What is chemotherapy?
Chemotherapy is a general term for the treatment of cancer using drugs. Patients with different types of lung cancer are likely to receive different combinations of chemotherapy drugs. After discussing treatment options with patients, doctors will decide which chemotherapy drugs are most suitable.
Why can chemotherapy be used to treat lung cancer?
- It can reduce symptoms such as breathlessness.
- It can extend length of life.
- It can shrink the cancer enough to allow further treatments such as surgery or radiotherapy.
Chemotherapy for small cell lung cancer
Chemotherapy is usually the standard first treatment for patients with small cell lung cancer (SCLC). Chemotherapy travels in the bloodstream and throughout most of the body. This usually leads to the relief of symptoms and longer survival of patients. If the cancer responds very well to this treatment, radiotherapy may also be given to try and stop the cancer from coming back.
Chemotherapy for non-small cell lung cancer
Chemotherapy can also be used to treat non-small cell lung cancer (NSCLC). If a patient is not suitable for surgery, they will be offered either chemotherapy on its own or in combination with radiotherapy. If a patient has had surgery for lung cancer and all of the cancer cells have been removed, they may be offered chemotherapy. However, if a patient has had surgery and the cancer cells remain, a doctor will discuss whether they should have radiotherapy and/or chemotherapy.
What actually happens when patients receive chemotherapy?
Some types of chemotherapy can be given at an out-patient clinic, others require a short stay in hospital. Before receiving chemotherapy, doctors make sure the patient does not have a higher than normal risk of developing side effects. A blood test will be taken to ensure that the patient’s blood, kidneys and liver are working normally. Most chemotherapy for lung cancer is given into a vein (intravenously) usually on the back of the hand or forearm. A small plastic needle (called a cannula) is put into the vein and attached to a drip.
Patients will be given anti-sickness medicines into the drip before starting the chemotherapy. Tablets are also given to patients to take home after treatment to prevent any initial sickness. A few types of chemotherapy are available in tablet form which still requires a visit to the out-patient clinic.
Generally, the time in between each treatment is three to four weeks which allows the body to recover before receiving more chemotherapy drugs. Doctors will assess patients’ side effects after each treatment, making adjustments to the next treatment as required.
I am frightened of needles and feel sick at the thought of treatment – what should I do?
It is not unusual to be frightened of needles and nursing staff have many ways of reducing your fears. Tell your nurse if you are feeling nervous before you begin your treatment as there are creams available to numb your skin. Some people feel sick at the thought of treatment or from the smell of hospitals. This is called anticipatory nausea and vomiting which can be helped with a variety of relaxing techniques. These include counselling and medication and your options can be discussed with your treatment team.
I have heard that chemotherapy has very bad side-effects. Is this true and is there anything that can be done about them?
All forms of cancer treatment have side-effects of one sort or another. Chemotherapy drugs have side-effects but these vary from one drug to another. Most chemotherapy drugs work by stopping cells dividing and growing. Cancer cells divide very quickly and can be destroyed by chemotherapy drugs. Patients’ blood will be checked regularly during chemotherapy to see if white cells (cells that fight infection), haemoglobin (cells that carry oxygen), and platelets (cells that clot the blood) are normal. Most cells in the body will be affected by chemotherapy.
Do the side-effects ease with time?
Yes, although they may last longer or start later in some patients. Sickness usually comes within the first week after treatment. White blood cells and platelets reach their lowest point 10-15 days after treatment and often the only sign of this is feeling tired when even the smallest task feels like a great chore. This is also the time when patients are at the most risk of picking up infections. Generally, side effects tend to reduce by the third week after chemotherapy and patients should start to feel better at this point in time for their next treatment. However, some side-effects including tiredness, bad taste in the mouth and tingling in the fingers and toes may continue for some time after treatment.
Should patients change their diet whilst having chemotherapy?
It is quite common for patients to lose their appetite while having chemotherapy and sense of taste may also be affected, such as having a metallic taste in the mouth or no taste at all. If a patient is concerned they are not eating or drinking enough, they should tell their doctor as there are dietary supplements available on prescription.
The following tips may help to make food taste better for patients:
- Try new foods that you haven’t tried before
- Use herbs and seasoning to add flavour to food
- Marinating food before cooking may help to improve flavour
- Sharp tasting foods such as fruit juices, pineapple and grapefruit will leave a refreshing taste in your mouth
- Cold food sometimes tastes better than hot food
- Eat small meals and snacks regularly throughout the day, rather than large ones only at meal times
- Avoid drinking too much liquid before eating as this will fill you up
How do doctors know if the chemotherapy is working?
Whilst it can be difficult to measure exactly how well it is working, usually an assessment will be made during treatment after approximately two-three courses of chemotherapy. Usually this will be done by chest x-ray and/or CT scan. An improvement in symptoms can also suggest that the treatment is working, for example, reduced coughing or breathlessness. If there is evidence that the cancer is responding to the chemotherapy then treatment will continue, as long as the patient is not having intolerable side effects.
It is important to know of any evidence that the cancer is not responding so that a decision about alternative treatment can be made. Sometimes there may be no change in the state of a tumour when the x-ray scan has been done. This may seem disappointing but is a worthwhile response, especially if the patient is feeling better. Even if the chemotherapy has not changed the size of the tumour, it may well have delayed the growth of it.
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