Having chemotherapy

Most of the time, IV chemotherapy treatment is given:

• in the outpatient unit at a cancer treatment centre
• in a hospital where staff are trained in giving chemotherapy

Most people have IV chemotherapy as an outpatient and do not need to stay overnight at a cancer treatment centre or hospital. You may need to stay overnight if the treatment has to be given for 24 hours or longer. Some people are admitted for a few days when they start chemotherapy so the healthcare team can watch for side effects.

If you live far from a hospital or cancer treatment centre, you may be referred to a family doctor with specialized training in giving chemotherapy or another specialist closer to your home. This means you may not have to travel as far from where you live to get chemotherapy. This doctor or specialist will work with other members of your healthcare team, especially your medical oncologist, to deliver your treatment locally.

For some types of chemotherapy drugs, you might be sent home with a chemotherapy pump connected to your port-a-cath or your PICC line, depending on which one you have. The pump will infuse chemotherapy for a certain amount of time. Your healthcare team will teach you how to disconnect the pump or a healthcare professional can come to your home to help.

There are also other ways to have chemotherapy at home. You may be given a cream or ointment that contains the chemotherapy drugs to rub onto your skin (called topical chemotherapy) or pills that you take by mouth (called oral chemotherapy). Find out more about taking oral chemotherapy at home.

Before each chemotherapy cycle, your healthcare team will make sure you are healthy enough to have chemotherapy treatment. You may need to have tests and procedures to make sure it is safe for you to start the treatment and reduce the risk of any treatment complications. You will also have the chance to talk to your healthcare team about any areas of concern and ask questions to help you feel prepared for treatment.

You may need to have one or more of the following tests and procedures before your first chemotherapy cycle.

A central venous catheter will be placed inside your body if you are getting IV chemotherapy delivered through this device. This is done in a short procedure using a local anesthetic (the area will be numbed or frozen) or a surgery using a general anesthetic (you will be asleep). After you have been given the anesthetic, the central venous catheter is put into your vein and will remain in place for all of your chemotherapy treatments. You may also have x-rays taken to make sure the central venous catheter is in the right place.

Heart and lung tests check that these organs are healthy before you start chemotherapy. Since some chemotherapy drugs can damage your heart or lungs, these tests may also be done regularly during chemotherapy treatment or if you show any signs of heart or lung problems. Your healthcare team may need you to do tests such as:

• an echocardiogram (echo)
• an electrocardiogram (ECG)
• a multigated acquisition (MUGA) scan
• lung function tests

Blood tests are done before your first chemotherapy cycle and before each new cycle in your treatment plan.

• A complete blood count makes sure your blood counts are high enough to start each new chemotherapy cycle safely. A small drop in blood cell counts is expected and usually not harmful. If blood cell counts stay above a certain limit, it is safe to keep having chemotherapy. But if the count for one type of blood cell is too low, your healthcare team may have to adjust the dose or postpone your treatment for a short time (usually a week). Your blood cell counts will take time to recover completely after chemotherapy is finished, sometimes several months.
• Blood chemistry tests make sure that your kidneys and liver are working normally, and that the chemotherapy drugs are not causing any damage. If problems are found, your healthcare team may have to adjust the dose or change your chemotherapy drugs.

A DPD blood test is needed if you are having fluorouracil (also called 5-fluorouracil or 5-FU) or capecitabine as part of your chemotherapy. DPD stands for dihydropyrimidine dehydrogenase, which is an enzyme that helps the liver break down part of these drugs so that they can be removed from the body. The gene that controls DPD is the DPYD gene. Changes to the DPYD gene cause lower levels of the enzyme. This is called a DPD deficiency, which causes fluorouracil or capecitabine to build up in the body. If this happens, the side effects can be severe and life-threatening. The DPD blood test is done before you start chemotherapy.

A complete dental checkup may be recommended. Dental work is not usually done during chemotherapy unless there is an urgent problem, such as a tooth abscess. Your healthcare team may suggest that your dentist fill any cavities or do other necessary dental work before your treatment begins. A dental checkup is often important if you are having chemoradiation for a head and neck cancer or if you are being given chemotherapy drugs that may cause a dry mouth or a sore mouth and throat.

Your relationship with your healthcare team is an important part of your cancer care. They are there to answer your questions about how chemotherapy works and what precautions to take during your treatment. Being clear, honest and respectful with everyone on your healthcare team will help you play an active role in your cancer treatment. It may be helpful to discuss the following with your healthcare team before you start chemotherapy:

• Chemotherapy can affect your fertility (the ability to get or stay pregnant or get someone else pregnant). If you want to have children in the future, there may be ways to protect your fertility before or during treatment, like freezing your eggs.
• Chemotherapy drugs can cause gene mutations or birth defects in a developing baby (fetus). It's important to avoid getting pregnant or getting someone pregnant during chemotherapy treatment. Your healthcare team can tell you the best birth control method for you and your partner and how long you should take precautions for.
• Vitamins and mineral supplements and other natural health products like herbs can affect how well chemotherapy works. Tell your healthcare team about any supplements or natural health products you take.
• Cannabis or other recreational drugs can affect how well chemotherapy works. Tell your healthcare team if you use any type of recreational drug.

