Page last updated: August 2024
The information on this webpage has been adapted from Understanding Chemotherapy - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in February 2024.
Expert content reviewers:
This information was developed with help from a range of health professionals and people affected by cancer who have had chemotherapy. We thank the reviewers of this booklet:
- A/Prof Kate Mahon, Director of Medical Oncology, Chris O’Brien Lifehouse, NSW
- Katherine Bell, Dietetics Department, Liverpool Hospital, NSW
- Brigitta Leben, Dietetics Department, Liverpool Hospital, NSW
- Sophie Michele, 13 11 20 Consultant, Cancer Council SA
- Dr Jess Smith, Medical Oncologist, Macquarie University Hospital, NSW
- Karene Stewart, Consumer
- Julie Teraci, Clinical Nurse Consultant, Skin Cancer and Melanoma, Cancer Network WA
Most cancers have treatment protocols that set out which drugs to have, how much and how often. You can find information about protocols for chemotherapy online at eviQ.
Your specialist may need to adjust the protocols to suit your individual situation. You may have treatment with one chemotherapy drug or a combination of several drugs.
The chemotherapy drugs given, the dose and the treatment schedule (how often you have the drugs) will be recorded in a treatment plan.
You will have tests throughout chemotherapy to monitor your response, and your treatment plan may be adjusted based on the results and any side effects.
Chemotherapy can be given on its own or as part of a treatment plan that could include surgery, radiation therapy or other drug therapies.
The treatment course
How often and for how long you have chemotherapy is known as a treatment course. This will vary depending on:
- the type of cancer you have
- the reason for having treatment
- the drugs used, and
- how you respond to chemotherapy.
Chemotherapy is commonly given as a period of treatment followed by a break. This is called a cycle. For example, you may have treatment on days 1, 2 and 3, then a break until day 28. Then a new cycle will begin.
The length of the cycle depends on the chemotherapy drugs being given. The break between cycles lets your body recover.
If you need more time for your blood count to recover and any side effects to improve, the specialist may decide to delay your next cycle. If you have any concerns about changes to your treatment or any delays, talk to your specialist.
What to expect
This information will apply in most cases, but things may be done slightly differently depending on how and where you have treatment.
Tests you may have
Before chemotherapy and between cycles, you will have several tests to help plan treatment, and these may include:
- weight and height measured to work out the right dose
- blood tests to check how well your kidneys and liver are working and the number of blood cells
- x-rays and scans to check that you are fit for treatment and see how the tumour is responding to treatment.
For some chemotherapy drugs, you may also have:
- heart monitoring tests to see if the drugs are affecting how your heart works
- lung function tests to check whether the drugs are affecting how your lungs work.
Receiving the treatment
While having chemotherapy, you will usually be:
- seated in a reclining chair in a room with other patients; during treatment it’s a good idea to shift your weight in the chair
- able to walk around the room (e.g. if you need to go to the toilet)
- given anti-nausea (antiemetic) medicine so you don’t feel sick
- given several glasses of water to help flush the chemotherapy drugs through the kidneys and bladder
- monitored throughout the session; nurses will also talk to you about ways to manage side effects
- able to have someone with you to support you during treatment
- able to travel to and from treatment by yourself; it’s recommended that someone travels with you the first time in case you feel unwell.
Intravenous (IV) chemotherapy
Chemotherapy drugs are usually put straight into your blood as a liquid through a drip inserted into a vein (intravenous infusion).
To prepare for IV chemotherapy, the treatment team will insert a narrow tube into a vein. The drugs may be injected through a cannula or a type of central venous access device.
The type of device used will depend on how often you need chemotherapy, how long it will take to give each dose and how long the device will need to stay in place. Chemotherapy will usually be given during day visits.
In most cases, a single session takes between 20 minutes and several hours. This depends on what kind of treatment you are having. For some types of cancer, a treatment session may take several days.
This can be given with a portable pump that you can use at home to provide a continuous dose of chemotherapy. The infusion process may cause reactions (e.g. feeling hot or flushed, skin rashes, or difficulty breathing).
While some drugs are more likely to cause a reaction in the first and second infusions, others may cause reactions later in the course. Your doctor can provide you with information.
A nurse will check for signs of a reaction and may give you medicines to help prevent them. Sometimes a reaction happens several hours after the infusion. If you develop any signs or feel unwell after you get home, contact the hospital straightaway.
How IV chemotherapy is delivered
Central venous access device (CVAD)
This is a thin plastic tube that remains in your vein throughout the treatment course (for several weeks or months). It allows the treatment team to give chemotherapy, other drugs, fluid or blood transfusions, and draw blood.
