Changing your chemotherapy plan

This page is about the reasons why your chemotherapy plan may change. There are sections about

Your blood count
Personal reasons
Whether the cancer is shrinking

Throughout your treatment you will have blood tests to check

Your white blood cell levels – known as white blood cell count
Other blood cell levels – such as red blood cells and platelets
That your kidneys and liver are working normally

Your doctor or chemotherapy nurse regularly checks the effects of the chemotherapy on your blood and bone marrow. You will have blood tests before each chemotherapy treatment. These are mostly to check your white blood cell counts. But your red blood cells and platelets will be checked as well. You may also have blood tests to see how the treatment is affecting your kidneys and liver. This is more important with some drugs than with others. For example, some chemotherapy drugs are known to affect the kidneys.

If your blood cell levels are too low, your next treatment will have to be put off until they have recovered. This does not matter too much and should not make the treatment any less effective in treating your cancer. But if this happens too often, or if, for example your kidneys are being affected, you may need to have lower doses of the chemotherapy drugs. It is important not to think of this as a set back. Some people are more affected by chemotherapy than others, and the doses need to be adjusted to take this into account.

Your doctor will try to plan the treatment around any special requests you have. You may be able to delay a treatment to fit in with special occasions. For instance, you may want to arrange it around your holiday dates. Or you may have a family wedding you are keen to go to. If you tell your doctor in plenty of time, it is sometimes possible for the treatment to be scheduled to allow you to fit in these special occasions.

Some people find it hard to feel positive about the effect of their treatment because they don't have any evidence that it is working. Sometimes this can't be helped. If you are having chemotherapy after surgery to remove cancer, there may not be anything to see. The aim of chemotherapy treatment is to kill off any cancer cells that have broken away before your operation and these are too small to be seen.

But if you have a cancer that can be seen on scans, your doctor may want to know if your treatment is affecting it. At least once in your course of treatment, you could have

X-rays
Scans
Blood tests to check the levels of chemicals (markers) produced by some tumours

The results from these tests may show how much the cancer is shrinking as a result of your treatment. If the drugs are not shrinking the cancer enough, your doctor may change your treatment plan completely. Different drugs, or even a different type of treatment altogether, may give a better result.

Cancers do behave differently to each other and respond to treatment differently. If your doctor doesn't suggest scanning you in the middle of your treatment, this is likely to be because there will be nothing much to see. It may be better to wait until the whole course of treatment is over and then see what has happened.