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Ovarian Cancer

Chemotherapy for ovarian cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is given after surgery if all the cancer could not be removed at the operation, or if the surgeon feels that cancer cells may have remained behind. If the tumour is likely to be difficult to remove, chemotherapy may be given before surgery to shrink the cancer and make the operation easier and more effective. Chemotherapy is the main treatment if the cancer has spread to the liver or beyond the abdomen. 

Chemotherapy drugs are usually given by infusion into a vein (intravenously), which may take several hours. Women described it as feeling cold, but painless. This is usually followed by a rest period of a few weeks, which allows the body to recover from unwanted effects of the treatment. Together, the treatment and rest period is known as a cycle of chemotherapy. The number of cycles depends on the type of cancer and how well it responds to the drugs. Generally six cycles of chemotherapy are given, over 4-5 months. Chemotherapy is often given as an out-patient treatment but it sometimes means spending a few days in hospital. The drug most commonly used to treat ovarian cancer in the first instance is carboplatin, either alone or in combination with paclitaxel (Taxol) but there are other chemotherapies used.

Some women we talked to were anxious because they didn't know what chemotherapy would involve. A few felt discouraged because other people being treated looked very ill. Women described the process of being given the treatment, including extra drugs to minimise unwanted effects. A few had veins that were difficult to inject because they had already been used many times.

 

She knew little about chemotherapy before she had it

She knew little about chemotherapy before she had it

Age at interview: 48
Sex: Female
Age at diagnosis: 48
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I knew nothing at all about chemotherapy except that it's this awful thing. I hadn't got a clue what it meant, I didn't know how you had it, what it was. Whether you lay down or, you know, what happened to you. Nothing, nothing at all. So you know, only very negative things about it, that it's just this awful thing and, you know, you feel awful and you lose your hair. 

 

Describes the process of being given chemotherapy and other drugs to minimise unwanted effects

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Describes the process of being given chemotherapy and other drugs to minimise unwanted effects

Age at interview: 53
Sex: Female
Age at diagnosis: 52
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Yes it's a very long process actually because you go in about 9 o'clock in the morning and then they have to do routine blood work and then they analyse that and then they put all of the, I suppose, components in to figure out what you are going to be getting that day, and they have to put in anti-emetics and steroids.

You get those first and then you get a main drug say like carboplatin, and that takes two hours, they have to do that separately. And then they have to maybe put something else in first, another bag of fluid and then they'll start the Taxol. But it is a process from say 9.00 to 6.30, 9.00 till 7.00 at night, I've been there quite late.

 

Her veins were difficult to find, making the chemotherapy injection difficult.

Her veins were difficult to find, making the chemotherapy injection difficult.

Age at interview: 44
Sex: Female
Age at diagnosis: 41
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And how were the drugs administered, is it all intravenous?

Intravenous yes. I think that's quite traumatic. In, you know, for some people I had a problem them finding a vein, always was a problem and I think that's a problem for a lot of people. And so you're almost relieved when they get the cannula in and start getting the chemotherapy in because you think 'thank goodness that bit's over'. Because, you know, physically at the time that's the worst bit, you don't actually feel the effects of the drugs going in you at that time and, obviously it's all flushed through with saline and they put lots of other bits and bobs in as well as the chemotherapy! So that's physically probably the worst thing is the having the drip put in.

A woman who had been very fearful about chemotherapy reflected that, unpleasant as it was, the experience helped her to see kindness in other people.

 

Describes how chemotherapy frightened her and how it brought out the good in people.

Describes how chemotherapy frightened her and how it brought out the good in people.

Age at interview: 55
Sex: Female
Age at diagnosis: 50
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And the fear. I mean I was so frightened about that, that I was almost sick. Just the not knowing, just the absolute fear of 'What are they going to do to me?' And knowing that while they're doing it, okay they're putting a fluid inside me which is making me better, but it's absolutely killing the system that my body's lived with all these years that has kept me well. And I know when the drip was going through and you can see the liquid coming down the tubes, it's poison. And to be' I thought about it like bleach. When I stick bleach in the sink and it cleans the sink or cleans the loo, that's what it felt like, going into my body. Like bleach. 

And the thing that I had to hang onto, because that would have been quite a destructive thought really, was that it is attacking the bad bits. It's attacking the bad bits. The good bits have got a chance to get good again. 

