Ovarian Cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells or disrupt their growth. Chemotherapy can be 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 (adjuvant chemotherapy) 
• before surgery to shrink the cancer and make operation easier and more effective (neo-adjuvant chemotherapy)  
• as the main treatment if the cancer has spread to the liver or beyond the abdomen or if surgery is not the best treatment option 

Chemotherapy drugs for ovarian cancer are usually given by infusion into a vein (intravenously) at an appointment (a session) in a day unit. Sessions typically last for a few hours and people are sent home after each session. Women described it as feeling cold but painless.  

Each session of chemotherapy 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 session and rest period are 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, 6 cycles of chemotherapy are given over 4-5 months with each cycle lasting between 1-4 weeks depending on the type of chemotherapy that is given.  

Chemotherapy is typically 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 other chemotherapies are used. 

Experiences with chemotherapy for ovarian cancer

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.

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.

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.

Most women found their body responded in a similar way each time or session 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 'Side effects of chemotherapy for ovarian cancer').

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.

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 due to a serious reaction to the drugs.

Women whose cancer returns after initial treatment also receive chemotherapy. In addition to carboplatin and paclitaxel, other drugs that can be tried include: pegylated liposomal doxorubicin (Caelyx), topotecan (Hycamtin), cisplatin, docetaxel, gemcitabine and etoposide (VP-16, Etopophos, Vepesid), with some given intravenously and some given orally. One woman had five courses of four different chemotherapy drugs for her cancer.