Chemotherapy treatment

Chemotherapy drugs are usually given as a liquid through a drip inserted into a vein (intravenous infusion). To prepare for IV chemotherapy, the treatment team will insert a narrow tube into a vein.

The drugs may be injected through a cannula or a type of central venous access device. The type of device used will depend on how often you need  chemotherapy, how long it will take to give each dose and how long the device will need to stay in place.

Chemotherapy will usually be given during day visits to your hospital or treatment centre. In most cases, a single session takes from 20 minutes to several hours. For some types of cancer, a treatment session may take several days. A portable pump that you can use at home can provide a
continuous dose of chemotherapy for up to a week.

The infusion process may cause reactions (e.g. flushing, skin rashes, or difficulty breathing) during the session or several hours afterwards. You may be given medicines to help prevent these reactions.

How IV chemotherapy is delivered

Central venous access device (CVAD)

A thin plastic tube that remains in your vein throughout the treatment course, often for several weeks or months. It allows medical staff to give chemotherapy and other drugs, fluid or blood transfusions, and draw blood. A CVAD is inserted under local anaesthetic and it shouldn’t cause  discomfort or pain.

Common types are:

• Hickman line – inserted into the chest
• peripherally inserted central catheter (PICC) line – inserted into the arm
• port-a-cath (port) – a device inserted under the skin of the chest or arm.

Caring for your CVAD

A nurse will show you how to look after your CVAD to prevent infection or blockage. You may visit the clinic, or a nurse may visit you at home to help  clean tubes or lines. Contact your health care team immediately if there is pain, redness or swelling around the line or port.

Cannula

A small plastic tube inserted into a vein in your arm or the back of your hand. Having a cannula put in can be uncomfortable, but it should only take a few minutes. The cannula can be kept in place if you need to stay in hospital for a few days. If you have day treatment every few weeks, the cannula is usually put in and taken out each time you visit.

Portable pump

A device that gives a prescribed amount of chemotherapy continuously for up to a week. It is attached to a CVAD and does not need to be connected to a power point. Different types of pumps are used. The pumps are small and can be carried in a bag and tucked under a pillow when sleeping.

There are other ways of having chemotherapy, depending on the drugs being used and the type of cancer you have. You may have oral chemotherapy, injections into various parts of the body or creams you apply to the skin.

Oral chemotherapy – Some people are able to take chemotherapy as tablets or capsules at home. Your doctor, nurse or pharmacist will tell you how and when to take them, and how to handle the drugs safely.

Injections – Less commonly, chemotherapy can be injected using a needle into different parts of the body:

• into a muscle, usually in your buttock or thigh (intramuscular)
• just under the skin (subcutaneous)
• into the fluid around the spine (intrathecal, also known as a lumbar puncture)
• into an artery (intra-arterial)
• into your abdominal area (intraperitoneal)
• into the outer lining of the lungs (intrapleural)
• into the bladder (intravesical)
• into the tumour (intralesional; this method is rare).

Cream – Some skin cancers are treated using a chemotherapy cream applied directly to the skin. This is called topical chemotherapy.

Transarterial chemoembolisation (TACE) – Used for primary liver cancer or some types of cancer that have spread to the liver, TACE involves injecting high doses of chemotherapy directly into the liver tumours. The chemotherapy will either be mixed with an oily substance or loaded onto tiny plastic beads. The blood vessels feeding the tumour may also be blocked (embolisation).

For some types of cancer, you may be given chemotherapy as part of another treatment, such as a stem cell transplant or radiation therapy, or in combination with other drug therapies.

high-dose chemotherapy – Usually given as part of a stem cell transplant for blood cancers, such as leukaemia or lymphoma. It kills off all the cancer cells before the new, healthy blood cells are given. The transplant usually occurs 1-2 days later.

chemoradiation (chemoradiotherapy) – Also called chemoradiotherapy, this is when chemotherapy is combined with radiation therapy. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. Chemoradiation is commonly used for brain, bowel, cervical and oesophageal cancers.

hormone therapy – May be used after chemotherapy. Some cancers, such as breast and prostate cancer, can grow in response to hormones. Drugs that block these hormones may be given as tablets or injections.

targeted therapy – Often combined with chemotherapy, targeted therapy drugs may be given through a drip in a vein (intravenously), injections or tablets.

immunotherapy – May be used in combination with chemotherapy. Immunotherapy is usually given through a drip in a vein (intravenously).

steroids – Often given with chemotherapy to ease or prevent nausea, manage allergic reactions, make chemotherapy more effective or directly treat the cancer. Steroids are usually given as tablets. Side effects include indigestion, increased appetite, mood swings, difficulty sleeping, increased blood
glucose levels and muscle weakness.

When you have chemotherapy, you may spend a lot of time waiting for health professionals, blood tests, test results, and for the necessary safety checks to be undertaken. It also takes time for your drugs to be prepared, and for the drugs to be given.

While you are waiting, you may want to:

• read a book or magazine, or complete a crossword puzzle
• listen to music or a podcast, or write in a journal
• chat with a companion (if health guidelines allow a support person to stay with you during treatment)
• meditate, practise relaxation techniques or just have a rest
• use a laptop, smartphone or ereader – check whether it is okay to use devices and if power points are available
• knit, crochet or embroider.

