Traditional or standard chemotherapy works by disrupting the cell cycle. Each time a new cell forms it goes through a series of phases in order to become mature. Traditional chemotherapy drugs target the different phases of the cell cycle. By disrupting or stopping a particular phase, a cancerous cell can no longer mature and divide and ultimately dies.
Unfortunately, traditional chemotherapy cannot tell the difference between healthy and cancerous cells. Normal cells are also damaged during treatment, particularly those that turnover more rapidly. These include the hair, nails and white blood cells (neutrophils), which are responsible for warding off infections. This is why traditional chemotherapy is often associated with hair loss and the need to take care to practice extra hygiene. Most normal cells will, however, recover over time, and effective medications are available to help alleviate many of the expected side-effects from treatment.
Traditional chemotherapy drugs can be further classified depending on how they work, their chemical structure or their relationship to other drugs. Some common traditional chemotherapy drug classes include:
- Alkylating agents: Damage the DNA of the cell across all phases of the cell cycle to stop cells from reproducing. e.g. carboplatin, cisplatin, cyclophosphamide, dacarbazine, ifosfamide, oxaliplatin.
- Antimetabolites: Interfere with a cell’s DNA and RNA to stop cells from reproducing. e.g. 5-fluorouracil (5-FU), capecitabine, gemcitabine, methotrexate, premetrexed.
- Anthracyclines: Change the DNA inside the cancer cell which stops them from multiplying. e.g. doxorubicin, liposomal doxorubicin, epirubicin.
- Topoisomerase inhibitors: These drugs block the action of topoisomerases which are enzymes that control the changes in DNA structure. By interfering with topoisomerases, the DNA is damaged and can’t repair which leads to cell death. e.g. irinotecan, topotecan, etoposide, mitoxantrone.
- Mitotic inhibitors: These compounds are derived from natural products, such as plants, and are also known as plant alkaloids. They work by stopping cell division through the disruption of microtubules which pull chromosomes apart when a cell divides. Mitotic inhibitors can be further classified as taxanes (e.g. cabazitaxel, docetaxel, nab-paclitaxel, paclitaxel) and vinca alkaloids (e.g. vinblastine, vincristine, vinorelbine). Docetaxel was originally derived from the needles of the European yew tree, Taxus baccata, and paclitaxel from the bark of the Pacific yew, Taxus brevifolia.
Once you have met with your medical oncologist, discussed treatment options, and decided to proceed with treatment, a series of appointments will be made for you. Your treatment appointments will take place in the chemotherapy suite, and you will meet with one of the oncology nurses prior to starting treatment. The number of treatment sessions and their duration varies greatly from person to person. Rest assured that any treatment you consent to receive will be personalised and based on the latest scientific research. Throughout your course of treatment, you will need regular blood tests to monitor your body’s ability to tolerate the medications you receive. Your medical oncologist may also request CT or MRI scans at various intervals to check on your progress.
The chemotherapy suite is the therapeutic clinical area where treatment is delivered in a welcoming and supportive environment. You will be admitted as ‘a day inpatient’ meaning that you are being admitted to a hospital setting for treatment but only for part of the day.
The chemotherapy suite is staffed by a small team of highly experienced oncology nurses who will take the time to get to know you. Your nursing team will provide education about your treatment, answer any questions, administer treatment, discuss side-effects, follow-up on your progress and provide overall holistic care in conjunction with your medical oncologist. The chemotherapy suite is also supported by pharmacists, dietitians and other specialised nurses or allied health professionals.
Comfortable recliner chairs and beds are available within the chemotherapy suite. If you prefer more privacy, screens or curtains can be provided. WiFi, magazines, books, and a private kitchenette or refreshment area are also available, and some centres provide TV screens and/or iPads. Feel free to bring your own reading materials, music or mobile device. A family member or friend is also most welcome to come along and keep you company.
As treatments may involve the delivery of medication into a vein in your hand or forearm, it’s a good idea to wear comfortable clothing with a sleeve that can be rolled up. Drink an adequate amount of water leading up to your appointment as this can make it easier for your nurse to access your veins.
Before beginning treatment, some people may also be fitted with a ‘port-a-cath’ (port). This device is placed just under the skin, usually in the chest, and provides access for medications to be delivered into a large vein. It remains in place throughout treatment and avoids the need for repeated needles into the hand or forearm.
Remember, each person is different and so are the treatments. Your oncology nurse will provide you with more information about what to do and what you can expect before your first treatment appointment.
Exercise and cancer
Historically, doctors advised cancer patients to rest during treatment. Recent research has shown, however, that physical activity can influence cancer outcomes and play a pivotal role in cancer survivorship.1 GenesisCare considers exercise to be an important part of your treatment plan. Exercise is something you can do to help your body following a cancer diagnosis, even if you have never exercised before. Ask your specialist doctor if exercise could be right for you and how to get started. More information about exercise and cancer can be found here.
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- Schmitz KH, Courneya KS, Matthews C et al. for the American College of Sports Medicine. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010;42:1409-1426.
Dr Andrew Dean
Dr Andrew Dean is driven by his passion to help patients with life-threatening illnesses and furthered his training in medical oncology and began working full-time as a medical oncologist in 2006, initially at SCGH and SJOG.
Dr Tim Clay
Tim’s professional interests include clinical trials, to improve the treatment options of future cancer patients, and the undergraduate and postgraduate training of health care professionals.
Dr Kelvin Siew
Kelvin completed his medical degree with honours from the University of Western Australia in 2003. After medical school, he worked initially as a medical registrar in various medical specialties across Perth’s tertiary hospitals.