Most chemotherapy is given as a liquid drip into your vein (intravenously), 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.
Topics on this page:
- Your treatment plan
- Intravenous (IV) chemotherapy
- Intravenous devices
- Other chemotherapy methods
- Chemotherapy with other treatments
- Waiting for chemotherapy
Your treatment plan
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. 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.
Anti-nausea medicine – Before chemotherapy, you may be given medicine so you don’t feel sick (anti-nausea or anti-emetic medicine).
Water – 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.
Seating – 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.
Nurses – 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.
Transport – 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.
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.
Steroids – 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.
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.