How chemotherapy is given
Chemotherapy drugs into a vein (intravenous) are usually given to you by nurses in a chemotherapy day unit. They take blood samples, give you your chemotherapy and monitor you for side effects. They also provide information and support for you and your family.
The nurses try to make sure the unit has a calm atmosphere and the environment is comfortable. There are normally recliner chairs and some beds if you need to rest. A relative or friend can usually stay with you during your treatment.
There may be volunteers who can give you drinks or snacks when you need them. Some units also have complementary therapists, who provide therapies such as massage and reflexology.
Having the chemotherapy drugs may take from half an hour to a few hours. But you may have to wait:
- for blood tests results
- for your chemotherapy drugs to be prepared and checked
- to see your cancer doctor.
You can take things with you to help pass the time like a book, music or playing cards.
After you have had your chemotherapy, the nurses may give you drugs to take at home or a prescription for the hospital pharmacy. This may include anti-sickness drugs, steroids or any chemotherapy tablets you need to take. Your nurse or pharmacist will explain these to you.
Some chemotherapy treatments are more complicated or take longer. This may mean you need to stay in hospital to have your treatment. Your cancer doctor or specialist nurse will explain more about this.
Sometimes, specialist chemotherapy nurses visit people at home to give intravenous chemotherapy. If you are having chemotherapy through a pump, the nurses can come and disconnect the pump when it is finished. This means you do not have to come back to the hospital.
This service is only available in some parts of the UK, and only with certain chemotherapy treatments. Your cancer doctor can tell you more about this.
If you are having chemotherapy at home as tablets or through a pump, there are certain things to remember:
- Store your medicines safely
Chemotherapy tablets, capsules or injections may need to be stored in a particular way, such as in the fridge. Always follow the instructions given by your nurse or pharmacist.
- Be aware of other people at home
Other people in your household should avoid direct contact with your chemotherapy drugs and avoid picking them up with bare hands. All drugs must be stored out of the reach of children, as they could cause serious harm if taken by accident.
- Follow instructions if your pump leaks
If you are having intravenous chemotherapy by pump and you notice the drug leaking from the pump or tube, you should close the clamps on the pump, wrap it in a plastic bag and wash your hands. Some hospitals provide a spill or leakage kit, which includes instructions on what to do if your pump leaks. You should then contact the nurse or doctor at the hospital straight away.
- Keep your contact numbers close by
If you feel unwell at any time of the day or night, use the contact numbers you have been given to get advice.
Chemotherapy drugs given into a vein (intravenously) can be delivered in different ways. Your chemotherapy nurse will wear gloves and a plastic apron while giving you chemotherapy. This is just a precaution to protect them from spills.
Chemotherapy given into a vein (intravenous) goes directly into your blood and is carried to all areas of your body.
It can be given through:
- a cannula – a short, thin tube put into a vein in your arm or the back of your hand
- a central line – a long, thin tube inserted into a vein in your chest
- a PICC (peripherally inserted central venous catheter) put into a vein in the arm and threaded through to a vein in the chest
- an implantable port (portacath) put into a vein, with an opening (port) under the skin on your chest or arm.
When your cannula, line or port is in place, the chemotherapy drugs can be given into it by injection, as a drip or through a pump.
Your nurse will check that the cannula, line or port is working properly before giving you the chemotherapy.
As an injection
The chemotherapy drugs are injected directly into a vein through your cannula or central line over a few minutes. Sometimes, a bag of clear fluid is attached to plastic tubing and connected to the cannula or line in your vein first (called a drip or infusion). The drug is injected into a connection or tap on the plastic tubing and flushed into your vein with fluid from the bag.
As a drip through pump
The chemotherapy drugs are dissolved in a bag of fluid and given to you as a drip that runs through an infusion pump. The nurses set the pump to give you a controlled amount of chemotherapy over a fixed time. This can be from 10 minutes to several hours, depending on the chemotherapy you are having.
As a drip on its own
Sometimes chemotherapy is given through a drip without a pump. The nurses set the rate and check it regularly to make sure it is at the right speed.
Through a small portable pump
Some types of chemotherapy are given over a few days and are set up at the hospital, so you can go home with it. The chemotherapy is in a small pump which your nurse connects to your central or PICC line. The pump is small enough to be carried in a bag or belt holster.
You, and sometimes a family member or friend, will be taught how to look after it. Some pumps are battery-operated, so you need to be careful not to get them wet when you are washing. There are also disposable pumps that are operated by a balloon mechanism or spring control.
