Long-term Intravenous Chemotherapy

GENERAL INFORMATION:

What is it?

• Long-term intravenous (in-trah-VEE-nus) (IV) chemotherapy (kee-moh-THER-ah-pee) is one way to give chemotherapy. There are many ways to give chemotherapy, and there are many different types of chemotherapy medicines. Depending on the medicine you need, long-term IV chemotherapy may be the best way to treat you.
  
  
• An IV catheter (KATH-e-ter) will be placed into a large vein in your body. This is usually in your arm or upper chest. Long-term IV catheters can stay in place for many months or years. There are many types of IV catheters. You and your caregiver will decide which type of catheter is right for you. IV catheters are placed by a caregiver specially trained in putting them in. Once you have your IV catheter placed, your caregiver will begin your treatments.

How is the long-term IV catheter put in? The catheter may be placed into a vein (blood vessel) in your arm. Catheters that are placed into your arm can be done while you are awake and in bed. The catheter may be placed in your upper chest, near your collarbone. You will have a surgery done to place a catheter into your chest. The catheter may be placed while you are a patient in the hospital. You may also be able to arrive at the hospital to have the catheter put in, and go home the same day. Ask your caregiver for more information about the procedure used to place an IV catheter.

What does a long-term IV catheter look like? Most IV catheters have a small piece that you will be able to see and touch on the outside of your body. The other part of the IV catheter will be inside you and you will not be able to see it. The IV catheters may be different colors and sizes. Some IV catheters are completely inside your body. They are called "ports".

What will I feel after the catheter is put in? You may have some discomfort after you have your long-term IV catheter is placed. You may also have some bruising where the catheter was put in. There may also be some bleeding from the site where the IV catheter was put in. Caregivers may use medicine to make you lose feeling in the area where the catheter is being placed. Feeling will return to the area after the procedure.

What is chemotherapy? Chemotherapy is also called "chemo". It is a special medicine used to fight cancer. Chemo can cure some cancers. Chemo may also help you live longer if you have cancer. Chemo cannot cure all kinds of cancers. There are many different kinds of chemo. Sometimes chemo can make you feel sick. Your caregiver will decide what kind of chemo you will get and how you will get it. How often and how long you get chemo depends on the type of cancer you have. It also depends on the chemo medicines that are used and how your body handles the chemo.

How does chemotherapy work?

• In your body, you have healthy cells that divide and grow to make more healthy cells. Cancer cells do not divide and grow normally. Cancer cells multiply much more quickly than normal cells. This is how they take over normal cells. Your body cannot fight off these cancer cells because they grow so quickly.
  
  
• Chemotherapy prevents cancer cells from growing and dividing. Chemo may also help prevent the spread of cancer to other parts of your body. Chemo directly attacks these rapidly dividing cells. Chemo also harms healthy cells. Some healthy cells that may be harmed by chemo are hair and reproductive (ree-proh-DUK-tiv) cells. Reproductive cells are cells in your ovaries (OH-var-ees) or testicles (TES-ti-kls). These cells will usually repair themselves when you are done with chemo.

How long will I need to have long-term IV chemotherapy? Your caregiver will decide how long you need to receive long-term IV chemo. The kind of cancer you have will affect how long you need to have chemo. Different chemo medicines may be used together. For some people, combining chemo medicines may decrease the amount of time the medicine is needed. You may need chemo for a few hours every day, every week, or once or twice a month. You may need to take this medicine for several months or longer. Chemo is often given in cycles. This means that you will get the medicine for a period of time, and then you will have a break from it. This allows your body to grow new, healthy cells.

Where will I be treated? You and your caregiver will decide where you need to go to be treated with IV chemo. Chemo may be given in a hospital, a special clinic, or at home. The type of chemo you get will affect where you are treated. The very first time you get chemo, you may be in the hospital. Your caregivers can watch you closely to see how you feel during and after treatment. Your caregivers can then decide if any changes in the chemo need to be made. If you get your chemo at home, a caregiver specially trained in giving chemo will give it to you.

How will I feel after getting my long-term IV chemotherapy? You may be tired for a few days or longer after your treatment. You may be too tired to go to work or do any other activities. You may also feel nauseated (sick to your stomach) or may vomit (throw up). Follow your caregiver's instructions about rest and activity after chemo treatments.

What are the side effects of chemotherapy? Chemo can have many different side effects. You may have one or more of these side effects, or you may have none of them. Most chemo side effects are short-term, and will go away after the treatments are done. One possible bad side effect from long-term IV chemotherapy is extravasation (eks-trav-ah-ZAY-shun). Extravasation is when the chemo medicine leaks out of your vein, causing burning and blistering. This can cause long-term damage to your skin. Extravasation is very rare with long-term IV catheters. Caregivers will teach you what to look for and what to do if there are signs of extravasation. Other possible side effects from chemo include:

• Blood problems: Chemo may change the amount of certain blood cells in your body. These cells are called white blood cells, red blood cells, and platelets. Your blood may not have enough red blood cells because of your chemo treatments. This is called anemia (ah-NEE-mee-uh). Your blood may not clot as well once you start chemo. Clotting is how fast you stop bleeding. You may also bruise easier than normal. Blood cell changes can cause serious health problems. Your caregiver will do blood tests to check these blood cells and find any problems early.
  
