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What to Expect During Chemotherapy Treatment

Learn when, where, and how chemotherapy is given, and get tips on how to make the process as easy as possible.
 
 

How chemotherapy is given

Chemotherapy medicines come in many forms and can be given in a number of ways, depending on the breast cancer's location and characteristics.

Intravenously (IV)

Intravenously, also called an IV, is a common way to receive chemotherapy for breast cancer. The medicine is delivered directly into your bloodstream through an IV needle — also called a butterfly needle or catheter needle (a very thin tube with a retractable needle attached) — inserted into a vein in your hand or lower arm.

Through a port

Receiving chemotherapy through a port is also very common during breast cancer treatment. A port is a small reservoir placed under the skin, usually on the right side of the chest, during a short outpatient surgery. The port is attached to a catheter that is threaded into the large vein above the right side of the heart. You may hear a port referred to as a portacath or Mediport.

Chemotherapy medicines are given through a special needle that fits into the port. You also can have blood drawn through the port. So having a port means you have fewer needle sticks.

It’s very important to watch for signs of infection, including fever, chills, and swelling or redness around the port.

In some cases, you may have a pump attached to the port. Pumps can be inside your body (usually placed at the same time as the port) or outside your body. The pump controls how much and how fast the chemotherapy medicines go into the port.

The port stays in place as long as you’re receiving chemotherapy. After you complete chemotherapy, the port is removed during a short outpatient surgery.

Through a catheter

Also called a long line or a PICC (peripherally inserted central catheter), a catheter is a thin, flexible tube. One end of the catheter is inserted into a large vein, usually in your chest, during a short outpatient surgery. The other end of the catheter stays outside your body. It’s very similar to having a port.

Chemotherapy medicines are given through a special needle that fits into the catheter. You also can have blood drawn through the catheter. So having a catheter means you have fewer needle sticks.

It’s very important to watch for signs of infection, including fever, chills, and swelling or redness around the catheter.

In some cases, you may have a pump attached to the catheter. Pumps can be inside your body (usually placed at the same time as the catheter) or outside your body. The pump controls how much and how fast the chemotherapy medicines go into the catheter.

The catheter stays in place as long as you’re receiving chemotherapy. After you complete chemotherapy, the catheter is removed during a short outpatient surgery.

Orally

Some chemotherapy medicines are available as pills or capsules that you can take by mouth.

Chemotherapy cycles

Chemotherapy usually is given in cycles — a period of treatment followed by a period of recovery. For instance, a cycle may include:

  • chemotherapy on the first day and then have three weeks of recovery with no treatment

  • chemotherapy for several days in a row, or every other day, and then a recovery period

A complete chemotherapy treatment regimen is made up of several cycles. The number of cycles in a regimen and the total time it takes to complete one regimen depends on the chemotherapy medicines you receive. But most regimens take three to six months to complete.

In some cases, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between cycles — say every two weeks instead of every three weeks. Doctors usually recommend dose-dense regimens for breast cancer that is aggressive or has a high risk of recurrence.

 

Getting a chemotherapy infusion step by step

Together, you and your doctor choose a chemotherapy treatment plan that is tailored to your unique situation.

It’s most common to get chemotherapy as an infusion through a needle, port, or catheter, so we’ve summarized the general steps below.

Before chemotherapy

You meet with your oncologist. Your doctor looks at your medical records — including the results of any tests and imaging you’ve had — and does a physical exam.

Your doctor recommends a chemotherapy regimen and explains how long each cycle lasts, as well as the regimen’s benefits and side effects.

A member of your healthcare team also reviews the treatment consent form with you before asking you to sign it.

Your healthcare team also lets you know if there are any foods or other medicines you should avoid while receiving chemotherapy. It’s very important to tell your healthcare team about all the other prescription medicines, non-prescription medicines, vitamins, and supplements you take. Certain medicines, vitamins, and supplements can interact with chemotherapy medicines, making them stronger or weaker.

At this appointment, you are likely to schedule your first chemotherapy treatment.

On the day of chemotherapy

Many people prefer to have someone with them while they’re receiving chemotherapy treatment. But it’s a good idea to check with the facility first in case they have restrictions in place because of COVID-19 or other reasons. In many cases, chemotherapy can make you very tired, so you may need someone to drive you home. If there are any restrictions at the infusion center, someone can wait outside and pick you up when your treatment is done for the day.

Before chemotherapy starts, the doctor needs a blood sample to see your blood count — the number of red and white blood cells. Your doctor reviews this information before each chemotherapy cycle.

You may receive chemotherapy during a hospital stay, at a doctor’s office, at an infusion center, or at a hospital. No matter where you go, you can expect to do the following:

  • Register at whichever place you are receiving treatment, just as you sign in for a doctor’s appointment.

  • Meet the healthcare professional who is going to give you the chemotherapy treatment.

  • Have your blood pressure, pulse, temperature, and breathing checked.

  • Have your height and weight recorded; these measurements are used to calculate the correct dose of medicine.

  • Have an IV put in if you don’t already have a catheter or port. The chemotherapy medicines are given through the IV. If you have a port or catheter, you usually don’t need an IV.

  • Have a blood sample taken through the IV, port, or catheter so your doctor can see your blood count.

  • Your doctor examines you and goes over all the information the healthcare team has collected before your chemotherapy session begins. Your doctor then calculates and orders the amount of medicine needed for your treatment.

  • You may get some medicine before the chemotherapy medicine — called pre-chemotherapy medicine — to prevent nausea or an allergic reaction. You also may be given fluids, which help certain chemotherapy medicines work better.

