Understanding Chemotherapy Booklet August 2016

Understanding
Chemotherapy
A guide for people with cancer,
their families and friends
Treatment
For information & support, call

Understanding Chemotherapy
A guide for people with cancer, their families and friends
First published May 2002. This edition August 2016.

© Cancer Council Australia 2016. ISBN 978 1 925136 18 0
Understanding Chemotherapy is reviewed approximately every two years. Check the publication
date above to ensure this copy is up to date.
Editor: Jenni Bruce. Designer: Eleonora Pelosi. Printer: SOS Print + Media Group.
Acknowledgements
This edition has been developed by Cancer Council NSW on behalf of all other state and territory
Cancer Councils as part of a National Publications Working Group initiative.
We thank the reviewers of this booklet: Dr Andrew Haydon, Medical Oncologist, The Alfred Hospital
and Cabrini Hospital, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern
Beaches, NSW; Mish Blacher, Consumer; Nicole Loft, Haematology Nurse Practitioner, Royal
Adelaide Hospital, Central Adelaide Local Health Network, SA; Simoene Smith, 13 11 20 Cancer
Information Consultant, Cancer Council NSW, NSW.
This booklet is funded through the generosity of the people of Australia.
Note to reader
Always consult your doctor about matters that affect your health. This booklet is intended as a
general introduction to the topic and should not be seen as a substitute for medical, legal or financial
advice. You should obtain independent advice relevant to your specific situation from appropriate
professionals, and you may wish to discuss issues raised in this book with them.
All care is taken to ensure that the information in this booklet is accurate at the time of publication.
Please note that information on cancer, including the diagnosis, treatment and prevention of cancer,
is constantly being updated and revised by medical professionals and the research community.
Cancer Council Australia and its members exclude all liability for any injury, loss or damage incurred
by use of or reliance on the information provided in this booklet.
Cancer Council
Cancer Council is Australia’s peak non-government cancer control organisation. Through the eight
state and territory Cancer Councils, we provide a broad range of programs and services to help
improve the quality of life of people living with cancer, their families and friends. Cancer Councils
also invest heavily in research and prevention. To make a donation and help us beat cancer, visit
cancer.org.au or call your local Cancer Council.
Cancer Council Australia

Level 14, 477 Pitt Street, Sydney NSW 2000
Telephone 02 8063 4100 Facsimile 02 8063 4101
Email [email protected] Website cancer.org.au
ABN 91 130 793 725
Introduction
This booklet has been prepared to help you understand more
about chemotherapy, one of the main treatments for cancer.
Chemotherapy treats cancer using a range of drugs.
Many people feel concerned about the side effects of chemotherapy,

but most side effects are temporary and they can often be controlled
or reduced. The side effects vary depending on the drugs used,
and they also vary from one individual to another. We cannot
give advice about the best treatment for you, but we hope this
information will answer some of your questions and help you
think about other questions to ask your treatment team.
This booklet does not need to be read from cover to cover – just
read the parts that are useful to you. Some terms that may be
unfamiliar are explained in the glossary. You may also like to pass
this booklet to your family and friends for their information.
How this booklet was developed

This information was developed with help from a range
of health professionals, as well as people affected by cancer
who have had chemotherapy.
If you or your family have any questions,

call Cancer Council 13 11 20. We can send
you more information and connect you with
support services in your area. Turn to the
last page of this book for more details.
Contents
What is cancer?................................................................. 4
How is cancer treated?..................................................... 6
Key questions.................................................................... 8
What is chemotherapy?...................................................................... 8
How does it work?................................................................................ 8
How is chemotherapy given?................................................................ 8
Why have chemotherapy?..................................................................... 9
Does chemotherapy hurt?................................................................... 10
Where will I have treatment?............................................................... 10
How long does treatment last?......................................................... 10
How do I prepare for chemotherapy?................................................. 12
How much does treatment cost?....................................................... 14
Can I have chemotherapy during pregnancy?................................... 14
Making treatment decisions........................................... 16

Talking with doctors........................................................................... 16
A second opinion............................................................................... 17
Taking part in a clinical trial................................................................. 17
Treatment....................................................................... 18
Intravenous (IV) chemotherapy............................................................ 18
Other chemotherapy methods............................................................ 22
Chemotherapy with other treatments.................................................. 23
Waiting for chemotherapy...................................................................24
Safety precautions............................................................................. 25
Chemotherapy safety in the home...................................................... 26
Targeted therapy................................................................................. 28
Is the treatment working?.................................................................... 30
Which health professionals will I see?.................................................... 30
Managing side effects..................................................... 33

Feeling tired and lacking energy.......................................................... 36
Appetite changes, nausea or vomiting................................................ 38
Hair loss............................................................................................... 40
Skin and nail changes........................................................................ 42
Mouth sores....................................................................................... 43
Constipation or diarrhoea.................................................................... 44
Memory and concentration changes.................................................. 45
Anaemia............................................................................................... 46
Infections............................................................................................. 46
Bleeding problems............................................................................. 48
Nerve and muscle effects.................................................................... 49
Change in hearing.............................................................................. 50
Sex and fertility.................................................................................... 50
After treatment.............................................................. 54
Follow-up appointments.................................................................... 54
Coping with your emotions................................................................ 55
Cancer Council services................................................. 56

Caring for someone with cancer................................... 58
Useful websites............................................................... 59
Question checklist........................................................... 60
Glossary.......................................................................... 61
How you can help............................................................ 64
What is cancer?
Cancer is a disease of the cells, which are the body’s basic building
blocks. The body constantly makes new cells to help us grow,
replace worn-out tissue and heal injuries. Normally, cells multiply
and die in an orderly way.
Sometimes cells don’t grow, divide and die in the usual way. This
may cause blood or lymph fluid in the body to become abnormal, or
form a lump called a tumour. A tumour can be benign or malignant.
Benign tumour – Cells are confined to one area and are not able
to spread to other parts of the body. This is not cancer.
Malignant tumour – This is made up of cancerous cells, which

have the ability to spread by travelling through the bloodstream
or lymphatic system (lymph fluid).
How cancer starts
Normal cells Abnormal Angiogenesis

cells
Boundary
Lymph vessel
Blood vessel
Normal cells Abnormal cells Abnormal cells Malignant or

multiply invasive cancer
4 Cancer Council
The cancer that first develops in a tissue or organ is called the
primary cancer. A malignant tumour is usually named after
the organ or type of cell affected.
A malignant tumour that has not spread to other parts of the

body is called localised cancer. A tumour may invade deeper into
surrounding tissue and can grow its own blood vessels, a process
known as angiogenesis.
If cancerous cells grow and form another tumour at a new site,

it is called a secondary cancer or metastasis. A metastasis keeps
the name of the original cancer. For example, breast cancer that
has spread to the liver is called metastatic breast cancer, even
though the person may be experiencing symptoms caused by
problems in the liver.
How cancer spreads

Primary cancer
Local invasion
Angiogenesis –
tumours grow their
own blood vessels
Lymph vessel
Metastasis –
cells invade other
parts of the body via
blood vessels and
lymph vessels
What is cancer? 5
How is cancer treated?
Different treatments for cancer are used alone or in combination.
Most cancers are treated with surgery, chemotherapy and/
or radiotherapy. Other treatments, such as hormone therapy
and immunotherapy, can also be used for some types of
cancer. Sometimes targeted therapy is used instead of or with
chemotherapy. Cancer treatments can be given with a range of
aims (see page 9).
Main types of cancer treatments

An operation to remove or repair a part of
Surgery
the body affected by cancer.
The use of cytotoxic drugs (see page 8) to

Chemotherapy treat cancer by killing cancer cells or slowing
their growth.
Radiotherapy The use of radiation, usually x-rays or

(radiation gamma rays, to kill cancer cells or injure
therapy) them so they cannot grow and multiply.
Hormone Treatment that blocks the body’s natural

therapy hormones, which sometimes help cancer
(endocrine cells grow. It is used when the cancer is
therapy) growing in response to hormones.
The prevention or treatment of disease

Immunotherapy using substances that alter the immune
system’s response.
Treatment that attacks specific particles
Targeted (molecules) within cells that allow cancer to
therapy grow. Some immunotherapy and hormone
therapy drugs are types of targeted therapy.
6 Cancer Council
Your treatments
The treatments you have depend on several factors, including:
• the type of cancer you have
• where it began
• whether it has spread to other parts of your body
• your general health
• your age
• what treatments are currently available
• your preferences.
Cancer Council has information about different cancer types and

their treatments, as well as booklets about surgery and radiotherapy.
Call Cancer Council 13 11 20 for free copies of these resources, or
download them from your local Cancer Council website.
Chemotherapy for children

This booklet has been written primarily for adults having
chemotherapy, although some of the information will also be
relevant for children. Talk to your treatment team for specific
information about chemotherapy for children. You might
also want to get in touch with Camp Quality or CanTeen for
age-appropriate resources and support:
• Camp Quality – for children • CanTeen – for young

aged 0–13 who are living people aged 12–24 who
with cancer and their have been affected by
families. Call 1300 662 267 cancer. Call 1800 226 833
or visit campquality.org.au. or visit canteen.org.au.
How is cancer treated? 7

Key questions
Q: What is chemotherapy?
A: Chemotherapy (sometimes just called ‘chemo’) is the use of
drugs to kill or slow the growth of cancer cells. The drugs are
called cytotoxics, which means toxic to cells (cyto). Some of
these drugs are obtained from natural sources such as plants,
while others are completely created in a laboratory.
Q: How does it work?

A: Most chemotherapy drugs enter the bloodstream and travel
throughout the body to reach cancer cells in the organs and
tissues. Sometimes chemotherapy is delivered directly at the
tumour site rather than via the bloodstream (see page 22).
Chemotherapy drugs damage cells as they divide. This makes

the drugs effective against cancer cells, which divide much
more rapidly than most normal cells do. However, some
normal cells – such as hair follicles, bloods cells, and cells
inside the mouth or bowel – also divide rapidly. Side effects
occur when chemotherapy damages these normal cells (see
pages 33–53). Unlike cancer cells, normal cells can recover,
so most side effects are temporary.
Q: How is chemotherapy given?

