin burning.

Your Nails

Chemotherapy may make your nails grow more slowly, or become brittle or flaky. You may notice white lines appearing across them. False nails or nail varnish may disguise these. Sometimes the shape or colour of your nails may change.

Other Possible Side Effects of Chemotherapy on the Nerves

Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, or a sensation of pins and needles. This is called peripheral neuropathy. It is important to let your doctor know if this occurs. They may need to change the chemotherapy drug if it gets worse. Usually, it gradually gets better when the chemotherapy treatment ends. Very occasionally it can damage the nerves permanently.

• Effects on the Nervous System: Some drugs can make you feel anxious, restless, dizzy, sleepy or have headaches. Some people also find it hard to concentrate. If you have any of these effects let your doctor know, as medicines can often be given to help.
• Change in Kidney Function: Some chemotherapy drugs can affect how well your kidneys work (kidney function). In order to prevent this, fluids may be given by drip into your vein for several hours before you have the treatment. Your kidney function will be carefully checked by blood tests before each treatment. The nurses may ask you to drink plenty of fluid and it is important to do this. They may also ask you to measure the amount of urine you pass.
• Changes in Hearing: Some chemotherapy drugs can affect your hearing. You may lose the ability to hear some high-pitched sounds. Some people find they have a continuous noise in the ears known as tinnitus, which can be very distressing. Let your doctor know if you notice any change in your hearing. They can arrange a hearing test for you.
• Second Cancer: Some chemotherapy drugs can increase the risk of developing particular types of cancer or leukemia later in life. This is extremely rare and your doctors will weigh up the small increase in risk of cancer or leukemia, against the benefit of chemotherapy in treating your current cancer. If the chemotherapy you are having may cause a second cancer, your doctors will discuss this with you.
• Contraception: It is very important to take effective contraceptive precautions when having chemotherapy, as chemotherapy drugs might harm the baby if pregnancy occurs. For this reason, your doctor will advise you to use a reliable method of contraception (usually 'barrier' methods – such as condoms or the cap) throughout your treatment and for a few months afterwards.
  If you are taking the contraceptive pill, you need to check with your doctor if it is all right for you to continue using it. The side effects of chemotherapy, such as sickness and diarrhea, can make the pill less effective.
• Sexuality: Some people go through chemotherapy without it having any effect their sex lives. Others find that their sex lives are temporarily or permanently changed in some way due to their chemotherapy.

Most changes that occur during chemotherapy are temporary, and should not have a long-term effect on your sex life. There may be times when you just feel too tired, or perhaps not strong enough for the level of physical activity you are used to during sex. If your treatment is making you feel sick, you may not want to have sex at all for a while. Remember that most side effects from chemotherapy that may affect your sex life, such as tiredness or sickness, will gradually wear off once your treatment is finished.

Anxiety may also play a part in putting you off sex. The anxiety may not be directly related to sex; you may be worried about your chances of surviving your cancer, or how your family is coping with the illness, or about your finances. Stresses like these can easily push everything else, including sex, to the back of your mind.

There is no medical reason to stop having sex at any time during your course of chemotherapy. It is perfectly safe, and the chemotherapy drugs themselves will have no long-term physical effects on your ability to have and enjoy sexual activity. Cancer cannot be passed on to your partner during sex and it won't make the cancer worse.

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What is chemotherapy?
Chemotherapy refers to using drugs to treat cancer. These drugs can kill or slow down the growth of cancer cells.

How does chemotherapy work?
Chemotherapy works by targeting rapidly dividing cells, which include cancer cells. They interfere with the cell division process, preventing the cancer cells from growing and spreading.

Which types of cancer can be treated with chemotherapy?
Chemotherapy treats different types of cancer, including breast cancer, lung cancer, colorectal cancer, leukaemia, lymphoma, and many others.

Is chemotherapy the only available treatment option for cancer?

No, chemotherapy is not the only treatment option for cancer. Depending on the type and stage of cancer, other treatments like surgery, radiation therapy, immunotherapy, or targeted therapy may also be used.

How is chemotherapy administered?
Chemotherapy is administered in different ways; it may include intravenous administration (IV), oral administration (in the form of pills or capsules), or injections into muscles or under the skin.

Does chemotherapy have side effects?
Yes, chemotherapy may cause side effects. Specific side effects depend on the type and dose of chemotherapy drugs used, and individual factors. Common side effects may include nausea, hair loss, fatigue, loss of appetite, and increased susceptibility to infections.

Can chemotherapy make you infertile?
Some chemotherapy drugs may affect fertility in both men and women. However, there are strategies, such as fertility preservation options, that may be discussed with a doctor before starting chemotherapy.

How long does chemotherapy treatment last?
The duration of chemotherapy treatment varies depending on the type and stage of cancer and the individual treatment plan. It can range from a few weeks to several months.

Will I lose my hair during chemotherapy?
Hair loss is a common side effect of several chemotherapy drugs. Not all chemotherapy drugs can cause hair loss, and the extent of hair loss varies among individuals.

Can I continue working during chemotherapy?
Whether you can continue working during chemotherapy depends on your circumstances and the side effects you experience. Some people are able to work throughout their treatment, while others may need to take time off or adjust their work schedule.

Can I still exercise during chemotherapy?
Moderate exercise during chemotherapy can have several benefits, like reducing fatigue and improving overall well-being. However, it's important to consult with your healthcare team before starting or continuing an exercise regimen.

Can chemotherapy affect my immune system?
Yes, chemotherapy can temporarily weaken the immune system, making you more susceptible to infections. Taking precautions, like avoiding large crowds and practising good hand hygiene, is important to help reduce the risk of infections during treatment.

Can I drink alcohol while undergoing chemotherapy?
It is recommended to avoid or limit the consumption of alcohol during chemotherapy, as alcohol can interact with some chemotherapy drugs and increase the risk of side effects.

Will chemotherapy make me gain weight?
Weight gain is not a direct side effect of chemotherapy, but some people may experience weight changes due to factors like fluid retention, changes in appetite, or hormonal effects. It varies from person to person.

Can chemotherapy cure cancer?
Chemotherapy can be curative for certain types and stages of cancer. In other cases, it may be used to control the disease, relieve symptoms, or shrink tumours before surgery or radiation therapy.

Can chemotherapy affect my memory or cognitive function?
Some people may experience a temporary decline in memory, concentration, or other cognitive functions during chemotherapy. This usually improves after treatment ends.

Can I travel during chemotherapy?
Travelling during chemotherapy may be possible, but it depends on your overall health, treatment schedule, and the destinations you plan to visit. Discussing your travel plans with your doctor beforehand is crucial.

Can I take over-the-counter medications while on chemotherapy?
It's important to consult with your healthcare team before taking any over-the-counter medications during chemotherapy. Some medications may interact with chemotherapy drugs or have adverse effects.

How often would I need to undergo chemotherapy sessions?
The frequency of chemotherapy sessions depends on the specific treatment plan. It may range from daily to weekly or longer intervals, with breaks in between cycles to allow the body to recover.

Will I be able to resume my normal activities after chemotherapy?
Most people are able to resume their normal activities after completing chemotherapy. However, the recovery period may vary, and it's important to listen to your body and gradually increase your activity levels.

Review

Reviewed by Dr. Bhuvan Chugh, Senior Consultant –Medical Oncology - Cancer Care / Oncology, Medical Oncology, Thoracic Oncology, Head & Neck Oncology, Breast Cancer, Gastrointestinal & Hepatobiliary Oncology.