A CVAD is inserted under local anaesthetic and it shouldn’t cause discomfort or pain. Common types include:
- centrally inserted catheter – inserted into the chest
- peripherally inserted central catheter (PICC) – inserted into the arm
- port-a-cath (port) – surgically inserted under the skin of the chest or arm (pictured above).
Caring for your CVAD
A nurse will show you how to look after your CVAD to prevent infections or blockages. You may visit the clinic, or a nurse may visit you at home to help clean tubes or lines.
Contact your health care team immediately if there is pain, redness or swelling around the line or port.
Cannula
This is a small plastic tube inserted into a vein in your arm or the back of your hand. Having a cannula put in can be uncomfortable, but it should only take a few minutes.
The cannula can be kept in place if you need to stay in hospital for a few days. If you have day treatment every few weeks, the cannula is usually put in and taken out each time you visit.
Portable pump
This is a device that gives a prescribed amount of chemotherapy continuously for up to a week. It is attached to a CVAD and does not need to be connected to a power point.
Different types of pumps are used. The pumps are small and can be carried in a bag and tucked under a pillow when sleeping.
Other ways of having chemotherapy
There are other ways of having chemotherapy, depending on the drugs being used and the type of cancer you have.
Oral chemotherapy
Some types of chemotherapy can be taken as tablets or capsules at home. Your doctor, nurse or pharmacist will tell you how and when to take them, and how to handle the drugs safely.
Injections (local chemotherapy)
Less commonly, chemotherapy can be injected using a needle into different parts of the body, including:
- into a muscle, usually in your buttock or thigh (intramuscular)
- under the skin (subcutaneous)
- into the fluid around the spine (intrathecal – this is also known as a lumbar puncture)
- into an artery (intra-arterial)
- into the abdomen (intraperitoneal)
- into the outer lining of the lungs (intrapleural)
- into the bladder (intravesical)
- into the tumour (intralesional; this method is rare).
Cream
Some skin cancers are treated using a chemotherapy cream applied directly to the skin. This is called topical chemotherapy.
Transarterial chemoembolisation (TACE)
Used for primary liver cancer or some types of cancer that have spread to the liver, TACE involves injecting chemotherapy directly into the liver tumours.
The chemotherapy will either be mixed with an oily substance or loaded onto tiny plastic beads. The blood vessels feeding the tumour may also be blocked (embolisation).
Telehealth appointments
You may be able to have some appointments from home over the phone or a video link. Called telehealth, it can reduce how often you need to go to the hospital, which can be useful if you live a long way from treatment.
Although telehealth can’t replace all face-to-face appointments, you can use it to talk about a range of issues including test results, prescriptions and side effects.
For more information, talk to your treatment team or call Cancer Council 13 11 20.
Call cancer support
Waiting for chemotherapy
Having chemotherapy may mean you spend a lot of time waiting for health professionals, blood tests, test results, and for the necessary safety checks to be done.
It also takes time for your drugs to be prepared, and then, for the drugs to be given. While you are waiting, you may want to:
- read a book or magazine
- listen to music or a podcast, or write in a journal
- do a crossword puzzle or play a game on your phone
- chat with a companion (if health guidelines allow a support person to stay with you during treatment)
- meditate, practise relaxation techniques or rest
- use a laptop, smartphone or ereader – check whether it is okay to use devices and if power points are available. Ask if there is wi-fi.
You will be able to sit in a comfortable chair and wear your own clothes while receiving treatment. Many treatment centres will provide biscuits and water, tea and coffee, but it’s a good idea to bring your own water bottle and snacks in case of long delays.
At first, you may feel uncomfortable or anxious being around other people with cancer. However, many people find support from others who are having chemotherapy treatment at the same time.
Joining a support group may be a good way to meet other people going through a similar experience.
"I became good friends with a lady who began chemotherapy on the same day as me. We ended up going walking several times a week for 18 months. The companionship was a great support." - Tania
How will I know chemotherapy is working?
You might wonder whether experiencing side effects is a sign that the chemotherapy is working. However, whether or not you have side effects is not a sign of how well chemotherapy is working.
Throughout treatment, you will be closely monitored by your specialist. You will have tests to check how well the chemotherapy drugs are working, and whether the cancer has shrunk or disappeared after chemotherapy.
This is called the treatment response, and it helps your doctor decide whether to continue or change the chemotherapy plan.
If tests show that the cancer has shrunk and is unable to be detected, this may be called remission or complete response, which means there is no evidence of disease (NED).
Depending on the guidelines for the type of cancer you have, this may mean chemotherapy can stop or it may continue for a period of time.
Once you’ve completed the course of chemotherapy, your doctor will monitor you for several months or years. This is because cancer can sometimes come back in the same place or grow in another part of the body.
