CHEMOTHERAPY FOR BREAST CANCER

Chemotherapy (sometimes just called “chemo”) is a treatment that uses drugs to kill cancer cells. The drugs are called cytotoxics, which means toxic to cells (cyto). 

Chemotherapy damages cells that are dividing rapidly. Cancer cells are fast growing and most likely to be affected by chemotherapy. 

Chemotherapy is given after surgery (known as adjuvant chemotherapy) to reduce the risk of cancer returning. Adjuvant chemotherapy is usually started within 4 weeks after surgery.

Chemotherapy may be given before surgery (known as neoadjuvant chemotherapy) to shrink a large breast cancer - this may mean you can have breast conserving surgery rather than a mastectomy.

Neoadjuvant chemotherapy may also be recommended to

• To reduce the size of your tumour so that a smaller amount of tissue can be removed - this may give you a better cosmetic outcome

• To reduce the number of lymph nodes that need to be removed

• To give you time to have genetic testing - you may decide to have a different type of surgery if you are found to have an inherited breast cancer gene mutation

• To give you time to consider your surgical options, including breast reconstruction

• To be able to see how effective the chemotherapy is against your cancer

• To give you a better idea of your prognosis

• To help decide if extra treatment is needed after surgery 

• To be eligible to participate in a clinical trial

Chemotherapy may be recommended if the risk of cancer returning outside your breast is high or if the cancer has spread outside the breast already. The benefit of chemotherapy might be clear for some people but less clear in others. Your medical oncologist may use an online program to help estimate the benefit you might expect to get from chemotherapy.

Genomic assays, also known as molecular assays, are tests that look at the patterns of certain genes within the cancer cells. These patterns help predict the risk of the cancer returning, and this information helps identify who is most likely to benefit from chemotherapy.

Genomic assays are used only for early breast cancers that are hormone receptor positive and HER2 receptor negative. The tests are carried out on breast tissue removed during surgery. Current available genomic assays include Oncotype Dx, Endopredict and Prosigna. These tests are quite expensive (up to several thousand dollars) and are not covered by Medicare or private health funds.

The Oncotype Dx test is used in Australia. The cost is $5000. The test is processed in the USA and results take around 2 to 3 weeks. Learn more in the Oncotype Dx Patient Information booklet produced by Specialised Therapeutics.

Most people will have chemotherapy for 3 to 6 months.

Chemotherapy is given as a series of treatments with a break between each treatment to give your body time to recover from any short-term side effects. The treatment and period of time before the next one starts is called a cycle. Chemotherapy may be given weekly, every 2 weeks or every 3 weeks.

You will be treated as an outpatient in the chemotherapy unit at a hospital. Local treatment centres include Gosford Private Hospital, Gosford Hospital and Wyong Hospital.

Chemotherapy for breast cancer is usually given into a vein (intravenously).

The most common way of giving chemotherapy involves inserting a small needle and plastic tube called a cannula into a vein, either in the back of the hand or lower arm. The needle is removed and the plastic tube left in place. The chemotherapy drugs are slowly injected into the vein. If a large volume of fluid is used it can be given as an infusion (drip) through the cannula over a fixed period of time. The cannula is taken out after you have had the drugs and a new one is inserted before each cycle of chemotherapy.

An implanted port is a small device connected to a thin tube (catheter). It is inserted under the skin in the chest. The other end of the tube goes into a large vein just above the heart. The port is hidden but can be felt under the skin. Chemotherapy drugs are given directly into the port by puncturing it each time with a special needle. It can also be used to take blood samples.

Chemotherapy damages cells that are dividing rapidly throughout the body. Cancer cells divide rapidly, as do some normal cells, such as hair follicles, blood cells and cells inside the mouth or bowel. Side effects occur when chemotherapy damages these healthy cells. Unlike cancer cells, normal cells can recover, so most side effects are temporary.

Side effects include

• Hair loss
• Changes in thinking and memory “chemo brain”
• Changes in taste and appetite
• Mouth ulcers
• Nausea and vomiting
• Diarrhoea or constipation
• Anaemia
• Increased risk of infection
• Increased risk of bruising
• Early menopause
• Loss of fertility
• Fatigue

Most people feel well enough to travel to and from the hospital by themselves during chemotherapy. However, it is recommended that a family member or friend comes with you to your first appointment to support you and help you get home if necessary.

Most people are able to continue working during their treatment. Others may need to reduce their hours or take time off. How much you will be able to work depends on the type of chemotherapy you have, how the treatment makes you feel and the type of work you do. You may need to take a few days off after each cycle of chemotherapy, and when you get back to work you may find it difficult to work long hours.

Talk to your employer about your working arrangements. Explain that it is hard to predict how chemotherapy will affect you and discuss the options of flexible hours, modified duties or taking leave.

Understanding Chemotherapy by Cancer Council

Neoadjuvant Patient Decision Aid by Breast Cancer Trials

Chemotherapy For Breast Cancer by Westmead Breast Cancer Institute