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.
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.
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 blood cancers, 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.
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.