You will be able to sit in a comfortable chair and wear your own clothes while receiving treatment. Many treatment centres will provide biscuits and water, tea and coffee, but it’s a good idea to bring your own water bottle and snacks in case of long delays.

At first, you may feel uncomfortable being around people who are sick because of cancer or their treatment. You may not identify with them. However, many people gain support from others who are receiving chemotherapy at the same time. You may find it helpful to join a support group to meet other people going through a similar experience.

While providing many benefits, chemotherapy is strong, cytotoxic (toxic to cells) medicine, so it is safest for people without cancer to avoid direct contact with the drugs. Cancer (oncology) nurses and doctors often wear gloves, goggles, gowns or masks because they are exposed to chemotherapy drugs every day. When the treatment session is over, these items are disposed of in special bags or bins.

After each chemotherapy session, the drugs may remain in your body for up to a week. During this time, very small amounts of the drugs may be released from the body in your vomit, urine (wee), faeces (poo), blood, saliva, sweat, semen or vaginal discharge, and breastmilk.

You may worry about the safety of family and friends while you are having chemotherapy. There is little risk to visitors (including children, babies and pregnant women) because they aren’t likely to come into contact with any chemotherapy drugs or body fluids.

The safety measures listed below are recommended for people who are providing care or have other close contact with you during the recovery period at home. If you have questions, talk to your treatment team or call Cancer Council 13 11 20.

Chemotherapy safety in the home

There are simple and effective ways to reduce exposure to chemotherapy drugs at home, both for you and your family and friends.

Safety precautions will vary depending on the drugs you receive, so ask your treatment team what you need to do at home.

Clean up spills – Keep a supply of cleaning cloths, paper towels and disposable waterproof gloves handy. During the week after a treatment session, clean up any body fluids or chemotherapy drugs that spill onto household surfaces. Put on waterproof gloves, soak up the spill with paper towel, clean around the area with a disposable cloth and soapy water, and rinse the area with water. Put used gloves, cloths and paper towels into a plastic bag,  and then into a second plastic bag (this is called double-bagging). This can then be put in the household rubbish bin.

Use a plastic bucket – If you need to vomit, use a plastic bowl or bucket (or a thick plastic bag with no holes). Empty it into the toilet and flush the toilet twice. Don’t use the bowl or bucket for anything else and throw it out after your final chemotherapy session.

Wear disposable gloves – In the week after a chemotherapy treatment session, wear disposable waterproof gloves when handling containers,  clothing or bedsheets soiled with vomit or other body fluids. After use, double-bag the gloves and put them in the household rubbish bin.

Take care going to the toilet = For a week after a chemotherapy treatment session, both men and women are encouraged to sit down to use the toilet. Put the lid down before flushing to avoid splashing. Flush the toilet with a full flush, then wash your hands with soap and water.

Keep tablets whole – Don’t crush, chew or cut chemotherapy tablets. If you can’t swallow a tablet whole, ask your oncologist or pharmacist whether  the drug comes in other forms, such as a liquid, or can be dissolved.

Handle laundry carefully – Wash items soiled with body fluids – such as clothing, bedsheets and towels – straightaway. Use the longest washing  machine cycle (hot or cold water can be used) and wash separately from other laundry.

Keep medicines in a safe place – Store all tablets, capsules or injections as directed by your oncologist or pharmacist. Medicines often need special  storage to keep them effective and safe. Keep them out of reach of children and do not store them in a pill organiser with other medicines.

Practise safe sex – Your doctor may advise you to use barrier contraception, such as a condom, during any type of sex for up to a week after  treatment. This protects your partner while drugs may be in your body fluids.

Pregnancy and breastfeeding – Avoid getting pregnant, or getting your partner pregnant, while having chemotherapy. If you are planning to have a baby, speak to your doctor about the timing for pregnancy. If you already have a baby, you will not be able to breastfeed during treatment.

You might wonder whether experiencing side effects is a sign that the chemotherapy is working. However, whether or not you have side effects does not indicate how successful the chemotherapy will be.

Throughout treatment, you will be closely monitored by your specialist. You will have tests to check how well the chemotherapy drugs are working, and whether the cancer has shrunk or disappeared after chemotherapy. This is called the treatment response and it helps your doctor decide whether to continue or change the chemotherapy plan.

If tests show that the cancer has shrunk and is unable to be detected, this may be called remission or complete response, which means there is no evidence of disease (NED). Depending on the guidelines for the type of cancer you have, this may mean chemotherapy can stop or it may continue for a period of time.

Once you’ve completed the course of chemotherapy, your doctor will monitor you for several months or years. This is because cancer can sometimes come back in the same place or grow in another part of the body.

Telehealth appointments

You may be able to have some appointments with your health professionals over the phone or a video link from home. This is known as telehealth and it can reduce the number of times you need to attend hospital.

Although telehealth can’t replace all face-to-face appointments, you can use it to talk about a range of issues including test results, prescriptions and side effects. For more information talk to your treatment team or call Cancer Council 13 11 20.