A: Chemotherapy is most often given via a vein (intravenously).
It is sometimes given in other ways, such as by mouth as
tablets (orally), as a cream, or as injections into different
parts of the body. For more information, see pages 18–23.
8 Cancer Council
Q: Why have chemotherapy?
A: Chemotherapy can be used for different reasons:
To achieve remission or cure – In many cases, the aim of
chemotherapy is to cause the signs and symptoms of cancer to
reduce or disappear (remission). The treatment may be called
curative chemotherapy. It could be given either on its own or
with other treatments, such as surgery and radiotherapy.
To help other treatments – Chemotherapy is sometimes

given either before or after other treatments. Used before
(neoadjuvant therapy), its purpose is to reduce the cancer
so your main treatment is more effective. If chemotherapy is
given after your main treatment (adjuvant therapy), its aim
is to get rid of any remaining cancer cells.
To control the cancer – Even if chemotherapy cannot

achieve remission (see above), it may be used to control the
cancer’s growth and stop it spreading for an extended period
of time. This may be called palliative chemotherapy.
To relieve symptoms – By shrinking a tumour that is

causing pain and other symptoms, chemotherapy can improve
quality of life. This is also called palliative chemotherapy.
To stop cancer coming back – Chemotherapy might be

given for months or years after the initial chemotherapy has
achieved remission of the cancer. This is called maintenance
chemotherapy. It aims to prevent or delay the cancer returning.
Key questions 9
Q: Does chemotherapy hurt?
A: Having intravenous chemotherapy may feel like having your
blood taken. If you have a temporary tube (cannula) in your
hand or arm, only the initial injection may hurt. If you have
a central venous access device, it should not be painful. See
pages 20–21 for an explanation of these methods.
Some types of chemotherapy will cause side effects. However,

there are ways to manage these (see pages 33–53). The drugs
used for chemotherapy are constantly being improved to give
you the best possible results and to reduce potential side effects.
Q: Where will I have treatment?

A: Most people have chemotherapy during day visits to a hospital
or treatment centre. In some cases, an overnight or extended
hospital stay may be needed. People who use a portable
pump (see page 21) or have oral chemotherapy can have their
treatment at home. Some programs provide a visiting nurse
to give chemotherapy in your home. Your treatment team will
discuss which options are available to you.
Q: How long does treatment last?

A: How often and for how long you have chemotherapy depends
on the type of cancer you have and the drugs that are used.
You will usually have a number of treatment sessions to
try to destroy all the cancer cells, and these may be daily,
weekly or monthly.
10 Cancer Council
Chemotherapy is commonly given in courses (cycles), with
rest periods in between. This allows normal cells to recover
and your body to regain its strength. If your body needs
more time to recover, your next cycle may be delayed.
Your doctor will discuss your treatment plan with you.

Sometimes people have chemotherapy over 6–12 months,
but it’s possible to have it for a shorter or longer period.
Maintenance treatment (to prevent the cancer coming back)
and palliative treatment (to control the cancer or relieve
symptoms) may last many months or years.
When to call your treatment team or 000

Chemotherapy can temporarily affect the white blood cells that
usually fight infection, so even a minor infection can rapidly
become serious. Let your GP or treating specialist know if you
have symptoms that may indicate an infection (e.g. sore throat,
night sweats, stinging on passing urine, easy bruising). Contact
them urgently or call 000 if you have any of these symptoms:
• a temperature of 38°C • shaking chills

or above • severe abdominal pain,
• persistent or severe nausea constipation or diarrhoea
or vomiting • unusual bleeding (e.g. nose
• redness or swelling around bleeding for over 30 minutes)
the site of the intravenous • any serious unexpected
chemotherapy device or side effects or sudden
the previous injection deterioration in health.
Key questions 11
How do I prepare for chemotherapy?
Chemotherapy affects everyone differently, so it can be hard
to know exactly how to prepare. However, a number of general
issues are worth considering in advance.
Look after yourself

Try to stay as healthy as
you can before and during
treatment. Eat a nourishing Sort out work
diet, drink lots of water, get If you are working, talk to your
enough sleep, and balance employer about what time you
rest and physical activity. are likely to need off. It is hard to
Good nutrition and regular predict how chemotherapy will
exercise can help with some affect you, so you could discuss
side effects of chemotherapy. the option of flexible hours.
Freeze some meals

You may not feel like cooking
during the weeks of your Check your teeth
chemotherapy treatment. It is often a good idea to visit your
Consider making some meals dentist for a check-up before
ahead and freezing them. chemotherapy begins. The dentist
Sometimes, family and friends can check for any current mouth
will arrange a meal roster. infections that may cause issues
if chemotherapy affects your
immune system.
Arrange transport
Plan how you will get to chemo sessions.
If travelling by car, ask about parking.
Since you won’t know how you will feel, it
is best to arrange a driver for at least your
first session. You can call Cancer Council
13 11 20 to find out if there are transport
to treatment services in your area.
12 Cancer Council
Check other medicines
Make sure your doctor knows
about any other medicines or
therapies you are using. Some
over-the-counter medicines,
home remedies, herbs and
vitamins can interfere with
the chemotherapy.
Organise help at home Prepare for

If you have young children, you side effects
may need to arrange for someone Talk to your treatment
to look after them during the team about the likely
treatment sessions and possibly side effects of the
afterwards if you become unwell chemotherapy drugs
from side effects. Older children you are having. Ask
may need lifts to and from school whether you should
and activities. Some support with Discuss your concerns take medicine to
housework and errands can also Keep a list of questions for prevent nausea and
ease the load. Consider asking your oncologist and add to vomiting. If you may
one friend or family member to it whenever a new question lose your hair, think
coordinate offers of help. occurs to you. If you are feeling about whether you
anxious about the diagnosis want to choose a wig,
and treatment, try talking to a hats or scarves before
family member or friend, or to treatment starts.
your GP or another member
of your health care team.
Ask about fertility

Some types of chemotherapy
Pack a chemo bag can affect your fertility. If you
A bag for your chemo sessions could think you may want to have
include: warm clothing layers in case children in future, talk to your
you get cold; healthy snacks; lip balm; health care team about your
and something to pass the time, such as options before chemotherapy
books, magazines, crossword puzzles, begins (see page 52).
and a laptop computer or tablet.
Key questions 13
Q: How much does treatment cost?
A: Chemotherapy drugs are expensive, but most people pay only
a fraction of the cost as many drugs are heavily subsidised by
the Pharmaceutical Benefits Scheme (PBS). However, there
are some drugs that are not covered by the PBS.
Ask your specialist or treatment centre for a written quote that

shows what you will have to pay. You will usually have to cover
the cost of any medicines that you take at home to relieve the
side effects of chemotherapy (such as anti-nausea medicine).
If you have private health insurance and elect to be treated

as a private patient, you may have to pay for out-of-pocket
expenses and contribute to the cost of the drugs. Check with
your doctor and health fund before you start treatment.
Q: Can I have chemotherapy

during pregnancy?
A: Being diagnosed with cancer during pregnancy is rare. In
Australia, about one in 2500 women is affected.1
It is possible for some pregnant women to have chemotherapy.

Your medical team will discuss all of the available treatment
options with you. Their recommendations will be based on
the type of cancer you have, its stage, the other treatment
options, and how to avoid harming your developing baby.
Sometimes chemotherapy or other treatment can be delayed
until after the baby’s birth.
14 Cancer Council
If you have chemotherapy during pregnancy, your doctor
will probably advise you to stop having it at least 3–4 weeks
before your delivery date. This is because the side effects
of chemotherapy on your blood cells increase your risk of
bleeding or getting an infection during the birth. Stopping
chemotherapy allows your body time to recover from
the side effects.
Researchers are currently doing long-term studies on

women and children to explore this issue further. Having
chemotherapy in the first trimester (12 weeks) may increase
the risk of birth defects, but there seems to be a lower risk
in the later stages of pregnancy. Studies on children who
were exposed to chemotherapy in the womb during the
second and third trimesters show that chemotherapy did
not affect their development.2
However, chemotherapy drugs may affect a developing

baby in other ways. For example, chemotherapy may cause
premature delivery, and preterm babies often have other
health issues, such as respiratory problems. Your doctor can
talk in detail about your specific situation and what is best
for your health and your unborn baby.
Many pregnant women with cancer feel anxious about the potential
impact of treatment on their unborn child. It may be easier to cope
if you are well informed about treatments and side effects.
Key questions 15
Making treatment
decisions
Sometimes it is difficult to decide on the type of treatment to have.
You may feel that everything is happening too fast. Check with
your doctor how soon your treatment should start, and take as
much time as you can before making a decision.
Understanding the disease, the available treatments and possible

side effects can help you weigh up the pros and cons of different
treatments and make a well-informed decision that’s based on
your personal values. You may also want to discuss the options
with your doctor, friends and family.
You have the right to accept or refuse any treatment offered. Some
people with more advanced cancer choose treatment even if it
offers only a small benefit for a short period of time. Others want
to make sure the benefits outweigh the side effects so that they
have the best possible quality of life.
Talking with doctors

When your doctor first tells you that you have cancer, you may
not remember the details about what you are told. Taking notes
or recording the discussion may help. Many people like to have
a family member or friend go with them to take part in the
discussion, take notes or simply listen.
If you are confused or want clarification, you can ask for further
explanation – see page 60 for a list of suggested questions. If you
have several questions, you may want to talk to a nurse or ask the
office manager if it is possible to book a longer appointment.
16 Cancer Council
A second opinion
You may want to get a second opinion from another specialist to
confirm or clarify your doctor’s recommendations or reassure you
that you have explored all of your options. Specialists are used to
people doing this.
Your doctor can refer you to another specialist and send your
initial results to that person. You can get a second opinion even if
you have started treatment or still want to be treated by your first
doctor. You might decide you would prefer to be treated by
the doctor who provided the second opinion.
Taking part in a clinical trial

