Questions & Answers about Chemotherapy
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For Any Cancer Diagnosis
- Q.
I just started chemotherapy. I am not eating as much as before I started treatment. I don't have the energy to prepare my meals and sometimes feel nauseated. What should I do?
A.Nausea and fatigue are common side effects in cancer treatment but can be well managed with the help of your health care team and medications. Daily chores and tasks can be especially difficult when you are tired. This is the time to ask others to help you prepare your food so that you can maintain good eating habits during your treatments. Perhaps you don’t want to “bother” your family or friends or ask them to do simple tasks. Most of the time, family and friends are looking for a way to contribute to your care, even if they can’t be there all the time. Try having one family member or friend to be your primary caregiver, and have that person organize help from the others. Together, they can work as a team to do your food shopping, bring you meals and help you around the house. Giving each one a specific task allows each one to feel that he or she is helping you.
You can also get help with meals and house chores from your hospital, non-profit agencies and private organizations. Sometimes this help is covered by insurance, and sometimes you may need financial assistance to get the help you need.
CancerCare resources that will provide you with useful information include:
- Tips for Managing Nausea and Increasing Appetite During Cancer Treatment
- Coping with Nausea and Vomiting from Chemotherapy
- Coping with Cancer: Tools to Help You Live
Eating Hints for Cancer Patients: Before, During, and After Treatment from The National Cancer Institute is another great resource.
CancerCare’s professional oncology social workers assist people living with cancer, family members and caregivers with the practical and emotional concerns arising from a cancer diagnosis. Call us at 800-813-HOPE (4673) or email info@cancercare.org.
Answered by
Carolyn Messner, DSW, BCD, FAPOS, FAOSW, Senior Director of Education and Training
For Breast Cancer
- Q.
Since being diagnosed with breast cancer, I can't seem to keep on top of things like I used to and it seems like I'm in a fog. I've mentioned this to my doctor but I think his focus is more on my treatment and less on my concerns. Anything I can say to make him listen?
A.After being diagnosed with cancer, many women report having trouble finding words and remembering things. Be persistent in communicating with your doctor about what you are experiencing. Here are some tips that may help you:
- Request a time to speak with your doctor to focus on your specific concerns
- Express how these concerns are affecting you and your quality of life
- Be specific and give examples
- Use statements such as, “I need your help understanding this” and “Do you have any suggestions on what I can do?”
For more tips read our publications, Communicating With Your Health Care Team and “Doctor Can We Talk?”
It’s also possible that you may be experiencing side effects from chemotherapy. This is sometimes referred to as “chemobrain,” a condition that affects your short-term memory. You may consider getting evaluated by a neuropsychologist (an expert trained in how the nervous system, especially the brain, controls mental functions such as language, memory, and perception) who can assess any cognitive changes and suggest mental exercises to improve memory and thinking. Chemobrain usually lessens over time once treatment has ended.
A few steps you can take now to improve your memory:
- Keep a notebook or day planner where you can write down things you need to remember
- Keep the notebook in a specific place so you can find it when you need to
- Use Post-it notes to place reminders in your home, office or other spaces
To learn more about chemobrain, read CancerCare’s fact sheets:
- Chemobrain: What You Need to Know
- Coping With Chemobrain: Keeping Your Memory Sharp
- Improving Your Concentration: Three Key Steps
Answered by
Patricia Spicer, MSW, LMSW
For Lung Cancer
- Q.
My 68-year-old husband was diagnosed with lung cancer, had radiation and chemo, and is currently in remission. Since ending his treatment, his personality has changed drastically and he directs his anger towards me. Can chemo affect a person mentally?
A.Chemotherapy can affect a person’s mood, as can other medications such as steroids. It is important that you and your husband inform his doctor of changes in his mood to rule out any medical causes. The change in his personality may also be a sign that he is still struggling emotionally with his diagnosis and treatment. Cancer can be overwhelming and bring up many feelings from anxiety to anger to sadness. As your husband’s primary caregiver, those feelings may be directed towards you since you are the one he is closest to and trusts. If you haven’t done so already, letting your husband know how his feelings and behavior affect you is important. Seeking couple’s counseling is also a good idea if you are having difficulties communicating with each other.
The end of treatment often can lead to many strong and conflicting feelings. When a person is first diagnosed with cancer, he/she is often focused on learning about the diagnosis and getting through treatment. This can delay the emotional impact of cancer and feelings may come up once treatment ends, as there is more time to think about what has happened. For more information on coping post-treatment read, After Treatment Ends: Tools for the Adult Cancer Survivor.
Answered by
Sarah Kelly, MSW, LCSW-R - Q.
My husband has just been diagnosed with small cell lung cancer with small tumors in his liver. He starts chemo next week with 4 hours, day 1 and 2 hours, day 2 and 3. He repeats this every 18 days for six sessions. Is this the normal treatment for small cell lung cancer? Where would I look to find information on clinical trials?
A.Later-stage small cell lung cancer is characterized by a spread of the disease from the lungs to other organs such as the liver, and is normally treated with aggressive chemotherapy. Since the treatment is aggressive, it must be administered over a number of days for each session, and the sessions are spaced out with non treatment breaks of 18 to 21 days to make sure that the patient’s overall health is not affected. Patients whose tumors respond well to chemotherapy may be considered for a radiation treatment to the brain called Prophylactic Cranial Irradiation (PCI) in which the entire brain receives radiation with the intent of stopping the spread of the disease. For more information about the treatment of small cell lung cancer, please visit the National Cancer Institute’s website.
CancerCare collaborates with EmergingMed’s clinical trials matching service, which is designed to assist lung cancer patients in identifying and accessing clinical trials which may be appropriate to their medical situation.
Answered by
Winfield Boerckel, MSW, MBA, LCSW-R - Q.
