When is chemotherapy recommended for metastatic cancer?

Metastatic cancer has travelled from its original site to another part of the body. The treatment plan depends first on where the cancer began, because different cancers respond to different medicines. Doctors also review pathology and biomarker results, the sites involved, the pace of change, previous therapies, general health and personal priorities.

Chemotherapy may be used to shrink or slow cancer, reduce symptoms, or prevent a threatened organ from losing function. Some people receive it with another treatment, while others move between treatments as the cancer responds or side effects become difficult. The purpose and expected trade-offs should be clear before starting.

Take your pathology reports and medication list to the appointment if available. Ask what the treatment is intended to achieve, whether a biomarker changes the options, how the medicine is given, and how the team will assess response. Tell the team about kidney, liver, heart or nerve problems, prior chemotherapy, allergies and medicines or supplements.

Arrange help for transport and daily tasks if fatigue or nausea affects you. Ask for an after-hours contact number and a written plan for fever, vomiting, diarrhoea, pain or reduced fluid intake.

Call your cancer team promptly for fever or chills during chemotherapy, or for vomiting or diarrhoea that makes it hard to drink. Emergency assessment is needed for severe breathlessness, chest pain, fainting, confusion, uncontrolled bleeding or sudden weakness. New severe pain, yellowing of the skin, or very little urine should also be assessed without delay.

What is the goal of chemotherapy in my case? Which alternatives are appropriate? What tests will guide the choice? How will we know whether to continue, change or stop? Which symptoms require a same-day call?