Changing your chemotherapy plan

Sometimes you might have a change to your chemotherapy plan. There are a number of reasons for this.

Your blood count

Your doctor or chemotherapy nurse regularly checks the effects of the chemotherapy on your blood and bone marrow.

Throughout your treatment you’ll 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
• your kidneys and liver – to make sure they’re working normally

Checking the kidneys and liver is more important with some drugs than others. For example, some chemotherapy drugs are known to affect the kidneys.

Chemotherapy breaks

If your blood cell levels are too low, the doctors will have to put off your next treatment until the levels have recovered. This may be called a chemotherapy break.

This doesn’t matter too much. It shouldn’t make the treatment any less effective. But if it happens too often or if the chemotherapy is affecting your kidneys (for example), you may need to have lower doses of the drugs.

It’s important not to think of this as a setback. Chemotherapy affects some people more than others, and doctors need to adjust the doses to take this into account.

Personal reasons

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, such as a holiday or a family wedding. Tell your doctor about this in plenty of time and it may be possible.

Whether the cancer is shrinking

Sometimes it can be difficult to assess whether chemotherapy is working. For example, if you’re having chemotherapy after surgery to remove cancer. This treatment aims to kill off any cancer cells that may have broken away before your operation. These cells are too small to see on scans.

But your doctor might be able to assess your treatment response with scans or blood tests. So you might have tests to see how well treatment is working. At least once in your course of treatment, you could have:

• x-rays
• scans 
• blood tests – to check the levels of chemicals (markers) that some tumours produce

The results from these tests could show how much the cancer is shrinking as a result of your treatment.

If the drugs aren’t 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 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 probably because there’ll be nothing much to see. It might be better to wait until the whole course of treatment is over and then see what’s happened.