Why is chemotherapy given?

Chemotherapy is used in the treatment of breast cancer when there is a risk that the cancer has spread beyond the breast and lymph nodes. It helps to reduce the risk of having the cancer come back either in the breast, lymph nodes, or elsewhere in the body.

Your medical oncologist will determine if chemotherapy will benefit you by looking at the stage of your cancer, its aggressiveness, your age, ER/PR status, Her2 status, and other factors. You may also get an Oncotype DX (or similar) test that examines the genetic profile of your cancer to help predict your 10 year risk of having the cancer come back elsewhere in the body. Chemotherapy also includes hormonal therapy.

Questions you should ask your oncologist

There is one critical question you should ask. How much will chemotherapy reduce my risk of having the cancer come back? You do have a say in this decision. For some people a reduction in risk of 1% is enough to take on chemotherapy. You may not feel this way. Be sure you understand the numbers from your medical oncologist and listen closely to the reasons he or she has for recommending chemotherapy. As difficult as it may be, do not turn down chemotherapy just because you are afraid of it. There are medicines, people, and resources to help you get through it. Don’t risk a recurrence just because you are afraid.

Once you know you are getting chemotherapy, here are some of the questions you should have answers to:

What drugs will I be getting? How many cycles? How frequently? Ask for written information about your chemotherapy drugs.

Can I eat before chemotherapy?

What medicines will I need to take before my chemotherapy? You will often have medicines you need to take the night before.

Will I need a port? This is a type of longer term IV access.

How long will I have to be in the cancer center receiving my chemotherapy dose?

Will someone be able to come with me for treatments?

Will I have any food restrictions? Be sure to ask about raw fruits, veggies, and meats (like sushi).

Will I be able to work during treatment? If not, when can I return to work?

What type of exercise should I do?

What are the most troublesome side effects? You will get a detailed review of side effects before you sign your consent form, but it helps to talk about specific or serious side effects that may affect you even if they are uncommon.

Who do I call if I am having problems when I get home?

Will I need a white blood cell booster (Neupogen or Neulasta)?

Can I take my vitamins and herbs?

Will I go into menopause with treatment?

Should I use birth control? If so, what type?

What do I need to do if I want to have more children?

What to expect

Chemotherapy administration has improved dramatically over the last few decades. The chemo is still powerful medicine but oncologists now have much better medicines to get you through the side effects. These include more effective nausea medicines, medicines to boost your white blood cell counts, and broad spectrum antibiotics.

Common side effects (not a complete list by any means):

Pretty well controlled with modern nausea medications.

Low white counts. Ask if you need a white blood cell booster.

Hair loss. This is very common with many of the drugs used to treat breast cancer. Some of these are Adriamycin, Cytoxan, taxol, and taxotere.

Dry skin.

Changes in the appearance and texture of your nails.

Mouth irritation and sores.

It is important to remember that you can always ask questions. And you can ask the same questions many times. You won’t remember much of the information you receive so it is best to take notes, bring a friend to listen as well, or record the conversation if you can.