Chemotherapy Treatment

Monday 1 August, 2016

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On this page: Intravenous (IV) chemotherapy | Other chemotherapy methods | Chemotherapy with other treatments | Waiting for chemotherapy | Safety precautions | Chemotherapy safety in the home | Targeted therapy | Is the treatment working? | Which health professionals will I see? | Key points


Most chemotherapy is given as a liquid drip into your vein (intravenously, see below), but it is sometimes given by mouth (orally) or in another way.

You may have one drug or a combination of drugs. Different drugs and combinations are effective for different cancer types.

The choice of chemotherapy drugs, the dosage and the treatment schedule will be recorded in a treatment plan. In deciding on which drugs and dosage to give you, your treating specialist will usually consult clinical guidelines for your cancer type. These guidelines are based on the available evidence and aim to ensure the best possible outcomes. You can ask your specialist which guidelines they are following.

Your specialist may need to tailor your treatment according to your individual situation. Tests throughout treatment will monitor your response, and your treatment plan may be adjusted based on those results.

Intravenous (IV) chemotherapy

Chemotherapy is most commonly given intravenously through a narrow tube (see below). Depending on the treatment, a single session could take from 20 minutes up to several hours and will usually be given during day visits to your hospital or treatment centre. Sometimes chemotherapy is given continuously over a few days via a portable pump or device that you are able to use at home.

Before chemotherapy, you may be given medicine so you don’t feel sick (anti-nausea or anti-emetic medicine). You may also be encouraged to drink several glasses of water during the session. This helps ensure that the chemotherapy drugs don’t sit in the kidneys or bladder too long. It is also a good idea to be well hydrated in case you later experience vomiting as a side effect.

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

The nurses will assess you before chemotherapy, and monitor you during and after the session. They will let you know when you are able to leave the hospital or treatment centre. They will also talk to you about managing any side effects and tell you about any medicine you need to take at home.

Many people feel well enough to travel to and from chemotherapy sessions by themselves. Even so, it is recommended that a relative or friend comes with you to your first appointment to support you and help you get home in case you feel unwell. It is safe for family and friends to stay with you during the treatment.

"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
Intravenous devices

To prepare you for IV chemotherapy, you will have a narrow tube inserted, usually in a vein in your arm. This may be a short-term or longer-lasting device. The treatment team will select the most appropriate device depending 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.

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 may 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.

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

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 and dress your line, or this can be done at a hospital or treatment centre. Dressings usually happen weekly; how often the line needs rinsing with saline (flushing) depends on the device.

A CVAD 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. In this case, you will be given medicine to help fight the infection and the device may need to be removed and replaced with a new one. If you do not experience any infections, the device will usually stay in place until after your last chemotherapy session.

Portable pumps

Some people are able to have chemotherapy at home using a portable pump. The pump is programmed to give the prescribed amount of chemotherapy over a specified period. The pump is usually attached to a central line and can be carried in a bag or belt holster. Your hospital or treatment centre will explain how to care for the pump.

Other chemotherapy methods

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 medicine safely, and what side effects might occur.

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
  • 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.
Chemoembolisation

Used for liver cancer or some types of cancer that have spread to the liver, chemoembolisation involves 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.

Chemotherapy wafers

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

Chemotherapy with other treatments

For some types of cancer, you may be given chemotherapy as part of another treatment, such as a stem cell transplant or radiotherapy.

High-dose chemotherapy

This is a treatment given as part of a stem cell transplant for blood cancers, such as leukaemia or lymphoma. The high-dose chemotherapy kills off all the cancer cells before the new, healthy blood cells are transplanted. The transplant may occur a day or two or several days later.

Chemoradiotherapy or chemoradiation – Chemotherapy is given during the course of radiotherapy for some cancers, such as bowel cancer. It aims 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. It can seem like a tough time to stop smoking, but research shows that people who have never smoked or ex-smokers have a better survival rate from cancer than smokers. Smoking during chemotherapy may reduce the effectiveness of the treatment. For advice, talk to your doctor, call 13 QUIT (13 7848) or visit quitnow.gov.au.

