How chemotherapy is given
Where do you have chemotherapy?
Depending on the type of chemotherapy, you may have it:
- in a chemotherapy day unit or outpatient clinic
- during a stay in hospital
- at home.
Chemotherapy day units
Chemotherapy drugs given into a vein (intravenous) are usually given by nurses in a chemotherapy day unit. The nurses will:
- take blood samples
- give you chemotherapy
- monitor you for side effects
- 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 safe and comfortable. There are normally recliner chairs and some beds if you need to rest. A family member or friend may be able to 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. The nurses can tell you more about what is allowed in the unit where you have your treatment.
Having the chemotherapy drugs may take between 30 minutes to a few hours. But you may have to wait:
- for blood test results
- for your chemotherapy drugs to be made up and checked by the pharmacy
- to see your cancer doctor.
The nurses will try to make sure you do not have to wait too long. You can take some things with you to help pass the time and feel more comfortable, such as:
- relaxing music
- a newspaper, some magazines, a phone, book or an e-reader
- something to eat and drink in case you get hungry
- playing cards or some knitting.
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.
Chemotherapy in hospital
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 nurse will explain more about this.
Chemotherapy at home
Sometimes, specialist chemotherapy nurses visit people at home to give chemotherapy into a vein (intravenous). 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 it is important to remember to:
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Store your medicines safely
Some chemotherapy tablets, capsules or injections may need to be stored in a certain way, such as away from direct light or in a fridge. Always follow the instructions given by your nurse or pharmacist.
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Be aware of other people at home
Other people in your household should not touch your chemotherapy drugs 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, rarely the drug may leak 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.
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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 into a vein
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 any spillage of the drugs.
Chemotherapy given into a vein (intravenous) goes directly into the blood and is carried to all areas of the body.
It can be given through:
- a cannula – a short, thin tube put into a vein in the back of the hand or the lower arm
- a central line – a long, thin tube inserted into a vein in the chest
- a PICC line (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 the 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 nurse injects the chemotherapy drugs through your cannula or central line directly into a vein 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. This is 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.
A drip through a pump
The chemotherapy drugs are mixed 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.
A drip on its own
Sometimes the nurse will give the chemotherapy through a drip without a pump. The nurse will set the rate and check it regularly to make sure it is at the right speed.
Through a small 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.
A nurse will teach you how to take care of it. Sometimes a family member or friend may be taught too. 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 is 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 outside the vein
Rarely, 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 line or port.
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.
Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein. If you develop any of these problems after you go home, contact the hospital straight away.
Other ways of having chemotherapy
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, usually as tablets or capsules. This is known as oral chemotherapy. It is just as effective as other types of chemotherapy. The drug is absorbed into the blood and carried around the 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.
Your nurse or pharmacist will tell when to take your chemotherapy tablets or capsules. They may give you other instructions, such as if you can take them with food or not, 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 – 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. This is called an intramuscular injection. It might feel a bit painful or uncomfortable for a short time.
Some drugs are given by injection under the skin using a very fine needle. Injections under the skin are called subcutaneous injections.
Injection into the spinal fluid (intrathecal)
A fluid called cerebrospinal fluid, or CSF, surrounds and protects the brain and spinal cord. In some cancers, such as some leukaemias, lymphomas, or brain tumours, the cancer cells can pass into the CSF. Doctors may give intrathecal chemotherapy to prevent this from happening, or to destroy any cancer cells in the CSF.
Only certain chemotherapy drugs can be given in this way. Chemotherapy into a vein or by mouth cannot reach these cancer cells.
The doctor numbs an area of skin over the spine with local anaesthetic. After a few minutes, they gently insert a needle between 2 of the spinal bones, into the CSF. This is called a lumbar puncture. The doctor then injects intrathecal chemotherapy through the needle into the CSF.
Having a lumbar puncture is not usually painful, but some people may find it uncomfortable. Your cancer doctor and nurse will explain it to you, so you will know what to expect. They will make sure you are comfortable.
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. It does not usually cause side effects in other parts of the body.
A fine tube called a 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:
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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 intravesical chemotherapy for bladder cancer.
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Into the abdominal cavity (intraperitoneal chemotherapy)
This is very occasionally used to treat ovarian cancer or mesothelioma in the abdomen (peritoneal mesothelioma).
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Between the 2 layers of the pleura (tissue that covers the outside of the lungs)
Chemotherapy is sometimes put in between the 2 layers of the pleura to treat cancer cells that have spread there.
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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
Chemotherapy creams are used to treat some types of skin cancer. A thin layer of the cream is put on the affected skin and the area is covered 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.
Contacting the hospital
You will be given phone numbers to contact the hospital if you:
- have a raised temperature
- feel unwell
- need advice on side effects.
The phone numbers should include out-of-hours contact details for evenings, during the night or at 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 (0800 917 7711).
It is very important to keep the numbers somewhere safe and to follow the contact advice you have been given by the cancer doctor or nurse. You could save the numbers in:
- your phone
- your Macmillan Organiser
- the ‘Your chemotherapy’ section of the Understanding chemotherapy booklet.
About our information
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References
Below is a sample of the sources used in our chemotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Brighton, D. Wood, M. The Royal Marsden Hospital Handbook of Cancer Chemotherapy. Elsevier Churchill Livingstone. 2005.
National Institute for Health and Care Excellence (NICE) Neutropenic Sepsis Guideline CG151. 2012.
Perry, MC. The Chemotherapy Source Book (5th ed.) Philadelphia: Lippincott, Williams & Wilkins. 2012.
UKONS Acute Oncology Initial Management Guidelines Version 3, March 2018. Available from www.ukons.org (accessed June 2021).
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
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