Welcome to Mayo Clinic podcast. Our topic today is deciding on chemotherapy — what you need to know. I'm your host, Rich Dietman.

In today's podcast we're talking about what to consider when deciding whether or not chemotherapy is right for you. My guest is Mayo Clinic cancer specialist, Dr. Tim Moynihan. Dr. Moynihan practices in the department of medical oncology at Mayo, and he's also cancer medical editor for MayoClinic.com. Dr. Moynihan, thanks for being with us.

Dr. Moynihan: Great, thanks for having me Rich.

Rich Dietman: What factors determine whether or not a person with cancer is a candidate for chemotherapy?

Dr. Moynihan: Multiple factors go into that decision, including what type of cancer they have. What stage is it at, which means how far spread is it — is it very localized or has it spread to other places? What is the overall condition for the patient? What other medical conditions do they have? How is their overall health — are they a very healthy person, or is it a person who has a lot of other medical conditions and other problems going on? And really the bottom line comes down to is, is this a situation where chemotherapy will be helpful, and how helpful will it be? If it is something that will be helpful, then it's something that should be pursued. If it's not helpful in that particular situation, it doesn't have to be given. Not all cancers need chemotherapy. Not all patients benefit from chemotherapy, but many do.

Rich Dietman: Can the side effects of chemotherapy and their severity be predicted?

Dr. Moynihan: For the most part, yes. For most of our standard chemotherapy drugs, we have a pretty good idea of what typical side effects to expect, although each individual certainly may experience somewhat different side effects, but the general pattern we're fairly good at predicting. There are, as I say, some individuals who may have more or less side effects. And as we learn more about things, we're learning how to predict that a little bit better. For example, how anybody deals with a drug that they're given of any type, whether it be chemotherapy or any other drug, depends on how your body metabolizes that drug, or gets rid of that drug. As we learn more about the genes and the enzymes that your body's born with, we know that some people may hang on to a particular medication longer than others. If they do that, it may be good against the cancer, but it may lead to more side effects. So we're starting to learn how to test patients ahead of time with certain simple blood tests to look at what enzyme levels they carry and then adjust our doses of chemotherapy appropriate to that individual. So we do two things: One, decrease the side effects of the treatment, and two, increase the effect of the treatment.

Rich Dietman: How can someone best prepare both physically and mentally for chemotherapy?

Dr. Moynihan: There are several items there. No. 1, try to decrease the stress in your life as much as you can. This is a very stressful time for anyone, anybody going through chemotherapy. But any other side distractions that you can get rid of, that's always very helpful. Two, learn all you can about it. Why are you taking it? What do you expect to get out of it? How much is it going to help? What are the side effects to get ready for? Thirdly, you should really speak to your physician and find out, are there anything in particular you should do on the day of the chemotherapy or the days leading up to the chemotherapy to get ready for it? As a general rule, for most of our chemotherapy, we don't have too many particular things that people need to get ready for the day before. I do advise a lot of my patients, particularly if they're getting fairly strong chemotherapy, to probably eat a fairly light meal. Don't try to eat very heavy. Try to get a good night's sleep the night before. That may be difficult because of the anxiety of the appointment coming, but just try to relax as best you can and come in with as good of an attitude as you can and as relaxed as you can.

Rich Dietman: You've just talked, really, about how a person can participate with the health care team in preparing for chemotherapy. Are there any additional things that a person might do during the chemotherapy itself?

Dr. Moynihan: Yes, things like making sure that, again, you get enough rest, making sure that you eat a relatively well-balanced diet. Again, appetite is often put off by chemotherapy. Some types of chemotherapy actually increase your appetite, so we have to be a little careful about that, and some of our anti-nausea medications may increase the appetite, so trying to get a healthy appetite is very helpful there. Making sure you get rest. There's some interesting data that shows that people who exercise or maintain a more normal routine, maybe actually do better with chemotherapy, have a better effect, and fewer side effects. And so trying to maintain as much of a normalcy to your life as you can is very helpful also.

Rich Dietman: Might I be able to choose when and how the treatment is given so it fits my schedule? For example, could I schedule a treatment on a Friday so that I might have the weekend to recover, at least from the initial impact of the treatment?