Waiting for chemotherapy

When you have chemotherapy, you may spend a lot of time waiting, usually in the hospital or treatment centre: waiting for health professionals, for blood tests, for test results, for your drugs to be prepared and for the drugs to be given. There are sometimes additional delays because of necessary safety checks, emergencies or the workload of the treatment centre. Many treatment centres will provide biscuits and water, tea and coffee, but you might want to bring your own water bottle and snacks 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
  • write or draw in a journal
  • meditate or practise relaxation techniques
  • use a laptop, tablet or other electronic device – check with the nurses whether this is okay and if power points are available.

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.

"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

Safety precautions

Chemotherapy is strong medicine, so it is safest for people without cancer to avoid direct contact with the drugs. That’s why oncology nurses and doctors wear gloves, goggles, gowns and, sometimes, masks. 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. This depends on the types of drugs used. The drugs are then released into urine, faeces and vomit. They could also be passed to other body fluids such as saliva, sweat, semen and breast milk.

Some people having chemotherapy worry about the safety of family and friends. 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 family or friends who are providing care or have other close contact during the recovery period at home. If you have questions, talk to your treatment team or call Cancer Council 13 11 20.

Tell your doctor if you plan to take over-the-counter medicines, home remedies or complementary therapies, such as herbal or nutritional supplements, before or after your chemotherapy treatment. These may make side effects worse or affect how well the chemotherapy works in your body. 

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 treatment team about your individual situation.

  • For a week after a treatment session, sit down to use the toilet. Put the lid down before flushing to avoid splashing.
  • Vomit into a plastic bowl or bucket (or a plastic bag with no holes). Don’t use the bowl or bucket for anything else and throw it out after your final chemotherapy session.
  • Keep a supply of cleaning cloths, paper towels and disposable waterproof gloves handy. If any body fluids (during the week after a treatment session) or chemotherapy drugs spill onto household surfaces, put on a pair of waterproof gloves, soak up the spill with paper towels, clean around the area with a disposable cloth and soapy water, and rinse the area with water. Seal used gloves, cloths and paper towels in a plastic bag before putting them in the bin.
  • During the week after a treatment session, wear disposable waterproof gloves when handling clothing or bed sheets soiled with vomit or other body fluids, such as urine or faeces. Seal the gloves in a plastic bag and discard after use.
  • Wash items soiled with body fluids in a separate load in a washing machine on the longest cycle (hot or cold water can be used). Line dry the items.
  • Use a condom or a female condom if having any type of sex within 7 days of a chemotherapy session. Your doctor or nurse can give you more detail about when you need to use protection.
  • Avoid pregnancy while you are having chemotherapy. If you have a baby, you will not be able to breastfeed during your course of chemotherapy.
  • Don’t crush, chew or cut chemotherapy tablets. If you can’t swallow a tablet whole, talk to your treatment team or pharmacist.
  • Store all chemotherapy tablets, capsules or injections as directed by your doctor or pharmacist – they 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.

Many people are given steroid medicine with their chemotherapy treatment, most often in a low dose to help ease or prevent nausea. Steroids are sometimes also used to manage allergic reactions, to make chemotherapy more effective, or to directly treat the cancer.

Targeted therapy

Targeted therapy may be used instead of or together with chemotherapy. This treatment uses drugs that work in a different way to chemotherapy drugs. While chemotherapy affects all rapidly dividing cells and works by killing cancerous cells (cytotoxic), targeted therapy targets specific molecules within cells and often works by blocking cell growth (cytostatic).

Although targeted therapy minimises harm to healthy cells, it can still have side effects (see below). Not all cancers respond to targeted therapy, and the drugs are sometimes hard to access because they are expensive, not yet developed for all types of cancer, and sometimes available only in clinical trials.

Cancer cells often become resistant to targeted therapy drugs. If this happens, your doctor will change your treatment and may suggest trying chemotherapy or another type of targeted therapy.

Side effects of targeted therapy

Side effects vary depending on the targeted therapy used, but may include fevers, allergic reactions, rashes, diarrhoea, blood-clotting problems, and blood pressure changes. Particular drugs can affect the way your heart or liver works. Some side effects that are of little concern after standard chemotherapy can be very serious if they occur with a targeted therapy – your doctor will explain what to watch out for, and will monitor you throughout the treatment.

Types of targeted therapy

There are currently two main types of targeted therapy: monoclonal antibodies and small molecule inhibitors.