My sister has stage 4 non-small cell lung cancer as well as tumors in her liver. Are there two different chemotherapy treatments for both the lung and the liver or are they treated with the same drugs?
A.Stage 4 non-small lung cancer is characterized by the spread (also known as metastasis) of lung cancer cells through the bloodstream to organs outside the lungs such as the liver, brain, adrenal glands or bones. These cells attach to the new areas and begin to grow new tumors. The cells of the new tumor site, however, are lung cancer cells rather than liver cancer cells. So the chemotherapy your sister’s oncologist has chosen to treat the main tumor site in the lungs would also be considered the most appropriate treatment for the lung cancer tumors that have grown in her liver.
One of the benefits of chemotherapy used for Stage 4 lung cancer is not only that it’s treating tumors known to exist, but it is also working on other tumors that may be too small to be detected yet. That’s why chemotherapy is considered a systemic therapy - it treats cancer tumors throughout the body.
Find more information about treatments for lung cancer in our booklet, Treatment Update: Lung Cancer.
CancerCare also offers a full range of free support services for people affected by lung cancer.
Answered by
Winfield Boerckel, MSW, MBA, LCSW-R - Q.
I was diagnosed with non-small cell lung cancer and am receiving chemotherapy. I've had two colds within a three-week period and also a low level of hemoglobin in my blood (the doctor has recommended erythropoietin treatments). Could these issues be diet related?
A.Chemotherapy for either small cell or non-small cell lung cancer tends to be fairly aggressive and can produce some difficult side effects. While chemotherapy is focused on destroying lung cancer cells it can also interferes with the production of the three types of blood cells: red blood cells, white blood cells, and platelets. Normally, just before you start a chemotherapy session, your doctor arranges for you to have blood tests to determine the effect the chemotherapy is having on your blood cells. Low counts of any of these cells may prompt either a change in dosage or frequency of treatment, or a need to take medication that can stimulate bone marrow production of the blood cells.
Your colds may be due to the chemotherapy’s suppression of the bone marrow’s production of white blood cells, which are the body’s infection fighters. If your doctor feels that your white cell count has significantly decreased, he or she may consider putting you on a medication for this condition. Ask your doctor whether this might be a possibility.
Similarly, the low levels of hemoglobin you mention may be due to low red blood cell counts caused by chemotherapy. Red blood cells carry oxygen and iron to provide the body with components necessary for energy. Red blood cells are an important factor in maintaining energy levels in our bodies and too few of them can result in fatigue and anemia. It sounds like your doctor believes an erythropoietin-type drug might be helpful in boosting your red blood cell count. While extreme low red blood cell counts are not normally related to diet, you might also want to ask your doctor for a referral to a dietitian who works with cancer patients to develop a meal plan that would increase your dietary intake of iron and help you maintain a healthy weight.
CancerCare offers publications that provide more detailed information on managing chemotherapy side effects.
Answered by
Winfield Boerckel, MSW, MBA, LCSW-R - Q.
I was diagnosed with stage IB non-small cell lung cancer. I had surgery (lobe resection) and my doctor gave me a referral to an oncologist for "adjuvant treatment," meaning chemotherapy. Why do I need to do this?
A.For a long time, it was believed that only surgery was necessary to achieve a successful outcome for lung cancer patients diagnosed with stage IB to IIIA non-small cell lung cancer. However, a number of recent investigational research studies provided evidence that patients who received both surgery as their primary treatment and chemotherapy as an “adjuvant,” or secondary treatment, reduced their risk of the cancer recurring. Unlike chemotherapy used as a primary therapy, adjuvant chemotherapy is usually shorter-term and has a fixed duration.
You should discuss any of your concerns about the side effects of chemotherapy with your oncologist before treatment starts. I do want to say that there are significantly fewer, less severe side effects in current-day chemotherapy treatments and much more can be done to address them.
For more information on lung cancer staging and treatment, read our lung cancer publications
View all of CancerCare’s publications about managing side effects.
Answered by
Winfield Boerckel, MSW, MBA, LCSW-R - Q.
My wife was diagnosed with stage IV non-small cell lung cancer (NSCLC) and we have health insurance. One of her chemotherapy drugs is very expensive and insurance only pays $1000 per chemo treatment. She is 63 and does not qualify for Medicare. We are looking at co-payment debt of over $100,000. Any suggestions?
A.We often find that the private health insurance we have is fine when you are healthy, but not sufficient enough when diagnosed with cancer. Unfortunately, you are correct that she must either be 65 years old or determined to be disabled by the Social Security Administration for 24 months before qualifying for Medicare. I suggest you begin the disability application process if you have not already. Certain cancer diagnoses qualify for expediting the application process (called Compassionate Allowances). You can find out more about the qualifications and can apply online or call to speak with a Social Security representative about your specific situation.
Co-pay foundations are independent charities that assist insured patients who qualify with the co-pay costs of their pharmaceutical products. Current charities that assist non small-cell lung cancer (NSCLC) patients are:
- CancerCare Co-Payment Assistance Foundation
- Good Days
- The Patient Advocate Co-Pay Relief Foundation
- Patient Access Network Foundation
CancerCare also offers limited assistance for transportation, homecare, and childcare for patients who qualify. Some local divisions of the American Cancer Society may also have help with transportation to treatment as well as assistance with wigs.
The Patient Advocate Foundation’s trained case managers provide guidance and support and can intervene on your behalf regarding medical debt. They also maintain a network of volunteer attorneys.
Lawhelp.org provides referrals for affordable and/or free legal assistance programs in one’s area and advice about bankruptcy protection and other financial issues.
And finally, you may read our fact sheets about finding financial assistance in your community for further suggestions:
Answered by
Michele McCourt, Executive Director of the CancerCare Co-Payment Assistance Foundation