Your doctor or nurse may suggest you take part in a clinical trial.
Doctors run clinical trials to test new or modified treatments and
ways of diagnosing disease to see if they are better than current
methods. For example, if you join a randomised trial for a new
treatment, you will be chosen at random to receive either the best
existing treatment or the modified new treatment.
Over the years, trials have improved treatments and led to better
outcomes for people diagnosed with cancer.
It may be helpful to talk to your specialist or clinical trials nurse,

or to get a second opinion. If you decide to take part, you can
withdraw at any time. For more information, call Cancer Council
13 11 20 for a free copy of Understanding Clinical Trials and
Research, or visit australiancancertrials.gov.au.
Making treatment decisions 17

Treatment
Most chemotherapy is given as a liquid drip into your vein
(intravenously, see below), but it is sometimes given by mouth
(orally) or in another way (see pages 22–23).
You may have one drug or a combination of drugs. Different drugs

and combinations are effective for different cancer types.
The choice of chemotherapy drugs, the dosage and the treatment

schedule will be recorded in a treatment plan. In deciding on
which drugs and dosage to give you, your treating specialist will
usually consult clinical guidelines for your cancer type. These
guidelines are based on the available evidence and aim to ensure
the best possible outcomes. You can ask your specialist which
guidelines they are following.
Your specialist may need to tailor your treatment according

to your individual situation. Tests throughout treatment will
monitor your response, and your treatment plan may be
adjusted based on those results.
Intravenous (IV) chemotherapy

Chemotherapy is most commonly given intravenously through
a narrow tube (see pages 20–21). Depending on the treatment,
a single session could take from 20 minutes up to several hours
and will usually be given during day visits to your hospital or
treatment centre. Sometimes chemotherapy is given continuously
over a few days via a portable pump or device that you are able
to use at home.
18 Cancer Council
Before chemotherapy, you may be given medicine so you don’t
feel sick (anti-nausea or anti-emetic medicine). You may also be
encouraged to drink several glasses of water during the session.
This helps ensure that the chemotherapy drugs don’t sit in the
kidneys or bladder too long. It is also a good idea to be well
hydrated in case you later experience vomiting as a side effect.
You will probably be seated in a comfortable, padded lounge chair

in a room with other patients when you are having chemotherapy.
You are usually able to walk around the ward during the treatment
session – for example, if you need to go to the toilet.
The nurses will assess you before chemotherapy, and monitor

you during and after the session. They will let you know when you
are able to leave the hospital or treatment centre. They will also
talk to you about managing any side effects and tell you about any
medicine you need to take at home.
Many people feel well enough to travel to and from chemotherapy

sessions by themselves. Even so, it is recommended that a relative
or friend comes with you to your first appointment to support
you and help you get home in case you feel unwell. It is safe for
family and friends to stay with you during the treatment.
My chemo infusions took about eight hours because

I had two drugs and a saline solution in between. It was a
long day, sitting in the chair having infusions. I was lucky my
partner stayed with me each time. Cheryl
Treatment 19
Intravenous devices
To prepare you for IV chemotherapy, you will have a narrow
tube inserted, usually in a vein in your arm. This may be a
short-term or longer-lasting device. The treatment team will
select the most appropriate device depending on how often you
need chemotherapy, how long it will take to give each dose,
and how long the device will need to stay in place.
Cannula – A small, single-use plastic tube that is temporarily

inserted into a vein using a needle. When the needle is removed,
the cannula remains in place in your arm or the back of your
hand. The cannula may be kept in place if you need to stay in
hospital for a few days. If you have day treatment every few weeks,
the cannula is usually put in and taken out each time you visit.
Central venous access device (CVAD) – A type of thin plastic

tube that remains in your vein throughout the entire course of
treatment, often for several weeks to months. Blood for testing
can sometimes be taken through this tube. Common types of
CVADs include:
• central line – inserted into the chest or neck
• Hickman line – inserted into the chest
• PICC (peripherally inserted central catheter) line – inserted
into the arm
• port-a-cath (port) – a small device inserted under the skin
of the chest or arm.
All tubes or lines need to be kept clean to prevent infection or

blockage. If you have a CVAD, a nurse may visit you at home
20 Cancer Council
to clean and dress your line, or this can be done at a hospital or
treatment centre. Dressings usually happen weekly; how often the
line needs rinsing with saline (flushing) depends on the device.
A CVAD doesn’t cause pain or discomfort if it is properly placed

and cared for, although you will be aware that it is there. Tell your
doctor or nurse immediately if you have pain, discomfort, redness
or swelling around the line. This could mean that you have an
infection. In this case, you will be given medicine to help fight
the infection and the device may need to be removed and replaced
with a new one. If you do not experience any infections, the device
will usually stay in place until after your last chemotherapy session.
Portable pumps
Some people are able to period. The pump is usually
have chemotherapy at home attached to a central line and
using a portable pump. The can be carried in a bag or
pump is programmed to give belt holster. Your hospital or
the prescribed amount of treatment centre will explain
chemotherapy over a specified how to care for the pump.
CHEMOTHERAPY PUMP
LOCK
START
STOP
OFF
ON
ENTER
CLEAR
NEXT
PRIME
Treatment 21
Other chemotherapy methods
There are other ways of having chemotherapy, depending on the
drugs being used and the type of cancer you have.
Oral chemotherapy – Some people take chemotherapy tablets

or capsules at home. Your doctor, nurse or pharmacist will tell you
how and when to take them, how to handle the medicine safely,
and what side effects might occur.
Cream – Some skin cancers are treated using a chemotherapy

cream applied directly to the skin.
Injections – Less commonly, chemotherapy can be injected using

a needle into different parts of the body:
• intramuscular – into a muscle, usually in your buttock or thigh
• subcutaneous – just under the skin
• intrathecal – into the fluid around the spine (also known as
a lumbar puncture)
• intra-arterial – into an artery
• intraperitoneal – into your abdominal area (peritoneum)
• intrapleural – into the outer lining of the lungs
• intravesical – into the bladder
• intralesional – into the tumour; this method is rare.
Chemoembolisation – Used for liver cancer or some types of

cancer that have spread to the liver, chemoembolisation involves
injecting chemotherapy directly into the blood vessels supplying a
tumour. The chemotherapy is mixed with tiny spheres that block
the vessels and stop the tumour getting nutrients and oxygen.
22 Cancer Council
Chemotherapy wafers – Some people who have surgery for a
brain tumour (craniotomy) will have small, soluble gel wafers of
chemotherapy placed into the tumour site during the operation.
Chemotherapy with other treatments

For some types of cancer, you may be given chemotherapy as part
of another treatment, such as a stem cell transplant or radiotherapy.
High-dose chemotherapy – This is a treatment given as part

of a stem cell transplant for blood cancers, such as leukaemia or
lymphoma. The high-dose chemotherapy kills off all the cancer
cells before the new, healthy blood cells are transplanted. The
transplant may occur a day or two or several days later.
Chemoradiotherapy or chemoradiation – Chemotherapy is

given during the course of radiotherapy for some cancers, such as
bowel cancer. It aims to make the radiotherapy more effective.
Smoking and chemotherapy

If you smoke, it’s best to try to better survival rate from cancer
quit, especially while you are than smokers. Smoking during
having chemotherapy. It can chemotherapy may reduce the
seem like a tough time to stop effectiveness of the treatment.
smoking, but research shows For advice, talk to your doctor,
that people who have never call 13 QUIT (13 7848) or visit
smoked or ex-smokers have a quitnow.gov.au.
Treatment 23
Waiting for chemotherapy
When you have chemotherapy, you may spend a lot of time
waiting, usually in the hospital or treatment centre: waiting for
health professionals, for blood tests, for test results, for your drugs
to be prepared and for the drugs to be given. There are sometimes
additional delays because of necessary safety checks, emergencies
or the workload of the treatment centre. Many treatment centres
will provide biscuits and water, tea and coffee, but you might want
to bring your own water bottle and snacks in case of long delays.
To pass the time, you may want to do the following:

• read a book or magazine, or listen to music
• complete a crossword or other puzzle
• chat with a companion
• write or draw in a journal
• meditate or practise relaxation techniques
• use a laptop, tablet or other electronic device – check with the
nurses whether this is okay and if power points are available.
At first, you may feel uncomfortable being around people who are
sick because of cancer or their treatment. You may not identify
with them. However, many people find support from others who
are receiving chemotherapy at the same time as them.
I became good friends with another lady who began

chemotherapy on the same day as me. We ended up
going walking several times a week for 18 months. The
companionship was a great support. Tania
24 Cancer Council
Tell your doctor if you plan to take over-the-counter medicines,
home remedies or complementary therapies, such as herbal
or nutritional supplements, before or after your chemotherapy
treatment. These may make side effects worse or affect how
well the chemotherapy works in your body.
Safety precautions
Chemotherapy is strong medicine, so it is safest for people without
cancer to avoid direct contact with the drugs. That’s why oncology
nurses and doctors wear gloves, goggles, gowns and, sometimes,
masks. When the treatment session is over, these items are
disposed of in special bags or bins.
After each chemotherapy session, the drugs may remain in your

body for up to a week. This depends on the types of drugs used.
The drugs are then released into urine, faeces and vomit. They
could also be passed to other body fluids such as saliva, sweat,
semen and breast milk.
Some people having chemotherapy worry about the safety of family

and friends. There is little risk to visitors, including children,
babies and pregnant women, because they aren't likely to come
into contact with any chemotherapy drugs or body fluids. The
safety measures listed on the next two pages are recommended
for family or friends who are providing care or have other close
contact during the recovery period at home. If you have questions,
talk to your treatment team or call Cancer Council 13 11 20.
Treatment 25
Chemotherapy safety in the home
Follow these safety guidelines to reduce exposure to chemotherapy
while at home. Safety precautions can vary depending on the drugs you
receive, so ask your treatment team about your individual situation.
For a week after a treatment session, sit

down to use the toilet. Put the lid down
before flushing to avoid splashing.
Vomit into a plastic bowl or bucket (or a

plastic bag with no holes). Don’t use the
bowl or bucket for anything else and throw
it out after your final chemotherapy session.
Keep a supply of cleaning cloths, paper

