Chemotherapy in Singapore | National Cancer Centre Singapore

Chemotherapy is a type of treatment that uses anti-cancer drugs to kill cancer cells. It stops cancer cells from growing and reproducing. Chemotherapy drugs can be given orally (by mouth) or by injection, where it enters the blood stream and circulates throughout the body to kill cancer cells. How chemotherapy is administered depends on the cancer type, stage of the disease and health of the patient. Chemotherapy is commonly given in cycles, with each cycle consisting of a treatment period followed by a recovery period.

Most patients receive a combination of drugs over a few days, followed by a recovery period of two to three weeks. As cancer drugs also affect normal cells, the recovery period is to allow the body to recover before the next treatment cycle starts. Some patients may have treatment where the chemotherapy is given continuously via an infusion pump.

Each patient’s chemotherapy plan at NCCS is carefully customised according to the cancer type, stage, and patient’s overall health, to ensure safe and effective cancer treatment.

Chemotherapy may be used alone or together with other treatments such as surgery, radiotherapy or targeted therapy. The aim of chemotherapy depends on the type and stage of cancer.

At NCCS, chemotherapy treatment follows a step-by-step process designed to ensure patients receive safe and effective care from consultation to follow-up.

Initial Consultation – Patients first meet with an oncologist who reviews their diagnosis and discusses the goals of chemotherapy.
Treatment Planning – The oncologist determines the most suitable drug treatment, dosage and schedule based on the cancer type, stage of disease and the patient’s overall health status.
Administration – Chemotherapy is usually given in cycles, either intravenously, orally, or through specialised delivery systems. Each chemotherapy cycle consists of a treatment period followed by a rest period for the body to recover before the next treatment cycle.
Monitoring and Support – Throughout chemotherapy treatment, patients are closely monitored by the oncology care team to manage side effects and adjust the medication when needed.
Follow-Up Care – After completing chemotherapy, follow-up visits, tests and scans are arranged to monitor the patient's progress and recovery.

Intravenous (IV) chemotherapy
In most cases, chemotherapy is given intravenously through a small fine plastic tube (IV cannula) that is inserted into a vein at the back of the hand or lower arm. The cannula is secured with tapes during treatment and removed after each treatment. IV chemotherapy may also be given through catheters or ports, sometimes attached to a pump.

Depending on the types and number of drugs prescribed, the length of intravenous treatment may range from 30 minutes up to several hours. It is usually given during day visits to the Ambulatory Treatment Unit (ATU) at NCCS.
- Catheter – A catheter is a thin, soft hollow tube that is inserted in a large vein, usually in the chest area. The other end of the catheter remains outside the body and stays in place till chemotherapy is completed. The catheter can be used for other prescribed IV drugs and to draw blood for tests. It is important to watch for signs of infection around the catheter.
- Implanted Port – In some cases, an implanted port (a small round disc) is placed underneath the skin through a minor surgical procedure before chemotherapy treatment starts and remains until treatment is completed. A catheter from the port connects the port to a large vein. A needle is inserted through the port externally for chemotherapy infusion and blood draws for tests.
- Pump - Pumps are often attached to catheters or ports and can be programmed with the prescribed dosage and duration of chemotherapy to be delivered via the catheter or the port. Sometimes, the portable pump is programmed to deliver a prescribed dosage and amount of chemotherapy continuously over a few days.

Oral chemotherapy – chemo drugs that come in pills or capsules to be swallowed. The pharmacist will tell you how and when to take them, and how to handle the drugs safely
Injections - chemo drugs given by a shot in a muscle in the arm, thigh or buttocks or under the skin (subcutaneous) in the fatty part of the arm, leg or abdominal area.
Intrathecal injection – chemo drugs that are delivered into the space between the layers of tissue that cover the brain and spinal cord
Intraperitoneal (IP) – chemo drugs that are delivered directly into the peritoneal cavity, the area in the body that contains organs such as intestines, stomach and liver.
Intra-arterial (IA) – chemo drugs injected directly into the artery
Topical – chemo drugs that come in a cream to be rubbed onto the skin

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly like the cells that line the mouth and intestines as well as the cells that cause the hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better after completion of chemotherapy regime.

At the National Cancer Centre Singapore (NCCS), patients undergoing chemotherapy treatment are closely monitored throughout the chemotherapy process to manage and reduce discomfort. Common side effects after chemotherapy include fatigue, appetite loss, diarrhoea, vomiting, and increased risk of infection. These side effects can vary depending on the type of cancer being treated, such as chemotherapy for breast cancer, and the medication dosage prescribed.

Most side effects are temporary and improve after the completion of treatment. Your oncology team will advise you on managing these effects safely, as well as provide information on your chemotherapy cost, treatment schedule, and follow-up care.

Pack a bag for your chemotherapy treatment session
You may want to bring a jacket or shawl to keep warm, healthy snacks, drinks, lip balm and something to keep you entertained like a book, magazine, music, laptop or tablet with headphones or earbuds.
Arrange for someone to accompany you
It is best to arrange for someone to bring you home after chemotherapy, as some medications can cause drowsiness.
Arrange for help at home
Arrange childcare for your young children before and after your treatment session so that you can rest. Ask a friend or family member to help you.
Seek support from your employer
Make work arrangements with your employer and arrange any time off or leave required especially on the day of your treatment and the day after.
Look after yourself
Stay healthy before and during the treatment by drinking lots of water, getting enough sleep, eating nutritious food, staying physically active and having enough rest. All these can help to reduce some of the side effects of chemotherapy.
Seek support on your concerns
The diagnosis of cancer can affect people mentally and emotionally. Speak to a family member, a friend or your doctor for support or speak with one of our Nurse Counsellors by calling the Cancer Helpline Tel No: 6225 5655.
Be aware and prepare for possible side effects
Speak to your doctor about what side affects you are likely to have and ways to manage them. You may wish to cut your hair before treatment starts if one of the side effects is hair loss.
Inform about other medicines
Inform your doctor of any medications you are taking as they may interfere with the chemotherapy.

The cost of chemotherapy depends on various factors including:

Type and number of doses of chemotherapy used
How long and how often chemotherapy is given
Whether chemotherapy is administered at home, in the clinic or during a hospital stay

Based on your recommended treatment plan, your healthcare team will provide an estimated breakdown of the treatment cost and the subsidies available before you start treatment.