How cancer drug treatments are given
Where do you have cancer drug treatment?
Depending on the type of cancer drug, you may have it:
- in a day unit or outpatient clinic
- during a stay in hospital
- at home
- at your GP practice.
Hospital day units
Cancer drugs given into a vein (intravenous) are usually given by nurses in a day unit. They will check the results of any blood tests you had before treatment. They will also ask about any side effects you are having and whether you need any help managing them.
How long you will be there depends on the type of treatment you are having. But sometimes you may have to wait:
- for blood test results
- for your cancer drugs to be made up and checked by the pharmacy
- to see your cancer doctor.
You can take some things with you to help pass the time and feel more comfortable, such as:
- something to read or listen to
- a drink or snack.
The nurses can tell you more about what is allowed in the unit where you have your treatment.
After you have had your treatment, the nurses may give you drugs to take at home or a prescription for the hospital pharmacy. This may include anti-sickness drugs, steroids or any other tablets you need to take. Your cancer team will explain these to you. They will also give you and your family information and support about what to expect after you have had treatment, such as possible side effects or how to avoid infection.
Cancer drug treatment in hospital
Cancer drug treatments at home
Some cancer drugs come as tablets or capsules that you can take at home.
It is also sometimes possible to have a cancer drug treatment into a vein (intravenous) at home. This service is only available in some parts of the UK, and only with certain cancer treatments. Your cancer team can tell you more about this.
It may include:
- a specialist cancer nurse who visits people at home to give an intravenous treatment (see ‘Cancer drugs into a vein’ below)
- treatment given through a small pump that you take home from hospital with you.
If you are taking cancer drugs by mouth or having treatment at home, it is important to remember to:
- store your medicines safely
- follow any instructions from your cancer team
- keep your cancer team or hospital contact numbers close by.
Contacting the hospital
During and after any cancer treatment, it is important to know who to contact if you need support or information.
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your cancer doctor, nurse or pharmacist can explain the risk of these side effects to you.
They will give you phone numbers to contact the hospital if you:
- have a raised temperature
- feel unwell
- need advice on side effects.
The phone numbers should include out-of-hours contact details for evenings, during the night or at the weekend. Some cancer centres have a 24-hour number you can call at any time for advice. In Scotland, you may be given the number for the Cancer Treatment Helpline (0800 917 7711).
It is very important to keep the numbers somewhere safe and to follow the contact advice you have been given. You could save the numbers in:
- your phone
- your Macmillan Organiser
- the ‘Your chemotherapy’ section of the Understanding chemotherapy booklet.
Cancer drugs into a vein
Cancer drugs given into a vein (intravenously) can be delivered in different ways. Your cancer nurse will wear gloves and a plastic apron while giving you treatment. This is just a precaution to protect them from any spillage of the drugs.
Cancer drugs given into a vein go directly into the blood and are carried to all areas of the body.
You may have cancer drugs through:
- a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
- a central line – a fine tube that goes under the skin of your chest and into a vein close by
- a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
- an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.
When your cannula, line or port is in place, you can have the cancer drugs by injection, as a drip or through a pump. Your nurse will check that the cannula, line or port is working properly before giving you the treatment.
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As an injection
The nurse injects the cancer drugs through your cannula or central line directly into a vein over a few minutes.
Sometimes, a nurse attaches a bag of clear fluid to plastic tubing and connects it to the cannula or line in your vein first. This is called a drip or infusion. The drug is injected into a connection or tap on the plastic tubing and flushed into your vein with fluid from the bag.
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As a drip through a pumpThe cancer drugs are mixed in a bag of fluid. You have them as a drip that runs through an infusion pump. The nurses set the pump to give you a controlled amount of the drug over a fixed time. This can be from 10 minutes to several hours, depending on the cancer drugs you are having.
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As a drip on its ownSometimes the nurse will give the cancer drug through a drip without a pump. The nurse will set the rate and check it regularly to make sure it is at the right speed.
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Through a small pump
Some types of cancer drugs are given over a few days. These are set up at the hospital so you can go home with them. The cancer drug is in a small pump that your nurse connects to your central or PICC line. The pump is small enough to be carried in a bag or belt holster.
A nurse will teach you how to take care of it. Sometimes a family member or friend may be taught too. Some pumps are battery operated, so you need to be careful not to get them wet when you are washing. There are also disposable pumps that are operated by a balloon mechanism or spring control.
When the infusion is finished, there may some fluid left in the pump. This is normal – some pumps need to be overfilled to get the correct dose. Your nurse or pharmacist can tell you if you should expect this.