Dr. Moynihan: Absolutely. It may depend partly upon the type of cancer that you have and the type of treatment that you need. The vast majority of our chemotherapy treatments are done as an outpatient, just in the clinic. And for the vast majority of those, yes, the cancer center may well be able to adjust the schedule, what's most convenient for you. There are a few types of chemotherapy that require very strict schedules and may be several days in a row, so we may have less choice with that. There are a few chemotherapies also that still need to be delivered in the hospital and where you have to be hospitalized for several days in a row. So it really depends on the type of cancer you have, the urgency with which we need to treat it — if it's an emergency and we have to treat immediately — we may not have the luxury of waiting. But that's a fairly rare situation. And exactly what the schedule is for the treatment.

Rich Dietman: Does everyone with cancer benefit from chemotherapy? Are there some people who should not get chemotherapy?

Dr. Moynihan: Absolutely. Chemotherapy can be of great benefit to people, but not everybody needs it, nor does it help everyone. So this is an important decision you have to make with your own physician regarding the specifics of your own situation. If chemotherapy will lead to a benefit, make sure you understand what that benefit is, and make sure you understand what the side effects are that you will need to endure to get that benefit. In certain cancers that are found very early, simple removal may be all that's needed because chemotherapy may not be very helpful at all. Other types of cancer are very sensitive to hormone treatment, so sometimes we use hormone treatments instead of chemotherapy treatments. But there are other situations where clearly chemotherapy is the best way to go and the best chance for either a cure or prolongation of life or remission, so it is often a very helpful thing also.

Rich Dietman: Some people are, understandably, very afraid of the whole idea of chemotherapy. Are there times when people might refuse chemotherapy just based on horror stories that they've heard when in fact they might stand a good chance of getting better with it?

Dr. Moynihan: Absolutely. Unfortunately we do still see this sometimes. Chemotherapy has, very rightly, earned a reputation of being very difficult. But chemotherapy has gotten much easier. Again, the vast majority of our chemotherapy is done as an outpatient, and the majority of our patients can actually maintain a relatively normal lifestyle while receiving their chemotherapy, often still going to work or doing their normal activities. However, there are some forms of chemotherapy that still are very toxic and do have a lot of side effects, so it's again very important that you speak with your physician. What side effects are you likely to have for your specific situation? Because they may be fairly mild, they may be very severe, or they may be somewhere in between the two. So I do not want people to be afraid of chemotherapy because it can be very good, and it clearly does have side effects. But for the most part, hopefully we can manage those side effects so they're fairly mild, realizing there will still be some.

Rich Dietman: Can I change my mind once I've started chemotherapy? Can I stop and then start again later on? Or can I opt out now altogether and with the idea that maybe I would choose it later on in my treatment?

Dr. Moynihan: Once again, it depends on the individual's situation. If a chemotherapy is only going to give you a small amount of benefit and it's giving you very severe side effects, you may make the decision that that chemotherapy is not worth it to you. On the other hand, if we're trying to treat certain diseases for a cure, it is best to go through all of the prescribed treatment upfront because that's our best chance at curing it. So again, we have to go back to the individual's specific situation, discuss with their individual physician the details of that situation, and understand why are we giving the chemotherapy and what do we hope to get out of it? If we are really going for a cure, it's usually best to try and go through the prescribed amount of chemotherapy right upfront because if we interrupt that, that does decrease our chance of cure. If, on the other hand, we're just trying to treat to try and decrease symptoms, or perhaps extend life a small amount, sometimes there we do have the option of interrupting chemotherapy for a period of time. As with everything in medicine, you still have the right to control your own body, so you will always have the right to refuse chemotherapy. If you do that, I just want to make sure anybody who does that, understands why they're doing it, what the benefits and the risks are, for each individual person.

Rich Dietman: Well, thanks very much Dr. Moynihan. We've been talking about what to consider when deciding on chemotherapy with Dr. Tim Moynihan, a cancer specialist at Mayo Clinic and cancer editor for MayoClinic.com. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.