towels and disposable waterproof gloves
handy. If any body fluids (during the week
after a treatment session) or chemotherapy
drugs spill onto household surfaces, put on
a pair of waterproof gloves, soak up the spill
with paper towels, clean around the area
with a disposable cloth and soapy water,
and rinse the area with water. Seal used
gloves, cloths and paper towels in a plastic
bag before putting them in the bin.
During the week after a treatment session,

wear disposable waterproof gloves when
handling clothing or bed sheets soiled with
vomit or other body fluids, such as urine or
faeces. Seal the gloves in a plastic bag and
discard after use.
26 Cancer Council
Wash items soiled with body fluids in a
separate load in a washing machine on
the longest cycle (hot or cold water can be
used). Line dry the items.
Use a condom or a female condom if

having any type of sex within 7 days of a
chemotherapy session. Your doctor or nurse
can give you more detail about when you
need to use protection.
Avoid pregnancy while you are having

chemotherapy (see page 51). If you have
a baby, you will not be able to breastfeed
during your course of chemotherapy.
Don’t crush, chew or cut chemotherapy

tablets. If you can’t swallow a tablet whole,
talk to your treatment team or pharmacist.
Store all chemotherapy tablets, capsules

or injections as directed by your doctor or
pharmacist – they often need special storage
to keep them effective and safe. Keep them
out of reach of children, and do not store
them in a pill organiser with other medicines.
Treatment 27
Many people are given steroid medicine with their chemotherapy
treatment, most often in a low dose to help ease or prevent nausea.
Steroids are sometimes also used to manage allergic reactions, to
make chemotherapy more effective, or to directly treat the cancer.
Targeted therapy
Targeted therapy may be used instead of or together with
chemotherapy. This treatment uses drugs that work in a different
way to chemotherapy drugs. While chemotherapy affects all rapidly
dividing cells and works by killing cancerous cells (cytotoxic),
targeted therapy targets specific molecules within cells and often
works by blocking cell growth (cytostatic).
Although targeted therapy minimises harm to healthy cells, it

can still have side effects (see below). Not all cancers respond
to targeted therapy, and the drugs are sometimes hard to access
because they are expensive, not yet developed for all types of
cancer, and sometimes available only in clinical trials (see page 17).
Cancer cells often become resistant to targeted therapy drugs. If

this happens, your doctor will change your treatment and may
suggest trying chemotherapy or another type of targeted therapy.
Side effects of targeted therapy

Side effects vary depending on the targeted therapy used, but may
include fevers, allergic reactions, rashes, diarrhoea, blood-clotting
problems, and blood pressure changes. Particular drugs can affect
28 Cancer Council
the way your heart or liver works. Some side effects that are of
little concern after standard chemotherapy can be very serious if
they occur with a targeted therapy – your doctor will explain what
to watch out for, and will monitor you throughout the treatment.
Types of targeted therapy

There are currently two main types of targeted therapy: monoclonal antibodies
and small molecule inhibitors.
Monoclonal antibodies Small molecule inhibitors
• act like the natural antibodies • can get inside cancer cells
that our bodies produce to fight and block certain proteins and
infection and disease but are enzymes that tell the cancer
made in a laboratory (synthetic) cells to grow
• lock onto a protein on the surface • include tyrosine kinase inhibitors
of certain cells and interfere with (TKIs) – these block the function
the growth or survival of cancer of a group of enzymes called
cells in some way, e.g. may tyrosine kinases, which tell
deliver a toxic drug to cancer cancer cells to grow, multiply
cells, interrupt the growth and and spread
spread of cancer cells, or prompt • given as tablets or capsules
cells of the immune system to to be taken by mouth, usually
attack cancer cells on a daily basis over months
• given intravenously or as or years
an injection under the skin • drug names end in ‘-ib’ (for
(subcutaneous injection) inhibitor), e.g. imatinib, sorafenib
• drug names end in ‘-mab’
(for monoclonal antibody),
e.g. bevacizumab, rituximab
Treatment 29
Is the treatment working?
You might wonder whether experiencing side effects is a sign that
the chemotherapy is working. However, side effects usually do not
indicate how successful the chemotherapy is going to be.
Your doctor will use physical examinations and other tests to see
if the cancer has shrunk or disappeared after chemotherapy. This
is called the treatment response and it helps your doctor decide
whether to continue or change the chemotherapy plan.
If tests show that the cancer has shrunk and is unable to be detected,
this may be called remission, which means there is no evidence of
active cancer. Depending on the guidelines for the type of cancer
you have, this may mean chemotherapy can stop or may continue
for a period of time. Once your chemotherapy treatment has
finished, your treatment team will monitor you for several months
or years. This is because cancer can sometimes come back in the
same place or grow in another part of the body.
Which health professionals will I see?

You will be cared for by a range of health professionals during
chemotherapy. This is called a multidisciplinary team (MDT)
and it may include some or all of the professionals listed opposite.
Note that only some patients see a cancer care coordinator.
It is important to maintain or develop a relationship with a regular

general practitioner (GP), as they will be involved in your ongoing
care, particularly once the cancer treatment finishes.
30 Cancer Council
Health professional Role
refers you to specialists and provides ongoing
GP
care during and after your treatment
medical oncologist* prescribes and coordinates the course
or haematologist* of chemotherapy
prescribes and coordinates radiotherapy
radiation oncologist*
(which is sometimes given with chemotherapy)
cancer care coordinates your care, liaises with other
coordinator or clinical members of the MDT, and supports you
nurse consultant (CNC) and your family throughout treatment
administer drugs, including chemotherapy,
nurses and provide care, information and support
throughout your treatment
nurse who has had additional training and
nurse practitioner may be able to prescribe some medicines
and refer you to other health professionals
palliative care work closely with the GP and oncologist
specialist* and or haematologist to help control symptoms
palliative care nurses and maintain quality of life
dispenses medicines and gives advice
pharmacist
about dosage and side effects
recommends an eating plan to follow while
dietitian
you are in treatment and recovery
occupational therapist,
assist with physical and practical problems
physiotherapist
links you to support services and helps
social worker
with emotional, physical or practical issues
provide emotional support and help
psychologist, counsellor
manage anxiety and depression
* Specialist doctor
Treatment 31
Key points
• Chemotherapy is most protective clothing when giving

commonly given via a tube chemotherapy. However, there
into a vein (intravenously). is little risk to visitors during
and after your chemotherapy
• You may have one drug treatment.
or a combination of drugs
depending on the cancer type. • Your treatment team will
advise you about taking
• Usually people will have precautions at home to make
intravenous chemotherapy sure your family members
as an outpatient at a hospital don’t come into contact with
or treatment centre, but your body fluids, such as urine
sometimes they can have it at or vomit, as the drugs may be
home using a portable pump. passed into them. You should
also handle chemotherapy
• Chemotherapy is sometimes drugs with care.
given by mouth as tablets or
capsules (orally). • Targeted therapy may be
used instead of or with
• For some types of cancer, chemotherapy. The drugs
chemotherapy is given in target specific molecules
other ways, e.g. cream for skin within cancer cells.
cancer, chemoembolisation
for liver cancer, or wafers for • You will see a range of health
brain cancer. professionals when you have
chemotherapy. As well as
• It is safest for people without your GP, these will include
cancer to avoid direct contact a medical oncologist or
with chemotherapy drugs, haematologist, nurses and
so nurses and doctors wear other health professionals.
32 Cancer Council
Managing side effects
While chemotherapy can kill cancer cells, it can also affect normal
cells that grow or divide rapidly, such as the new blood cells in the
bone marrow and the cells in the mouth, stomach, skin, hair and
reproductive organs. When the normal cells are damaged, this
causes side effects.
Whether or not you have side effects, and how severe they are,
depends on the type and dose of drugs you are given and how you
react individually from one treatment cycle to the next. Most side
effects are temporary and can be managed. They tend to gradually
disappear once treatment stops and the normal healthy cells recover.
Why chemotherapy affects the blood

Chemotherapy can affect the cells are made by the bone
production of blood cells. The marrow, the spongy material
three main types of blood cells inside bones. Because the new
have specific functions: blood cells are rapidly dividing,
they can be damaged by
• red blood cells – carry chemotherapy and your blood
oxygen around the body count will be reduced. This
• white blood cells – fight may cause anaemia, infections
infection or bleeding problems (see
• platelets – help blood to pages 46–48).
clot and prevent bruising.
You will have blood tests to
To maintain normal levels of check that your blood count
each type in your bloodstream has returned to normal before
(your blood count), new blood your next chemo session.
Managing side effects 33

Common issues
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Preparing for side effects

Some people have no side effects, others experience a range. If you
have side effects, they will usually start during the first few weeks
of treatment and may become more intense with each treatment
cycle. Before treatment begins, your doctor or nurse will discuss
the side effects to watch out for or report, what medicine to take to
help prevent or manage them, and who to contact after hours.
If the side effects change your appearance and self-esteem,

consider attending the free Look Good Feel Better program. For
more details and to book, call 1800 650 960 or visit lgfb.org.au.
34 Cancer Council
Chemotherapy diary
It can be useful to record information about your chemotherapy
treatment in one place. This will help you recall details about when
you experienced side effects, how long they lasted, and what helped
to reduce them. Some people use a notebook or a diary, while
others prefer to use technology such as a smartphone or tablet.
Share the information you record with your doctors and nurses.
They will be able to suggest ways to manage the side effects or
they may adjust your treatment, if appropriate.
Complementary therapies
Complementary therapies are sometimes used with conventional
medical treatments. They may offer physical, emotional and
spiritual support, help manage side effects, and improve quality of
life. Some have been proven to be safe and effective in scientific
studies. For example, therapies such as meditation, relaxation,
massage and counselling can reduce anxiety, and acupuncture can
reduce chemotherapy-induced nausea and fatigue.
It is important to talk to your doctors about any complementary

therapies you are using or thinking about trying, as some
could interfere with your treatment or worsen side effects.
Complementary therapies are different to alternative therapies,
which are used instead of conventional medical treatments.
Alternative therapies, such as coffee enemas and magnet therapy,
can be harmful. For more information, call 13 11 20 and ask
for a free copy of the Understanding Complementary Therapies
booklet, or download a digital version from your local Cancer
Council website.

