Chemotherapy

I think the best way to look at chemotherapy is that it's your friend.  It's attacking any cancer cells that may be floating around your body, trying to kill them.  I've got to be honest and say that it's difficult when you're going through chemo and feeling like crap to feel nice towards these horrible drugs but they are one of your lines of defence so try not to hate them too much!

Chemo can be given in a number of ways and for breast cancer it's normally injected (or dripped) into your veins.  Some chemo is given in tablet form but for the majority of breast cancers, you start with it being injected.

How is Chemotherapy Administered?

Chemo can have a horrible effect on your veins and, if like me, you have bouncy veins (who knew I had Tigger veins!!!!) that try to push the needle out, the Breast Care Nurses will normally encourage you to have a line put in that stays throughout your treatment into which they inject.  The three I know of are Hickman, Picc and Portacaths.  All 3 can stay in during (and beyond) the course of your treatment and they use larger veins that go towards the right ventricle of your heart.  With the Hickman and Picc lines, the entrance is above the skin.  With the Portacath, it's inserted under the skin and has 3 little bobbles that can be felt through the skin and blood can be taken or needles inserted into the centre of those 3 bobbles.  All 3 need to be flushed after use and injected with heparin to avoid them clogging up.

The good thing about having a line (whichever one is available to you), is that blood can be taken from the line/port and your chemo can also be given through that as well.  That means that your veins are largely protected and there's less needles every time you go.

Either the day before, or the day of chemo, you will need your blood taken.  The Breast Care Nurses/Oncologist will then decide if you are fit enough for chemotherapy.  As chemo destroys cancer cells, it also eradicates your immune system which means you are vulnerable to infections, colds etc during your treatment.  You need to be in good condition (blood wise) to be able to have the chemotherapy and it may be cancelled on occasion.  Don't worry if it's cancelled.  You will pick up where you left off as soon as you're well enough again.

Chemotherapy Regimes:

I joined a breast cancer forum when I was first diagnosed and my head began swimming with all the acronyms, chemotherapy names, duration of regimes etc.  What I can tell you is that each Oncologist has his/her own preferred method of treating each particular type of cancer.  The following is a typical regime that seems to be applied most often and is in two parts:

  • Every 21 days you will have 3 chemotherapy drugs called (1) Fluorouracil (2) Epirubicin and (3) Cyclophosphamide. You will see this referred to as "FEC" - childlishly, this did make me smile when I first saw it.  Normally you will have 3 x 21 day cycles - so chemo on day 1, 21, and 42,

Treatment is then changed for the second half of treatment and is typically:

  • One of the "Taxel" family of drugs that may include Docetaxel (also called Taxotere) and when given with FEC is commonly abbreviated to FEC-T or Paclitaxel.  Docetaxel is typically given in 3 cycles of 21 days apart and Paclitaxel can be given the same way, or on a two weekly or weekly basis.

Don't worry if your regime is different but please ask your Oncologist why he/she has chosen the regime for you.  For example, my regime is as follows:

  • 4 x 21 day cycles of EC only (no F).
  • 12 x weekly Paclitaxel

At my initial appointment with my Oncologist he was going to add another drug called Carboplatin into the second half of the regime.  However, I had a new to market test called an HRD Assay on my tumour that found that Carboplatin wouldn't actually work so that was removed from my treatment plan. 

If you are interested, the Macmillan website has a fantastic page full of breast cancer drugs and typical regimes.  You can find that information here:  http://www.macmillan.org.uk/cancerinformation/cancertreatment/treatmenttypes/chemotherapy/combinationregimen/fec-t.aspx

Side Effects:

Like me, you've probably seen films where cancer patients have been depicted as lying on a bathroom floor, slowing dying - and it's probably scared you stupid.  That was my impression of what going through chemotherapy would be like.  Thankfully it's not quite as extreme!  The Breast Care Nurses will tell you "we have a tablet for every side effect and if they give you side effects, we have tablets for that too" and they do!

There are very common side effects but the ones that nearly everybody gets are nausea and tiredness.  Typically, you will be given anti-sickness tablets to take just before treatment and then for a certain amount of days after at home.  These can be adjusted if you suffer from severe sickness so don't be afraid to ask.  You are also likely to be given steroids - these really help with side effects for the first few days but can make going to sleep a bit difficult as you may feel a bit "wired".

Just to be different, because I'm diabetic, I can't have steroids and so my Oncologist decided to give me a new to market anti-sickness tablet called "Akynzeo".  I take one tablet an hour before each chemo and then I've never had to take anything else.  At worst, I've had mild sickness for a day or two but nothing too bad.  It may be worth asking your Oncologist is they can prescribe it.

So common side effects are:

  • Sickness
  • Tiredness
  • Hot flushes (very frequent and very annoying)!
  • Headaches
  • A feeling of being spaced out
  • Dizziness
  • Sore mouth / throat
  • Sore gums
  • Changes to taste or smell
  • Aching joints (especially with the Taxol range of drugs)
  • Changes to your emotions.

Unfortunately there's a long list and the ones above are the more common ones.  One tip that I found really useful was to make sure I drunk lots of water before, during and after each chemo session to help flush the chemo around and out.  I have found this has helped (but be warned if you're having the E part of FEC that this is bright red and comes out in your urine that way too)!

With all chemotherapy regimes though, you have to watch your temperature.  If it goes above 37.8 then you must seek medical assistance urgently.  As you have no immune system, you may need some help to fight off an infection if you're unlucky enough to get one.

During my chemotherapy, I managed to get something called Klebsiella Pneumonia and chemo was cancelled for 3 weeks.  However, my Doctor and Oncologist worked together and with the help of a lot of antibiotics, I managed to beat it!

To put this into perspective, most people can function almost normally during chemotherapy.  The first few days of each cycle may be tough and you may want to hug the sofa but then you'll pick up again.  Some people are well enough to work all the way through.  The one piece of advice I would give is to listen to your body.  If you need to sleep or have a nap during the day - sleep!  It's your body telling you to recharge your batteries.  If you need a few days on the sofa, do it!  Be kind to yourself.  Some side effects are cummulative so will get more evident towards the end of your treatment so it may be worth bearing that in mind.

From an emotional point of view, you are going through a fairly traumatic time - everything is new and scarey - so don't be surprised if you have some dark days or your emotions run away with you.  You WILL get through it.  I cried virtually all the way through the first cycle of EC and had to apologise to the Breast Care Nurses for being such a wimp afterwards!  I was terrified of being injected with the chemotherapy but your Breast Care Nurse will have seen it all before and you won't be the first or the last to panic or have a meltdown.  This is pretty normal believe it or not!