Treatment

Friday 1 August, 2014

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On this page: Intravenous (IV) chemotherapy | Other ways of having chemotherapy | Chemotherapy is time consuming | Safety precautionsTargeted therapies | Is the treatment working? | Which health professionals will I see? | Key points


Intravenous (IV) chemotherapy

Chemotherapy is most commonly given as a liquid drip into your vein (intravenously). It is usually given through a tube. Depending on the treatment, this could take about 20 minutes or several hours. Sometimes chemotherapy is given continuously over a few days via a portable pump or device

Before chemotherapy, you may be given medication so you don’t feel sick (anti-nausea or anti-emetic medication). You may also be encouraged to drink several glasses of water during the treatment.

You will probably be in a room or a lounge area with other patients when you are having chemotherapy. You are usually able to walk around the ward during the treatment, for example if you need to go to the toilet.

The nurses will assess you before chemotherapy, and monitor you during and after the treatment. They will let you know when you are able to go home.

Your nurses will also talk to you about managing side effects and tell you about any medication you need to take at home.

Many people feel well enough to travel to and from the hospital or clinic by themselves during chemotherapy. However, it is recommended that a relative or friend comes with you to your first appointment to support you and help you get home if necessary.

Inserting the intravenous device

To prepare you for IV chemotherapy, you will need to have a tube inserted, usually in a vein in your arm. There are different types – the doctor will select the most appropriate one depending on how often you need chemotherapy and how long each treatment will last.

Cannula

A small single use plastic tube that is temporarily inserted into a vein using a needle. When the needle is removed, the cannula remains in place in your arm or the back of your hand. The cannula can be kept in place if you are required 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.

Central venous access device (CVAD)

A type of thin plastic tube that remains in your vein throughout the entire course of treatment, often for several weeks to months. Blood for testing can sometimes be taken through this tube. Common types of CVADs include:

  • central line: inserted into the chest or neck
  • Hickman line: inserted into the chest
  • peripherally inserted central catheter: inserted into the arm
  • port-a-cath (port): small device inserted under the skin of the chest or arm.
"My chemo infusions took about eight hours, because I had two drugs and a saline solution in-between. It was a long day, sitting in the chair having infusions. I was lucky my partner stayed with me each time." — Cheryl (ovarian cancer)

All tubes or lines need to be kept clean to prevent infection or blockage. If you have a CVAD, a nurse may visit you at home to clean, dress and flush your line, or this can be done at a clinic. Dressings usually happen weekly; flushing depends on the device.

A line doesn’t cause pain or discomfort if it is properly placed and cared for, although you will be aware that it is there. Tell your doctor or nurse immediately if you have pain, discomfort, redness or swelling around the line. This could mean that you have an infection.

A portable chemotherapy pump

Intravenous chemotherapy at home

Some people are able to have their chemotherapy at home using a portable pump. The pump is programmed to give the prescribed amount of chemotherapy over a specified period.  A chemotherapy pump can be carried in a bag or belt holster. It's usually attached to a central line. The nurses at the clinic or hospital will show you how to care for the pump.

Other ways of having chemotherapy

There are other ways of having chemotherapy, depending on the drugs being used and the type of cancer you have.

Oral chemotherapy

Some people take chemotherapy tablets or capsules at home. Your doctor, nurse or pharmacist will tell you how and when to take them, how to handle the medication safely, and what side effects to expect.

Cream

Some skin cancers are treated using a chemotherapy cream applied directly to the skin.

Injections

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

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

Chemotherapy wafers

Some people who have surgery for a brain tumour (craniotomy) will have small, dissolvable gel wafers of chemotherapy placed directly into the tumour site during the operation.

High-dose chemotherapy

This is a treatment given as part of a bone marrow or peripheral blood stem cell transplant for conditions such as leukaemia or lymphoma. The high-dose chemotherapy kills off all the cancer cells in the blood before the new, healthy cells are transplanted a day or two later.

Chemoembolisation

Used for liver cancer or some types of cancer that have spread to the liver, chemoembolisation is a procedure of injecting chemotherapy directly into the blood vessels supplying a tumour. The chemotherapy is mixed with tiny spheres that block the vessels and stop the tumour getting nutrients and oxygen.

Chemoradiation

Giving chemotherapy together with radiotherapy is used for some cancers, such as head and neck cancer or rectal cancer. The chemotherapy is given during the course of radiotherapy to make the radiotherapy more effective. 

Smoking and chemotherapy

If you smoke, it’s best to try to quit, especially while you are having chemotherapy. Reseach shows that people who have never smoked or ex-smokers have a better survival rate from cancer than smokers. Recent studies also suggest that smoking during chemotherapy may reduce the effectiveness of the treatment. Talk to your doctor for advice, or call 13 QUIT (13 7848) to talk to a Quitline adviser and request a free Quit Pack. See www.quitnow.gov.au for tips. 