But the nurses on the wards were superb. They were so kind and I mean there were people on the wards hanging on to life, virtually hanging on there. But it wasn't a depressing ward, it wasn't a ward where you' There was a lightness about the ward, people were very kind towards each other. Even though it was kind of' I don't know, that's, they're the kind of sad things that make me look back and, it was almost bringing out the good in people. 

Many women found the surroundings in the chemotherapy unit pleasant and comfortable and the nurses very knowledgeable and supportive. Some women read books or took someone with them to help pass the time. Several said that steroids made them hungry and were surprised how much they wanted to eat while they were having their treatment. Chatting to other patients was not always possible if they already had company or didn't feel like talking, or because they were treated in individual rooms. Travelling to and from the hospital for chemotherapy could be a problem for those living a long distance away, or who felt very ill.

 

Describes how she passed the time during chemotherapy treatments.

Describes how she passed the time during chemotherapy treatments.

Age at interview: 51
Sex: Female
Age at diagnosis: 48
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Sometimes I had a friend with me; sometimes I went by myself, it depended if this friend that was with me, my friend that's in her 70s, if she could come, she would come with me. But I always felt a bit guilty because it's a long day - it was eight hours - and you're just sat in a room. I mean, it's quite comfortable there, and they come round with sandwiches and tea, but even so it's pretty boring if you're just sat there all day, and I didn't mind not having somebody, I was alright on my own. 

It was comfortable but yes, people didn't really talk. Most of them had people with them and they didn't really chat. I got chatting to one man that was in there a couple of times, but I used to just doze off in the chair and read a book and do some crosswords and things like that, and just sort of sit there and think, 'hhmmm, boring'.

 

Spent hours travelling to the hospital for chemotherapy while feeling ill.

Spent hours travelling to the hospital for chemotherapy while feeling ill.

Age at interview: 62
Sex: Female
Age at diagnosis: 61
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We live in a wonderful rural area here which has it's drawbacks because it does mean that the nearest hospital for most treatment is at least an hour away and the oncology hospital is a two hour journey away. And this meant that maybe four hours in a day could be spent travelling and several hours spent at hospital having chemotherapy at a time when you really did not feel like travelling these distances. And I would have to dose up on Imodium because I was perhaps having diarrhoea and couldn't cope with a two hour journey. 

Most women found their body responded in a similar way each time they were treated. This meant they could plan to avoid doing things on the days when they expected to feel ill, and to do things when they expected to feel well. Some found that the more treatments they had the worse they felt. Keeping a diary sometimes helped women to feel more in control. (See also 'Unwanted effects of chemotherapy'.)

 

Her body's reaction to chemotherapy followed a pattern.

Her body's reaction to chemotherapy followed a pattern.

Age at interview: 65
Sex: Female
Age at diagnosis: 62
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But then I had 6 weeks, 6 sessions of the Taxol and I said to my Oncologist 'how will I know this is working 'cos I am really really suffering?' It's not nice, it's not something you would want to wish on anyone. But I think having, I've said it before I think I got away pretty well. I mean I had the session sort of we'll say on the Friday, I was OK till perhaps the Monday and then I started to go downhill. You can't sleep, you, I wasn't sick because I had plenty of drugs to stop that, so I wasn't sick. And as I say, this kept going on, you'd get two weeks of feeling really rotten then suddenly it lifts and you're back feeling a bit normal. I continued with my golf, I couldn't do 18 holes, but I continued with the support of my friends, you know, and you sort of age 20 years, you feel really really lethargic, you know, I got that I could hardly move my legs at one stage, they just felt like glue at the end, when I'm getting to the end of the 6 sessions.  

 

One can plan one's life around chemotherapy treatments because the body reacts similarly after...

One can plan one's life around chemotherapy treatments because the body reacts similarly after...

Age at interview: 41
Sex: Female
Age at diagnosis: 40
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I mean that's the good thing, if you like, about cancer and the treatment of chemotherapy is that everything has a time limit. You know exactly when you're having your treatment, you know you might feel poorly for three or four days afterwards but you know after that you'll feel fine, so you can plan your life to work round it. The same as avoiding busy places when your blood count is low, you know, don't go shopping on a Saturday afternoon, but you can go at a quieter time.

 

The more chemotherapy she had the more ill she felt.

The more chemotherapy she had the more ill she felt.

