Chemotherapy means using anti cancer (cytotoxic) drugs to destroy cancer cells. These work by disrupting the growth of cancer cells.
Small cell lung cancer (SCLC)
Chemotherapy is the main treatment for small cell lung cancer. Doctors use it because this type of cancer responds very well to chemotherapy. And small cell lung cancer tends to have spread beyond the lung when it is diagnosed.
Chemotherapy drugs circulate in the bloodstream around the body. So, they can treat cells that have broken away from the lung tumour and spread to other parts of the body.
On its own
You might have chemotherapy on its own to treat small cell lung cancer.
Before or after radiotherapy
You might have chemotherapy before or after radiotherapy, or at the same time as radiotherapy.
Before or after surgery
If you are going to have surgery for very early small cell lung cancer, your doctor might suggest that you have chemotherapy before or after your operation.
Non small cell lung cancer (NSCLC)
Chemotherapy is a common treatment for non small cell lung cancer.
Before or after surgery
Some people might have chemotherapy before surgery (neo-adjuvant chemotherapy). This can shrink the cancer and make it easier to remove.
For early stage NSCLC, chemotherapy after surgery can help to lower the risk of the cancer coming back. It is important that your doctor talks to you beforehand about the benefits and possible risks of chemotherapy. The drugs can cause side effects. Chemotherapy tends to work best in patients who are fit. If you are fit enough to have chemotherapy, you usually start it within about 8 weeks of having surgery.
Before, after, or alongside radiotherapy treatment
Giving chemotherapy before or after radiotherapy can sometimes help to get rid of early stage NSCLC in people who can't have surgery.
If you are fairly fit, your doctor might suggest combined treatment with radiotherapy and chemotherapy (chemoradiotherapy).
You might have chemotherapy if you have lung cancer that has spread or if you have locally advanced non small cell lung cancer. It can help some people to live longer even if their cancer can’t be cured.
Types of chemotherapy
Treatment for small cell lung cancer is different to non small cell lung cancer.
Small cell lung cancer
You usually have a combination of chemotherapy drugs, including either cisplatin or carboplatin. Combinations include:
- EP (cisplatin and etoposide)
- carboplatin and etoposide
- Gemcarbo (gemcitabine and carboplatin)
Small cell lung cancer usually responds well to these treatments. But researchers are continuing to test other combinations to see if they can either improve the results, lessen the side effects, or both.
Non small cell lung cancer
You are most likely to have cisplatin or carboplatin with at least one other chemotherapy drug such as:
- paclitaxel (Taxol)
- docetaxel (Taxotere)
How you have chemotherapy
You have most of these drugs into your bloodstream but some are capsules that you swallow.
Into your bloodstream
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might 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.
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 specialist or advice line before you stop taking a cancer drug.
When you have chemotherapy
You usually have chemotherapy every 3 to 4 weeks if you have it into a vein. Each 3 to 4 week period is called a cycle. You might have between 4 to 6 cycles of chemotherapy.
If you have capsules that you swallow you might have the treatment once a week. Or you might have it once a day for 5 days every 3 weeks.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.
You have some types of chemotherapy over a couple of days and stay in a hospital ward. But this is not usual with lung cancer chemotherapy.
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 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
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
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.
Your team can help you manage any side effects.
When you go home
Chemotherapy for lung 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.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.