Chemotherapy

Treatments are usually carried out at the Day Hospital, a unit equipped for outpatient treatment, with nursing staff specialised in administering this type of medication.

Therefore, except in specific cases, it is not necessary to be admitted to the clinic.

Chemotherapy is usually administered intravenously through an infusion system.

Chemotherapy is sometimes administered orally in tablet form, intravesically via a urinary catheter, intramuscularly, subcutaneously, or intrathecally.

The treatment schedule is organised into cycles. A cycle is a treatment that can be carried out over one or several days and is repeated at specific intervals.

Chemotherapy terms:

Depending on the moment and/or intention:

• Adjuvant chemotherapy: Therapy that is done AFTER potentially curative surgery. Intention: curative.
• Neoadjuvant chemotherapy: Therapy that is done BEFORE potentially curative surgery. Intention: curative.
• Concomitant chemotherapy: Therapy is administered in conjunction with radiotherapy with the aim of enhancing the effect of the latter. Intention: curative.
• Palliative chemotherapy: It is a type of chemotherapy that is administered specifically to control symptoms without expecting it to significantly reduce the cancer.
• Subsequent lines: successive therapies AFTER completing the first line. Intention: usually palliative.

When long or repeated cycles of chemotherapy are required, venous access devices such as a PICC catheter, peripheral central venous access, or a port-a-cath may be placed in the patient. These are subcutaneous devices that provide permanent access to the vascular system and are connected to a venous reservoir through which chemotherapy is administered.

The PICC catheter is inserted by nursing staff in the Oncology Day Hospital, while the port-a-cath is inserted by a surgeon in the operating theatre under local anaesthetic. During the procedure, the specialist will verify that the device is correctly positioned.

The patient will wear the port-a-cath throughout the entire treatment. In most cases, once treatment is complete, the patient wears the device for a reasonable period of time. The system causes no discomfort whatsoever. The nursing staff will carry out the necessary checks to determine that the port-a-cath is working correctly.

The PICC catheter is removed at the end of the last treatment session.

In parallel with the chemotherapy cycles, the oncologist will perform a series of tests on the patient, mainly blood tests, to check that the treatment is not affecting your body adversely, including damaging anything in your body, e.g., kidneys, or altering blood platelet levels. Depending on the results, the specialist may adapt chemotherapy cycles until the patient’s blood tests have returned to normal levels.

Chemotherapy can be administered as the sole treatment for metastatic disease or as neoadjuvant therapy, which means it is administered prior to local curative treatment, or as adjuvant or complementary therapy after the first local curative procedure.

• Cancer cells grow rapidly, and chemotherapy drugs kill rapidly growing cells. However, because these drugs circulate throughout the body, they can affect healthy, normal cells that also grow rapidly. The cause of side effects is damage to healthy cells.
• The normal cells most likely to be damaged by chemotherapy are the blood-producing cells in the bone marrow, as well as cells in the mouth, digestive tract, reproductive system, and hair follicles. Some chemotherapy drugs can damage cells in the heart, kidneys, bladder, lungs, and nervous system.
• Many of the side effects disappear fairly quickly, although some take months or even years to disappear completely. Sometimes side effects can last a lifetime; this is the case when chemotherapy causes long-term damage to the heart, lungs, kidneys, or reproductive organs. Certain types of chemotherapy sometimes cause delayed effects, such as a second cancer, which appears many years later.

Depending on the type of medication administered in each treatment, side effects may vary or, in the best case scenario, may not occur at all. If they occur, they may manifest in the following ways:

• Greater than usual fatigue
• Nausea, vomiting, diarrhoea and/or constipation. These symptoms occur when the effects of chemotherapy affect the digestive system. To prevent these symptoms, especially dehydration, your specialist will prescribe medication that can help you.
• Ulcers and sores. The mucous membranes are particularly sensitive to chemotherapy, which can result in mouth sores or ulcers. Therefore, it is important to maintain good oral and dental hygiene.
• Hair loss. Hair loss can affect the scalp as well as other parts of the body, such as the armpits, legs, eyebrows, etc. This is because some drugs used in chemotherapy treatment affect the hair follicle, which causes hair growth.
• Changes in taste. Chemotherapy can affect the taste buds on the tongue and palate. As a result, some patients often perceive less flavour in food or notice a different, more metallic and/or bitter taste. This effect disappears after chemotherapy treatment is completed.
• Skin changes. Itching, dryness, or flaking may occur. It is important to keep your skin hydrated. You can consult with a specialist about the most recommended creams.

In any case, side effects, when they occur, are temporary and do not affect everyone in the same way. Many patients can maintain their work, sports, social life, etc. habits.