Chemotherapy is time consuming

When you have chemotherapy you may spend a lot of time waiting, usually in the hospital or clinic: waiting for the doctor, for blood tests, for test results, for your drugs to be prepared and for the drugs to be given. There are sometimes additional delays due to safety checks, emergencies or workload of the treatment centre. Bring water and snacks with you in case of long delays.

To pass the time, you may want to do the following:

  • read a book or magazine, or listen to music
  • complete a crossword or other puzzle
  • chat with a companion
  • use a laptop, tablet or other electronic device – check with the treatment centre if this is okay and the availability of power points
  • write or draw in a journal
  • meditate or practise relaxation techniques. 
"I became good friends with another lady who began chemotherapy on the same day as me. We ended up going walking several times a week for 18 months. The companionship was a great support." — Tania (breast cancer) 

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 find support from others who are receiving chemotherapy at the same time as them.  

Safety precautions

Chemotherapy is strong medicine that can be harmful to healthy people. That’s why the oncology nurses and doctors wear gloves, goggles, gowns, and sometimes masks. This protective clothing reduces their risk of exposure to the drugs as they administer the chemotherapy. When treatment is over, these items are disposed of in special bags or bins.

After chemotherapy treatment, the drugs may remain in your body for up to a week. This depends on the types of drugs used. The drugs are then released into urine, stools and vomit. They could also be passed to other body fluids such as saliva, sweat, semen and breast milk.

Some people worry about the safety of their friends and family during chemotherapy treatment, especially if looking after someone at home. Your family and friends, including children, babies and pregnant women, can visit you while you’re having chemotherapy. Research about the effects of coming into contact with chemotherapy drugs is continuing, and it is recommended family and friends take the safety measures listed on the next page when caring for someone at home.

If you still have questions after reading the chemotherapy safety in the home information below, talk to your treatment team or call Cancer Council 13 11 20. 

Chemotherapy safety in the home

Follow these safety guidelines to reduce exposure to chemotherapy while at home. Safety precautions can vary depending on the drugs you receive, so ask your medical oncologist about your individual situation.

  • Put the lid down when flushing the toilet for up to a week following a treatment session to avoid splashing.
  • Wash items soiled with body fluids in a separate load. Choose the maximum cycle that the fabric will allow. Line dry these items.
  • Keep a supply of disposable rubber gloves and cleaning cloths handy. Seal used gloves and cloths in a plastic bag before putting them in the bin.
  • Wear rubber or disposable waterproof gloves when handling clothing or bed sheets soiled with vomit or other body fluids, such as urine or stools.
  • If body fluids or chemotherapy medication spill onto household surfaces (such as the carpet or a mattress), wear rubber gloves, soak up the spill with disposable paper towels, clean around the area with a disposable cloth and soapy water, and rinse the area with water.
  • If medication spills on your skin, wash the area with soap and running water. Contact the hospital if any redness or irritation caused by the spillage doesn’t clear up within the hour.
  • Avoid pregnancy while you are having chemotherapy. If you have a baby, you will not be able to breastfeed during your course of chemotherapy.
  • Use a condom or a female condom if having any type of sex within 7 days of chemotherapy treatment. Your doctor or nurse can give you more information about how long you need to use this protection.
  • Don’t crush, chew or cut chemotherapy tablets. If you can’t swallow a tablet whole, talk to your doctor or pharmacist.
  • Store chemotherapy tablets, capsules or injections as directed by your doctor or pharmacist – do not keep them in a pill organser with other medications. Keep them out of reach of children. Seal empty tablet containers in a plastic bag and return them to your pharmacy or hospital oncology department for disposal.

Targeted therapies

Other drugs, called targeted therapies, may be used instead of or together with chemotherapy to target particular types of cancer cells while minimising harm to healthy cells.

Targeted therapies have different actions to help destroy or stop the growth of cancer cells. Not all cancers respond to targeted therapies, and some of these therapies are only available in clinical trials

Side effects

You may have side effects that are caused by the targeted therapy rather than by the chemotherapy. Side effects depend on the medication used. Some typical effects include fevers, allergic reactions, rashes, diarrhoea and blood pressure changes. Some targeted therapies can affect the way your heart works.

Rarely, some targeted therapies may cause life-threatening side effects. Your doctor will discuss this with you.

Tell your doctor if you plan to take over-the-counter medications, home remedies or complementary therapies such as herbal or nutritional supplements, before or after chemotherapy treatment. These may make side effects worse or affect how chemotherapy works in your body. For example, the herb St John’s Wort can reduce how well some drugs work.

