Your oncology care at Burnside

The frequency of chemotherapy depends on the type of cancer and the specific treatment plan prescribed by your doctor.

Chemotherapy is typically given in cycles, which consist of a treatment period followed by a rest period.

A common chemotherapy schedule may involve twelve weekly treatments, followed by three monthly treatments. This cycle allows the body time to recover and produce healthy cells between treatments. Your doctor will tailor the cycle to suit your individual needs and treatment goals.

Cancer patients should only take the drugs that their healthcare provider approves.

You should tell your doctor what over-the-counter and prescription medications you are currently taking, including laxatives, allergy medicines, cold medicines, and pain relievers.

Private health cover usually covers the cost of your chemotherapy treatment but not the cost of discharge medications.

There is the option to self-fund chemotherapy treatment, with quotes available from our accounts staff .

If you are part of an access program or having medication that is not Pharmaceutical Benefit Scheme (PBS) you may be required to pay the full cost of the medication. Your oncologist will talk to you about this during your first consultation if that is pertinent to you.

The doctors and chemotherapy nurses will discuss the recommended treatment with you, explain how it will affect you, and answer your questions and concerns. You will be asked to sign a consent form with your oncologist confirming you understand the aims, side effects and potential risks and benefits of treatment.

You can change your mind about treatment at any stage.

Before you start chemotherapy you will have a detailed 'pre-treatment information telehealth appointment' with a chemotherapy nurse.

Chemotherapy is the use of medicines to treat cancer. Chemotherapy may be used alone or in combination with radiotherapy and/or surgery and/or other anti-cancer drugs.

Chemotherapy circulates anti-cancer drugs through the bloodstream to all parts of the body. The drugs attack rapidly growing cells, including cancer cells. Chemotherapy also causes temporary damage to normal cells which leads to side effects, most of which are short term and reversible. 

The benefits of treatment vary for different patients depending on the type of cancer and how advanced it is.

Chemotherapy can be used to:

• Cure the cancer by destroying cancer cells.
• Reduce the chances of a cancer coming back by killing cancer cells that may be present in the body but are too small to detect.
• Relieve symptoms by shrinking a tumour and easing some or all of the symptoms it causes.

We recommend having a friend or relative drive you home after chemotherapy as we may give you pre-medications that make you drowsy. If you are having treatment with a monoclonal antibody e.g. Herceptin, you can drive as normal.

The majority of treatments are administered as an inpatient / day patient so you are admitted. Occasionally you may need to stay in hospital if you are unwell, but this is rare.

• By mouth (oral): as a tablet or capsule which can be taken at home. Your oncologist will monitor your treatment carefully.
• By injection into a vein (intravenous): as either a short injection or a longer infusion over some hours in hospital, usually as a day patient.
• Infusion pumps: attached to a belt around the waist, infusion pumps are sometimes used to give an intravenous infusion of drugs over a number of hours or days at home.

Some chemotherapy treatments involve a combination of intravenous and oral chemotherapy.

Most patients can safely receive their intravenous chemotherapy through a temporary drip (cannula) placed in the vein in the arm on the day of treatment. This is removed before the patient goes home. A more permanent line is sometimes required to administer chemotherapy, which stays in for the the duration of the treatment.

Different types of lines are used:

• PICC lines (peripherally inserted central catheters) are similar to central lines but are placed in the arm.
• Vascular Access Device (VAD) contains a small chamber placed under the skin inserted into a vein, usually the chest.

Depending on the chemotherapy drugs being used, most patients will receive anti-sickness medication before treatment  (administered by the chemotherapy nurses) and will be sent home with a supply of anti-sickness tablets.

Patients are assessed prior to each chemotherapy cycle by their oncologist, and chemotherapy nurses will then administer the treatment.

Any necessary modifications to the treatment or anti-sickness drugs will be made so please let your oncologist know if you have experienced side effects .

A blood test is essential before most treatments.

Chemotherapy can temporarily lower one or more of the three main types of blood cells the body produces:

• White blood cells fight infection: resistance to infection is lowered when the white blood count drops. White cell numbers usually improve without any treatment but injections may be prescribed to aid white cell recovery.
• Red blood cells carry oxygen: occasionally chemotherapy causes mild anaemia, which might lead to tiredness, breathlessness and dizziness. This usually settles without treatment but sometimes requires a blood transfusion.
• Platelets help the blood clot. Low platelet counts can cause nose bleeds, easy bruising or bleeding and gum bleeding when brushing your teeth. The platelet count usually recovers but very rarely a platelet transfusion may be necessary. 