  
• Diarrhea (deye-ah-REE-ah) or constipation (kon-sti-PAY-shun): Chemo can affect your intestines (bowel). You may have diarrhea (loose stools) or constipation (having hard BMs, less often than usual). Let your caregiver know if you have diarrhea for more than one day. Let your caregiver know if you have pain and cramping with your diarrhea. Also let your caregiver know if you do not have a BM for several days.
  
  
• Fatigue: You may feel fatigued (very tired) after you get chemo. This may happen suddenly or over time. Your fatigue may not be relieved with rest or naps. Fatigue can last for days, weeks, or months.
  
  
• Flu-like symptoms: You may feel like you have the flu after you get chemo. You may have chills, a fever, or muscle and joint aches. These may last for a few days.
  
  
• Hair loss: This can be a common side effect of chemo. Your hair may become thinner or fall out. Hair loss may happen anywhere on your body that you have hair. It can happen right after you begin chemo, or several weeks later. It may not happen at all. Your hair will usually grow back when you stop your chemo treatments.
  
  
• Infection (in-FEK-shun): Chemo harms healthy white blood cells. A decrease in healthy white blood cells puts you at risk for infection. Ask your caregiver about protecting yourself from infection.
  
  
• Kidney or bladder problems: Some types of chemo may cause bladder or kidney infections. They may also cause permanent damage to your kidneys or bladder.
  
  
• Mouth, gum, and throat problems: You may develop sores in your mouth or throat. You may also have white patches in your throat. Ask your caregiver about ways to prevent these problems.
  
  
• Nausea or vomiting: You may have nausea and vomiting with your chemo. There are special medicines that your caregiver can give you to help decrease these side effects.
  
  
• Nerve and muscle problems: Chemo can cause the nerves in your body to hurt, feel weak, burn, or tingle. These are usually not a sign of a serious problem, but may be hard to live with. These symptoms usually go away after you are done with chemo. It may take a year or more for these symptoms to go away or get better.
  
  
• Pain: Chemo can cause many side effects that cause pain. Let your caregiver know if you have pain that does not go away, or gets worse.
  
  
• Poor appetite: You may not feel like eating. Ask your caregiver about what you can do to have a balanced and healthy diet.
  
  
• Problems with memory or mood: Chemo may make you feel depressed (very sad) or confused. Talk to family, friends and your caregiver about your feelings. Caregivers may suggest ways to help you cope with your treatment, and feel better.
  
  
• Sexual problems: Chemo can affect your sexual organs. In women, their menstrual (MEN-stroo-al) cycle (monthly periods) may change or stop. There may be vaginal (VAJ-i-nal) dryness, which may cause pain or discomfort with sexual intercourse (sex). There may also be hot flashes. A hot flash is a sudden feeling of heat that spreads throughout your body. It may be dangerous for a woman to become pregnant. Men may not be able to have or keep an erection (ee-REK-shun). Both men and women may be unable to have a child. Ask your caregiver for more information about sexual function while using chemo.
  
  
• Skin problems: Chemo can cause dry skin. It can also cause other skin problems such as a rash, itching, redness, and sensitivity to the sun. Your nails may also peel, become yellow, or cracked.

What are the tests or treatments I may need during chemotherapy? Your caregiver may order several different tests to be done. This will help your caregivers see how the chemo is working. It will also allow your caregiver to see how your body is handling the chemo. Your caregiver may order one or more of the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Blood culture: Your blood may be tested to see if there is infection in it. You may need to have your blood tested more than one time.
  
  
• CT scan: This is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your cancer. Your caregivers look at these pictures. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps cancer areas show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Blood transfusion: You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.

Risks:

• There are risks with getting long-term IV chemo. There is a very small risk of the chemo leaking out of your vein. This could permanently harm your skin, vein, or the inside of your body. You could also develop an infection of your catheter or the vein where the catheter is placed. You may have an allergic reaction to the catheter and it will need to be removed. The catheter could move out of the right position, or come out completely. You may also develop blood clots from the catheter.
  
  
• You could have a bad reaction to the chemo medicine. You may also develop infection in your mouth or other places in your body. Chemo could permanently damage many organs in your body. The chemo may not work well for you, and the cancer could spread to other places in your body. A new cancer could grow. You could die. If you choose not to get chemo, the cancer may spread more quickly. You could die sooner. Ask your caregiver if you have any questions or concerns about your cancer or treatments.

Support: You and your family may feel scared, confused, and anxious after being told you have cancer. Getting chemo is very frightening. These feelings are common. Talk about them with your caregiver or with someone close to you. For more information, you may call or write:

• American Cancer Society
  Phone: 1-800-227-2345
  Web Address: http://www.cancer.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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