Chemotherapy is the use of a type of strong cytotoxic (toxic to cells) medicine to destroy or slow the growth of cancer cells (Healthdirect 2021; Cancer Council NSW 2020).
Chemotherapy works by specifically targeting fast-growing cells, which includes most cancer cells (Healthdirect 2021).
Most chemotherapy is systemic, i.e. administered into the bloodstream, but in some cases, it’s delivered directly to the cancer site (local chemotherapy) (Cancer Council NSW 2020).
Chemotherapy might be combined with, or used before or after, other cancer treatments including surgery, radiation therapy, hormone therapy, targeted therapy and immunotherapy (Cancer Council NSW 2020).
What Are the Aims of Chemotherapy?
Chemotherapy may be used to:
Cure the cancer, if possible
Control the cancer by shrinking tumours and impeding the growth and spread of cancerous cells
Shrink the cancer before surgery or radiation therapy to increase the likelihood of successful treatment
Destroy any remaining cancer cells after surgery or radiation therapy to reduce the risk of cancer coming back
Provide palliation by reducing symptoms and improving the person’s quality of life, if the cancer is in an advanced stage.
(ACS 2019; Cancer Council 2021)
How is Chemotherapy Administered?
Chemotherapy can be administered in a variety of ways, including:
Orally, via tablets or liquid
Intravenously (injected via a vein)
Via a central venous catheter
Intramuscularly (injected into the upper arm or thigh)
Intra-arterial injection (injected into an artery that supplies blood to the cancer)
Intraperitoneal injection (injected into the abdomen)
Intrathecal injection (injected into the spine)
Subcutaneous injection (injected under the skin, usually in the thigh or abdomen)
A cream that is applied to the skin.
(Cancer Australia 2015; Healthdirect 2021)
The route of administration will depend on the type of cancer and the specific medicine being given (Cancer Council 2021).
Intravenous administration is the most common method as it’s the most efficient way of delivering the medicine into the bloodstream (NCI n.d.).
Frequency and Duration of Chemotherapy Treatment
The frequency and duration of chemotherapy depend on a number of factors, including:
The type of cancer
The way in which the cancer is responding to treatment
The person’s ability to tolerate treatment
The specific medicine being administered
The aim of the chemotherapy
Whether the person is experiencing side effects.
(Cancer Council 2021; Cancer Council QLD 2015)
Generally, chemotherapy is administered in treatment cycles (usually lasting between two and six weeks) with periods of rest in between so that normal cells have a chance to recover (Cancer Council 2021; Cancer.Net 2021).
An entire course of chemotherapy is usually three to six months, but this may be shorter or longer (Cancer Council 2021).
Chemotherapy is often an outpatient procedure where the person attends treatment during the day and then goes home (Cancer Council 2021; Healthdirect 2021).
If the person requires chemotherapy for a prolonged period of time, a port (an intravenous tube that can stay in situ for weeks or months) may be inserted (Healthdirect 2021).
Side Effects of Chemotherapy
Chemotherapy targets all fast-growing cells, including those unrelated to cancer. Consequently, cells related to the skin, hair, gut and immune system, which are also fast-growing, may be adversely affected by treatment. This can lead to side effects such as:
Side effects related to the nervous system (tingling, burning, muscle weakness).
(Cancer Council 2021; Cancer Australia 2015)
Most side effects are temporary, however, there is a possibility for long-term issues such as:
Organ damage (heart, kidneys, liver, lungs or brain)
Infertility
Increased likelihood of developing other cancers.
(Cancer Australia 2015)
Caring for Clients Undergoing Chemotherapy
The side effects of chemotherapy can be unpleasant and upsetting, and as a result, clients undergoing chemotherapy might require extra support and assistance.
Helping the client to groom (e.g. makeup, hair) may help them feel more confident and in control, even if they’re staying in bed all day
Ensure the client’s teeth are brushed two times per day with a soft toothbrush
Prepare a mouth rinse for the client to use, comprising one teaspoon of bicarbonate of soda or salt in a glass of warm water. The client should rinse their mouth four times per day
If helping the client to bathe, ensure the water temperature is comfortable. They may have dry skin, so gently pat them dry and apply a water-based moisturiser
If the client’s skin is uncomfortable, encourage them to wear clothes in soft fabrics (e.g. cotton) and avoid uncomfortable, tight-fitting clothes
Ensure the client uses a mild shampoo and soft hairbrush
Ensure the client wears hats and sunscreen when outside
Consider serving frequent small snacks instead of large meals
Use liquid meal replacements if the client doesn’t feel like eating
Ensure the client stays hydrated
Plan activities for when the client has the most energy
Help the client to balance rest and activity, and maintain a social life
Maintain stringent infection control to reduce the risk of the client contracting an infection
Ensure the patient has sufficient pain relief (refer to treating doctors if you have any concerns)
Perform bowel care where necessary.
(Swiner 2020; Cancer Council VIC 2017)
Personal Safety
It’s recommended that people who are not receiving cancer treatment avoid direct exposure to chemotherapy medicine, as the medicines used are toxic. Chemotherapy medicines may remain in the client’s body for up to a week after administration and are released via body fluids. To keep yourself safe:
Always wear appropriate PPE
Ensure the toilets are flushed twice after the client uses them, or if possible, provide the client with a separate toilet from others
Immediately dispose of gloves and perform hand hygiene after cleaning body fluids
Avoid crushing or cutting chemotherapy tablets
Store chemotherapy medicines safely
Wash soiled bedding twice in hot water with regular laundry detergent (do not handwash)
If you make contact with a body fluid, wash the affected area several times with soapy water
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