Chemotherapy - How chemotherapy is performed

Chemotherapy can be carried out in many different ways, depending on your specific circumstances.

Your care team

Many hospitals use multidisciplinary teams (MDTs) to provide chemotherapy treatment. MDTs are teams of specialists that work together.

Deciding what treatment is best for you can often be confusing. Your care team will recommend what they think is the best treatment option, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the doctor in charge of your care.

For example, you may want to find out:

• what the purpose of your chemotherapy is – for example, whether it's being used to cure your cancer, relieve your symptoms or make other treatments more effective
• what side effects you're likely to experience and whether anything can be done to prevent or relieve them
• how effective the chemotherapy is likely to be at curing your cancer or at least slowing it down
• whether any alternative treatments can be used instead of chemotherapy

Tests

Before chemotherapy begins, you will probably need to have a number of tests to assess your health and to make sure you can cope with any side effects. Tests may also be carried out during treatment to monitor your progress.

The tests you require will depend on the type of cancer you have.

Blood tests

In most cases, a blood test is carried out to assess the health of your liver and kidneys. This is important because chemotherapy medications will pass through your liver and kidneys, where they will be broken down. The medication can harm the liver. Therefore, if you have liver damage, it may not be suitable for you until your liver and kidneys have recovered.

Blood testing can also assess your blood count. This is a measurement of how many blood cells you have.

If you have a low blood count, treatment may be delayed until your blood count has returned to normal. In some cases, medication or a blood transfusion may be required. Your blood count is important because chemotherapy reduces the number of cells in your blood.

Regular blood tests may also be carried out during your treatment so your liver, kidneys and blood count can be carefully monitored.

Scans

Before having chemotherapy, scans may be carried out to help identify the best way to treat you and to provide a reference point so your progress can be checked during treatment.

Several different scans may be used, including X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans.

Your treatment plan

You will need to have regular chemotherapy over a set period of time for it to be effective.

Your care team will draw up a treatment plan detailing how many sessions you will need, how long the course should last, and how much time should pass between each session. It is common for there to be a break after each session to allow your body to recover from the effects of the medication.

This treatment plan is known as a chemotherapy protocol. Chemotherapy protocols vary depending on the type of cancer you have and how advanced it is.

Types of chemotherapy

Chemotherapy is usually given in one of two ways:

• as a tablet – which is known as oral chemotherapy
• injected directly into a vein – which is known as intravenous chemotherapy

However, chemotherapy medication can be given in many other ways too. For example, it can be injected into the spine (intrathecal chemotherapy) and it can come as a cream that is directly applied to the skin.

The type of chemotherapy used will depend on the type of cancer you have and how advanced it is.

Oral chemotherapy

If you are in good health, you may be able to take your tablets at home. However, you will still need to go to hospital for regular check-ups.

It is very important that you only take your tablets on the days specified in your chemotherapy protocol. If you forget to take a tablet, contact your care team for advice. Also, contact your care team if you are sick shortly after taking a tablet.

Intravenous chemotherapy

A number of different devices can be used to give chemotherapy medication into a vein.

The type of device used will often depend on the type of cancer you have and your general health. You may be able to choose which device you have, although this is not always possible.

Intravenous chemotherapy is not usually like having a vaccine, where you are given one quick injection. Instead, chemotherapy medications are slowly released into a vein over a period of time. The time it takes to give one dose can range from several hours to several days.

Occasionally, some people need a continuous low dose of chemotherapy medication over several weeks or months. If this is the case, you may be given a small portable pump that you can take home with you.

The devices used for intravenous chemotherapy are described below.

Cannula

A cannula is a small tube that is placed into a vein on the back of your hand or lower arm. Chemotherapy medication is slowly injected through the tube into your vein. Once the dose of medication has been delivered, the tube can be removed.

Central line

A central line, also known as a skin-tunnelled catheter, is a fine tube that is inserted into your chest and connected to one of the veins near your heart. The tube can be left in place for several weeks or months, so that you do not have to have repeated injections. It can also be used to carry out blood tests.

Peripherally inserted central catheter

A peripherally inserted central catheter (PICC) is similar to a central line, except the tube is connected to your arm rather than your chest.

Implanted port

An implanted port is a rubber chamber surgically inserted under your skin. It is connected to a vein with a soft plastic tube. Chemotherapy medication is given using a special needle placed through the skin into the chamber. The port is kept in place throughout the course of treatment.

Things to consider

During chemotherapy treatment, there are a number of important things you need to bear in mind.

Other medication

Check with your care team before you take any other medication, including over-the-counter medicines and herbal remedies. Other medication could react unpredictably with your chemotherapy medication.

Pregnancy

You should avoid becoming pregnant while having chemotherapy. This is because many medications used in chemotherapy can cause birth defects.

You will need to use a barrier method of contraception, such as condoms, while having chemotherapy and for at least six months after your treatment has finished.

Contact your care team immediately if you think you may have become pregnant while having chemotherapy.

Side effects

Chemotherapy usually causes severe side effects such as hair loss, fatigue, nausea and vomiting.

See side effects of chemotherapy for more information about these.