Chemotherapy uses powerful drugs to kill cancer cells, control their growth or relieve pain symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and its rate of progression.
Chemotherapy can be used in combination with other treatments to either shrink tumors before surgery or radiation (neoadjuvant therapy), or to make sure all cancer cells have been eliminated after other treatments have been performed (adjuvant therapy).
Chemotherapy is administered in several ways:
Intravenous (IV) is the most common method. A needle is inserted into a vein and attached with tubing to a plastic bag holding the drug. For patients who undergo several chemotherapy sessions, a catheter is inserted into one of the large veins and left in place during the entire course of treatment. Some patients have a metal or plastic port implanted under the skin as an IV connection device.
Oral chemotherapy drugs are taken by mouth, either in pill or liquid form.
Injections are administered into the muscle, under the skin or directly into a cancer lesion, depending on the type or location of the cancer.
Isolated limb perfusion is a method of administering chemotherapy drugs directly to tumors in the arm or leg. The blood supply of the affected limb is isolated from the rest of the body. Then, heated chemotherapy drugs are pumped into the treatment area through tubes inserted into tiny incisions. Isolated limb perfusion is used to treat advanced or metastatic melanoma and some sarcomas.
Hepatic arterial infusion is used to treat liver cancer. A tiny pump is surgically inserted under the skin and connected to the hepatic artery, which supplies blood to the liver. Drugs are administered through the pump over a period of about two weeks.
Side Effects of Chemotherapy
Side effects depend on the type of chemotherapy drugs used. The length and severity of chemotherapy side effects differ from patient to patient. Most are temporary and will disappear once treatment has ended. There are drugs and non-invasive complementary therapies that can help alleviate some of the more severe symptoms.
The most common side effects of chemotherapy include:
The most common side effects of chemotherapy include:
Sometimes, chemotherapy is delivered safely through a standard (or “peripheral”) IV line. Other times, infusions must be administered through a central line catheter, such as a PICC, CVC or port.
What are the differences between an IV, a port and a central line?
- A peripheral IV line (PIV, or just “IV”) is a short catheter that’s typically placed in the forearm. It starts and ends in the arm itself.
- A PICC line is a longer catheter that’s also placed in the upper arm. Its tip ends in the largest vein of the body, which is why it’s considered a central line. PICC stands for "peripherally inserted central-line catheter.”
- A CVC is identical to a PICC line, except it’s placed in the chest or neck. CVC stands for “central venous catheter.”
- A port is a catheter that’s implanted surgically under the skin on the chest. It’s another type of central line.
Which one should I get?
It depends on the type of chemotherapy you need and the time required to administer it.
- A PIV can be left in place for up to four days and can only be used with certain types of chemotherapy (those that don’t cause irritation or blistering, which can damage veins).
- A PICC line can be left in place for weeks or months, but must be kept dry at all times (even when showering). It also requires regular cleaning and maintenance to function well.
- A CVC can remain in place for weeks, months, or until treatment is complete. It must also be kept dry and regularly maintained.
- A port can stay in place for years. It requires only limited maintenance, which is performed by MD Anderson staff. And patients can shower — or even swim — with a port.
All central lines (PICC, CVC and port) can be used to deliver any type of chemotherapy.
Which patients should consider getting a port or a central line?
If you’ve had difficulty getting regular IVs placed, you may want to consider having a port or other central line installed. Most patients have had experience with PIVs and can report if it’s difficult to insert them. And as treatment progresses, it may become more and more difficult to place a PIV. So, it’s important to talk to your doctor about it before starting treatment.
You should also consider getting a port or other central line if you’ve had reactions to chemotherapy that was infused through a PIV — such as pain, redness or swelling at the IV site and/or streaking (redness/discoloration tracing along the vein).
Under what special circumstances might a doctor recommend a port or central line?
If you need a continuous infusion of chemotherapy through a portable pump at home, you’ll need a central line. These types of infusions cannot be given through a PIV, due to the high risks of chemotherapy leaking into surrounding tissues and accidental dislodging.
Your doctors may also recommend one based on the state or accessibility of your veins. If you already have small, weak or hard-to-find veins, or MD Anderson staff routinely have difficulty placing PIVs or drawing blood for lab work, a central line or port may be placed prior to starting treatment.
What’s the most common objection patients have to getting a central line? What do you tell them?
Most patients have concerns about care and maintenance. PICC lines and CVCs need dressing changes every week, and flushing is recommended daily.
At MD Anderson, we have resources to help patients and caregivers learn how to do this. We offer classes on how to care for central lines. Patients also can visit one of two walk-in Infusion Therapy Clinics (Main Building, Floor 8, Elevator C and Mays Clinic, Floor 8, Elevator U) for routine care and maintenance. And finally, home health care may be an option. Check with your MD Anderson case manager to see if your insurance policy covers it.
Since port placements require sedation and/or anesthesia in an operating room, some patients have concerns about having surgery. But other central lines can be placed in the clinic using local anesthesia. So, if you want to avoid general anesthesia, we typically recommend a PICC line.
How long do patients typically have to use a port or a central line?
Most patients keep their PICC, CVC or port until they’re done with treatment, but it’s different for every person. Ports are often requested because they allow patients more normalcy in their daily living and require less maintenance. But ports are not always the best choice. If you need a central line only for a few days to a few weeks, a PICC line may be recommended, since it’s the easiest to place and remove.
How long does it take for a patient to get a central line?
PICC lines and CVCs can usually be placed at MD Anderson’s Infusion Therapy Clinic within 24 to 48 hours of receiving an order from the physician. An implanted port takes up to a week to be placed, as it’s considered a surgical procedure. Those are only scheduled after you have a consultation with an oncologist.
What do patients report as the hardest aspect of having a port or central line? What advice do you give them?
For PICCs and CVCs, care can sometimes be a challenge. You have to keep the dressing clean, dry and intact at all times, so you have to cover it with plastic wrap and tape during showers, and you can’t take baths or go swimming.
Patients also complain about limitations to their activities. Exercising can be hard, because external catheters sometimes catch on things.
We remind patients that there are still some activities they can do, such as walking or cycling. We also note that ports allow patients more freedom, so talk to your oncologist if you’re interested in one to see if you’d be a good candidate.
How should patients care for their ports and central lines?
CVCs and PICCs require weekly dressing changes and daily flushing for maintenance. Ports are flushed after each use and only require flushing once a month when they are not being used regularly. No dressing changes are required with a port.
What myths or misconceptions about ports and central lines do you hear a lot?
Actually, there are two:
- Patients sometimes
mention that they don’t want a port or central line because the
infection rate or risk is high. While it’s true that there’s a risk
of infection with any catheter, that risk can be decreased with
proper care and maintenance. Mindful observation of the site will
help catch any complications early on and produce better
- Ports and central lines do not end with the tip of the catheter inside the heart. The tip of the catheter is located either in the superior vena cava (SVC) or at the atriocaval junction (ACJ), which is where that large central vein meets the heart.
What’s the one thing you wish patients knew about ports and central lines?
Ports and central lines are there to help you, and they are very safe ways of delivering chemotherapy.
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