Feeling tired and lacking energy
Feeling tired and lacking energy (fatigue) is the most common and
often the most debilitating side effect of chemotherapy. Fatigue
can include feeling exhausted, drowsy, confused or impatient. You
may have a heavy feeling in your limbs, get worn out quickly, or
find it difficult to do daily activities.
Tips for managing fatigue

• Work out your priorities, so you Cancer booklet, or download
save your energy for the most a digital version from your local
important things. Cancer Council website.
• Allow your body to recover • Let people help you. Family,

by resting when you need to, friends and neighbours often
but balance this with regular want to assist but may feel
physical activity. Exercise can unsure about what to do.
reduce treatment-related fatigue They could ease your load by
and can also help with other helping with shopping, driving,
common side effects, such as housework or gardening.
nausea and loss of appetite.
• If you have children, ask
• Aim to fit in some light exercise, trusted family and friends to
such as walking, on most look after them during your
days and/or keep up with your chemotherapy sessions and
normal exercise routine. Talk to be on call in case you
to your health care team about become unwell afterwards.
suitable activities for you. You
• Plan activities for the time
can also call Cancer Council
of day when you tend to
13 11 20 for a free copy of our
feel most energetic.
Exercise for People Living with
36 Cancer Council
Fatigue can appear suddenly, and rest may not relieve it. You might
still feel tired for weeks or months after a treatment cycle ends.
While fatigue is a common side effect of chemotherapy, it can also
be a symptom of depression (see page 55). If you think you may be
depressed, it’s important to talk to your health care team as there
are treatment options available.
• Try to eat a well-balanced • Chemotherapy sometimes

diet with plenty of fruits causes a poor appetite,
and vegetables. nausea and/or vomiting, all of
which can leave you feeling
• Fatigue can be made worse if exhausted. See the next two
you are feeling anxious and/
pages for tips.
or having trouble sleeping
well. Try doing relaxation or • Check with your doctor
meditation exercises to see whether your fatigue is related
if they improve your sleep or to low levels of red blood cells
give you more energy. Call (anaemia). Anaemia can be
13 11 20 and check whether treated (see page 46).
your local Cancer Council
• Discuss the impact of the
can provide CDs or other
treatment with your employer.
resources that may help.
Some workplaces may allow
• Consider whether you would you to work flexibly during or
like to try acupuncture, which after chemotherapy. Options
some studies suggest may include taking a few weeks
help reduce physical tiredness off work, reducing your
after chemotherapy. hours or working from home.

Appetite changes, nausea or vomiting
It is common for your appetite to change when you are going
through chemotherapy, and the drugs may temporarily change
how food tastes. Sometimes you may not feel hungry or you may
prefer different types of food.
Chemotherapy can make you feel sick (nauseated) or cause you to

vomit. Not everyone feels sick during or after chemotherapy, but if
nausea affects you, it will usually start a few hours after treatment.
Nausea may last for many hours and be accompanied by vomiting
or retching. Sometimes nausea lasts for days after treatment.
Tips for coping with nausea and changed appetite

• If you are nauseous or have • Sip fluids throughout the day,
vomited a lot, try to keep rather than trying to drink a lot
sipping fluids so that you don’t at once. Sucking on ice cubes,
get dehydrated. If you aren’t iceblocks or jellies can also
able to keep fluids down, increase your fluid intake.
contact your doctor or hospital
• If your stomach is upset, try
immediately. They may be
drinking fizzy drinks such as
able to treat the vomiting, or
soda water or dry ginger ale.
you may need to have fluids
through an intravenous drip • If you wake up feeling sick, eat
in hospital. a dry biscuit or a slice of toast
rather than skipping food.
• Eat a light meal before your
treatment (e.g. soup with dry • Breathe deeply and gently
biscuits or toast), and drink through your mouth if you feel
as much fluid as possible. like you’re going to vomit.
38 Cancer Council
Often the best way to manage nausea is to stop it before it starts.
Anti-nausea (anti-emetic) medicine helps most people, but
finding the right one can take time. If you still have nausea or
vomiting after using the prescribed medicine, let your nurse
or doctor know so that another medicine can be tried.
Being unable to keep liquids down because of vomiting can cause

you to become dehydrated. Signs of dehydration include a dry
mouth and skin, dark urine, dizziness and confusion. It is best
not to be left alone if you are vomiting a lot, as the confusion may
make it difficult to realise you have become seriously dehydrated.
• Eat what you feel like, when • If the taste of certain foods
you feel like it. Have frequent has changed, don’t force
snacks instead of large meals. yourself to eat them. Your
sense of taste should return to
• Avoid strong odours and normal after treatment ends.
cooking smells. Prepare meals
ahead and freeze them for days • Speak to the hospital dietitian
you don’t feel like cooking. for advice about eating.
• Eat and drink slowly. Chew • Call Cancer Council 13 11 20

your food well to make it for copies of the Nutrition
easier to digest. and Cancer booklet and the
Understanding Taste and
• Consider trying acupuncture, Smell Changes fact sheet, or
which research shows can
find digital versions on your
reduce chemotherapy-related
local Cancer Council website.
nausea and vomiting.

Hair loss
Many people having chemotherapy worry about hair loss. Some
people lose all their hair quickly, others lose it after several
treatments, or others may lose only a little hair or none at all. Ask
your doctor if hair loss is a possibility and how you can prepare.
When hair loss does occur, it usually starts 2–3 weeks after the first
treatment and grows back when chemotherapy is completed. Before
and while your hair is falling out, your scalp may feel hot, itchy,
tender or tingly. Some people find that the skin on their head is
extra sensitive, and they may develop pimples on their scalp.
Tips for managing hair loss

• Keep your hair and scalp very • Cut your hair, especially if
clean. Use a mild shampoo like it is long, before it falls out.
baby shampoo. If you want to You could also consider
use lotion on your head, use shaving your head. Some
sorbolene. Check with your people say this gives them
nurse before using any other a sense of control.
hair or skin care products.
• Wear a light cotton turban or
• Comb or brush your hair gently beanie to bed if you are cold
using a large comb or hairbrush at night, or to collect hair.
with soft bristles.
• Use a cotton, polyester or satin
• Explain to family and friends, pillowcase, as nylon can irritate
especially children, that the your scalp. If you prefer to
chemotherapy may make your leave your head bare, protect it
hair fall out. against sunburn and the cold.
40 Cancer Council
Although losing head hair is most common, you may also lose hair
from your eyebrows, eyelashes, arms, legs, chest and pubic region.
It takes 4–12 months to grow back a full head of hair. When your
hair first grows back, it may be a different colour or curly (even
if you have always had straight hair). In time, your hair usually
returns to its normal condition.
Many people find losing their hair difficult. You may see your hair
as part of your overall image and its loss can make you feel sad or
vulnerable. Talking to your treatment team may help.
• Talk to your hairdresser about • Consider choosing a wig

making your hair look as good before chemotherapy starts.
as possible even if it is thin or Call Cancer Council 13 11 20
patchy. If you want to dye your for assistance in finding a wig
hair during or for about six library or shop.
months after chemotherapy,
• Consider booking in for
it is best to use vegetable-
a Look Good Feel Better
based, non-chemical dyes.
workshop, where you can try
• If your eyelashes fall out, wear on wigs and hair coverings
sunglasses outside to protect and learn new make-up
your eyes from dust and sun. techniques. Visit lgfb.org.au
or call 1800 650 960.
• Wear a wig, hat, turban or
scarf, or go bare-headed – • Read Cancer Council’s
whatever feels best to you. Hair Loss fact sheet.

Skin and nail changes
Your skin may peel, darken or become dry and itchy during and
after chemotherapy treatment. It is also likely to be more sensitive
to the sun.
Some people find their nails also change and become brittle and
dry, develop ridges, or have white lines across them.
Tips for looking after your skin and nails

• Use a moisturising soap or • Protect your skin from the
sorbolene cream as a soap sun, especially between
replacement. After showering, 10am and 3pm. Wear
gently pat your skin dry with high-protection sunscreen
a towel. (SPF 50+), a broad-brimmed
hat, protective clothing and
• Use a moisturising lotion sunglasses, and try to stay
or cream containing the
in the shade. This advice
ingredient urea to help with
applies to everyone, but is
the dryness.
especially important when
• Wear loose, non-restricting having chemotherapy.
clothing. Choose cotton fabric
• If your skin becomes red or
instead of rough wool or
sore in the area where the
synthetic fibres.
intravenous device went
• Wash your clothing in mild in, tell your doctor or nurse
detergent for people with immediately.
sensitive skin.
• Avoid chlorinated swimming
• Stop shaving or waxing until pools as the water can make
your skin is healed. skin changes worse.
42 Cancer Council
Mouth sores
Some chemotherapy drugs can cause mouth sores, such as ulcers,
or infections. This is more likely if you have had or are having
radiotherapy to the head, neck or chest, or if you have dental or
gum problems. If you notice any change in your mouth or throat,
such as sores, ulcers or thickened saliva, or if you find it difficult
to swallow, contact your doctor.
Tips for mouth care

• Discuss any dental problems have a dry mouth. Moisten
with your doctor before seeing foods with gravy or sauce.
the dentist. If you need any
• Soothe tender gums and
dental work, tell your dentist
mouth with plain yoghurt.
you are having chemotherapy.
• Blend foods to make them
• Use a soft toothbrush to clean easier to eat. Try smoothies
your teeth twice a day.
with fruit and yoghurt.
• Try a homemade mouthwash
• Avoid smoking and alcoholic
(1 tsp bicarbonate of soda
drinks, as well as very hot
or salt in a glass of warm
foods and spicy, acidic or
water) four times a day. Avoid
coarse foods (e.g. nuts
mouthwashes with alcohol.
or grains). These can all
• Try to prevent mouth ulcers aggravate mouth sores.
by sucking on ice during
• Read the Mouth Health and
chemotherapy sessions.
Cancer Treatment fact sheet,
• Sip fluids, especially water, available from your local
and eat moist foods such as Cancer Council website, or
casseroles or soups if you call 13 11 20 for information.

