What is chemotherapy?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to
destroy cancer cells.
How does chemotherapy work?
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide
quickly. But it can also harm healthy cells that divide quickly, such as those that line
your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side
effects. Often, side effects get better or go away after chemotherapy is over.
What does chemotherapy do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no
longer detect them in your body and they will not grow back.

Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or
destroys cancer cells that have spread to other parts of your body.

Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that
are causing pain or pressure.
How is chemotherapy used?
Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get
chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:
Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant
chemotherapy.

Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant
chemotherapy.

Help radiation therapy and biological therapy work better.

Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your
body (metastatic cancer).
How does my doctor decide which chemotherapy drugs to use?
This choice depends on:
The type of cancer you have. Some types of chemotherapy drugs are used for many types of
cancer. Other drugs are used for just one or two types of cancer.

Whether you have had chemotherapy before

Whether you have other health problems, such as diabetes or heart disease.

How is chemotherapy given?

Chemotherapy may be given in many ways.
 Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right
under the skin in the fatty part of your arm, leg, or belly.

Intra-arterial (IA). The chemotherapy goes directly into the arterythat is feeding the cancer.

Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that
contains organs such as your intestines, stomach, liver, and ovaries).

Intravenous (IV). The chemotherapy goes directly into a vein.

Topically. The chemotherapy comes in a cream that you rub onto your skin.

Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.
Things to know about getting chemotherapy through an IV
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower
arm. Your nurse will put the needle in at the start of each treatment and remove it when
treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you
are getting IV chemotherapy.

IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.
Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large
vein, often in your chest area. The other end of the catheter stays outside your body. Most
catheters stay in place until all your chemotherapy treatments are done. Catheters can also be
used for drugs other than chemotherapy and to drawblood. Be sure to watch for signs of
infection around your catheter.
Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A
catheter connects the port to a large vein, most often in your chest. Your nurse can insert a
needle into your port to give you chemotherapy or draw blood. This needle can be left in place
for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of
infection around your port.
Pumps. Pumps are often attached to catheters or ports. They control how much and how fast
chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps
remain outside your body. Most people can carry these pumps with them. Internal pumps are
placed under your skin during surgery.
How will I feel during chemotherapy?
Chemotherapy affects people in different ways. How you feel depends on how healthy you are
before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are
getting, and the dose. Doctors and nurses cannot know for certain how you will feel during
chemotherapy.

Some people do not feel well right after chemotherapy. The most common side effect is fatigue,
feeling exhausted and worn out. You can prepare for fatigue by:
Asking someone to drive you to and from chemotherapy

Planning time to rest on the day of and day after chemotherapy

Getting help with meals and childcare the day of and at least 1 day after chemotherapy
There are many ways you can help manage chemotherapy side effects.
The Side Effects of Chemotherapy on the Body
Cancer cells divide more quickly than healthy cells, and chemotherapy drugs effectively target
those cells. Unfortunately, fast-growing cells that are healthy can be damaged too. There are
many different chemotherapy drugs with the potential for many different side effects. These
effects vary from person to person and from treatment to treatment.

Factors that play a role in side effects include other ongoing treatments, previous health issues,
age, and lifestyle. Some patients experience few side effects while others feel quite ill. Although
most side effects clear up shortly after treatment ends, some may continue well after
chemotherapy has ended, and some may never go away.

Chemotherapy drugs are most likely to affect cells in the digestive tract, hair
follicles, bone marrow, mouth, and reproductive system. However, cells in any part of the body
may be damaged.

Circulatory and Immune Systems

Routine blood count monitoring is a crucial part of chemotherapy. Thats because the drugs
can harm cells in the bone marrow, where blood is produced. This can result in several
problems. Red blood cells carry oxygen to tissues. Anemia occurs when your body doesnt
produce enough red blood cells, making you feel extremely fatigued. Other symptoms of anemia
include:
lightheadedness
pale skin
difficulty thinking
feeling cold
general weakness
Chemo can lower your white blood cell count, which results in neutropenia. White blood cells
play an important role in the immune system: they help fight infection and ward off illness.
Symptoms arent always obvious, but a low white blood cell count raises the risk of infection and
illness. People with an immune system weakened by chemotherapy must take precautions to
avoid exposure to viruses, bacteria, and other germs.

