Chemotherapy and other drugs are often given in combination with each other and can be given in different ways. The method of administering the drug is based on the actual disease diagnosed and the agent's effectiveness. Common methods include:
- Intravenous (IV) (into a vein)
- Oral (by mouth)
- Intramuscular (IM) injection (into a muscle)
- Subcutaneous (SC) injection (under the skin)
- Intrathecal Therapy (within the spinal canal)
The intravenous (IV) route is a common way of giving medicine, especially chemotherapy, directly into a vein.
How Does It Work?
Your nurse inserts a small plastic needle into one of the veins in your lower arm. You may feel discomfort when the needle is inserted into your vein, but the rest of the procedure should be painless. The drugs flow from a plastic bag through tubing into your bloodstream. Sometimes a syringe is used to push the drugs through the tubing. If you feel any pain or burning while undergoing therapy, let your nurse know right away.
Using a Central Line
Many patients find that drug therapy can be given more conveniently and comfortably through a central line (catheter) than a regular IV. Certain medications irritate the veins and make repeated IV placement difficult. Catheters can also be used to supply nutrition, other drugs and blood cells and can be used to take blood samples.
Short-term catheters are temporary access devices for giving drugs and are removed before you leave the hospital. They're put in place in your hospital room, usually with local anesthesia.
Long-term catheters (also called tunneled catheters, or "Hickman®," "Broviac®" or "Groshong®" catheters) can remain in place for weeks or months. To place the catheter, your doctor makes a small incision and threads the IV line — a long, thin tube — into the vein and under the skin to a second small incision at a distance from the first. (This distance helps prevent infection.) Most catheters are positioned on the chest wall. You may have a few stitches at one or both sites until the areas have healed. Small, clear dressings are changed frequently to prevent infection. Hospital or clinic staff will show you, your family members or caregivers how to clean and care for the central line.
Using a Port
Sometimes a port is implanted to access the vein. A port is a type of long-term catheter that's surgically implanted under the skin's surface on the upper chest wall. Once the site heals, no dressings are needed and no special home care is required. To deliver the drugs, the nurse inserts a needle through your skin to access the port. You can choose to have a local numbing cream applied to the injection site before the port is used. The port can be used to draw and supply blood as well as provide nutrition.
Using a PICC Line
Another option is a percutaneously inserted central venous catheter, more commonly referred to as a PICC or PIC line. This type of catheter — a long, thin, flexible tube — is inserted through a vein in the arm. Before the PICC's insertion, you'll be given a local anesthetic to numb your arm in the area between the elbow and shoulder. The doctor threads the PICC line through the skin into a vein in the arm until it reaches the superior vena cava just above the heart. The superior vena cava is one of the veins in the central venous system.
You'll need to have any long-term devise periodically flushed. Your doctor will give you a plan for how to have your device flushed as well as how often.
The oral method takes the form of a pill, capsule or liquid that you swallow. This is the easiest and most convenient method since it can be done at home. Thalidomide, lenalidomide and imatinib mesylate are examples of blood cancer drugs taken by mouth. The side effects of oral chemotherapy are similar to those from IV chemotherapy.
To take anticancer drugs by mouth at home, you must understand the drug dosage and frequency, any possible interactions with food and other drugs, storage and handling, and potential side effects. You must take these drugs exactly as prescribed. You may find that medication calendars, planners and timers set as reminders to take medications are useful.
Intramuscular drugs are injected into the muscle, usually in the arm, thigh or buttock. You'll feel a slight pinch, lasting a few seconds, as the nurse slips the needle through your skin and into the muscle.
Subcutaneous drugs are injected into the tissue under the skin instead of into the muscle. You'll feel a slight pinprick as the nurse inserts the needle under your skin.
Certain types of leukemia and lymphoma have a tendency to spread to the nervous system. To prevent or treat this, your doctor delivers the drugs directly into your spinal canal, which more effectively treats hard-to-reach spine and brain cells than chemotherapy drugs injected into a vein. This is known as an intrathecal drug delivery, meaning within the spinal canal, which is the space between the double-layered covering or lining of the brain and spinal cord. The lining is called the meninges.
How Does It Work?
When you undergo intrathecal therapy, your doctor performs a lumbar puncture (spinal tap) by inserting a needle into your spinal canal; this can be done with either local anesthesia or with sedation/anesthesia. He or she removes spinal fluid, which is examined for leukemic cells, and then injects fluid containing chemotherapy drugs, usually cytarabine or methotrexate.
If you need many treatments, your doctor may place a permanent device called an Omaya reservoir under your scalp. Once the Omaya reservoir is inserted, your treatments can be delivered through this device and you'll no longer need lumbar punctures. You'll be able to go home with the Ommaya reservoir in place.