Constipation or diarrhoea
Some chemotherapy drugs, pain medicines and anti-nausea drugs
can cause constipation or diarrhoea. Tell your doctor or nurse if
your bowel habits have changed.
Tips for managing bowel changes

Constipation Diarrhoea
• Eat more high-fibre foods, • Choose bland foods such

such as wholegrain bread as clear broth or boiled rice.
and pasta, bran, fruits and Avoid spicy foods, wholegrain
vegetables, nuts and legumes products, fatty or fried
(e.g. baked beans or lentils). foods, rich sauces, and raw
fruits or vegetables with
• Drink plenty of fluids, both skins or seeds.
warm and cold, to help loosen
the bowels. Prune, apple or • Limit alcohol, fruit juice, soft
pear juice can work well. drinks, strong tea or coffee,
and dairy products, as these
• Do some light exercise, stimulate the bowel.
such as walking.
• Drink water to help replace
• Don’t use enemas or fluids lost through diarrhoea.
suppositories. They are not
recommended for people • Talk to your pharmacist
having chemotherapy. about using over-the-counter
medicines for diarrhoea.
• Let your treatment team know
if you have constipation for • If diarrhoea is severe, it can
more than a couple of days. cause dehydration and you
They will be able to help. may need to go to hospital.
44 Cancer Council
Memory and concentration changes
Some people say they have trouble thinking clearly after they
have had chemotherapy. This is called cognitive impairment or,
sometimes, ‘chemo brain’. You may find that it takes you more
time to process information, or you may experience short-term
memory loss or have trouble concentrating for long periods.
This side effect may last for a short time or for years.
There is some evidence that self-help techniques such as exercise,

relaxation, and memory games can help. Tell your doctor if this
issue is affecting your day-to-day life.
Tips for managing cognitive changes

• Use a calendar to keep track • Get plenty of sleep. Deep
of tasks, appointments, social sleep is important for memory
commitments, birthdays, etc. and concentration.
• Write down anything you • Do light exercise each day.

need to remember, e.g. to-do This may help you to clear
items, where you parked the your mind and sleep better.
car, when to take medicine.
• Learn something new, e.g.
• Plan to do things that require take up a new hobby or do
focus when you are fresher, crosswords or puzzles.
such as in the morning. At
• Talk to your partner, family
other times, choose activities
or friends about how you’re
that need less concentration,
feeling. This can help
e.g. read magazines instead
prevent misunderstandings
of complex novels.
and frustration.

Anaemia
A low red blood cell count is called anaemia. This can make you
feel tired, lethargic, dizzy or breathless. The tips for coping with
fatigue on pages 36–37 may be helpful. To minimise dizziness,
take your time when you get up from sitting or lying down.
Your treatment team will monitor your red blood cell levels.
If the levels drop too low, you may need a blood transfusion
to build them up again.
Infections
If white blood cell numbers drop during chemotherapy, it can
lower your immunity. This makes you more prone to infections
and less able to fight any infections that do occur. Your doctor
may recommend antibiotics as a precaution against infection.
The white blood cells known as neutrophils protect you against

infection by destroying harmful bacteria and yeast that enter the
body. A low level of neutrophils (neutropenia) is a common side
effect of chemotherapy. If you have neutropenia, you may be given
an injection of granulocyte-colony stimulating factor (G-CSF)
after chemotherapy. Your doctor or nurse will speak to you about
possible side effects. Some people may experience bone pain or
tenderness at the injection site, or show signs of an allergic reaction.
During chemotherapy treatment, even a minor infection could

rapidly become serious. See page 11 for when you need to contact
your doctor urgently.
46 Cancer Council
Tips for managing low immunity and infections
• Check your temperature • Cook food thoroughly to
every day and seek urgent reduce the risk of bacteria
medical attention if it rises developing.
to 38oC or above.
• Don’t eat food or drinks
• See your doctor if you are past their use-by or best
unwell, even if you just before dates.
have a cold.
• Stay away from people who
• Wash hands well with soap are unwell, especially if they
and water before handling have the flu, conjunctivitis,
food and after using the toilet. measles, mumps, a cold sore
or chickenpox. If a member
• Try to eat freshly cooked or of your household is unwell,
freshly prepared foods. Avoid
try to avoid close contact
pre-made sandwiches, salads
until they have recovered.
and takeaway; soft cheeses;
raw or rare fish, meat or eggs; • Try to avoid crowded places
unpasteurised dairy foods; and such as public transport
soft-serve ice-creams. during rush hour, shopping
centres or public pools to
• Use separate chopping reduce the risk of picking up
boards and utensils for raw
an infection.
and cooked foods, and clean
well with hot, soapy water. • Check with your doctor about
having the flu vaccine if you
• Wash fruits and vegetables are having chemotherapy
well, or peel where possible.
during winter.
• Store raw and cooked foods
• Let your doctor know if you
separately. Put leftover food in
think you’ve been in close
airtight containers in the fridge
contact with someone who
as soon as possible.
has chickenpox.

Bleeding problems
Platelets are the blood cells that help the blood to clot, and a low
level of platelets (thrombocytopenia) can cause problems with
bleeding. You may bleed for longer than normal after minor cuts
or scrapes, have nosebleeds or bleeding gums, or bruise easily.
Your treatment team will monitor your platelet levels. If

chemotherapy causes thrombocytopenia, you may need to go
to hospital for a platelet transfusion.
Contact your treatment team or call 000 if you have any persistent
bleeding, such as a nosebleed that doesn’t stop within 30 minutes.
Tips for when you have a low platelet count

• Be careful when using • Use a soft toothbrush to
scissors, needles, knives or avoid irritating your gums.
razors, as you may bleed
• Avoid cuts and scrapes
easily. Small cuts or nicks
on your feet by wearing
can also harbour germs
comfortable, well-fitting shoes
where an infection can start.
indoors and outside.
• Use an electric razor when
• Take care when blowing
shaving to reduce the chance
your nose.
of nicking yourself.
• If you bleed, apply pressure
• Wear thick gloves when for about 10 minutes and
gardening to avoid injury.
bandage as needed.
(The gloves will also prevent
infection from soil, which • If you have problems with
contains bacteria.) bleeding, talk to your doctor.
48 Cancer Council
Nerve and muscle effects
Some drugs can cause tingling (‘pins and needles’), pain or loss
of sensation in your fingers and/or toes, and muscle weakness in
your legs. This is called peripheral neuropathy. If you experience
these side effects, tell your doctor or nurse before your next
treatment. Your treatment may need to be changed or the problem
carefully monitored.
For many people, peripheral neuropathy is a short-term issue,

but for others, it can last a long time or even be permanent. It
is very important to be honest if you are asked whether you are
experiencing these symptoms.
Tips for managing peripheral neuropathy

• Take care when moving make the tingling worse,
around – you may be more while loose shoes may make
prone to trip and fall if your you stumble.
feet are numb or your legs
• Use your elbow to check
are weak.
water temperature so you
• Keep your hands and feet don’t scald yourself.
warm to help the blood
• Talk to an occupational
circulate. Gloves and warm
therapist from your treatment
socks can help when it’s cold.
team about aids that may
• Soak your hands and feet help, e.g. bed posts to raise
in warm water to relieve the sheets off your feet.
symptoms.
• If your symptoms are severe,
• Make sure your shoes fit talk to your doctor about
properly – tight shoes can medicines that may offer relief.

Change in hearing
Some chemotherapy drugs can affect your hearing. Your doctor
may recommend that you have a hearing test before you start
treatment. You may be at risk of losing the ability to hear
high-pitched sounds. Sometimes, chemotherapy also causes a
continuous ringing noise in the ears known as tinnitus. While
these changes are usually temporary, let your doctor know if you
notice any change in your hearing.
Sex and fertility

Chemotherapy can have an impact on your desire or ability to
have sex. It may also affect sexual organs and functioning in men
and women. This can affect your ability to have children (fertility).
Changes in sexuality
Many people have a range of worries that cause them to lose interest
in sex while they’re having treatment. Aside from feeling tired and
unwell, you may feel less confident about who you are and what you
can do, or there may be a physical reason for not being able or ready
to have sex. For example, vaginal dryness or erection difficulties are
common issues after treatment. Changes in appearance can also
affect feelings of self-esteem and, in turn, sexuality.
For more information, call Cancer Council 13 11 20 and ask about

free resources on sexuality and intimacy, or download them from
your local Cancer Council website.
50 Cancer Council
Partners may also feel concerned about having sex. They might
fear injuring the person with cancer or feel uncomfortable with
the changes in their partner. If you have sex after receiving
chemotherapy, follow the safety precautions described below.
Sexual intercourse may not always be possible, but closeness and

sharing can still be a part of your relationship. Talk about how
you’re feeling with your partner, and take time to adapt to any
changes. Try to see yourself as a whole person (body, mind and
personality) instead of focusing only on what has changed.
Contraception
Although chemotherapy often reduces fertility, it is important to
realise that it may not rule out pregnancy. Some women can still
become pregnant while having chemotherapy, and a man having
chemotherapy could still make his partner pregnant.
Chemotherapy drugs can harm an unborn baby, so women should

not become pregnant during the course of chemotherapy, and
men should not father a child. Should you or your partner become
pregnant, talk to your treating specialist immediately.
The type of birth control you choose will depend on what you
and your partner are comfortable using. Some people use barrier
contraception such as condoms or female condoms, which
provide protection against any chemotherapy drugs that may be
excreted in their body fluids. Young women may be prescribed
the contraceptive pill – as well as preventing pregnancy, the pill
may help protect the ovaries from the effects of chemotherapy.