When the infusion is finished, there may some fluid left in the pump. Some pumps need to be overfilled to get the correct dose, so this may be normal. Your nurse or pharmacist can tell you if you should expect this.
You usually come back to the hospital to have the pump disconnected. Sometimes, a district nurse will do this for you at home. Your chemotherapy nurse or pharmacist will explain how to look after the pump and what to do if there is a problem.
If a chemotherapy drug leaks
If a drug leaks into the area around the vein while being given, this is called extravasation. This is uncommon but can happen if a cannula moves and is not in the correct position in the vein. Extravasation rarely happens with a lines or ports.
Your nurse will be very careful to prevent extravasation when giving your chemotherapy. Some chemotherapy drugs can damage the tissues, so it is very important that extravasation is dealt with straight away.
If you notice any swelling, pain, stinging or redness during your chemotherapy, tell your nurse immediately. If you develop any of these problems after you go home, contact the hospital straight away.
There are other ways you can have chemotherapy, apart from into a vein (intravenously). Your chemotherapy nurse or cancer doctor will explain more about this.
By mouth (oral chemotherapy)
Some chemotherapy drugs can be taken by mouth (orally) as tablets or capsules. This is just as effective as other types of chemotherapy. The drug is absorbed into your blood and carried around your body, just like intravenous chemotherapy. You may have all your treatment as oral chemotherapy, or you may have it in some other ways as well.
You will be told when to take your chemotherapy tablets or capsules. Your nurse or pharmacist may give you other instructions, such as whether or not to take them with food, or any food or drinks to avoid.
It is very important to:
- read the labels on the drug boxes before you leave the hospital and speak to your nurse, doctor or pharmacist if any instructions are unclear
- take your drugs exactly as prescribed, because not taking them at the right times can affect how well treatment works
- contact your nurse or doctor at the hospital straight away for advice if you cannot take your medicines for any reason, are sick after taking them, or have forgotten to take a dose.
Chemotherapy by mouth can cause side effects, just like chemotherapy into a vein. It is important to know what they are. You also need to know how to store your drugs safely.
Injection into a muscle or skin
Some chemotherapy drugs are given by injection into a muscle in the leg or buttock (intramuscular). This might feel a bit painful or uncomfortable for a short time.
Some drugs are given by injection under the skin (subcutaneous) using a very fine needle.
Injection into the spinal fluid (intrathecal)
In some leukaemias, lymphomas or brain tumours, cancer cells can pass into the fluid that surrounds and protects the brain and spinal cord (cerebrospinal fluid or CSF).
Intrathecal chemotherapy can be used to prevent this from happening, or to destroy any cancer cells in the CSF. Only certain chemotherapy drugs can be given in this way.
Into a body space (intracavitary)
Chemotherapy drugs can be given into a space (cavity) in the body. This can cause irritation or inflammation in the area the drugs are given, but it does not usually cause side effects in other parts of the body.
A fine tube (catheter) is usually inserted into the body cavity and chemotherapy is put in through this tube. It may be drained out again after a set period of time. Chemotherapy can be given into the following places:
- Into the bladder (intravesical)
This is used to treat early bladder cancer. Liquid chemotherapy drugs are given directly into the bladder through a catheter, which is removed when it is over. We have more information about this treatment.
- Into the abdominal cavity
This is very occasionally used to treat ovarian cancer or mesothelioma in the abdomen (peritoneal mesothelioma).
- Between the two layers of the pleura
Chemotherapy is sometimes put in between the two layers of the pleura (tissue that covers the outside of the lungs) to treat cancer cells that have spread there.
- Into a limb (isolated limb perfusion)
Chemotherapy is very occasionally given directly into the blood vessels in a limb. This is to treat a skin cancer called melanoma that has come back. We have more information about isolated limb perfusion.
Chemotherapy creams are used to treat some types of skin cancer. You put a thin layer of the cream on the affected skin and cover the area with a dressing. Your specialist nurse or pharmacist will show you how to do this and will explain how often you need to apply the cream.
Although the cream can irritate the skin in the area or make it sore, it will not cause side effects in other parts of the body.
You will be given phone numbers to contact the hospital if you:
- have a temperature
- feel unwell
- need advice on side effects.
This should include out-of-hours contact details for evenings, during the night or the weekend. Some cancer centres have a 24-hour number you can call at any time for advice. In Scotland, you may be given the number of the Cancer Treatment Helpline.
It is very important to keep the numbers somewhere safe and to follow the contact advice you have been given by the chemotherapy nurse or cancer doctor. You could save the numbers in: