Systemic treatment refers to cancer treatment that targets the entire body. This includes chemotherapy, targeted therapy, immunotherapy, and hormonal blockers.
You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies
How are each given?
Chemotherapy – Usually intravenously (via a drip or a port). Occasionally oral chemotherapy (tablets) can be used.
Targeted therapy – Usually oral tablets, occasionally intravenously.
Immunotherapy – Usually intravenously, subcutaneous (under the skin) formulations are being developed.
Hormonal blockers – Usually oral tablets or three-monthly or monthly injections.
Preparing for chemotherapy
Each patient has a different attitude and response to starting reatment. The role of oncology nurses is to make the transition as comfortable as possible ensuring that you are well-prepared for the day.
Chemotherapy has different regimens. Some treatments can be administered daily, two-weekly, three-weekly, etc. It all depends on your diagnosis, the intent of treatment and the type of drug being administered. You’ll be reminded of your appointments to familiarise yourself with the regimen.
What to expect on the first day
You’ll be seen by the oncologist to discuss the treatment and sign the consent form. Then you’ll be escorted to the treatment room and introduced to the nursing staff. A chair will be allocated to you and an oncology nurse will explain that the medication will be prepared by the pharmacist. Preparation for chemotherapy administration will be done and you’ll be prepped for port or drip access.
What is a port?
A port is a device that is placed under the skin of the chest that allows healthcare providers to draw blood and give treatments without the difficulty of looking for a vein. It’s inserted by a surgeon in theatre, and is an outpatient procedure so you need not stay overnight. It’s done under general anaesthetic and a few days before chemotherapy. The cost is generally covered by medical aids. It can remain in place for weeks, months or even years. Your oncologist will guide you on whether a port would be suitable for you.
You’ll receive pre-medication (anti-nausea meds, with a corticosteroid, sometimes anti-histamines or anti reflux-meds) to mitigate side effects. These can be given orally or intravenously. The intravenous line is prepared and primed and you’ll be connected to the chemotherapy line. The infusion is commenced, and education given on which treatment is given and why, and side effects will be re-emphasised.
You’ll receive a script for supportive medication, and the importance of the medication, how to use it and where to obtain it will be explained. You’ll be monitored throughout and once treatment is completed, you’re free to go home, preferably driven by a loved one.
Another appointment date is given as well as contact numbers in case of emergencies or to discuss any side effects.
Be prepared for side effects
Side effects may start on the afternoon of the second day or third day after the first cycle and can range from moderate to severe and can occur at different stages. Note: not all patients experience the same side effects.
Common side effects
You will be treated to prevent or lessen the occurrence. Anti-nausea medication will be prescribed and antacid is advised to be used throughout. You may need to alter your diet as certain foods may increase the occurrence of nausea. If nausea is severe, you must inform your doctor and you may be admitted to hospital or treated as an outpatient by administering anti-nausea intravenously.
This is when the white blood cells in the body are low. Your white blood cells are responsible for protecting you against infection. These are usually monitored by blood tests before each chemotherapy cycle. If your white blood cells are low, your treatment may be delayed or an injection given to help your white blood cells to recover quicker. It is of utmost importance to report to your doctor or nurse if you have any fever, as it could mean you have an infection. This is termed febrile neutropenia and is an emergency and requires treatment, usually with antibiotics.
Not all chemotherapy drugs cause hair loss, so you will be warned beforehand of the treatment you’re getting and the degree of hair loss it will cause. This is often traumatising so it’s always needed to be informed of how soon it can happen, so you can prepare yourself by shaving your hair before it starts to fall out or to consider investing in a wig. For certain regimens, a cold-cap is useful to decrease the amount of hair loss experienced. Hair loss can cause sensitive scalps; a mild shampoo is advised and in severe cases a cortisone lotion is prescribed.
This is difficult to manage. Constipation is debilitating and can cause you to feel fatigued and irritable. If you have pre-existing constipation, start immediately with a laxative and adjust your diet and drink plenty of fluids.
This is common and can often not be avoided. You’re advised to get enough rest, especially the first four days post-chemotherapy. You shouldn’t engage in any vigorous exercise or work. It’s advised to have a conversation with your employer to explain your situation to get support and understanding from them.
This is a common side effect and can occur moderately or severe. You’re advised to keep anti-diarrhoea meds at home and you should monitor the number of stools passed over 24 to 48 hours and if it’s not settling with medication, call the nurses, visit a GP or emergency unit. Diet will be discussed to lower the incidence of diarrhoea.
This is also common and can be problematic if not treated early. Use a mouthwash and ensure regular oral care is carried out. The mouth is one of the easiest points of infection and if mucositis occurs with a fever and low white cell count, medical intervention will be needed.
