What to Expect During Chemotherapy

If you are starting chemotherapy, it helps to know what a typical course of treatment looks like. Chemotherapy is rarely a single event. It usually happens over weeks or months, often in a pattern of treatment and rest.

Chemotherapy follows a schedule that your team designs around your cancer and how your body responds.

Chemotherapy is often given in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest.

For instance, you might receive chemotherapy every day for one week, followed by three weeks with no chemotherapy. Those four weeks make up one cycle. The rest period is not wasted time — it gives your body a chance to recover and build new healthy cells before the next round.

Treatment schedules vary widely. How often and how long you get chemotherapy depends on:

• your type of cancer and how advanced it is
• whether the goal is to cure your cancer, control its growth, or ease symptoms
• the type of chemotherapy you are getting
• how your body responds to the chemotherapy

Because these factors differ from person to person, two people with the same cancer may have different schedules.

It is best not to skip a chemotherapy treatment. But sometimes your doctor may change your schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

Talk to your team before skipping or delaying a treatment on your own.

Chemotherapy affects people in different ways. How you feel depends on:

• the type of chemotherapy you are getting
• the dose you are getting
• your type of cancer
• how advanced your cancer is
• how healthy you are before treatment

Since everyone is different and people respond in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for it by asking someone to drive you to and from treatment, planning time to rest on the day of and the day after chemotherapy, and asking for help with meals and childcare.

You will see your doctor often. During these visits, they will ask how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests, and scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people believe that severe side effects mean chemotherapy is working well, or that no side effects mean it is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Your care team uses exams and scans — not how rough you feel — to judge progress.

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating. You might also find it helpful to speak with a dietitian.

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well. Many employers are required by law to change your work schedule to meet your needs during cancer treatment. A social worker can explain more about these laws.

Chemotherapy lowers the white cells that fight infection, so timing matters.

• Call 911 or go to an emergency department if you become confused or hard to wake, cannot get your breath, or bleeding will not stop.
• Ring your chemotherapy team at once, whatever the time, if a thermometer reads 100.4°F (38°C) or higher, or you shiver hard. On chemotherapy a fever is a medical emergency and needs treating within hours. Do not take a fever medicine first and wait to see what happens. If nobody answers quickly, go to an emergency department and tell them right away that you are on chemotherapy.
• Call your care team the same day if vomiting and diarrhea stop you keeping fluid down.
• Call your care team within a day or two if mouth sores make eating hard, or your fingers and toes start to tingle, burn or go numb.

Sources: National Cancer Institute — Infection and Neutropenia During Cancer Treatment; CDC — Fever During Chemotherapy.