Getting Chemotherapy: Step by Step

Before starting treatment

You will have your first consultation with your medical oncologist, and any follow-up appointments, as needed. He or she will:

• Take your medical history, conduct a physical exam, and review all lab and X-ray results.
• Present treatment recommendations.
• Explain the benefits and side effects of the recommended chemotherapy regimen.
• Carefully review the consent form with you, and have you sign it.
• Schedule your first treatment appointment; the timing will depend on your unique situation.

On the day of treatment

First you will:

• Register at the chemotherapy center.
• Meet the nurse or chemotherapy technologist who will administer your chemotherapy.
• Have your blood pressure, pulse, respiration rate, and temperature taken.
• Have your height and weight measured, so the appropriate doses of chemotherapy can be calculated.
• Have an intravenous catheter inserted. An intravenous catheter is a slender plastic tube that slips over a needle that has been placed into the vein in your arm. Once the needle and the plastic tube have been inserted, the needle is removed and drugs are given through the tube or "catheter." The catheter is removed before you go home. If you have an intravenous port, in your chest, the port will be prepared for use and the catheter is not required.
• Have blood taken to obtain a complete blood count.

Next:

You will meet with your medical oncologist, who will conduct a medical evaluation and then calculate, prescribe, and order the amount of chemotherapy you need.

After that:

• The pharmacy will prepare the chemotherapy. Processing can take up to an hour. (Chemotherapy orders may be written prior to your first day if the plan is set, and your blood counts are sufficient.)
• You will be given pre-chemotherapy medications—either by mouth (orally) or by vein (intravenously)—to prevent side effects such as nausea, anxiety, and inflammation.
• You may also be given fluids, as required for particular types of chemotherapy, especially if you haven't been drinking a lot. (Some drugs, like Cytoxan, require that you have a lot of liquid in your body. This ensures that the medication does its job fighting cancer cells and then is quickly eliminated by urination; if it stays a long time in your body it can irritate your bladder.)
• The chemotherapy drugs will arrive from the pharmacy. The nurse or chemotherapy technologist will double-check your name, the drug name, and the dosage before treatment begins.

During the actual chemotherapy process

• The chemotherapy will either be administered—via an intravenous pump "push" mechanism within a short period of time, or via a slow intravenous infusion drip that takes up to several hours.
• A nurse or doctor will supervise the "push" process, to be sure the medication goes into the intravenous line properly and does not leak outside the vein (called extravasation) where it can cause a burn.
• Some chemotherapy regimens will be administered by a combination of intravenous infusion and pill form. For example, in the case of CMF, the methotrexate and 5-fluorouracil are given intravenously, while Cytoxan is usually taken as a pill with a large glass of water.

Final steps

• When chemotherapy is finished, the intravenous catheter will be removed, and the nurse or chemotherapy technologist will check to see that your vital signs are stable.
• The doctor and nurse will tell you what side effects to expect and how to manage them, and will give you medications and instructions. You'll be told to call your doctor if you develop any significant symptoms, such as mouth sores, uncontrolled nausea, diarrhea, or fever. Be sure to get the telephone number of your doctor's answering service before you leave.