You and your doctor may go through several steps in preparation for chemotherapy.
Assess the potential benefit of chemotherapy
Your doctor considers a number of factors to determine whether and what kind of chemotherapy would benefit you. The higher your risk of recurrence or metastasis, the more likely chemotherapy will be of benefit. In some cases, characteristics of the breast cancer itself may suggest other more beneficial treatments.
Discuss your own treatment goals and preferences with your doctor. Factors commonly considered include:
- Tumor size and grade. The larger the tumor, the more likely chemotherapy may be useful in destroying stray cancer cells.
- Lymph node status. Breast cancer cells found in your lymph nodes during or before surgery signal a higher risk of metastasis. Your doctor is more likely to recommend chemotherapy.
- Age. Some studies suggest that breast cancer that occurs at a young age is more aggressive than breast cancer that develops later in life. So doctors may opt for adjuvant chemotherapy when treating those diagnosed at a younger age to decrease the chances of the cancer spreading.
- Previous treatments. Whether you've had chemotherapy before may affect your current treatment regimen.
- Chronic health conditions. Certain health problems, such as heart disease or diabetes, may affect the chemotherapy drugs used to treat you.
- Hormonal status. If your breast cancer is sensitive to the hormones estrogen and progesterone, hormone therapy — with drugs such as tamoxifen, fulvestrant (Faslodex) or aromatase inhibitors (Arimidex, Femara, Aromasin) — may be a better option for either pre- or post-surgical adjuvant therapy. Or they may be considered in addition to chemotherapy.
- HER2 status. If your breast cancer produces too much of a growth-promoting protein known as HER2, your doctor may recommend drugs that specifically target this protein — trastuzumab (Herceptin), pertuzumab (Perjeta), lapatinib (Tykerb), others — in addition to chemotherapy.
- Genetic profile. For certain types of breast cancer, some doctors may do genetic testing of your tumor tissue to learn genetic patterns that may help predict the risk of recurrence and which cancers benefit from chemotherapy. These tests can be particularly useful in helping you and your doctor to determine whether chemotherapy is necessary, or if you only need hormone-blocking treatments. These tests do not apply to cancers that are not hormone-sensitive.
Take steps to improve your overall health
Because chemotherapy can affect fast-growing healthy cells, such as your white blood cells, platelets and red blood cells, it helps to be as healthy as possible before you begin treatment, to minimize its side effects.
Your doctor may recommend that you take the following steps to optimize your overall health:
- Get plenty of rest.
- Eat a balanced diet rich in fruits, vegetables and whole grains.
- Minimize stress.
- Avoid infections, such as the common cold and the flu. Talk to your doctor about recommended vaccinations, including annual flu vaccines.
- See your dentist for any signs of infection in your teeth or gums.
- Undergo blood tests to check your liver function and tests to check your heart. If there are any problems, your doctor may delay your treatment or select a chemotherapy drug and dosage that are safer for you.
Plan ahead for side effects
Ask your doctor what side effects you can expect during and after chemotherapy and prepare. For instance, if your chemotherapy treatment will cause infertility, you may wish to store sperm or fertilized eggs for future use. If your chemotherapy will cause hair loss, consider a wig or head covering.
Make arrangements for help at home and at work
Most chemotherapy treatments are given in an outpatient clinic, which means most people are able to continue working and doing their usual activities during chemotherapy. Your doctor can tell you how much the chemotherapy will affect your usual activities, but it's difficult to predict just how you'll feel.
Prepare by asking for time off work or help around the house for the first few days after treatment. If you'll be in the hospital during chemotherapy treatment, arrange to take time off work, and find someone to take care of your children, pets or home.
Tell your doctor about any drugs or supplements you're taking
Be sure your doctor knows about any medications or supplements you're taking, including any herbal supplements, vitamins or over-the-counter drugs. These may affect the way the chemotherapy drugs work. Your doctor may suggest alternative medications or that you not take the medications or supplements for a period before or after a chemotherapy session.
The day of treatment
Your doctor or nurse will let you know what you can and can't eat or drink on the day of your chemotherapy session. It may help to take a family member or friend with you to the treatment session for support and companionship.