How is chemotherapy delivered?

Overview

There are a variety of schedules and techniques used to deliver chemotherapy and yours will depend on which treatment your doctor prescribes. Cancer chemotherapy may consist of a single drug or combinations of drugs that are delivered in cycles. A cycle consists of treatment with one or more drugs followed by a period of rest.

Chemotherapy can be administered orally in the form of a pill, into a vein (intravenous), injected into a body cavity (such as the bladder), into a muscle (intramuscular), or into the spinal fluid (intrathecal). Currently, most chemotherapy is administered intravenously; however, oral chemotherapy drugs are gaining wider use. In some cases, it may be beneficial to administer IV chemotherapy through a venous access device (VAD), which is inserted into a major vein in the body and can remain in place for a long period of time. Not every chemotherapy patient requires a VAD. However, for those that are undergoing frequent treatment, blood tests, and nutritional support, a VAD is beneficial by reducing the number of needle sticks and associated discomfort.

How often will I receive chemotherapy?

Chemotherapy drugs are typically given in cycles. The cycle consists of the day(s)  the drug is administered followed by a rest and recovery period. A cycle usually lasts one to four weeks and is then repeated, which means a treatment is administered every one to four weeks.  Each course of chemotherapy is different, but generally consists of four to six cycles. The actual administration of some chemotherapy drugs may take only seconds or minutes, while others may take hours or even days.

What are the advantages and disadvantages of oral chemotherapy drugs?

In the past, chemotherapy drugs were mainly administered into a vein (intravenous). Recently, oral chemotherapy drugs are being developed. Oral drugs may provide greater ease of administration since patients can take them at home rather than going to a clinic or hospital for treatments. Not all chemotherapy drugs are available in oral form. Furthermore, intravenous (IV) administration is sometimes preferable because the doctor can be more certain that the patient received the appropriate dose as scheduled and they can monitor the patient during administration.

What is a venous access device (VAD) and what types are used for cancer patients?

A VAD is a surgically implanted device that provides long-term access to a major vein. Although there are several different types of VADs, the two most commonly used for cancer treatment and taking blood samples are:

• Tunneled external catheters (Hickman® catheter), or
• Subcutaneous implanted ports (port-a-cath).

Both a Hickman® catheter and a port-a-cath are surgically implanted into a major vein. For the Hickman® catheter, the plastic tube or catheter is attached to a major vein and then comes out of the body for external access. A port-a-cath is implanted completely beneath the skin into a major vein under the collarbone. The port may then be accessed by a special needle through the skin to deliver chemotherapy, hydration, transfusions, and for taking blood samples.

The following are some key features that distinguish these two types of VADs:

Hickman® catheter

• Easier insertion, removal, and access
• Higher flow capacity due to single, double, or triple lumen (channel)

Port-a-cath

• Fewer device-related infections
• Fewer activity restrictions
• Less day-to-day maintenance
• Lower flow capacity due to only single or double lumen (channel)

Patients undergoing very demanding therapies that require frequent treatment, blood transfusions, and nutritional support—such as a stem cell transplant—may be required a Hickman® catheter instead of a port.

Who needs a VAD?

Not every chemotherapy patient requires a VAD. For some chemotherapy treatment plans, the inconvenience of implanting and accessing a VAD may outweigh the benefits. You may wish to ask your doctor if a VAD is an appropriate option for you, especially if you experience any of the following:

• You are extremely anxious about having needles inserted.
• Your veins are difficult to access or become inaccessible.
• You must have alternative veins in your foot or hand accessed, which may be associated with more discomfort.
• You are undergoing continuous infusion chemotherapy (over an hour).
• You anticipate many months of chemotherapy treatments.
• You are receiving intravenous chemotherapy that requires multiple needle sticks.
• Your treatment requires frequent drawing of blood samples.
• Your treatment strategy involves chemotherapy agents that may cause “vein pain” when administered through the arm.
• You have a physician or nurse who recommend a vascular access device.

What special precautions are necessary with a VAD?

Your VAD must be flushed in order for it to work properly. Flushing your VAD requires placing a needle in your port and flushing it out with heparin. Heparin is a blood thinner prevents the catheter (plastic tube) from becoming occluded (clogged). While you are on treatment, your VAD will be flushed after each treatment. When you are no longer on treatment you must still remember to have your VAD flushed regularly. This procedure needs to be done every 4-6 weeks. It is your responsibility to make the appointment to have your VAD flushed.

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