Chemotherapy
Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. There are lots of different types of chemotherapy drugs, which work in different ways to treat different types of cancer. The number of chemotherapy drugs used nowadays is huge and they are all different in terms of their strength and side effects.
How is chemotherapy given?
Most people do not need to stay in hospital overnight to receive chemotherapy. It is usually either injected into your vein (intravenously), injected under your skin (subcutaneously) or taken as a pill (orally).
If you have chemotherapy that is given intravenously, you’ll need go to hospital as an out-patient to a haematology day unit or oncology day unit. Specially trained nurses will insert a small tube (a cannula) into your vein and then drugs will be pumped into your body over a period of time. The length of time will depend on the type of drug. Some drugs are delivered by a drip, where they are mixed into a bag over your head and slowly dripped into your body. Chemotherapy given under the skin is also given by a specially trained nurse on a day unit.
Many chemotherapy treatments involve more than one chemotherapy drug. So, it is possible that you may have more than one intravenous chemotherapy drug, or have both an intravenous chemotherapy drug and chemotherapy pills.
You are likely to be on other medicines. These are to help prevent you from getting infections (antibiotics), protect your gut (such as lansoprazole) or prevent nausea (called antiemetics when you are having the chemo).
Some hospitals have specially trained nurses that can come out to your home to give chemotherapy under the skin or less commonly into a vein, but this service is not available to everyone or at every hospital. Speak to your healthcare team to find out more about the services available to you.
What are the side effects of chemotherapy?
Chemotherapy does come with side effects.
How many and how severe the side effects are will depend on:
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the drug or drugs you are being given
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your individual health
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how your body reacts
Importantly it is not possible for your doctor to predict which side effects you will get, when you will get them and how severe it might be. Your healthcare team will be able to talk through the side effects associated with your specific treatment, and any symptoms you need to watch out for. Importantly many patients have few or little side effects and some effects are rare. Also most side effects are not permanent. You may notice them on some days, improving over time or with medicines given by your doctor.
Whilst on chemotherapy, you’ll be at a higher risk of infection than you would normally be. Chemotherapy can cause a condition called neutropenia. This is where there is a lack of white blood cells to fight infection. Neutropenia can make you more at risk of getting ill from infection, and harder to treat any infections you do pick up. You doctors will be able to tell you what to look out for, and what to do if you show signs of infection so that they can treat you as quickly as possible.
Fatigue is quite common with a number of moderately strong chemotherapy drugs. You may have difficulty concentrating or your sleep patterns may change.
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Many chemotherapy drugs can affect the gut:
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sore mouth
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change in appetite or loss of appetite
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sickness
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indigestion
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diarrhoea
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constipation
These symptoms can be helped by medicines so it is important to discuss these with your healthcare team.
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Chemotherapy often lowers the number of normal blood cells although this is often not a problem. However, it is possible that you may need a blood transfusion or develop very low white blood cells that can lead to your next chemotherapy being delayed. You may be given injections under the skin to boost your white blood cells.
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Other side effects may be particular to the drug that you are taking, so be sure to talk to your healthcare team about the side effects you might encounter.
What types of chemotherapy are available?
Below you can find some of the most common chemotherapy drugs used to treat Waldenstrom's macroglobulinaemia. Many people living with WM will receive chemotherapy in combination with other drugs like monoclonal antibodies and steroids.
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What drug(s) your doctor chooses for you will depend on your personal needs, for example your general health and fitness, any chemotherapy you’ve previously had, and how advanced your Waldenstrom's macroglobulinaemia is.
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Why not start treatment straightaway?When you’re first diagnosed with WM, being told you don’t need immediate treatment may surprise, or even worry, you. You might think that it must be better to kill the cancer cells before they can increase more. However active monitoring is a safe and recommended way to care for people with slow-growing cancers like WM. There isn’t any evidence to show that being treated earlier has any benefits. Treatment itself can have some harsh side effects, which can be long lasting. By putting you on active monitoring, your doctor is saving treatment for when it can have the maximum impact. If your doctor sees signs that your WM is worsening, they will discuss treatment options with you immediately. However, many people stay on active monitoring for years, meaning they can lead full lives without the side effects of needless treatment.
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What happens on active monitoring?You’ll have regular check-ups with your healthcare team, where you’ll have blood tests and a chance to talk about how you’re feeling and any symptoms or concerns you have. Normally these are face-to-face at the hospital, but since the COVID-19 pandemic, many check-ups have moved to video call or telephone. This doesn’t affect how you are monitored, just the way you speak to your healthcare team. Your blood tests and symptoms will help your doctor understand how your WM is behaving, and whether it’s time to start treatment or not. The check-ups also mean your doctor can pick up on any other conditions, for example anaemia, and ensure you get the right treatment for this. It’s important to raise concerns or mention any symptoms, however minor, at your check-up as your healthcare team might want to investigate these further. When you’re first diagnosed, these check-ups may be more frequent – for example, every 3 months – but as time goes by and if your WM remains stable, the check-ups may become less frequent. Some people who have been on active monitoring for years might have one check-up a year.
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Is active monitoring safe?Yes. It is the recommended way to care for people with WM that isn’t growing and who either don’t have symptoms or whose symptoms are mild.