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Chemotherapy

Chemotherapy uses drugs known as cytotoxics to kill cancer cells or disrupt their growth.

There are many different types of chemotherapy; your doctor or oncology nurse will be able to explain the possible benefits and side effects of the drugs prescribed for you.

Chemotherapy works by targeting fast-growing cells. Unfortunately, while these include cancer cells, there are also fast-growing cells in other areas of the body such as the hair, nails, bone marrow and digestive system, which is why side effects such as low blood counts and hair loss may occur. Not everyone has significant side effects, and most side effects stop when the treatment stops. You should talk to your medical oncologist or oncology nurse if you are concerned about any side effects that you experience. Read more about managing side effects.

Chemotherapy is most commonly delivered by drip, known as intravenous infusion, or in tablet form.

Chemotherapy drugs may be used on their own or in combination. When used in combination, the first letter of the name of each drug is used to describe the particular regime – for instance, AC is a combination of the drugs Adriamycin and cyclophosphamide.

Questions to ask about chemotherapy

  • How often will I need chemotherapy?
  • How long will the course last?
  • What are the possible side effects?
  • Is there medication to help if I experience side effects such as nausea?
  • If I have any problems at night or at the weekend, who should I call?
  • Will I experience any fever or problems with infection? If so, how will I know and what should I do?
  • Will I lose my hair?
  • Can you provide information for me to read?
  • Will I need to have blood tests?
  • When and how will we assess how well the chemotherapy is working?

How can I avoid having sore veins from chemotherapy?

Ports and PICCs

Chemotherapy drugs are most commonly given intravenously – injected or dripped into a vein through a cannula (thin plastic tube) inserted into your arm or hand. Because you may be having chemotherapy regularly over a period of time, there are options that can make this easier.

A central venous access device, also known as a port-a-cath, infusaport or simply a port is one option. It provides access via a very slender, flexible tube that feeds directly into one of the major veins near the heart. A port is implanted under the skin in the chest wall or, less commonly, the arm, and it can stay in place for as long as you need it. The procedure to insert a port can be done in the radiology department under local anaesthetic or in surgery under general anaesthetic.

An alternative to a port is a peripherally inserted central catheter (PICC) line, which can also be called a PICC. A PICC is inserted into a vein in the arm near the elbow and travels into a larger vein near the heart. PICC lines are generally inserted under local anaesthetic in the radiology or outpatients department. The procedure usually takes about 30 minutes, and you will then need a chest X-ray to check that it is in the right position. A PICC can be used in hospital settings or at home and can stay in place for weeks or months if needed.

Both a port and a PICC can be used for giving chemotherapy drugs, blood transfusions and antibiotics when needed and taking blood for tests, so there’s no need to find a suitable vein each time.

I had a central venous access device inserted and at first I was apprehensive, but now I think it’s great as it really makes intravenous treatment easier. There is no need to find a vein each time I go in for treatment. The port has improved my quality of life considerably. – Veronica

 

The advantages of having a port or PICC line are that it can spare your veins from the frequent ‘needle sticks’ associated with chemotherapy and blood tests. It can also spare your veins and blood vessels from the irritating effects of intravenous medications, which over time can make your veins sore and scarred, so they can no longer be used.

The advantages of a port, are that, because it is under the skin, it is less susceptible to infection and does not require dressings. As it is not visible, other than a minor swelling under the skin, it is also less intrusive than a PICC line. You are able to go swimming with a port in place. The disadvantages might be that it means another hospital procedure and another scar. Also, even if you are not having treatment a port will need to be flushed with an anti-clotting agent at least once every six weeks.

The advantage of having a PICC is that it may be easier for your medical team to arrange for you to have this close to the time that you need to start your chemotherapy. PICC lines can be put in place in the radiology department at the same time that you have your chemotherapy.

Disadvantages of having a PICC include that it is held in place by a dressing that needs to be changed at least once per week. There is also a risk of infection associated with the external component of the catheter that enters the skin. The line will need to be flushed at least once per week to keep it from being blocked – the oncology nurse will do this for you. You may also be able to have a nurse visit you at home to do this if your treating centre offers this service. If you like to swim, a PICC line might not be the best option for you because of the increased risk of infection.

Questions you may like to ask if your doctor suggests a PICC line or port:

  • Where can it be inserted?
  • How do they work?
  • Which option is better for my lifestyle?
  • Will I be able to see it?
  • How do I care for it?
  • Will I need a general or local anaesthetic?
  • How often will it need to be flushed, and who will do that for me?
  • Can it be used for scan contrast injections?
  • How often will it need to be replaced?
  • Can blood be taken from it for tests?
  • How will I know if it gets infected?

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