How chemotherapy is given

How chemotherapy is given will depend on the type of cancer you have and the drugs used

Chemotherapy is most commonly given in one of two ways:

  • by mouth (orally)
  • by injection (intravenously) into a vein using a syringe or an infusion ('drip')

Occasionally, a drug may be injected into a muscle or under the skin. Sometimes it can be injected into your spine (intrathecal chemotherapy), lungs or bladder, if that is where treatment is needed. You may have one drug, several drugs or different drugs given at different times. You may have tablets or injections or both.

Oral chemotherapy

Some chemotherapy drugs can be taken as tablets or capsules, which means you can continue your treatment at home. You will still need to visit the outpatient department for regular check-ups.

When should I take my tablets?

All bottles of tablets given out by the pharmacy department carry instructions about how and when to take them. You will also be told whether or not you have to take them with food and how to store them safely. Please follow these instructions carefully, and if they’re not clear ask your doctor, nurse or pharmacist. You may be given an extra information sheet with some medicines.

You will probably be provided with only enough tablets for one cycle of therapy. This is so your doctor can assess your progress before you start your second cycle. Sometimes, it may be necessary to change the dose of the tablets.

Your chemotherapy tablets will have been prescribed specifically for you and you should not give them to anyone else. If you have any chemotherapy tablets left when you have finished treatment, take them back to the hospital pharmacy. If you think you are running out of chemotherapy tablets and should have more, contact your hospital doctor (not your GP).

What should I do if I am sick after taking my chemotherapy tablets?

It is very important that you take your tablets regularly on the days specified. If you miss a dose for any reason, contact your ward for advice. Do not take a double dose.

If you are sick immediately and you can see the tablet, repeat the dose one hour later. If you are sick later (even five minutes later), contact your ward for advice.

If you are using liquid or opened capsules, or you were asked to crush or dissolve tablets, the dose should not be repeated.

How is chemotherapy given into a vein?

When chemotherapy is given intravenously (into a vein), it is given through a 'venous access device'.

Types of venous access devices

There are several different types of devices available. These include:

  • Cannula: a small tube which is put into a vein in your lower arm or the back of your hand. It is inserted at the beginning of each treatment and removed after the chemotherapy has been given. Once the cannula has been taped to your arm, the chemotherapy drugs can be injected slowly into the vein through it. Sometimes the drugs are diluted and given through a 'drip' (called 'intravenous infusion') into a vein in your arm.

Some treatment drugs cannot be given into the vein of the hand or the arm and can only be given through one of the central venous access devices described below:

  • Skin-tunnelled catheter (sometimes called a Hickman line): a fine tube which is inserted through your chest into a large vein leading to your heart. It can be left in place for several weeks or months. As well as using it to give you fluids and drugs, it may also be used to take blood samples
  • Peripherally inserted central catheter (PICC): inserted into a vein in your arm above the bend in the elbow, a PICC goes into the large vein leading to your heart. A PICC can be used to give you drugs and to take blood samples
  • Implanted port: a device which is inserted under the skin into your body, usually on the chest. The port is made up of a portal body (or chamber) which is connected via a thin tube inserted into one of the body’s veins. A special needle is used to get into the chamber which can then be attached to a drip for injections, drips or blood tests

You may be able to choose the type of device you have, however your choice will depend on the type of therapy you are going to have, your physical condition and your lifestyle. Sometimes a choice isn’t possible.

More information about skin-tunnelled catheters, PICCs and implanted ports can be found the patient information booklet 'Central venous access devices' (see below).

Will having chemotherapy hurt?

Chemotherapy is generally no more painful than any other injection or blood test. However, occasionally veins become hardened or sore. Please tell your chemotherapy nurse or doctor if this happens, so that they can avoid the sore area.

Some drugs can cause damage if they leak out of the vein while they are being injected. If you feel any stinging, ‘burning’ or pain when you are receiving the drug, tell your nurse or doctor straight away. If your arm or hand where the cannula was sited or the area around the catheter or port is sore, painful or swollen following the injection, please contact your chemotherapy nurse or doctor. If this continues or we have difficulties with your veins, they may suggest you have a central venous access device inserted.

How long does it take to give intravenous chemotherapy?

Depending on the drug or combination of drugs, each cycle lasts from a few hours to a few days.

Your doctor may recommend that your chemotherapy is given continuously at a lower dose, over weeks or months. This keeps a steady level of the drug in your bloodstream. You will receive the drug from a small infusion pump while you are at home. This is called ambulatory chemotherapy.

What is intrathecal chemotherapy?

For some types of cancer, for example, lymphomas and leukaemias, cancer cells can pass into the cerebrospinal fluid (CSF) which surrounds the brain and spinal cord. If this is the case your doctor may prescribe intrathecal chemotherapy.

This means that anti-cancer drugs will be given through a needle into the space around the spinal cord in your back. This procedure is called a lumbar puncture. Injecting chemotherapy into the spinal fluid can destroy any cancer cells that may be there and prevent cancer cells growing.