Chemotherapy, Immunotherapy & Hormone Therapy
Cancer can happen to anyone. From the moment you walk through the doors at NMMC Hematology and Oncology, you are surrounded by the support and advanced care you need to fight your disease head-on. We have the capabilities and expertise to treat all cancer diagnoses using chemotherapy, immunotherapy treatments, hormone therapy, biological response modifiers and various supportive therapies.
But above all, we understand how scary having cancer can be. That's why we offer more than just treatments; you will receive emotional peace of mind and a friend you can count on to be there with you - every step of the way.
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancer cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.
There are a variety of schedules and techniques used to deliver chemotherapy and yours will depend on which treatment your doctor prescribes. Cancer chemotherapy may consist of a single drug or combinations of drugs that are delivered in cycles. A cycle consists of treatment with one or more drugs followed by a period of rest.
Chemotherapy can be administered orally in the form of a pill, into a vein (intravenous), injected into a body cavity (such as the bladder), into a muscle (intramuscular), or into the spinal fluid (intrathecal). Currently, most chemotherapy is administered intravenously; however, oral chemotherapy drugs are gaining wider use. In some cases, it may be beneficial to administer IV chemotherapy through a venous access device (VAD), which is inserted into a major vein in the body and can remain in place for a long period of time. Not every chemotherapy patient requires a VAD. However, for those that are undergoing frequent treatment, blood tests and nutritional support, a VAD reduces the number of needle sticks and associated discomfort.
How often will I receive chemotherapy?
Chemotherapy drugs are typically given in cycles. The cycle consists of the day(s) the drug is administered followed by a rest and recovery period. A cycle usually lasts one to four weeks and is then repeated, which means a treatment is administered every one to four weeks. Each course of chemotherapy is different, but generally consists of four to six cycles. The actual administration of some chemotherapy drugs may take only seconds or minutes, while others may take hours or even days.
What are the advantages and disadvantages of oral chemotherapy drugs?
In the past, chemotherapy drugs were mainly administered into a vein (intravenous). Oral drugs may provide greater ease of administration since patients can take them at home rather than going to a clinic or hospital for treatments. Not all chemotherapy drugs are available in oral form. Sometimes intravenous (IV) administration is preferable because the doctor can be more certain that the patient received the appropriate dose as scheduled and they can monitor the patient during administration.
What is a venous access device (VAD) and what types are used for cancer patients?
A VAD is a surgically implanted device that provides long-term access to a major vein. Although there are several different types of VADs, the two most commonly used for cancer treatment and taking blood samples are:
Tunneled external catheters (Hickman® catheter), or Subcutaneous implanted ports (port-a-cath).
Both a Hickman® catheter and a port-a-cath are surgically implanted into a major vein. For the Hickman® catheter, the plastic tube or catheter is attached to a major vein and then comes out of the body for external access. A port-a-cath is implanted completely beneath the skin into a major vein under the collarbone. The port may then be accessed by a special needle through the skin to deliver chemotherapy, hydration and transfusions, and for taking blood samples.
Who needs a VAD?
Not every chemotherapy patient requires a VAD. For some chemotherapy treatment plans, the inconvenience of implanting and accessing a VAD may outweigh the benefits. You may wish to ask your doctor if a VAD is an appropriate option for you, especially if you experience any of the following:
You are extremely anxious about having needles inserted.
Your veins are difficult to access or become inaccessible.
You must have alternative veins in your foot or hand accessed, which may be associated with more discomfort.
You are undergoing continuous infusion chemotherapy (over an hour).
You anticipate many months of chemotherapy treatments.
You are receiving intravenous chemotherapy that requires multiple needle sticks.
Your treatment requires frequent drawing of blood samples.
Your treatment strategy involves chemotherapy agents that may cause vein pain when administered through the arm.
You have a physician or nurse who recommends a vascular access device.
What special precautions are necessary with a VAD?
Your VAD must be flushed in order for it to work properly. Flushing your VAD requires placing a needle in your port and flushing it out with heparin. Heparin is a blood thinner that prevents the catheter (plastic tube) from becoming clogged. While you are on treatment, your VAD will be flushed after each treatment. When you are no longer on treatment you must still remember to have your VAD flushed regularly. This procedure needs to be done every four to six weeks. It is your responsibility to make the appointment to have your VAD flushed.