You usually come back to the hospital to have the pump disconnected. Sometimes, a district nurse will do this for you at home. Your cancer nurse or pharmacist will explain how to look after the pump and what to do if there is a problem.
If a cancer drug leaks outside the vein
Rarely, a drug leaks into the area of skin around the vein while being given. This is called extravasation. This is not common, but it can happen if a cannula moves out of position. Extravasation rarely happens with a line or port.
Your nurse will be very careful to prevent extravasation when giving your treatment. Some cancer drugs can cause serious damage to the tissues, so it is very important that extravasation is dealt with straight away.
Tell your nurse straight away if you have any of the following symptoms:
- stinging
- pain
- redness or swelling around the vein.
If you develop any of these problems after you go home, contact the hospital straight away.
Cancer drugs by mouth (oral drugs)
Some cancer drugs can be taken by mouth, usually as tablets or capsules. The drug is absorbed into the blood and carried around the body, just like cancer drugs given into a vein (intravenous treatments). You may have all your treatment as oral drugs, or you may have it in some other ways as well.
Your cancer team will tell you when to take your cancer tablets or capsules. They may give you other instructions – for example, whether you can take them with food, or whether there are any foods or drinks you should avoid.
It is very important to:
- read the labels on the drug boxes before you leave the hospital, and speak to your nurse, doctor, radiographer or pharmacist if any instructions are unclear
- take your drugs exactly as prescribed – for example, if you take your drugs at the wrong times, it can affect how well treatment works
- contact the hospital straight away on the 24-hour number for advice – for example, call if you cannot take your medicines for any reason, are sick after taking them or have forgotten to take a dose.
If you run out of tablets or capsules for cancer treatment, always contact the hospital. Never go to your GP to ask for more.
Cancer drugs taken by mouth can cause side effects, just like treatment into a vein. It is important to know what they are. You also need to know how to store your drugs safely.
Other ways of having cancer drugs
Injection into a muscle or skin
Some cancer drugs are given by injection into a muscle in the leg or buttock. This is called an intramuscular injection. It might feel a bit painful or uncomfortable for a short time.
Some drugs are given by injection under the skin using a very fine needle. Injections under the skin are called subcutaneous injections.
Injection into the spinal fluid (intrathecal)
A fluid called cerebrospinal fluid (CSF) surrounds and protects the brain and spinal cord. In some cancers, such as some leukaemias, lymphomas, or brain tumours, the cancer cells can pass into the CSF.
Cancer drugs into a vein or by mouth cannot reach these cancer cells. So you may have an injection of chemotherapy into the CSF instead. This is called intrathecal chemotherapy.
Only certain chemotherapy drugs can be given in this way.
Into a body space (intracavitary)
Cancer drugs can be given into a space (cavity) in the body. This can cause irritation or inflammation in the area in which the drugs are given. It does not usually cause side effects in other parts of the body.
A fine tube called a catheter is usually inserted into the body cavity. Cancer drugs are put in through this tube. They may be drained out again after a set period of time. Cancer drugs can be given into the following places.
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Into the bladder (intravesical)Non-muscle-invasive bladder cancer can be treated with cancer drugs given directly into the bladder. We have more information about intravesical chemotherapy for bladder cancer and BCG treatment for bladder cancer.
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Into the abdominal cavity (intraperitoneal chemotherapy)
This is very occasionally used to treat ovarian cancer or mesothelioma in the tummy area (abdomen) – this is called peritoneal mesothelioma.
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Between the 2 layers of the pleura (the tissue that covers the outside of the lungs)Chemotherapy is sometimes put in between the 2 layers of the pleura to treat cancer cells that have spread there.
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Into a limb (isolated limb perfusion)Chemotherapy is very occasionally given directly into the blood vessels in a limb. This is to treat a skin cancer called melanoma that has come back. We have more information about isolated limb perfusion for melanoma.
Skin creams
Some cancer drugs are available as skin creams. Medicines given as a cream on the skin are sometimes called topical treatments.
Cancer drug skin creams are used to treat some types of skin cancer. A thin layer of the cream is put on the affected skin and the area is covered with a dressing. Your cancer team will show you how to do this. They will explain how often you need to apply the cream.
Although the cream can irritate the skin in the area or make it sore, it will not cause side effects in other parts of the body.
Booklets and resources
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our cancer drug treatment information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
UK Oncology Nursing Society. Acute oncology initial management guidelines. Version 4.0. 2023. Available from www.ukacuteoncology.co.uk/information-hub/ao-guidelines/ukons-guidelines/ukons-acute-oncology-initial-management-guidelines [accessed February 2024].
Rajinder Nijjar
Reviewer
Lead Cancer Pharmacist
Date reviewed
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