Changes in fertility
If you want to have children in the future, talk to your doctor about
how chemotherapy might affect you and what options are available.
Women may be able to store eggs (ova) or embryos, and men may
be able to store sperm for use at a later date. This needs to be done
before chemotherapy starts and requires careful consideration.
For more information, call Cancer Council 13 11 20 and ask for a

free copy of the Fertility and Cancer booklet, or download it from
your local Cancer Council website.
Effects on women Effects on men
• For some women, periods become • Chemotherapy drugs may lower

irregular during chemotherapy but the number of sperm produced
return to normal after treatment. and reduce their ability to move.
For others, chemotherapy may This can sometimes cause
cause periods to stop completely infertility, which may be temporary
(menopause). or permanent.
• After menopause, women can’t • The ability to get and keep an

conceive children. Signs of erection may also be affected,
menopause include hot flushes, but this is usually temporary. If
sweating – especially at night – the problem is ongoing, talk to
and dry skin. your doctor.
• Menopause – particularly when it

occurs in women under 40 – may,
in the long term, cause bones to
become weaker and break more
easily. This is called osteoporosis.
• Talk to your doctor about ways to

manage menopausal symptoms.
52 Cancer Council
Key points
• Many people experience side nausea, hair loss, mouth

effects from chemotherapy. sores, skin problems and
Side effects are caused bowel issues.
when the chemotherapy
damages rapidly dividing • You may have a reduced
healthy cells. ability to concentrate or
remember things. There can
• Your doctor or nurse will also be nerve and muscle
advise you on how to cope effects and hearing changes.
with any side effects. You
may be prescribed medicine • You will be at increased risk
or given suggestions for of infections. This is because
eating, drinking and looking chemotherapy can reduce
after yourself. your levels of white blood
cells, which are necessary
• It may be helpful to record for fighting infections.
your symptoms, when they
occurred and what you did • You may have sexuality and
to relieve them, possibly in fertility problems, such as
a chemotherapy diary. Show reduced sexual desire or loss
your notes to your doctor of fertility. You might be able
or nurse. to store eggs (ova), embryos
or sperm for use at a later
• Most side effects are date. Talk to your doctor
temporary and gradually about these issues.
go away after you have
finished treatment. • If you have any side effects
that weren’t discussed with
• Common side effects include you before treatment, let your
feeling tired, loss of appetite, health care team know.

After treatment
After chemotherapy has finished, your treatment team will
give you general information about your recovery. They will
recommend ways to manage side effects and who to call if you
have any questions or concerns.
Follow-up appointments
You will have regular check-ups with your treating specialist.
These will become less frequent over time. During these
appointments, you will usually have a physical examination and
you may have blood tests, x-rays or scans to confirm that the
cancer hasn’t come back or spread. You will be able to discuss how
you’re feeling and mention any concerns you may have.
You may also have regular check-ups with other specialists who
have been involved in your treatment. Ask your treatment team
whether you can space out these appointments. Let your doctor
know immediately if you experience any health problems between
follow-up appointments.
When a follow-up appointment or test is approaching, many

people find that they think more about the cancer and may feel
anxious. Talk to your treatment team or call Cancer Council
13 11 20 if you are finding it hard to manage this anxiety.
You never get back to the normal you knew before you
had cancer. It’s a series of evolutions – evolving as a different
person. Julie
54 Cancer Council
Coping with your emotions
For most people, the cancer experience doesn’t end on the last
day of treatment. Life after cancer can present its own challenges.
You may have mixed feelings when treatment ends, and worry
that every ache and pain means the cancer is coming back. Some
people say that they feel pressure to return to ‘normal life’, but
they don’t want life to return to how it was before cancer. Take
some time to adjust to the physical and emotional changes, and
re-establish a new daily routine at your own pace.
Cancer Council 13 11 20 can help you connect with other people

who have had cancer, and provide you with information about the
emotional and practical aspects of living well after cancer.
Dealing with feelings of sadness

If you have continued feelings people are able to get a
of sadness, have trouble Medicare rebate for sessions
getting up in the morning or with a psychologist. Ask your
have lost motivation to do doctor if you are eligible. Your
things that previously gave local Cancer Council may also
you pleasure, you may be run a counselling program.
experiencing depression.
This is quite common among The organisation beyondblue
people after cancer treatment. has information about coping
with depression and anxiety.
Talk to your GP, as counselling Go to beyondblue.org.au or
or medication – even for a call 1300 22 4636 to order
short time – may help. Some a fact sheet.
After treatment 55
Cancer Council services
Cancer Council offers a range of services to support people
affected by cancer, their families and friends.
Cancer Council 13 11 20 – This is many people’s first point

of contact if they have a cancer-related question. Trained
professionals will answer any questions you have about your
situation. For more information, see the inside back cover.
Practical help – Your local Cancer Council can help you

access services or offer advice to manage the practical impact
of a cancer diagnosis. This may include access to transport and
accommodation or legal and financial support. Call 13 11 20
to find out what is available in your state or territory.
Support services – You might find it helpful to share your

experiences with other people affected by cancer. For some people,
this means joining a support group. Others prefer to talk to
a trained volunteer who has had a similar cancer experience.
Cancer Council can link you with others by phone, in person

or online at cancerconnections.com.au. Call us to find out what
services are available in your area.
Life after cancer – It’s natural to feel a bit lost after finishing
treatment. You might notice every ache or pain and worry that
the cancer is coming back.
Cancer Council can provide support and information to people

adjusting to life after cancer – call 13 11 20 for details.
56 Cancer Council
Printed, online and audiovisual resources – In addition
to this resource, Cancer Council produces a wide variety
of free information about cancer-related topics, including
easy-to-read booklets and fact sheets on more than 20 types
of cancer, treatment, emotional issues and recovery.
Cancer Council publications are developed in consultation with

health professionals and consumers. Content is reviewed regularly,
according to best practice guidelines for health information.
Related publications*
You might also find the following free Cancer Council
publications and audiovisual resources useful:
• Emotions and Cancer • Cancer, Work & You
• Nutrition and Cancer • Overcoming Cancer Pain
• Exercise for People Living • Caring for Someone
with Cancer with Cancer
• Talking to Kids About • Sexuality, Intimacy
Cancer and Cancer
• Understanding Clinical Trials • Living Well After Cancer
and Research • Living with Advanced
• Complementary Therapies Cancer
• Relaxation and meditation • Understanding Palliative
CDs Care
Call 13 11 20 for copies, or download them from your local
Cancer Council website.
* May not be available in all states and territories.
Cancer Council services 57

Caring for someone
with cancer
You may be reading this booklet because you are caring for
someone with cancer. Being a carer can be stressful and cause you
much anxiety. Try to look after yourself – give yourself some time
out and share your worries and concerns with somebody neutral,
such as a counsellor or your doctor.
Many cancer support groups and cancer education programs are

open to carers, as well as people with cancer. Support groups and
programs can offer valuable opportunities to share experiences
and ways of coping.
Support services such as Meals on Wheels, home help or visiting

nurses can help you in your caring role. You can find local support
services, as well as practical information and resources, through
the Carer Gateway. Visit carergateway.gov.au or call 1800 422 737.
There are also many groups and organisations that can provide
you with information and support, such as Carers Australia, the
national body representing carers in Australia. Carers Australia
works with the Carers Associations in each of the states and
territories. Phone 1800 242 636 or visit carersaustralia.com.au
for more information and resources.
You can call Cancer Council 13 11 20 to find out more about

carers’ services and support groups and to get a copy of the
Caring for Someone with Cancer booklet.
58 Cancer Council
Useful websites
The internet has many useful resources, although not all websites
are reliable. The websites listed below are good sources of support
and information.
Australian
Cancer Council Australia ��cancer.org.au
Cancer Australia................................................ canceraustralia.gov.au
Cancer Connections...................................cancerconnections.com.au
Carer Gateway.......................................................carergateway.gov.au
Carers Australia.................................................carersaustralia.com.au
Department of Health �� health.gov.au
Department of Human Services
(including Centrelink and Medicare) ��humanservices.gov.au
healthdirect Australia �� healthdirect.gov.au
Look Good Feel Better ��lgfb.org.au
International
American Cancer Society ��cancer.org
Macmillan Cancer Support (UK) �� macmillan.org.uk
National Cancer Institute (US) �� cancer.gov
Chemocare (US) �� chemocare.com
Useful websites 59
Question checklist
You may find this checklist helpful when thinking about the
questions you want to ask your doctor about your disease and
treatment. If your doctor gives you answers that you don’t
understand, ask for clarification.
• Why do I need chemotherapy?