Cells called platelets help the blood clot. A low platelet count, called thrombocytopenia, means
youre likely to bruise and bleed easily. Symptoms include nosebleeds, blood in vomit or stools,
and heavier-than-normal menstruation.

Some chemo drugs can weaken the heart muscle, resulting in cardiomyopathy, or disturb the
heart rhythm, causing arrhythmia. This can affect the hearts ability to pump blood effectively.
Some chemo drugs can increase the risk of heart attack. These problems are less likely to
occur if your heart is strong and healthy at the start of chemotherapy.

Nervous and Muscular Systems

The central nervous system controls emotions, thought patterns, and coordination.
Chemotherapy drugs may cause problems with memory, or make it difficult to concentrate or
think clearly. This symptom sometimes is called chemo fog, or chemo brain. This mild
cognitive impairment may go away following treatment, or may linger for years. Severe cases
can add to anxiety and stress.
Some chemo drugs can cause pain, weakness, numbness, or tingling in the hands and feet
(peripheral neuropathy). Muscles may feel tired, achy, or shaky. Reflexes and small motor skills
may be slowed. Its not unusual to experience problems with balance and coordination.

Digestive System

Some of the most common side effects of chemotherapy involve the digestive tract.
Mouth sores and dry mouth can make it difficult to chew and swallow. Sores also may form on
the tongue, lips, gums, or in the throat. Mouth sores can make you more susceptible to bleeding
and infection. Many patients complain of a metallic taste in the mouth, or a yellow or white
coating on the tongue. Food may taste unusual or unpleasant.
These powerful drugs can harm cells along the gastrointestinal tract. Nausea is a common
symptom, and may result in bouts of vomiting. However, anti-nausea medications given in
conjunction with chemotherapy drugs can help alleviate this symptom.

Other digestive issues include loose stools or diarrhea. In some people, hard stools and
constipation can be a problem. This may be accompanied by pressure, bloating, and gas. Take
care to avoid dehydration by drinking plenty of water throughout the day.

Side effects involving the digestive system can contribute to loss of appetite and feeling full
even though you havent eaten much. Weight loss and general weakness are common. Despite
all this, its important to continue eating healthy foods.

Hair, Skin, and Nails (Integumentary System)

Many chemotherapy drugs affect the hair follicles and can cause hair loss (alopecia)
within a few weeks of the first treatment. Hair loss can occur on the head, eyebrows, eyelashes,
and body. As troubling as it can be, hair loss is temporary. New hair growth usually begins
several weeks after the final treatment.
Some patients experience minor skin irritations like dryness, itchiness, and rash. You may
develop sensitivity to the sun, making it easier to burn. Your doctor can recommend topical
ointments to soothe irritated skin.

Fingernails and toenails may turn brown or yellow, and become ridged or brittle. Nail growth
may slow down, and nails may crack or break easily. In severe cases, they
can actually separate from the nail bed. Its important to take good care of your nails to avoid
infection.

Sexual and Reproductive System

Chemotherapy drugs can have an effect on your hormones. In women, hormonal

changes can bring on hot flashes, irregular periods, or sudden onset of menopause. They may
become temporarily or permanently infertile. Women on chemotherapy may experience dryness
of vaginal tissues that can make intercourse uncomfortable or painful. The chance of developing
vaginal infections is increased. Chemotherapy drugs given during pregnancy can cause birth
defects. In men, some chemo drugs can harm sperm or lower sperm count, and temporary or
permanent infertility is possible.
 Symptoms like fatigue, anxiety, and hormonal fluctuations may interfere with sex drive in both
men and women. So can worrying about loss of hair and other changes in appearance.
However, many people on chemotherapy continue to enjoy an intimate relationship and an
active sex life.

Kidneys and Bladder (Excretory System)

The kidneys work to excrete the powerful chemotherapy drugs as they move through
your body. In the process, some kidney and bladder cells can become irritated or damaged.
Symptoms of kidney damage include decreased urination, swelling of the hands and feet
(edema), and headache. Symptoms of bladder irritation include a feeling of burning when
urinating and increased urinary frequency.
Youll be advised to drink plenty of fluids to flush the medication from your system and to keep
your system functioning properly. Note: Some medications cause urine to turn red or orange for
a few days. This isnt cause for concern.

