Chemotherapy and hormone treatment: together or one after another?

It cannot tell you whether you need chemotherapy, hormone treatment or both. That depends on your cancer's features and your health.

It also cannot tell you when to start or stop any medicine. Only your oncologist can make those decisions with you.

Hormone-sensitive cancers

Some cancer cells grow in response to hormones such as oestrogen, progesterone or testosterone. Laboratory tests on the tissue show whether the cancer is hormone-sensitive. If it is, hormone treatment can slow or stop its growth by lowering hormone levels or blocking their effect. If it is not, hormone treatment is not used.

Deciding whether chemotherapy is needed

For some hormone-sensitive breast cancers, the benefit of adding chemotherapy is uncertain. Your team looks at tumour size, how many glands are involved, how fast the cells are growing and your age. A genomic test on the tissue may help estimate whether chemotherapy is likely to add benefit. Ask whether this test is relevant for you.

Radiotherapy and hormone tablets

Hormone tablets for breast cancer are sometimes started after radiotherapy and sometimes during it, depending on the team's practice and your situation. For prostate cancer, hormone treatment is often started before radiotherapy and continued during and after it. Your team will explain their reasoning for your plan.

Ovarian suppression

Younger women with breast cancer may be offered injections, such as goserelin or leuprolide, that switch off the ovaries. This may be used alongside hormone tablets to treat the cancer, or during chemotherapy to help protect fertility. These are different purposes, and your team will explain which applies to you.

Menopause after chemotherapy

Chemotherapy can stop periods, sometimes permanently. Stopped periods do not always mean the ovaries have stopped working, and this affects which hormone tablets are suitable. Your team may check hormone levels with blood tests before choosing a medicine. Use reliable non-hormonal contraception if pregnancy is possible.

Prostate cancer and added chemotherapy

For some prostate cancers that have spread, docetaxel may be given alongside hormone treatment, and newer hormone medicines such as abiraterone or enzalutamide may also be used. The combination chosen depends on how much the cancer has spread, your fitness and other health conditions. Your team discusses the options openly.

Side effects of each treatment

Chemotherapy side effects, such as tiredness, hair loss and low blood counts, usually ease after the course ends. Hormone treatment brings different effects, such as hot flushes, joint aches, mood changes, bone thinning or reduced sex drive, which can continue while treatment lasts. Giving them in sequence makes each easier to recognise.

Staying on hormone treatment

Hormone tablets often continue for years, and side effects can make it tempting to stop. If effects are difficult, tell your team; they may suggest ways to manage them or a different medicine. Never stop or change hormone treatment on your own, as the long-term plan depends on it.

Bone and heart health

Some hormone treatments thin the bones or affect cholesterol and blood sugar. Your team may recommend bone density scans, calcium and vitamin D, exercise and regular checks. Keeping active, not smoking and managing weight help protect bone and heart health throughout long-term treatment. Ask which checks you need and how often.

Medicine interactions

Some antidepressants and other medicines can interfere with tamoxifen, and herbal products containing plant oestrogens may not be suitable. Tell your oncologist and pharmacist about every medicine, supplement and remedy you take, so they can check for interactions before hormone treatment starts. Keep an updated list to show every doctor you see.

Pregnancy and fertility

Hormone treatments can harm an unborn baby, so pregnancy must be avoided during treatment. If you hope to have children, discuss fertility preservation before chemotherapy begins. Some women discuss a planned pause in hormone treatment to try for pregnancy, but this must only be done with their oncologist's guidance.

Cancer that has spread

For hormone-sensitive breast cancer that has spread, hormone treatment is often the first choice, sometimes combined with targeted tablets, and chemotherapy may be kept for later or used when rapid control is needed. This sequence differs from early breast cancer, so ask how it applies to you.

What to do next

Ask whether your cancer is hormone-sensitive, whether chemotherapy is needed as well, when hormone treatment will start, how long it may continue, which side effects to expect, and who to contact if they become hard to manage.