When? How? Where?

When?

Chemotherapy is given in cycles, with each period of treatment followed by a period of recovery. For instance, you may have your chemotherapy on the first three days of each month, and then rest the remainder of the month. Depending on the regimen you and your doctor choose, the total course of chemotherapy usually lasts from three to six months. Chemotherapy typically begins as soon as possible after surgery.

One important study found that chemotherapy every two weeks worked better than every three. This "dose-dense" approach attacks the cancer cells again when they are most vulnerable. But giving strong chemotherapy more often destroys white blood cells—infection fighting cells—at the same time. To keep your immune cell count up you'll receive a drug called Neulasta or Neupogen.

For some types of breast cancer, you may be offered chemotherapy BEFORE surgery. Such treatment—called neoadjuvant treatment—may shrink the cancer enough so you can have breast-conserving therapy (lumpectomy plus radiation) instead of breast removal (mastectomy). Only certain types of cancers respond well to chemo before surgery. Talk to your doctor to see whether your particular situation might lend itself to neoadjuvant chemotherapy.

How?

Chemotherapy can be given by mouth (orally) in pill, capsule, or liquid form. It can be given intravenously, through a thin needle inserted into a vein in your hand or lower arm. For some women, chemotherapy can be given through a port (sometimes referred to by a brand name, such as Port-a-cath or Mediport) that is inserted in the chest during a brief, same-day surgery. Even intravenous drugs (those not taken by mouth) can vary, from a single, quick injection to a slow drip or "infusion." How you receive your chemotherapy depends on the regimen you select.

One new method of delivering chemotherapy, being tested in clinical trials, uses heat therapy (hyperthermia) to reduce the size of the tumor. High-dose encapsulated chemotherapy is given through a thin plastic tube inserted with a needle directly into the tumor, followed by an hour with the breast in a pool of warm water. (Hyperthermia is already approved by the U.S. Food and Drug Administration to be used in combination with radiation.)

Where?

Chemotherapy can be given in a hospital, a doctor's office, a clinical setting, and sometimes at home. Most women are able to go home between treatments, but some are required to stay in the hospital so that the process can be monitored. In some instances, chemotherapy can be given through a portable pump that is attached to a port inserted in the chest wall. In that case you'll go to the hospital on the first day of treatment, and a small pump that dispenses drugs at a steady rate will be attached to the port. At the end of the treatment period, you'll return to the hospital, and the pump will be removed.

Other things you'll want to know

Does chemotherapy hurt? Many women ask this question. Chemotherapy generally feels the same as taking any other medication by mouth or by injection. Having an IV started usually feels like having blood drawn from your vein. If you experience any coolness, burning, or unusual sensation in the area of the injection or IV, you should report these to your doctor or nurse right away.

The chemotherapy treatment can take anywhere from an hour to several hours, depending on your regimen. Many treatment areas offer television and magazines, but you might want to do one of the following to help you pass the time:

• Bring a good book or listen to tapes.
• Bring your laptop computer and catch up on your e-mail.
• Bring some stationery and complete those thank-you notes you've been meaning to write.
• Practice relaxation or meditation techniques during treatment.
• Make a list of everything you can look forward to when the treatment is over. Practice the art of positive thinking.
• Start a journal or diary of your treatment process. It may be helpful to refer back to it when you start your second cycle.

Most treatment centers have space for a friend or partner to be with you during your treatments. Some women value this time with their close friends and family. Check with your nurse before you start chemotherapy to see if you can bring someone into the treatment center.

When your chemotherapy regimen is complete, you will be able to return home. You will be physically able to drive home by yourself, but you might feel more comfortable knowing that someone is there to drive you. You won't be in any pain, but it's probably better to plan a quiet evening, eat non-fatty foods, and definitely stay away from alcohol. As with any medication you are taking, you should consult with your physician for any restrictions on food and drink while you are receiving chemotherapy.

During the first week after chemotherapy, you may experience some side effects. While each woman responds differently, be prepared to have a decreased appetite, some additional fatigue, and perhaps some nausea. Don't leave your doctor's office without discussing the anti-nausea medication that will be right for you.