• What are the advantages and disadvantages of chemotherapy
for me?
• How successful is chemotherapy for the type of cancer I have?
• What is the goal of this chemotherapy?
• Are there any other treatments I can have instead?
• Is there any targeted therapy for the type of cancer I have?
• How much does treatment cost?
• What drugs will I be receiving? How will they be given?
• How often will I receive chemotherapy? How long will I have
treatment? How will you decide the dosage?
• Which clinical guidelines are you following?
• Where will I have chemotherapy? Can I have it close to
where I live?
• What are the possible side effects of this treatment and what
can I do to control them?
• Are there any complementary therapies that may help?
• How will I know if the treatment is working?
• Will chemotherapy affect my sex life and fertility?
• After treatment has finished, will I need check-ups?
• Who should I contact for information or if I have a problem
during treatment? Who is my after-hours contact?
60 Cancer Council
Glossary
adjuvant therapy central venous access device
A treatment given with or shortly after (CVAD)
the main treatment to enhance the A type of thin plastic tube inserted
main treatment’s effectiveness. into a vein. The CVAD gives access
anaemia to a vein so blood or chemotherapy
A low level of red blood cells. can be given, and blood can be taken.
antibody Types of CVADs include central lines,
A protein made by the blood in Hickman lines, peripherally inserted
response to an invader (antigen) in the central catheter (PICC) lines, and
body. Antibodies are part of the body’s port-a-caths.
immune system and help protect chemotherapy
against viruses, bacteria and other The use of cytotoxic drugs to treat
foreign substances. cancer by killing cancer cells or
slowing their growth. May be given
biological therapy alone or with other treatments.
A medicine made from purified chemotherapy pump
versions of chemicals that are naturally A portable device, usually attached
made in the body. Types of biological to a central line. It allows a person to
therapy include monoclonal antibodies have chemotherapy at home.
and immunotherapy drugs. Also called cycle
biotherapy. The time between one chemotherapy
bone marrow treatment session and the next.
The soft, spongy material inside cytostatic
bones. Bone marrow contains stem A substance (e.g. targeted therapy)
cells that produce red blood cells, that blocks the growth of cancer cells.
white blood cells and platelets. cytotoxic
A substance (e.g. chemotherapy) that
cannula is toxic to cells, so it can kill or slow
A plastic tube inserted into a narrow the growth of cancer cells.
opening (usually a vein) so that fluids
can be introduced or removed. fertility
cells The ability to conceive a child.
The basic building blocks of the body.
A human is made of billions of cells granulocyte-colony stimulating
that are adapted for different functions. factor (G-CSF)
central line A protein that helps the bone marrow
A type of central venous access device produce more neutrophils, the white
used to give direct access to a vein in blood cells that defend the body
the chest or neck. against bacteria and yeast.
Glossary 61
Hickman line neutropenia
A type of central venous access device A low level of neutrophils. It can be
inserted into a vein in the chest. a side effect of chemotherapy and
hormone therapy/treatment makes you more prone to infections.
A treatment that blocks the body’s neutrophils
natural hormones. It is used when A type of white blood cell that defends
the cancer is growing in response the body against bacteria and yeast.
to hormones. Also known as
endocrine therapy. oncologist
A doctor who specialises in the study
immunotherapy and treatment of cancer.
The prevention or treatment of disease
using substances that alter the palliative treatment
immune system’s response. May also Medical treatment for people with
be called biological therapy. advanced cancer to help manage pain
infusion and other symptoms. Treatment may
A slow injection of a substance into include chemotherapy, radiotherapy or
a vein or other tissue. other therapies. It is an important part
intravenous (IV) of palliative care.
Inserted into a vein. peripherally inserted central
catheter (PICC)
menopause A type of central venous access device
When a woman stops having periods that is inserted into a vein in the arm.
(menstruating). This can happen peripheral neuropathy
naturally, from treatment, or because Weakness, numbness, tingling or pain,
the ovaries have been removed. usually in the hands and feet, caused
molecule by damage to the nerves that are
A very small particle in a chemical located away from the brain and spinal
element. cord (peripheral nerves). This damage
monoclonal antibodies can be a side effect of chemotherapy.
A group of targeted therapy drugs that platelets
lock onto a specific protein on the Cells found in the blood that help the
surface of cancer cells and interfere blood to clot and stop bleeding. Also
with the cells’ growth or survival. called thrombocytes.
port-a-cath (port)
neoadjuvant therapy A type of central venous access
A treatment given before the main device. A thin tube put into a vein
treatment to try to make the with an opening under the skin for
main treatment more successful. delivering medicine.
62 Cancer Council
radiotherapy thrombocytopenia
The use of radiation to kill cancer cells A low level of platelets. It can be a side
or injure them so they cannot grow and effect of chemotherapy and makes you
multiply. Also called radiation therapy. more prone to bleeding and bruising.
red blood cells tissue
Cells found in the blood that carry A collection of cells that make up a
oxygen around the body. Also called part of the body.
erythrocytes. tumour
remission A new or abnormal growth of tissue
When the signs and symptoms of the on or in the body. It may be benign
cancer reduce or disappear. (not cancer) or malignant (cancer).
tyrosine kinase inhibitor (TKI)
side effect A small molecule inhibitor that blocks
Unintended effect of a drug or enzymes involved with cell growth. A
treatment. targeted therapy.
small molecule inhibitors
A group of targeted therapy drugs that white blood cells
can get inside cancer cells and block Cells found in the blood that help fight
proteins that tell the cells to grow. infection. Types of white blood cells
steroid include neutrophils, lymphocytes and
A class of drugs mostly used for monocytes. Also called leucocytes.
inflammation, but also used to treat
myeloma. Also called corticosteroids.
targeted therapy
Treatment that attacks specific
Can’t find a word here?
particles (molecules) within cells that
allow cancer to grow and spread. The For more cancer-related words, visit:
two main types of targeted therapy at • cancercouncil.com.au/words
present are monoclonal antibodies and • cancervic.org.au/glossary
small molecule inhibitors. • cancersa.org.au/glossary.
References
1. YY Lee et al., ‘Incidence and outcomes of pregnancy-associated cancer in
Australia, 1994–2008: a population-based linkage study’, BJOG: An International
Journal of Obstetrics and Gynaecology, vol. 119, 2012, pp. 1572–82.
2. FA Peccatori et al., ‘Cancer, pregnancy and fertility: ESMO Clinical Practice
Guidelines for diagnosis, treatment and follow-up’, Annals of Oncology, vol. 24,
suppl. 6, 2014, vi160–70.
Glossary 63
How you can help
At Cancer Council, we’re dedicated to improving cancer
control. As well as funding millions of dollars in cancer research
every year, we advocate for the highest quality care for cancer
patients and their families. We create cancer-smart communities
by educating people about cancer, its prevention and early
detection. We offer a range of practical and support services for
people and families affected by cancer. All these programs would
not be possible without community support, great and small.
Join a Cancer Council event: Join one of our community

fundraising events such as Daffodil Day, Australia’s Biggest
Morning Tea, Relay For Life, Girls’ Night In and Pink Ribbon Day,
or hold your own fundraiser or become a volunteer.
Make a donation: Any gift, large or small, makes a meaningful

contribution to our work in supporting people with cancer and
their families now and in the future.
Buy Cancer Council sun protection products: Every purchase

helps you prevent cancer and contribute financially to our goals.
Help us speak out for a cancer-smart community: We are a

leading advocate for cancer prevention and improved patient
services. You can help us speak out on important cancer issues
and help us improve cancer awareness by living and promoting
a cancer-smart lifestyle.
Join a research study: Cancer Council funds and carries out

research investigating the causes, management, outcomes and
impacts of different cancers. You may be able to join a study.
To find out more about how you, your family and friends can
help, please call your local Cancer Council.
64 Cancer Council
Cancer Council
13 11 20
Being diagnosed with cancer can be overwhelming. At
Cancer Council, we understand it isn’t just about the treatment
or prognosis. Having cancer affects the way you live, work and
think. It can also affect our most important relationships.
When disruption and change happen in our lives, talking

to someone who understands can make a big difference.
Cancer Council has been providing information and support
to people affected by cancer for over 50 years.
Calling 13 11 20 gives you access to trustworthy information

that is relevant to you. Our cancer nurses are available to answer
your questions and link you to services in your area, such as
transport, accommodation and home help. We can also help
with other matters, such as legal and financial advice.
If you are finding it hard to navigate through the health care

system, or just need someone to listen to your immediate
concerns, call 13 11 20 and find out how we can support you,
your family and friends.
Cancer Council services and programs vary in each area.

13 11 20 is charged at a local call rate throughout Australia (except from mobiles).
If you are deaf, or have

If you need information a hearing or speech
in a language other impairment, contact us
than English, an through the National
interpreting service is Relay Service.
available. Call 13 14 50. www.relayservice.gov.au
UNDERSTANDING CHEMOTHERAPY
For information and support
on cancer-related issues,
call Cancer Council 13 11 20.
This is a confidential service.
Visit your local Cancer Council website

Cancer Council ACT Cancer Council Queensland Cancer Council Victoria
actcancer.org cancerqld.org.au cancervic.org.au
Cancer Council NSW Cancer Council SA Cancer Council WA

cancercouncil.com.au cancersa.org.au cancerwa.asn.au
AUG 2016 CAN708
Cancer Council NT Cancer Council Tasmania Cancer Council Australia

nt.cancer.org.au cancertas.org.au cancer.org.au
This booklet is funded through the generosity of the people of Australia.

To support Cancer Council, call your local Cancer Council or visit your local website.

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Understanding

For information & support, call

First published May 2002. This edition August 2016.

This booklet is funded through the generosity of the people of Australia.

Cancer Council Australia

Many people feel concerned about the side effects of chemotherapy,

How this booklet was developed

If you or your family have any questions,

How is cancer treated?..................................................... 6

Making treatment decisions........................................... 16

Managing side effects..................................................... 33

Cancer Council services................................................. 56

Malignant tumour – This is made up of cancerous cells, which

How cancer starts

Normal cells Abnormal Angiogenesis

Normal cells Abnormal cells Abnormal cells Malignant or

A malignant tumour that has not spread to other parts of the

If cancerous cells grow and form another tumour at a new site,

How cancer spreads

Main types of cancer treatments

The use of cytotoxic drugs (see page 8) to

Radiotherapy The use of radiation, usually x-rays or

Hormone Treatment that blocks the body’s natural

The prevention or treatment of disease

Cancer Council has information about different cancer types and

Chemotherapy for children

• Camp Quality – for children • CanTeen – for young

How is cancer treated? 7

Q: How does it work?

Chemotherapy drugs damage cells as they divide. This makes

Q: How is chemotherapy given?

To help other treatments – Chemotherapy is sometimes

To control the cancer – Even if chemotherapy cannot

To relieve symptoms – By shrinking a tumour that is

To stop cancer coming back – Chemotherapy might be

Some types of chemotherapy will cause side effects. However,

Q: Where will I have treatment?

Q: How long does treatment last?

Your doctor will discuss your treatment plan with you.

When to call your treatment team or 000

• a temperature of 38°C • shaking chills

Look after yourself

Freeze some meals

Organise help at home Prepare for

Ask about fertility

Ask your specialist or treatment centre for a written quote that

If you have private health insurance and elect to be treated

Q: Can I have chemotherapy

It is possible for some pregnant women to have chemotherapy.

Researchers are currently doing long-term studies on

However, chemotherapy drugs may affect a developing

Understanding the disease, the available treatments and possible

Talking with doctors

Taking part in a clinical trial

It may be helpful to talk to your specialist or clinical trials nurse,

Making treatment decisions 17

You may have one drug or a combination of drugs. Different drugs

The choice of chemotherapy drugs, the dosage and the treatment

Your specialist may need to tailor your treatment according

Intravenous (IV) chemotherapy