Your healthcare team can also tell you what to expect at the hospital or cancer centre where you're having chemotherapy. You may have practical questions about food and visitors:

• While people often have a light meal or snack before chemotherapy, you might also want to eat during your treatment – especially if it will be long. Your healthcare team can let you know if the hospital or clinic will offer you a meal or snack or if you should bring your own.
• Hospitals and cancer centres may have space limitations. It's a good idea to find out if there are any policies that limit visitors or if you can have someone stay with you for support and company during chemotherapy.

Before giving IV chemotherapy, a nurse or another member of your healthcare team will:

• check your blood pressure, temperature, pulse and breathing to make sure you are healthy enough to have chemotherapy that day
• give you antinausea drugs and allergy medicines about an hour before treatment starts
• measure your weight and height to check that the chemotherapy dose is correct

The dose of chemotherapy drugs that you are going to be given is mixed together with sterile water in a plastic bag. The bag is hung from a pole next to where you are sitting. There is a tube coming out of the end of the bag, which will be attached to a needle to give you the chemotherapy. If you are being given chemotherapy with a pump, the end of the tube on the bag will be attached to the pump. A different tube coming out of the pump will be attached to a needle to give you the drugs.

IV chemotherapy is given while you sit in a large reclining chair so that you are comfortable during treatment. The chemotherapy pump and IV equipment are placed around the chair so that your healthcare team can get at them easily.

Your healthcare team will watch you closely during chemotherapy. They will check all the needles and tubes to make sure that everything stays in place and that the chemotherapy drugs are going into your vein safely. You may continue to be given antinausea drugs through the IV, as well as medications used to reduce the risk of an allergic reaction or to prevent damage to other organs (such as the bladder or kidneys). Your healthcare team will also watch you for any allergic reactions or sensitivity to the drugs.

Many antinausea drugs can make you feel sleepy. You may nap for a time during your treatment. Many people bring a favourite blanket and pillow for comfort or warmth. Fuzzy socks or slippers can help keep your feet warm.

Chemotherapy treatment may take several hours, depending on the drugs used. It can help to take along something to do while you are in the chemotherapy chair.

Most people go home to rest after they have finished chemotherapy. You may feel tired or ill afterwards. Talk to your healthcare team about driving home after treatment. It's a good idea to avoid driving yourself home after chemotherapy for the first couple of times to see how the treatment affects you.

Chemotherapy is a powerful medicine that can harm and destroy cells. It must be handled safely and disposed of carefully. Healthcare staff may wear gloves, a mask, protective goggles or a gown to avoid direct contact with the drugs. Some drugs called vesicants can damage the surrounding tissues if they leak out of the vein, so a member of your healthcare team will stay with you when these drugs are given.

Chemotherapy drugs are broken down by your liver and kidneys, and they are removed from your body in your urine or poop. This usually takes 2 or 3 days, but some chemotherapy drugs take longer.

To make sure that you and your caregivers are safe, your healthcare team will give you instructions on:

• taking precautions when using the toilet
• dealing with clothes or linens that get bodily fluids on them
• handling chemotherapy drugs if you are taking them at home
• taking precautions while having sex (including oral sex) or if abstaining from (not having) sex is necessary

Since chemotherapy drugs can cause immunosuppression, these precautions can help you avoid getting sick:

• Wash your hands often.
• Avoid people who are sick until they feel better. If avoiding a sick person is not possible, wear a medical mask to protect yourself and help prevent infection. You may want to ask the sick person to wear a mask, too.
• Follow public health guidelines around infectious disease in your community.
• Practice food safety.

You will be given medicines to take home after each chemotherapy treatment to help you cope with delayed side effects, such as nausea and vomiting or diarrhea. These medicines are usually pills that you take for a few days after your chemotherapy treatment. Your healthcare team will tell you how often you will need to take the medicines to help you deal with your symptoms.

It's important to take these medicines even if you are feeling well, so that they stop any nausea or vomiting that you could have before it starts. Make sure you follow the instructions that your healthcare team gives you about taking the medicines correctly.

Your healthcare team will tell you what other side effects or symptoms to watch out for, such as a high fever, cough or pain. They will give you instructions about what to do or who to call if you have experience these.

Find out more about side effects of chemotherapy.

Your chemotherapy treatments will end after you finished your last scheduled cycle. Your healthcare team will continue to follow up with you after your treatment is done.

Follow-up care lets your healthcare team keep track of your health for a period of time after chemotherapy ends. This important part of cancer care is often shared among the cancer specialists and your family doctor. They will help you recover from treatment side effects and monitor you for any signs that the cancer has recurred.

Follow-up care may not seem that important to you, especially if your treatment was long or very hard. You may find the idea of follow-up care stressful because it reminds you of your cancer experience or because you are worried about what a test might find. Talk to your healthcare team about how you feel and about why follow-up matters. Your healthcare team is there to help.

How often you will have follow-up visits is based on:

• the type of cancer
• the type of chemotherapy and other cancer treatments you have had
• any chemotherapy side effects that you may have
• your overall health

During a follow-up visit, you may have a physical exam along with blood tests and other tests or procedures. Your healthcare team will decide the specific tests and how often you have them based on clinical practice guidelines as well as your unique situation.

Find out more about after treatment ends.