Age at interview: 80
Sex: Female
Age at diagnosis: 79
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It would be about 10 days later I started chemotherapy. I had chemotherapy starting on the 5th of June, every 3 weeks. I had 3 hours of Taxol and an hour of carboplatin. The first 3 treatments, they weren't pleasant but I managed to handle them, but then the last 3, they were quite difficult. I found them very tiring, they would start about 2 days after the treatment and right on for about a fortnight I wasn't a very well person, very limited in what I could do. Towards the end of my treatment I discovered that there was maybe one or 2 days I wasn't even able to put on my clothes.

Some women could continue working on their good days between treatments, whilst others needed long periods of time off work. Women who worked with children had to stop work because they had been told to avoid coughs, colds and children.

 

She could work on days when she felt well between chemotherapy treatments.

She could work on days when she felt well between chemotherapy treatments.

Age at interview: 55
Sex: Female
Age at diagnosis: 50
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And I was really lucky with my business, because I'd got, I had some good customers who were prepared to wait until I was well to go back and work with them. But what I found I was able to do is, because I was being, having my treatment every three weeks, the first week I was useless for very much at all but during the second two weeks I was able to continue with my work. And that was good, I needed that.

Blood tests were done between treatments to check whether the body had recovered enough to cope with the next one, and waiting for these test results could be nerve-racking. Sometimes treatments were postponed for a few days to allow people longer to recover. This could be inconvenient as well as worrying for women who had worked out their treatment schedules and fitted other plans around them. A few had the dosage reduced or fewer courses of chemotherapy than planned because their bodies were not coping well. Occasionally treatment must be abruptly stopped because the patient has a serious reaction to the drugs.

 

Explains her anxiety when waiting for results of blood tests before being allowed the next...

Explains her anxiety when waiting for results of blood tests before being allowed the next...

Age at interview: 41
Sex: Female
Age at diagnosis: 38
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I'd say the hardest bit of the chemotherapy was the waiting with each session because at this particular hospital, I don't know if it was the same at all hospitals, but you had to turn up and you had to be declared fit by the doctor before they would prepare the chemotherapy. So the wait was a bit unnerving, you know, you'd think 'well I'll steel myself, this is something I've got to go through' but that hour's wait before the chemotherapy drugs came over was often, you know, just a bit unnerving. The urge to run off was great I have to say. But they were great in the chemotherapy suite so it wasn't too bad.  

 

A chemotherapy treatment was postponed because blood tests showed she had not recovered enough...

A chemotherapy treatment was postponed because blood tests showed she had not recovered enough...

Age at interview: 43
Sex: Female
Age at diagnosis: 41
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In the meantime I was due to go back in every 3 weeks to have chemotherapy. When my first 3 weeks came up I had my bloods tested at the local surgery on the Monday ready to go to hospital on the Wednesday. But the first session I wasn't allowed to go because the platelets in my blood hadn't risen high enough. So I was quite disappointed in this because I thought I was a failure, couldn't have my treatment, really wanted just to get through the 7, or the 6 treatments. However the next week my blood was up so they took me in the following week.

Women whose cancer returns after initial treatment also receive chemotherapy. In addition to carboplatin and paclitaxel, other drugs that can be tried include liposomal doxorubicin (Caelyx), topotecan, cisplatin and etoposide, some given intravenously, some orally. One woman had five courses of four different chemotherapy drugs for her cancer.

 

Had five courses of four different chemotherapy drugs because her cancer kept returning.

Had five courses of four different chemotherapy drugs because her cancer kept returning.

Age at interview: 61
Sex: Female
Age at diagnosis: 54
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So you've had four or five lots of chemo now?

This is my fifth, yes.

And different drugs every time or have you alternated?

I had carboplatin, cisplatin, Taxol, and then last time I had Caelyx and I'm having that again this time. When I had it I understood again from the oncologist that you couldn't have more than a maximum of X number of mls of this drug, but whether again this is research that's changed things in a short time, because things do don't they. It's wonderful really how things improve. He's quite confident now that I will be able to have another six, obviously we'll monitor it as we go along, but another six doses of Caelyx. 

And I didn't lose my hair with Caelyx, and I was treated at home on that occasion which was, I didn't know you could have chemotherapy at home, well that was quite interesting, and I think that was the drug that's caused me personally the fewest number of unpleasant side effects. Although I understand its, it has an effect on your heart and not everybody can take it because the risk to the heart is greater than the benefits, you know, to the cancer.


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Last reviewed June 2016.

Last updated June 2016.

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