  • Before you receive chemotherapy, the healthcare professional who starts the infusion process double-checks your name, the name of the medicine, and the medicine’s dosage.

  • The healthcare professional then starts the infusion process, which can take up to several hours to complete. Depending on the chemotherapy regimen, you may receive it in two different forms. For example, if you’re receiving a regimen of Cytoxan (chemical name: cyclophosphamide), fluorouracil, and methotrexate — called CMF by doctors — the fluorouracil and methotrexate are given as an infusion and the Cytoxan may be taken as a pill.

  • When the chemotherapy session is complete, the healthcare professional takes out the IV and makes sure your heart rate, blood pressure, and breathing are stable.

  • Either your doctor or nurse again goes over any side effects you might expect to have and how to manage them, and gives you medicine to ease nausea if you need it. You’re asked to contact your doctor if you have any severe side effects — such as fever, diarrhea, or nausea — that continue even after you take medicine for them. Make sure you know how to reach your doctor before you leave, just in case you have a problem.

 

How you know chemotherapy is working

During chemotherapy treatment, you see your doctor often. At these visits, you are likely to have physical exams, blood tests, and imaging tests. The results of all these tests let your doctor know how well your body is responding to the chemotherapy.

It’s very important to remember that you can’t tell how well chemotherapy is working based on side effects. Side effects have nothing to do with how well chemotherapy treatment is working.

 

Chemotherapy tips

Chemotherapy affects people in different ways. Two people receiving the same regimen may have completely different side effects. How you feel depends on:

  • the medicines you’re receiving

  • the medicines’ doses

  • the breast cancer’s characteristics

  • your general health before chemotherapy starts

Before you start chemotherapy

Many people say chemotherapy can make it hard for them to keep up their daily routines. Here are some things you may want to consider doing before starting chemotherapy:

  • Have a complete dental checkup and have your teeth cleaned. The bacteria in your mouth can get into your bloodstream during teeth cleaning or other dental procedures. Since chemotherapy weakens your immune system, you may be more susceptible to infection. So many doctors recommend having any dental work done before chemotherapy starts.

  • Get any heart tests your doctor recommends.

  • Have a pelvic exam and get a Pap smear, if it makes sense for you.

  • Make a plan for help around the house. It’s very common to feel tired after having chemotherapy. Although it can be hard to ask for and accept help, it makes sense to see if someone close to you can help with chores. Very often, friends and family really want to help but aren’t sure how. Helping around the house is something tangible they can do.

  • Talk to your doctor about any fertility concerns you may have. If you’re a pre-menopausal woman or man and would like to have children after completing breast cancer treatment, it’s a good idea to talk to your doctor about ways you can preserve your fertility before starting chemotherapy. For example, there is medicine that stops the ovaries from functioning, which may help protect the eggs. Eggs, sperm, and embryos also may be frozen for future fertility treatments.

  • Talk to your doctor or dietitian about any foods, medicines, vitamins, and supplements you should avoid while you’re receiving chemotherapy.

  • Talk to your doctor about hair loss. Most chemotherapy medicines cause some hair loss or thinning. Besides the hair on your head, chemotherapy also affects the hair on your arms, legs, face, and pubic area. If you plan to buy a wig, you may want to shop for it before you start chemotherapy so you can match your hair color and style. You also may want check whether your chemotherapy center offers a scalp cooling system or cold caps. You wear these tight-fitting, helmet-like hats filled with a cold gel or liquid during chemotherapy infusions. These devices have helped many people keep some or quite a bit of their hair during chemotherapy treatment.

  • Talk to your doctor about other possible side effects. If the chemotherapy medicine you receive causes nausea or diarrhea, your doctor can prescribe medicine to ease these side effects ahead of time so you have them on hand right after your first treatment. Your doctor also may recommend regular, gentle exercise to help ease side effects.

  • Think about how to coordinate chemotherapy treatment with your work schedule. Many people work during chemotherapy, as long as they can match their schedule to how they feel. Your ability to work depends on the type of job you have. If your job allows it, you may want to see if you can work part-time or from home on days you don’t feel well. Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Triage Cancer has webinars, videos, and other information on working through treatment.

  • Consider starting a blog or CaringBridge site to keep your friends and family updated and organize help.

During chemotherapy

A chemotherapy infusion can take several hours to complete, depending on your specific regimen. Some things you can take with you to pass the time are:

  • that thick book you’ve been meaning to read

  • movies, podcasts, audio books, or music you’ve downloaded to your phone or other portable player — don’t forget your headphones or earbuds!

  • a portable video game player

  • a crossword or other puzzle book

  • knitting, needlepoint, or other crafts

  • a sketchbook and pencils

  • notes, letters, or cards you want to write and send

  • a relaxation or meditation app on your phone

  • a journal

Other tips you may want to consider include:

  • wearing comfortable shoes and clothing that has an elastic waist and is stretchy

  • drinking lots of water to stay hydrated; it’s a good idea to take a refillable water bottle with you

  • wearing a cozy sweater and socks, and taking along a blanket or wrap, hat, and mittens; many people say they get cold during chemotherapy, especially if they’re using a scalp cooling system or cold cap to help preserve their hair

Reviewed by 2 medical advisers
 
Jenni Sheng, MD
Johns Hopkins University School of Medicine, Baltimore, MD
Sameer Gupta, MD, MPH
Bryn Mawr Hospital, Bryn Mawr, PA
Learn more about our advisory board

— Last updated on August 5, 2022, 8:08 PM

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