Monoclonal antibodies
  • act like the natural antibodies that our bodies produce to fight infection and disease but are made in a laboratory (synthetic)
  • lock onto a protein on the surface of certain cells and interfere with the growth or survival of cancer cells in some way, e.g. may deliver a toxic drug to cancer cells, interrupt the growth and spread of cancer cells, or prompt cells of the immune system to attack cancer cells
  • given intravenously or as an injection under the skin (subcutaneous injection)
  • drug names end in ‘-mab’ (for monoclonal antibody), e.g. bevacizumab, rituximab
Small molecule inhibitors
  • can get inside cancer cells and block certain proteins and enzymes that tell the cancer cells to grow
  • include tyrosine kinase inhibitors (TKIs) – these block the function of a group of enzymes called tyrosine kinases, which tell cancer cells to grow, multiply and spread
  • given as tablets or capsules to be taken by mouth, usually on a daily basis over months or years
  • drug names end in ‘-ib’ (for inhibitor), e.g. imatinib, sorafenib

Is the treatment working?

You might wonder whether experiencing side effects is a sign that the chemotherapy is working. However, side effects usually do not indicate how successful the chemotherapy is going to be.

Your doctor will use physical examinations and other tests to see if 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, which means there is no evidence of active cancer. Depending on the guidelines for the type of cancer you have, this may mean chemotherapy can stop or may continue for a period of time. Once your chemotherapy treatment has finished, your treatment team 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.

Which health professionals will I see?

You will be cared for by a range of health professionals during chemotherapy. This is called a multidisciplinary team (MDT) and it may include some or all of the professionals listed opposite. Note that only some patients see a cancer care coordinator.

It is important to maintain or develop a relationship with a regular general practitioner (GP), as they will be involved in your ongoing care, particularly once the cancer treatment finishes.

Health professional Role
GP refers you to specialists and provides ongoing care during and after your treatment
medical oncologist* or haematologist* prescribes and coordinates the course of chemotherapy
radiation oncologist* prescribes and coordinates radiotherapy (which is sometimes given with chemotherapy)
cancer care coordinator or clinical nurse consultant (CNC) coordinates your care, liaises with other members of the MDT, and supports you and your family throughout treatment
nurses administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
nurse practitioner nurse who has had additional training and may be able to prescribe some medicines and refer you to other health professionals
palliative care specialist* and palliative care nurses work closely with the GP and oncologist or haematologist to help control symptoms and maintain quality of life
pharmacist dispenses medicines and gives advice about dosage and side effects
dietitian recommends an eating plan to follow while you are in treatment and recovery
occupational therapist, physiotherapist assist with physical and practical problems
social worker links you to support services and helps with emotional, physical or practical issues
psychologist, counsellor provide emotional support and help manage anxiety and depression
* Specialist doctor

Key points

  • Chemotherapy is most commonly given via a tube into a vein (intravenously).
  • You may have one drug or a combination of drugs depending on the cancer type.
  • Usually people will have intravenous chemotherapy as an outpatient at a hospital or treatment centre, but sometimes they can have it at home using a portable pump.
  • Chemotherapy is sometimes given by mouth as tablets or capsules (orally).
  • For some types of cancer, chemotherapy is given in other ways, e.g. cream for skin cancer, chemoembolisation for liver cancer, or wafers for brain cancer.
  • It is safest for people without cancer to avoid direct contact with chemotherapy drugs, so nurses and doctors wear protective clothing when giving chemotherapy. However, there is little risk to visitors during and after your chemotherapy treatment.
  • Your treatment 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 chemotherapy drugs with care.
  • Targeted therapy may be used instead of or with chemotherapy. The drugs target specific molecules within cancer cells.
  • You will see a range of health professionals when you have chemotherapy. As well as your GP, these will include a medical oncologist or haematologist, nurses and other health professionals.

Reviewed by: Dr Andrew Haydon, Medical Oncologist, The Alfred Hospital and Cabrini Hospital, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches, NSW; Mish Blacher, Consumer; Nicole Loft, Haematology Nurse Practitioner, Royal Adelaide Hospital, Central Adelaide Local Health Network, SA; Simoene Smith, 13 11 20 Cancer Information Consultant, Cancer Council NSW, NSW.

Updated: 01 Aug, 2016