SUPPORT CANADIANS LIVING WITH CANCER
Each cancer is different, so each treatment plan is different. The healthcare team will estimate how often and for how long chemotherapy treatments will be given. Chemotherapy treatments may be given every day, every week or every month. Chemotherapy drugs are often given at regular intervals called cycles. For example, treatment may be given for several days or weeks followed by a rest period. This gives the body a chance to build new healthy cells and regain its strength. The treatment may then be repeated after a period of time (such as every week or every 3 weeks) for 3 months or longer.
Where chemotherapy is given
Where chemotherapy treatment takes place depends on the person’s situation, the drugs being used and the services available in the community. Treatment may be given:
- at a cancer clinic
- at a hospital
- at home
- in a doctor’s office
Most people receive chemotherapy as an outpatient and do not need to be in the hospital overnight to have treatments. However, a person will sometimes stay at the hospital if the treatment has to be given for 24 hours or longer. Some people stay at the hospital when they first start chemotherapy so the healthcare team can observe the effects of the drug.
How chemotherapy is given
Chemotherapy can be given in different ways, called routes of administration. Certain chemotherapy drugs can only be given by an injection, while others may be taken by mouth. The way chemotherapy is given depends on the type of drug, the goal of treatment and the type and location of the cancer. Most chemotherapy drugs are given intravenously (into a vein). Sometimes a central venous catheter (a soft, plastic tube placed into a vein) is used to give chemotherapy.
put directly on the skin as a cream, lotion or ointment
taken by mouth as a pill, capsule or liquid
injected through a needle into the fatty tissue just under the skin
injected through a needle into a muscle
injected through a needle or catheter into a vein in the hand or arm
sometimes injected into a larger vein in the arm, neck or chest through a central venous catheter (CVC) or vascular access device (VAD)
injected directly through a catheter into the main artery that supplies blood to the tumour (used to treat a single area, such as the liver or a limb)
injected through a needle directly into a tumour in or under the skin
rarely injected into a tumour on an organ inside the body
injected directly into the peritoneal space or peritoneal cavity (the space between the abdominal organs and the membrane lining the abdominal wall)
injected through a chest tube or catheter into the pleural cavity (the space between the membranes lining the lung and chest wall)
given through a lumbar puncture (spinal tap) into the space containing cerebrospinal fluid (CSF)cerebrospinal fluid (CSF)The fluid in the cavities in and around the brain and spinal cord that helps protect and cushion these organs.
given directly into the CSF through a small dome-shaped device (Ommaya reservoir) placed under the scalp and attached to a short tube (catheter)
The Ommaya reservoir is surgically inserted under the scalp and the catheter is threaded into the ventricle (fluid-filled space) of the brain. A small needle is inserted through the skin on the scalp into the Ommaya reservoir to inject the chemotherapy drug. With an Ommaya reservoir, the person does not need multiple lumbar punctures.
instilled into the bladder through a urinary catheter
Sometimes special external or internal pumps are used to control how fast chemotherapy drugs are given.
- Ambulatory pumps are external. They are small (about the size of a deck of cards) and portable (they run on batteries). They allow the person to go about their usual activities.
- Implanted pumps are surgically placed under the skin, usually in the abdomen. They are usually made out of metal with a power source built inside. The pump is about the size of a hockey puck. Implanted pumps are used to give continuous chemotherapy infusions.
Because chemotherapy drugs are considered hazardous and can harm or destroy cells, people need to take special precautions to safely handle and dispose of them. Healthcare staff may wear gloves, a mask, protective goggles or a gown while handling or giving chemotherapy drugs to avoid direct contact with them. Some drugs (described as vesicants) can also damage the tissues if they leak out of the vein during IV infusion, so the nurse will stay with the person as these drugs are given.
Special procedures are also used to dispose of materials used for giving chemotherapy. IV tubing and bags, needles, syringes and other articles are placed in specially marked plastic containers. A special procedure is followed to clean up a drug if it accidentally leaks or spills.
Chemotherapy drugs are usually passed from the body in wastes (such as urine, vomit and stool) within a few days of treatment. The healthcare team takes special precautions when handling body wastes for 48 hours after a person receives chemotherapy drugs.