This can come in the form of a pill, liquid, or tablet that you swallow or place under the tongue to dissolve. It can also lead to side effects as mentioned before. You’ll be monitored every 21 or 28 days depending on the schedule and will be required to do blood tests to monitor your immune system, kidney function and liver profile.
You’ll be educated on ingesting medication, and clear instructions should be given on dosages, what to
do when doses are missed and how to store medication. Often tools are given to assist with taking medication, such as blister packs, diaries, and set reminders on your phone.
Targeted therapy is a cancer treatment that uses drugs or other substances to precisely identify and attack certain types of cancer cells. It can be used by itself or in combination with other treatments, such as traditional or standard chemotherapy, surgery, or radiation therapy.
The treatment usually doesn’t have the same side effect profile as chemotherapy. In fact with some targeted therapies side effects, such as a rash, are usually an indication that the drug is working; you’ll be informed of this. However, we have to monitor these side effects and treat according to the grade or severity.
Treatments are usually ongoing or administered as maintenance treatment and used until disease progression or if toxicities are too severe.
Immunotherapy is usually given intravenously. There are different types of agents so the intervals between treatments may differ. Immunotherapy is different from chemotherapy as it activates the body’s immune system to fight cancer. The side effects are thus very different. Common side effects include fatigue, skin rash or diarrhoea. These are called immune-related side effects and can affect any organ system in the body. It’s very important that your oncologist explains what symptoms to look out for as some of them can be life-threatening.
These are used to block hormones, such as progesterone-, oestrogen- and testosterone-driven cancers. They are mostly indicated for breast, prostate and some endometrium cancers and are usually given for long periods of time. Some patients really can’t tolerate hormone blockers and they are monitored closely, with trial and error done to manage the patient.
You’ll be monitored every six months, and your oncologist can assist you with side effects which can include hot flashes, dry skin, irritabilty and joint pain.
What to bring to chemotherapy
These are useful if you’re undergoing intravenous chemotherapy as certain chemotherapy drugs can cause the sensation of pins and needles in the hands and feet.
Warm socks and gloves
These can be used in conjunction with the ice packs to help control the pins and needles as well as keep you warm.
Chemotherapy can often cause a harsh, metallic taste in the mouth. Having something to suck on to eliminate the taste is advised. Lemon and ginger sucking sweets have anti-nausea properties.
Button-down or zip sweatshirt
Wear comfortable clothes that are easy to take off; button or zip down if you’re using a port. Alternatively, sleeves should be loose to push them up if you’re receiving chemotherapy in the arms.
Pillows and blankets
A neck/travel pillow to support your neck. Smaller pillows to rest your arm on while receiving chemotherapy, or to protect your port from a seatbelt when travelling. A warm, thick blanket provides added comfort while sitting in the chemotherapy chair.
Puzzles, magazines and novels are all some activity ideas to help you pass the time.
Metal water bottle
Staying hydrated is imperative during treatment. A metal bottle is more hygienic than plastic as it can be soaked and cleaned in boiling water. If the metal bottle causes a metallic taste, then disposable or recyclable plastic bottles may be a better option.
Your lips may become dry and cracked during treatment.
Survivors’ DIY tips for side effects
- Nausea – Ginger sweets and biscuits.
- Mouth sores – Tea tree oil mouthwash, tongue scraper and toothpaste for sensitive teeth.
- Joint pain – Organic castor oil.
- Loss of appetite – Drink lots of water and have a nutritional supplement; I would add blue berries and used almond milk.
- Sore feet – Wear shoes with very soft soles.
- Leg cramps – Magnesium supplement.
- Constipation – Dried fruit.
- Mouth sores – Gargle with apple cider vinegar.
- Pins and needles – Vitamin B supplement tablets.
- Fatigue – Rest, rest and rest.
Dr Ronwyn van Eeden is a medical oncologist in private practice in Rosebank and an honorary consultant in oncology at Chris Hani Baragwanath Academic Hospital. She is a member of the executive committee for BIGOSA and previously executive-committee member for SASMO. She is a current associate editor of the Journal of Thoracic Oncology.
Sister Claudette Barker qualified as a registered nurse in 1997 and has a diploma in Midwifery, Community and Psychiatric Nursing. She has worked in oncology for the past 20 years, mainly administering chemotherapy. She is experienced in case management and clinical trials and is extremely passionate about her patients and strives to educate, show compassion and patience to make their journey easier.
Nompumeleo Jwili is a registered nurse. She achieved her qualification at Netcare Gauteng West College and has experience working in oncology, ICU, high-care and paediatrics. She is known as a hard worker willing to assist wherever there is a need and she has built herself a good reputation as a nurse that offers quality care to patients.
Header image by Freepik