• Many people with breast cancer need chemotherapy treatments to help destroy cancer and prevent it from returning.
• You may want to prepare for chemotherapy by planning to manage side effects, taking time off from work, and packing a bag to bring to your treatment sessions.
• Your cancer care team can help recommend ways to prevent or reduce chemotherapy side effects.

Chemotherapy (also called chemo) is one of the most common breast cancer treatments. Medications used in chemotherapy travel around the body, killing cancer cells or preventing them from growing.

Information from 2015 shows that nearly 65 percent of women with cancer in the lymph nodes had chemotherapy treatments. However, researchers have developed newer testing methods such as Oncotype DX that help show who is most likely to benefit from chemotherapy. Now, more women can avoid chemotherapy if it would not benefit them.

For those who still need it, researchers continue to introduce new chemotherapy drugs and regimens that can more effectively treat breast cancer. A medical oncologist usually oversees these treatments.

Role and Timing of Chemo

Chemotherapy may be given at different times during your treatment journey, such as:

• Before surgery, to shrink a tumor and make it easier to take out (neoadjuvant chemotherapy)
• After surgery, to destroy any cancer cells that were left behind and lower your risk of having new tumors form (adjuvant chemotherapy)
• To treat cancer that has metastasized (spread to other parts of the body)

As you get chemotherapy treatments, your doctor will use various tests to measure how well the chemotherapy is working. If your current treatment plan isn’t working, you may be switched to different chemotherapy drugs.

How well chemotherapy works affects your outlook — if chemotherapy is successful, you have a better chance of living longer and a lower chance of having your cancer return.

Chemotherapy Regimens

There are many chemotherapy options for breast cancer. Your treatment plan depends on factors like what type of breast cancer you have, your breast cancer stage (how far it has spread), whether there is cancer in your lymph nodes, how old you are, and your general health.

Your chemotherapy regimen is a plan that lists the types of chemotherapy drugs you are taking, the dosages of each, and how often you will receive them.

Chemotherapy Drugs

Chemotherapy drugs are most often given intravenously (injected into a vein) in a hospital, clinic, or doctor’s office. Some come in the form of a pill that you take at home.

Many people with breast cancer receive a combination of two or three chemotherapy medications. Common options include:

• Anthracycline drugs such as doxorubicin (Adriamycin)
• Taxane drugs such as paclitaxel (Taxol) or docetaxel (Taxotere)
• Cyclophosphamide (Cytoxan)
• Carboplatin (Paraplatin)
• Methotrexate (sold under brand names including Rheumatrex and Trexall)
• 5-fluorouracil, also called 5-FU

Specific types of breast cancer may be treated with different regimens. For example, advanced breast cancer may be treated with just one chemotherapy drug. People with HER2-positive breast cancer may receive targeted therapy drugs at the same time as chemotherapy. People with triple-negative breast cancer may receive immunotherapy at the same time as chemotherapy.

Chemotherapy Schedules

You will usually get chemotherapy in cycles. Each cycle is one or more treatments followed by a rest period. One cycle could include a single treatment followed by a few weeks of rest, getting treatment once per week for three weeks followed by a rest week, or something in between.

Overall, chemotherapy for breast cancer often lasts several months. It may be longer if your cancer has spread, the cancer is responding, and you are tolerating the treatment well.

Chemo Schedules May Be Flexible

Chemotherapy schedules can disrupt your everyday life, making it harder to go to work or school, get things done around the home, or take care of family. Many medical oncologists are willing to work with you to build a schedule that best fits your needs. Try not to skip any appointments, but if you need to, talk to your health care team to rearrange your schedule. If there’s a major event you’re unwilling to miss, it’s likely that your treatment schedule can be flexible enough to allow you to attend.

How To Prepare for Chemo

Find out ahead of time which chemotherapy drugs you will be receiving and research possible side effects so you know how to prepare. For example, you could buy a wig if you are at risk of hair loss.

Some members of MyBCTeam prepared in this way. “I cut my hair into a short do before starting chemo and had it donated,” commented one person. “I ordered a wig at the same time.”

