Understanding chemotherapy: what to expect and how to manage side effects

Chemotherapy works by targeting cancer cells with aggressive chemical drugs called cytotoxins. The blood is used as the vehicle to carry the drugs around the body so that they can attack cancer cells anywhere in the body. The cytotoxins work by preventing the division and multiplication of cancer cells. Ideally, the cytotoxins will only kill the cancer cells, but because they are so potent, they inevitably cause damage to healthy and helpful cells of the body. This will cause unintentional side effects that can take its toll on the body and mind, and it is good to be prepared for what may happen. Dr Dionysis Papadatos-Pastos, a leading consultant oncologist, goes over what to expect during chemotherapy and how to manage the side effects.

How is chemotherapy conducted?

Chemotherapeutics are administered either intravenously (through the veins via an IV) or orally with pills. The treatment will be divided into cycles, so that there are periods of rest and to let the good cells, like white blood cells, go back to normal for a bit. The number of cycles and how the chemotherapy is administered will differ for patients based on the type of cancer they have, the stage of cancer, and their current condition. Cycles of treatment can last for weeks to months, and the whole chemotherapeutic process may take many years. During chemotherapy treatment, the patient’s physical condition is closely monitored, like with blood tests and MRIs, to ensure they aren’t contracting other illnesses or infections whilst they are in this weakened state

Because cytotoxins are designed to attack rapidly reproducing cells, the parts of the body that normally do this will likely also be affected. This includes:

• bone marrow, where blood cells are made
• hair follicles
• the gastrointestinal system
• and the mucous tissue of the mouth

Not everyone with cancer will need to undergo chemotherapy, and patients will choose not to for personal reasons.

What are the side effects of chemotherapy?

The side effects of chemotherapy can be abrasive. Possible side effects include:

• Fatigue and dizziness
• Nausea, loss of appetite and changes of taste
• Ulcers of the mouth
• Weaker, discoloured nails
• Dry or itchy skin
• Infertility, temporary or permanent
• Low libido
• Diarrhoea or constipation
• Hair thinning and loss
• Weakened immune system
• Easily bruising
• Memory and concentration problems
• Anaemia

What is the impact of chemotherapy?

The body does recover once the chemotherapy stops, and these effects should go away after treatment has finished, though there might be permanent changes to the body like hair texture or early menopause.

Women planning a pregnancy in the future should explore options of freezing their eggs or embryos before undergoing chemotherapy as fertility capability is not guaranteed to go back to normal after chemo.

There is of course the mental toll of chemotherapy. It is upsetting to see the body behave in a way that is painful and sensitive, and the physical appearance will undoubtedly be altered, if just for the duration of chemotherapy. It is encouraged that patients access counselling services so they can express their feelings about the therapy, as well as have a support system. It helps to find groups with other people undergoing chemotherapy for honest, empathetic discussion and to share tips and tricks for dealing with the effects.

Adhering to a good diet and engaging in recommended, gentle activities helps to keep energy and spirits up.

The oncologist may prescribe auxiliary medications to help the patient manage the side effects, such as iron pills for anaemia or anti-nausea medicine. The care team is there to make the patient comfortable and they will be able to provide guidance on how to manage the side effects.

Knowing what is normal during chemotherapy and what would be irregular helps to manage expectations so that the strain of it isn’t too heavy, and so that anything unusual can be reported swiftly.

If you have concerns about cancer or cancer treatments, Dionysis Papadatos-Pastos is available for consultation which can be booked via his Top Doctors profile,