Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Aim of chemotherapy
Chemotherapy for secondary breast cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time, but it can’t cure the disease.
For some people treatment can control the cancer for many months or years.
Types of chemotherapy
In many situations, the chemotherapy drugs for secondary breast cancer are the same as those used for early breast cancer.
The chemotherapy drugs you have depend on:
- what chemotherapy drugs you've had before
- how well the cancer responded to those drugs
- what side effects you had
- your general health and fitness
Chemotherapy drugs that doctors often use for secondary breast cancer include:
- docetaxel (Taxotere)
- vinorelbine (Navelbine)
- capecitabine (Xeloda)
- paclitaxel (Taxol)
- nab paclitaxel (Abraxane)
- gemcitabine (Gemzar)
- epirubicin (Pharmorubicin)
- eribulin mesylate (Halaven)
- fluorouracil (5FU)
You may have one drug or a combination of drugs, for example, gemcitabine and paclitaxel, or capecitabine and docetaxel.
How you have chemotherapy
You may have chemotherapy directly into your bloodstream through a drip (intravenously). Some chemotherapy drugs are tablets or capsules that you swallow, such as capecitabine.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line, you might have treatment through a thin short tube (a cannula). The cannula goes into a vein in your arm each time you have treatment
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.
Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.
When you have it
You usually have chemotherapy as cycles of treatment. This means that you have one chemotherapy drug or a combination of drugs then a rest to allow your body to recover.
Each cycle of treatment varies depending on what you are having.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
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 okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. 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, such as 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 usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you take any supplements or if you’re prescribed them by an alternative or complementary therapy practitioner.
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
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.
Chemotherapy for breast cancer 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.
Electrochemotherapy for breast cancer that has spread to the skin
Sometimes breast cancer cells can start growing in the skin. It may start to grow on or near the scar after an operation to remove the primary cancer. Or it can grow in other parts of the body. This is secondary or metastatic breast cancer in the skin.
The skin may become itchy, red and painful.
Electrochemotherapy is a way of getting chemotherapy into cancer cells. It is a combination of:
- chemotherapy injected into the tumour or bloodstream
- an electric pulse to send the chemotherapy into the cancer cells (called electroporation)
This treatment can shrink the skin secondaries and help to relieve symptoms such as pain.