Chemotherapy - An Overview
Medically reviewed by C.H. Weaver M.D. Medical editor 9/20/2018
Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore, many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.
Being informed about chemotherapy and its potential side effects can help you to proactively manage your own care and optimize your treatment and outcome.
How is chemotherapy delivered?
There are a variety of schedules and techniques used to deliver chemotherapy and yours will depend on which treatment your doctor prescribes. Cancer chemotherapy may consist of a single drug or combinations of drugs that are delivered in cycles. A cycle consists of treatment with one or more drugs followed by a period of rest.
Chemotherapy can be administered orally in the form of a pill, into a vein (intravenous), injected into a body cavity (such as the bladder), into a muscle (intramuscular), or into the spinal fluid (intrathecal). Currently, most chemotherapy is administered intravenously; however, oral chemotherapy drugs are gaining wider use. In some cases, it may be beneficial to administer IV chemotherapy through a venous access device (VAD), which is inserted into a major vein in the body and can remain in place for a long period of time. Not every chemotherapy patient requires a VAD. However, for those that are undergoing frequent treatment, blood tests, and nutritional support, a VAD is beneficial by reducing the number of needle sticks and associated discomfort.
How often will I receive chemotherapy?
Chemotherapy drugs are typically given in cycles. The cycle consists of the day(s) the drug is administered followed by a rest and recovery period. A cycle usually lasts one to four weeks and is then repeated, which means a treatment is administered every one to four weeks. Each course of chemotherapy is different, but generally consists of four to six cycles. The actual administration of some chemotherapy drugs may take only seconds or minutes, while others may take hours or even days.
What are the advantages and disadvantages of oral chemotherapy drugs?
In the past, chemotherapy drugs were mainly administered into a vein (intravenous). Recently, oral chemotherapy drugs are being developed. Oral drugs may provide greater ease of administration since patients can take them at home rather than going to a clinic or hospital for treatments. Not all chemotherapy drugs are available in oral form. Furthermore, intravenous (IV) administration is sometimes preferable because the doctor can be more certain that the patient received the appropriate dose as scheduled and they can monitor the patient during administration.
What is a venous access device (VAD) and what types are used for cancer patients?
A VAD is a surgically implanted device that provides long-term access to a major vein. Although there are several different types of VADs, the two most commonly used for cancer treatment and taking blood samples are:
- Tunneled external catheters (Hickman® catheter), or
- Subcutaneous implanted ports (port-a-cath).
Both a Hickman® catheter and a port-a-cath are surgically implanted into a major vein. For the Hickman® catheter, the plastic tube or catheter is attached to a major vein and then comes out of the body for external access. A port-a-cath is implanted completely beneath the skin into a major vein under the collarbone. The port may then be accessed by a special needle through the skin to deliver chemotherapy, hydration, transfusions, and for taking blood samples.
The following are some key features that distinguish these two types of VADs:
- Easier insertion, removal, and access
- Higher flow capacity due to single, double, or triple lumen (channel)
- Fewer device-related infections
- Fewer activity restrictions
- Less day-to-day maintenance
- Lower flow capacity due to only single or double lumen (channel)
Patients undergoing very demanding therapies that require frequent treatment, blood transfusions, and nutritional support—such as a stem cell transplant—may be required a Hickman® catheter instead of a port.
Who needs a VAD?
Not every chemotherapy patient requires a VAD. For some chemotherapy treatment plans, the inconvenience of implanting and accessing a VAD may outweigh the benefits. You may wish to ask your doctor if a VAD is an appropriate option for you, especially if you experience any of the following:
- You are extremely anxious about having needles inserted.
- Your veins are difficult to access or become inaccessible.
- You must have alternative veins in your foot or hand accessed, which may be associated with more discomfort.
- You are undergoing continuous infusion chemotherapy (over an hour).
- You anticipate many months of chemotherapy treatments.
- You are receiving intravenous chemotherapy that requires multiple needle sticks.
- Your treatment requires frequent drawing of blood samples.
- Your treatment strategy involves chemotherapy agents that may cause “vein pain” when administered through the arm.
- You have a physician or nurse who recommend a vascular access device.
What special precautions are necessary with a VAD?
Your VAD must be flushed in order for it to work properly. Flushing your VAD requires placing a needle in your port and flushing it out with heparin. Heparin is a blood thinner prevents the catheter (plastic tube) from becoming occluded (clogged). While you are on treatment, your VAD will be flushed after each treatment. When you are no longer on treatment you must still remember to have your VAD flushed regularly. This procedure needs to be done every 4-6 weeks. It is your responsibility to make the appointment to have your VAD flushed.
Additional things about chemotherapy you may need to know include the following topics:
When to Call Your Doctor
The development of any of the following symptoms during your chemotherapy treatment may indicate a serious condition. If you experience any of the following throughout your cancer treatment, please inform your doctor.
- Fever higher than 101º F
- Shaking chills
- Vomiting that continues 48 hours after treatment
- Bleeding or bruising
- Shortness of breath/chest pain
- Severe constipation or diarrhea
- Painful or frequent urination
- Blood in the urine or stool
- Soreness, redness, swelling, pus, or drainage at your VAD site
- Irregular or rapid heart beat
- Pain in a new place.
- Pain that is not relieved by your pain medication.
- Headache that is not relieved by Tylenol®
- Inability to eat and continued weight loss
- Mouth sores
- Nasal congestion, drainage, cough
- One or more of the following symptoms in conjunction with repetitive diarrhea or vomiting (signs of dehydration):
- Dry, cracked lips
- Dry, sticky tongue
- Increased thirst
- Decreased urination
- Increased weakness
- Increased pulse rate
- Dizziness/lightheadedness (especially when rising to a standing position)