Lung Cancer – Chapter 12 Chemotherapy

Chemotherapy is a medicine
that’s used to treat lung cancer. And it’s most commonly
given intravenously as a drip treatment into a needle in
a vein in a person’s arm. Although sometimes it can
also be given in a tablet form. Chemotherapy actually
works by attacking cells when they’re trying to divide
and multiply into new cells, so it interferes with that process
and thereby kills the cancer cells. But because it attacks cells when they are dividing and
multiplying, it can also do that to some normal cells in the body
and that can be responsible for some of the side-effects that
we see with chemotherapy. The first time I had it,
the chemo was terrible. I was sick,
I couldn’t eat, I was really sick. Some people who’ve had an operation
for lung cancer might be recommended to have some follow-up treatment
with chemotherapy afterwards. And the idea of using chemotherapy
in this situation is to mop up any little cancer cells that maybe have
been left behind after the operation. The other setting in which
chemotherapy is used is together with radiotherapy
and in that setting, we often use quite low doses of chemotherapy
during the radiation treatment and it’s been shown that in that
setting, giving the two treatments together often works better than
just using the radiation itself. He said to me, Dr Ball, “Now,
in Australia, we like to give the radiation and the
chemotherapy together.” He said, “Some places don’t, but we
find that gives the best results.” But he said, “It is very severe
and you will be sick.” Well, when I was on chemo,
I was lucky, I didn’t have very many symptoms. My hair didn’t fall out. I didn’t get nauseous. I just whacked on a lot of
weight, a lot of fluid. I had restless feet syndrome, which nearly drove me
nuts, especially in bed. And the third setting in
which chemotherapy is used is in the patient, who has advanced
lung cancer that can’t be cured. And in that setting, we use
chemotherapy to try and shrink the cancer down as much as possible
and by doing that, hopefully improve the person symptoms and
their quality of life. Six months chemo. It wasn’t as bad as
thought it would be. I’d have two or three days
where I wasn’t really well, but I’d force myself to walk the dog,
even if it was only around the block and keep going. The side-effects that people get
from chemotherapy vary depending on the particular drug that’s given
to the patient. So some drugs will cause some side-effects and
some will cause different ones. For example, hair loss is a side-effect that we do see
with some chemotherapy drugs. But other drugs might just cause a
bit of hair thinning or other drugs cause no hair loss at all. Some of the other common
side-effects of chemotherapy include what we call ‘fatigue’ or tiredness. And also it’s quite common to
have problems with the bowel. So some people can get constipation
and other people can get diarrhoea. Another common side-effect
that people are very afraid of is whether they’ll get nausea and
vomiting with their chemotherapy. And again, some drugs are more
likely to cause this than others. But with drugs that we know that could cause nausea and vomiting,
what we do is before chemotherapy, we give people a premedication of
drugs to prevent nausea and vomiting. And we give some medication on
the day, before the chemotherapy, and then we give some extra tablets
for people to take home and use in the couple of days after treatment
to prevent nausea and vomiting. I was quite sick,
nausea and extremely tired, but it only lasted three or
four days and I’d be fine. It’s also important that we advise
people to look out for any sign of infection because we know that
when people are having chemotherapy, their immune system is going
to be somewhat suppressed. And this happens because the
chemotherapy will temporarily lower the levels of the white
blood cells in a person’s body. And white blood cells are a type of blood cell that we used
to fight infection. And we know after chemotherapy that the
level of these cells will fall and then it will rise back up again as
the person’s always making new ones. But when the cell counts are low,
people can be at risk of infection. So we get people to monitor
themselves for this by having a thermometer at home and checking
their temperature on a regular basis, or if they ever feel unwell. And we advise people to contact the
hospital or the doctor straight away if their temperature ever goes above
38 degrees. So it’s important that you talk to
the doctor about what the specific side-effects are for the particular
drug that you might be receiving. There’s a number of additional
resources, such as booklets or fact sheets about chemotherapy
that people can get from their doctor or their chemotherapy nurse.