Precautions at home
You may also have to take precautions if you take chemotherapy drugs at home. You will be given instructions about what precautions to take. For example, if you take chemotherapy pills, you should avoid touching the pills with your hands. Wash your hands after taking these drugs by mouth, especially if the pill accidentally touches your skin. You may be told to wear disposable gloves if you need to split pills.
Take the following precautions during chemotherapy and for 48 hours after finishing chemotherapy:
- Sit on the toilet to urinate. Flush the toilet twice with the lid down to avoid splashing.
- Wash your hands well after using the toilet and dry your hands with a paper towel.
- Wear rubber or disposable gloves when cleaning the toilet or if handling any body fluids. Wash your hands well with soap and water afterward even if you wear gloves.
- If vomiting occurs, discard into the toilet, clean off all splashes and flush the toilet twice.
- Sheets and clothing that have body fluids on them should be washed separately. You may be told to wash clothes twice. Wear disposable gloves when handling laundry during this time. If the soiled laundry cannot be washed right away, seal it in a plastic bag.
- If using disposable adult diapers, underwear or sanitary pads, seal them in plastic and discard with regular trash.
- Use a condom during sex because the drugs can be found in semen and vaginal secretions.
Food and drug interactions
Certain foods or medicines may interfere with the effects of some chemotherapy drugs. The healthcare team will tell you if you need to avoid any particular foods, drinks or other medicines while taking chemotherapy drugs. Make sure to tell the doctor or healthcare team about all of the medicines you are taking, including:
- prescription drugs
- nonprescription (over-the-counter) drugs
- vitamin or mineral supplements
- herbal remedies or other natural health products
Do not start or stop taking any medicines without first checking with your doctor, pharmacist or healthcare team.
The healthcare team will give you instructions if you need to do anything else because of your chemotherapy. For example, they will let you know if the drug should be taken with or without food, with a large glass of water or what to do if you forget to take a dose.
Many people wonder whether it’s okay to drink alcohol while being treated for cancer. Some people find that it increases their appetite and helps them enjoy their meal. However, alcohol is low in nutrition and high in calories, so a couple of drinks may make you feel full and not feel like eating anything else. Before you choose to drink, talk to your healthcare team to see if it’s okay for you to have alcohol during treatment.
Alcohol can interfere with some medicines and chemotherapy drugs. It may worsen the side effects of some drugs. Alcohol also increases the risk of developing certain types of cancer.
Medicines to manage side effects
Sometimes medicines are given after each chemotherapy treatment to help with delayed side effects, such as nausea, vomiting or diarrhea. These medicines are usually taken by mouth and may be continued for a few days after chemotherapy. Your healthcare team will tell you how often you will need to take the supportive care medicines to help you deal with your symptoms.
Monitoring during chemotherapy
Because chemotherapy affects rapidly dividing cells, blood cells that grow quickly can also be affected. Regular blood tests are done to check the level of blood cells throughout the course of treatment. A complete blood count (CBC) or other tests may be done weekly, before each chemotherapy treatment or every day (in some cases).
Blood cell counts do not usually drop right after chemotherapy is given. They typically drop about a week or so (7–14 days) after the start of treatment.
Nadir refers to when blood cell counts reach their lowest level. The nadir for each type of blood cell occurs at different times because white blood cells (WBCs), platelets and red blood cells (RBCs) have different life spans. Usually, WBCs and platelets reach their nadir first because they have shorter life spans. RBCs live longer and they are not usually affected as much by chemotherapy drugs, so they do not reach their nadir for several weeks.
A drop in blood cell counts shows that the chemotherapy drugs are working and stopping rapidly dividing cells from reproducing. A small drop in blood cell counts is usually not harmful. If blood cell counts are normal, then it is safe to give chemotherapy drugs. If the count for one type of blood cell is too low, the doctor may have to adjust the dose or postpone treatment for a while. Occasionally, a course of treatment may need to be stopped temporarily if side effects that require a break in treatment develop (for example, if blood cell counts remain low for too long).
Blood cell counts usually start to increase and return to normal about 3–4 weeks after chemotherapy treatment.
Sometimes more blood tests, x-rays or other imaging tests are done to see how the body is responding to treatment. The doctor will decide, or the treatment protocol will state, which tests are done and how often.
Activity during chemotherapy
Some people can work and continue their regular leisure activities while getting chemotherapy. Others find they tire easily, need to rest more or cannot do as much. Chemotherapy affects each person differently. The healthcare team will give you instructions about any limits to physical or sexual activity.