Skeletal System

Most peopleand especially womenlose some bone mass as they age. Some
chemotherapy drugs can cause calcium levels to drop and contribute to bone loss. This can
lead to cancer-related osteoporosis, especially in post-menopausal women and those whose
menopause was brought on suddenly due to chemotherapy.
According to the National Institutes of Health (NIH), women who have been treated for breast
cancer are at increased risk for osteoporosis and bone fracture. This is due to the combination
of the drugs and the drop in estrogen levels. Osteoporosis increases the risk of bone fractures
and breaks. The most common areas of the body to suffer breaks are the spine and pelvis, hips,
and wrists.

Psychological and Emotional Toll

Living with cancer and dealing with chemotherapy can exact an emotional toll. You may
feel fearful, stressed, or anxious about your appearance and your health. Some people may
suffer from depression. Juggling work, financial, and family responsibilities while undergoing
cancer treatment can become overwhelming.
Many cancer patients turn to complementary therapies like massage and meditation for
relaxation and relief. If you have trouble coping, mention it to your doctor. They may be able to
suggest a local cancer support group where you can speak with others who are undergoing
cancer treatment. If feelings of depression persist, professional counseling may be necessary.

Nursing Responsibilities:
BEFORE THE PROCEDURE
Explain the importance of the procedure to the patient.
Provide privacy.
Teach the patient on how the procedure is done.
A number of medical tests are done before chemotherapy is started. The oncologist will
determine how much the cancer has spread from the results of x rays and other imaging tests
and from samples of the tumor taken during surgery.
Review- The chemotherapy drugs prescription which should have
-Name of anti-neoplastic agent.
 -Dosage
-Route of administration
-Date and time that each agent to be administered.
Accurately identify the client
Medications to be administered in conjunction with the chemotherapy e.g antiemetics,
sedatives etc.
Assess the clients condition including
- Most recent report of blood counts including hemoglobin ,hematocrit, white blood cells and
platelets.
-Presence of any complicating condition which could contraindicate chemotherapeutic agent
administration i.e. infection, severe stomatitis , decreased deep tendon reflexes, or bleeding .
-Physical status
-Level of anxiety
-Psychological status
When a chemotherapy treatment takes a long time, Advise the patient that he may prepare
for it by wearing comfortable clothes. Bringing a book to read or a tape to listen to may help
pass the time and ease the stress of receiving chemotherapy. Some patients bring a friend or
family member to provide company and support during treatment.
Advise Sometimes, patients taking chemotherapy drugs known to cause nausea are given
medications called antiemetics before chemotherapy is administered. Anti-emetic drugs help to
lessen feelings of nausea. Two anti-nausea medications that may be used are Kytril and Zofran.

Other ways to prepare for chemotherapy and help lessen nausea are:
Regularly eat nutritious foods and drink lots of fluids.
Eat and drink normally until about two hours before chemotherapy.
Eat high carbohydrate, low-fat foods and avoid spicy foods.

DURING THE PROCEDURE

Prepare measures when administering chemotherapy.

Use gloves when handling chemotherapy drugs and excretions from clients receiving
chemotherapy.
Wear disposable long-sleeves gowns when preparing and administering chemotherapy.
Use Luer-lock fittings on IV tubing used in delivering chemotherapy.
Observe the 10 Rights

AFTER THE PROCEDURE

Dispose of all equipment used in chemotherapy preparation and administration in designated

containers.
Dispose all chemotherapy wastes as hazardous materials.
Monitor client for symptoms of anaphylactic reaction Urticaria (hives), pruritus (itching),
sensation of lump in the throat, shortness of breath.
Asses for electrolyte imbalances.
Teach client and family to report excessive fluid loss or gain, change in level of
consciousness, increased weakness or ataxia, paresthesia, seizures, persistent, headache,
muscle cramps or twitching, nausea and vomiting/diarrhea.
 Prevent extravasation of vesicant drugs, implement measures to treat extravasation of
vesicant medications if it occurs.
Teach the client to increase fluid intake to 2500 to 3000 ml/day unless contraindicated.
Assess for signs of bone marrow depression: decreased White blood Cell and Red Blood
Cell, granulocyte, platelet counts.
Assess for signs of bleeding and infection.
Monitor for signs of renal insufficiency.
- elevated urine specific gravity
- Abnormal electrolyte values
- Insufficient urine output (< 30 ml/hour)
- Elevated BP, BUN, Serum Creatinine