When, where and how you have chemotherapy for myeloma, and the possible side effects.
What chemotherapy is
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate around the body in the bloodstream.
Most chemotherapy is given in cycles of treatment. You have some drugs daily and others weekly. A cycle normally last 3 or 4 weeks. Usually 4 to 6 cycles make up one course of treatment. So a course can last 4 to 6 months.
Types of chemotherapy
The type of chemotherapy you have depends on several things including whether or not your doctor is planning for you to have a stem cell transplant, and your general health.
The chemotherapy drugs doctor use for myeloma include:
- doxorubicin (Adriamycin)
Most people have chemotherapy by mouth, as tablets or capsules (oral chemotherapy). Some people have chemotherapy through a drip into a vein (infusion).
You often have chemotherapy with steroids, such as dexamethasone or prednisolone. And you may also have a biological therapy, such as thalidomide or bortezomib (Velcade).
Combinations of treatment include:
- cyclophosphamide, thalidomide and dexamethasone (CTD)
- melphalan and prednisolone (MP)
- melphalan, prednisolone and thalidomide (MPT)
- melphalan, prednisolone and bortezomib (VMP)
- cyclophosphamide, bortezomib and dexamethasone (CVD)
- doxorubicin, bortezomib and dexamethasone (PAD)
Sometimes doctors use other drugs, such as in the combination DT-PACE or DR-PACE. These include:
- thalidomide or lenalidomide (Revlimid)
You are more likely to have one of these combinations for myeloma that has come back.
Some people have high dose chemotherapy, usually with melphalan, and a stem cell transplant. This is an intensive treatment, so your doctor will only offer it if you are fit enough to get through it.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Never stop taking a cancer drug without talking to your specialist first.
Having chemotherapy into your bloodstream
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Where you have chemotherapy
Most people with myeloma have chemotherapy as tablets, which you take at home. If you're having chemotherapy into your bloodstream (intravenous chemotherapy), you usually have this in the cancer day unit. Or you might need to stay in a hospital ward for a few days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning Iris my name is Clare, I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment, is that ok?
Before you have each treatment you’ll need to have a blood test to check your bloods are ok and you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for the few days that you’re having the chemotherapy drugs. Your treatment team can help to reduce your side effects.
When you go home
Chemotherapy for myeloma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you take any supplements or if you’re prescribed them by alternative or complementary therapy practitioners.
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.