Some combinations of chemotherapy drugs are more likely to cause a low white blood cell count. Patients on these treatments will be given a blood count injection (known as GCSF) routinely on the day after each cycle of chemotherapy to minimise the risks of infection.

In all other cases, GCSF may be given to patients who suffer repeated low white blood counts.

Depending on the treatment to be administered, the liver, heart or kidney function may need to be tested before chemotherapy.

Your treating oncologist will discuss and arrange if necessary. 

Please tell your doctor or nurse if you have (or have in the past suffered with) any of the following:

• Diabetes
• Heart disease
• Lung disease
• Kidney problems
• Bone marrow problems

Chemotherapy can cause damage to normal cells and this may lead to temporary side effects, most of which are reversible.

The side effects of chemotherapy vary, depending on the drugs used. Patients receiving the same treatment may experience different side effects. Your treating oncologist or nurse will tell you what to expect.

In very rare cases, the side effects of chemotherapy can be life threatening. Your treating oncologist and nurse will discuss this with you.

Potential side effects include:

• Febrile Neutropenia
• Infection
• Sore throat
• Cough
• Shivering
• A temperature of 38 ºC or higher

Urgent medical attention should be sought if chemotherapy patients develop any of the above symptoms.

We do not recommend taking panadol or paracetamol prior to attending hospital.

We advise our cancer patients to have a flu injection during winter, although it may not provide quite as much protection against flu as usual.

If you need a flu injection during chemotherapy it is best administered in the few days immediately before a cycle of treatment.

Other vaccinations are best avoided during chemotherapy – please check with your oncologist.

The following important steps are taken prior to administering chemotherapy:

• The blood count must be checked before every cycle of chemotherapy
• If the blood count is low a repeat test will be required and this may delay the treatment
• The treating oncologist will pre-prescribe the chemotherapy
• The pharmacist will double-check the prescription
• The drugs are individually prepared in a sterile area using specialised equipment
• The chemotherapy is delivered to the treatment unit for administration.

Drugs are often ordered in advance but some patients may experience frustrating delays particularly if a change of drug treatment is required . 

Women

Although menstrual periods may become irregular or stop during chemotherapy some women do remain fertile.

It is very important not to become pregnant during chemotherapy so contraception is essential.

Periods may or may not return to normal after chemotherapy. Some patients lose their fertility after chemotherapy. Some patients who have not started or finished having a family may wish to be referred for fertility counselling. Please discuss this further with your treating Oncologist if you have any concerns or would like to access fertility counselling.

Men

While men can remain fertile during chemotherapy treatment, some chemotherapy drugs can cause male infertility. If there is potential for male infertility, your doctor will discuss options with you.

It is very important not to father children while receiving chemotherapy, so contraception is essential during your chemotherapy treatment cycles.

It is possible to take a holiday in between chemotherapy cycles but delaying the next cycle of chemotherapy for a holiday is not recommended, Please discuss holiday scheduling with your oncologist.

We recommend avoiding overseas holidays until after chemotherapy is complete. 

Chemotherapy affects people in different ways. Some patients are able to lead a near-normal life and continue to work. Some find it more difficult. Depending on your occupation you may need to make some modifications between day 7 and 14 of your chemotherapy treatment cycle as this is when your white cells may be lowered and therefore so is your resistance to infection.

Most medication can be continued safely during chemotherapy but you should let your oncologist know which medicines you are taking. 

As per the Cancer Council guidelines, we do not advocate drinking alcohol during chemotherapy. If you choose to consumer alcohol during chemotherapy we recommend moderate consumption and avoiding any consumption for the first few days after each treatment.

Your oncologist or nurse will inform you if alcohol is not allowed due to your particular chemotherapy treatment.

Some supplements and herbal remedies can interact with chemotherapy so please tell your oncologist or nurse if you are taking any non-prescription supplements.

You will have to pay for any discharge medications. Your health fund should cover the cost of your medications during treatment unless you are self-funding, part of an access program, or having medication that is not PBS (Pharmaceutical Benefit Scheme).

If it is a health emergency please call 000.

You will be provided with contact details for your oncologist and the Burnside Hospital After Hours Manager for any questions about side effect management.