If you are of childbearing age, you may want to talk to your doctor about whether it’s safe to use birth control. If your breast cancer is hormone receptor-positive, you should not take birth control options that contain hormones.

Consider Cutting Back on Obligations

You will also want to make any necessary arrangements for work, school, or other responsibilities. You may need to spend a lot of time in the clinic receiving treatments, and you may feel extra tired for a couple of days after chemotherapy. However, many people continue going to work during their treatments.

One member wrote, “I planned on working through chemotherapy, but it did a number on me. Of course, maybe age has something to do with it too. I was 68 when diagnosed.” Another chimed in with how working helped them manage their treatments: “For me, working was good. It was normalizing and a great distraction.”

“While I was so glad to get back a piece of my old life, I came home exhausted,” said another member. “Be aware of what your job and home demands are and be willing to cut back on other activities so that you don’t wear yourself out.”

Chemo Port

In some cases, you may have a device implanted under your skin for the chemotherapy to be injected into. These devices, called chemo ports, central lines, or peripherally inserted central catheters (PICC lines), help you avoid multiple needle sticks. If you need one of these devices, it can be implanted at any time during your course of chemotherapy.

Getting Ready To Go to Your Appointment

To prepare for chemotherapy, pack a bag to bring to your appointment. You will want something to do and items to help you stay comfortable while you undergo your infusion.

You may want to bring:

• Books or magazines
• Music or an audiobook and headphones
• A laptop to watch movies
• Craft supplies for drawing, knitting, etc.
• A pen and paper to draw, sketch, or journal
• A pillow
• Comfortable sweatshirts, hats, or socks

“Pack yourself a chemo bag full of comfy, happy things (blankie, music, books, movies, snacks, drinks, etc.),” recommended one member.

You can also get ready by properly fueling your body before your appointment. “I don’t know if I would eat a huge breakfast, but for sure eat something,” wrote one member. “Also, start hydrating the day before and the morning of your infusion.”

What To Expect at a Chemo Appointment

During your appointment, you may undergo basic tests such as blood tests, temperature checks, and blood pressure tests. A nurse will start an intravenous line or set up an infusion into your chemo port, central line, or PICC line. You may receive other medications, such as anti-nausea or antianxiety drugs, and then receive chemotherapy. How long a chemo treatment takes depends on the drugs you are receiving. Treatments often last a few hours.

Some MyBCTeam members have discussed what to expect from chemotherapy for breast cancer. “I had my first chemotherapy treatment last Thursday — not fun, but not as bad as I worried it would be,” said one member. “The nurses are great and if you tell them you’re scared, they can be pretty reassuring.”

After Chemo Infusions

A few days after your appointment, you may feel tired or nauseous. Your health care provider may give you prescriptions for additional medications for side effects or recommend things to eat or drink that may help you feel better. For example, crystallized ginger can be an excellent remedy for nausea. You may want to suck on mints or chew gum. Remember that you will likely need someone to drive you home.

Chemotherapy may leave you too tired to do some of the things you used to do, which requires some adjustments. “It takes me several days to do all the tasks that I used to do in one day because at the end of the day I’m worn out, or the next day, I have less energy,” wrote one member. “I’ve learned the hard way — be the tortoise and not the hare.”

Side Effects of Chemotherapy

Although chemotherapy can kill cancer cells, it can also damage your healthy cells, leading to side effects. These health problems are not the same for everyone, and different drugs may lead to different effects.

Common side effects of breast cancer chemotherapy include:

• Tiredness
• Nausea or vomiting
• Loss of appetite
• Constipation or diarrhea
• Hair loss
• Mouth sores or tongue or throat pain
• Frequent infections
• Numbness, tingling, or a “pins and needles” feeling
• Chemo brain (difficulties remembering or focusing)
• Mood swings
• A low sex drive and vaginal dryness
• Menopause symptoms like hot flashes or night sweats, if you have not already gone through menopause

These side effects can be difficult to deal with. However, there are many types of medications, lifestyle changes, and other strategies that can help increase your comfort.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you had chemotherapy for breast cancer? Can you offer any tips about how to make chemo easier to deal with? Share your experiences in the comments below, or start a conversation by posting on your Activities page.