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 lasts 3 or 4 weeks. Usually 4 to 6 cycles make up one course of treatment. So a course can last 4 to 6 months.
Most people have a combination of chemotherapy drugs and a targeted cancer drug.
Types of chemotherapy
The type of chemotherapy you have depends on whether or not you are having a stem cell transplant, and your general health.
Chemotherapy with a stem cell transplant (intensive treatment)
Before you have intensive treatment you have a combination of drugs which includes a chemotherapy drug, a targeted cancer drug and steroids. This is called your induction treatment.
There are a few different types of chemotherapy you might have, they include:
- doxorubicin (Adriamycin)
The steroids might be dexamethasone or prednisolone.
There are a few different combinations of treatment. These will include a type of targeted cancer drug treatment. There are different types including thalidomide and bortezomib. The regimens include:
- cyclophosphamide, thalidomide and dexamethasone (CTD).
- bortezomib, doxorubicin and dexamethasone (PAD)
Or you might have a combination that doesn't include a chemotherapy drug but instead includes two targeted cancer drugs: bortezomib (Velcade), thalidomide and dexamethsone (VTD).
You have treatment in cycles and each cycle lasts for between 21 and 28 days. After each cycle of treatment your doctor will check how well treatment is working and how you are. Most people have between 4 and 6 cycles of treatment.
Depending on how well this treatment works you will either go on to have a stem cell transplant or have more chemotherapy.
Chemotherapy without a stem cell transplant
Some people are not able to have a stem cell transplant. They have chemotherapy, targeted cancer drug and steroids. Combinations of treatment include:
- melphalan, prednisolone and bortezomib (VMP)
- cyclophosphamide, bortezomib and dexamethasone (CVD)
Myeloma that comes back
Treatment depends on:
- how long your myeloma has been in remission
- the treatments you had before
- how your myeloma responded to previous treatments
- your general health
Treatment will be a combination of chemotherapy and a targeted cancer drug. There are a number of different combinations of treatment including DT-PACE and VDT-PACE. These regimens include these drugs:
- bortezomib (Velcade)
- thalidomide or lenalidomide (Revlimid)
How you have chemotherapy
You might have chemotherapy as:
- tablets or capsules (oral chemotherapy)
- an injection under the skin (subcutaneous chemotherapy)
- a drip into a vein (intravenous chemotherapy)
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 specialist or advice line before you stop taking a cancer drug.
Chemotherapy as an injection under the skin (subcutaneous)
The skin of the abdomen, thigh and upper arm are the most common areas for giving subcutaneous chemotherapy. You may be able to give these injections yourself.
The video below shows you how to give an injection just under your skin (subcutaneously).
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. This ideo about having chemotherapy lasts for 2 minutes and 55 seconds.
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 a few days or so. Your treatment team can help to manage any side effects that you have.
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 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.