 

Drug therapies
Several different types of targeted therapies are used to treat cancer.
angiogenesis inhibitors For cancer cells to grow and spread to other areas of the body, they need to make their own blood vessels. Drugs known as angiogenesis inhibitors attack developing blood vessels so that the cancer can’t grow and spread.
tyrosine kinase inhibitors These drugs may block certain proteins or enzymes that tell cancer cells to grow. They are sometimes called small molecule drugs.
apoptosis-inducing drugs Apoptosis means cell death. These drugs target the part of the cancer cell that tells it when to die.

 

Immunotherapies
Immunotherapies (also called biological therapies) strengthen the immune system so it finds and kills cancer cells.
Active immunotherapies
Stimulate your immune system to fight infection and disease. You might be given a vaccine to make your body produce antibodies to fight cancer.
Passive immunotherapies
These use man-made (synthetic) antibodies developed in a laboratory to get your immune system to fight cancer cells.
Receptor blocking agents
Blocking receptors can assist with cancer cell death in some cancers. For example, female hormones in breast cancer or male hormones in prostate cancer.

Is the treatment working?

Your doctor will use physical examinations, and in some cases, blood tests and scans to see if the cancer has shrunk or disappeared. If this is the case, the chemotherapy may continue.

You may wonder whether getting side effects is a sign that the chemotherapy is working. However, side effects are not usually a sign of how successful the chemotherapy is going to be.

If tests show that the cancer has shrunk and is unable to be detected, this may be called remission, which means there is no evidence of active cancer. Although the cancer is gone, your doctor will monitor you for several months or years before you are considered cured. This is because cancer can sometimes come back in the same place or grow in another part of the body.

If you are having adjuvant chemotherapy to prevent cancer coming back, it is not possible to tell if this treatment has been effective for some years. If chemotherapy is being given as palliative treatment, the relief of your symptoms will show if the treatment is working.  

Which health professionals will I see?

Your general practitioner (GP) will refer you to a specialist, who can advise you about your treatment options. Your GP may also play an important role in your ongoing care.

You will be cared for by a range of health professionals during chemotherapy. This multidisciplinary team may include:

  • medical oncologist and haematologist: specialists who can prescribe and coordinate the course of chemotherapy
  • radiation oncologist: specialist who prescribes and coordinates the course of radiotherapy, which is sometimes used with chemotherapy
  • registrar: a qualified doctor undergoing additional training to be a specialist (for example as a medical oncologist or radiation oncologist)
  • nurses: give the course of treatment and support and help you through all stages of your treatment
  • cancer nurse coordinator/ clinical nurse consultant/ cancer care coordinator: coordinates your care and liaises on your behalf with different specialist care providers
  • pharmacist: dispenses medications and gives advice about drugs, dosage and side effects
  • social worker, physiotherapist and occupational therapist: link you to support services and help you to resume your normal activities
  • dietitian: recommends an eating plan to follow while you're in treatment and recovery
  • palliative care team: helps you and your family with needs you have, including symptom management.

Key points

  • Chemotherapy is most commonly given via a tube into a vein (intravenously).
  • Usually people will have chemotherapy as an outpatient at a hospital or clinic, but sometimes they can have it at home using a portable pump.
  • Oral chemotherapy as tablets or capsules is also common.
  • Some chemotherapy is specific for some types of cancers: e.g. cream for skin cancer, chemoembolisation for liver cancer, or wafers for brain cancer. • You may have one drug or a combination of drugs. Different drugs and combinations are effective for different cancer types.
  • Chemotherapy can be harmful to others if they are exposed to it. For this reason, nurses and doctors wear protective clothing when giving chemotherapy. However, it is safe to be around family members and friends, including children and pregnant women.
  • Your medical team will advise you about taking precautions at home to make sure your family members don’t come into contact with your body fluids, such as urine or vomit, as the drugs may be passed into them. You should also handle medication with care.
  • Drugs known as targeted therapies may be used instead of or with chemotherapy to target particular types of cancer cells.
  • You will see a range of health professionals when you have chemotherapy. This may include a medical oncologist or haematologist, nurses and allied health professionals.  

Information reviewed by: A/Prof Paul Craft, Medical Oncologist, The Canberra Hospital, Medical Oncology, Australian National University Medical School and Clincial Director, Canberra Region Cancer Centre, ACT; Kate Archibald, Clinical Nurse Specialist (Oncology), Monash Health, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches Health Service, NSW; Ilne Geddes, Consumer; Tina Griffiths, Nurse Coordinator Chemotherapy, Cancer Services, Olivia Newton- John Cancer & Wellness Centre, VIC; and Cecelia van Raders, Team Leader, Cancer Council Helpline, Cancer Council Queensland, QLD.

Updated: 01 Aug, 2014