Managing Chemotherapy Side Effects
The treatment of cancer may include the use of chemotherapy, radiation therapy, biological therapy, surgery or some combination. All of these treatment options are directed at killing or eradicating cancer. Unfortunately, the delivery of cancer therapy, including chemotherapy, often affects the body’s normal organs and tissues too. The undesired consequence of damaging healthy cells is a complication of treatment, or a side effect. Side effects may be acute (short-term), chronic (longer-term), or permanent. When cancer treatments are evaluated, side effects are measured and reported as part of the treatment evaluation. Examples of acute side effects include nausea and vomiting, and mouth sores (mucositis).
Why do side effects occur?
Unfortunately, most chemotherapy drugs cannot tell the difference between a cancer cell and a healthy cell. Therefore, chemotherapy often affects the body’s normal tissues and organs which results in complication of treatments, or side effects.
Side effects cause inconvenience, discomfort and may occasionally be fatal. Additionally and perhaps more importantly, side effects may prevent doctors from delivering the prescribed dose of therapy at the specific time and schedule of the treatment plan. Because the expected outcome from therapy is based on delivering treatment at the dose and schedule prescribed in the treatment plan, a change from the treatment plan may reduce your chance of achieving an optimal outcome. This is extremely important to understand. In other words, side effects not only cause discomfort and unpleasantness, but may also compromise your chance of cure by preventing the delivery of therapy at its optimal dose and time.
What are the most common side effects?
All chemotherapy is associated with a wide variety of side effects. However, some side effects occur more frequently than others. Whether you will experience side effects, which ones, and their severity depends on a variety of factors, including your type of cancer, the type of chemotherapy drug or regimen you are taking, your physical condition, your age and others. However, the following side effects are typically associated with chemotherapy:
Low Blood Counts
Nausea and Vomiting
Reproduction/Sexuality Side Effects
Can anything be done about side effects?
Fortunately, in the last 20 years there has been a great deal of progress in the development of treatments to help prevent and control the side effects of cancer therapy. Your physician or nurse will help you come up with ways to manage your side effects.
Hormone Therapy to Treat Cancer
Hormone therapy is a cancer treatment that slows or stops the growth of cancers that use hormones to grow. Hormone therapy is also called hormonal therapy, hormone treatment or endocrine therapy.
Hormone therapy is used to:
- Treat cancer. Hormone therapy can lessen the chance that cancer will return or stop or slow its growth.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
Who Receives Hormone Therapy
Hormone therapy falls into two broad groups, those that block the body’s ability to produce hormones and those that interfere with how hormones behave in the body. Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.
Hormone Therapy Can Cause Side Effects
Because hormone therapy blocks your body's ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you may have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.
How Hormone Therapy Is Given
Hormone therapy may be given in many ways. Some common ways include:
- Oral: Hormone therapy comes in pills that you swallow.
- Injection: The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg or belly.
- Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.
Immunotherapy to Treat Cancer
Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.
How Immunotherapy Works against Cancer
One reason that cancer cells thrive is because they are able to hide from your immune system. Certain immunotherapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other immunotherapies boost your immune system to work better against cancer.
Types of Immunotherapy
There are several types of immunotherapy are used to treat cancer. These treatments can either help the immune system attack the cancer directly or stimulate the immune system in a more general way.
How Immunotherapy Is Given
Different forms of immunotherapy may be given in different ways. These include:
- Intravenous (IV): The immunotherapy goes directly into a vein.
- Oral: The immunotherapy comes in pills or capsules that you swallow.
- Topical: The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.
- Intravesical: The immunotherapy goes directly into the bladder.
You may have treatment every day, week, or month. Some immunotherapies are given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to the immunotherapy, and build new healthy cells.
Immunotherapy Can Cause Side Effects
Immunotherapy can cause side effects, which affect people in different ways. The side effects you may have and how they make you feel will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of therapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during treatment. You will receive specific medication information for the immunotherapy your doctor orders. It is important to be aware of any possible side effects and notify your health care professional of serious or worsening symptoms. Because many of these side effects can occur from other causes that would be treated differently; make sure health care professionals that treat you are aware that you are or were on immunotherapy.