If you're having chemotherapy intravenously, you’ll usually need to go to hospital before your home treatment can start. This is so you can have either a central line, peripherally inserted central catheter (PICC) line or implantable port (portacath) inserted. You may also need to have your first dose of chemotherapy in hospital to make sure you don't have a reaction to the medicines.
You will be assigned an oncology or chemotherapy nurse who will arrange a date for a first visit.
During the first visit, your nurse will explain your chemotherapy treatment and answer any questions you have. You will also have your temperature, blood pressure, pulse and any symptoms you have recorded. This is to check that you're well enough to have chemotherapy. Your nurse may also take a sample of your blood. This will be sent to a laboratory for testing to check your blood count. This is the number of different types of blood cells in your blood. Your nurse will also carry out a risk assessment of your home to check that it’s safe for you to have chemotherapy there. This will show if there’s anything that needs to be done to ensure that it’s suitable.
If you're well enough to have treatment, your nurse will arrange a date for your first treatment session.
If you’re having your chemotherapy at home, your medicine will usually be delivered to your home on the day of your treatment. Or, your nurse will bring it with them. Take care to store your medicine correctly. Your medicine will be transported in a sealed, cold-storage box. It’s important that you don't open any of the packaging unless your nurse has asked you to do so.
Your nurse will insert a cannula into a vein in your arm or the back of your hand. It will be taped securely in place. Your nurse will then attach a clear bag of fluid to the cannula with plastic tubing. This is called a drip. Your chemotherapy can be given as a bag of medicine or injected into rubber bungs in the tubing. If you feel any discomfort or pain while your medicine is being given, let your nurse know.
If you have a central or peripherally inserted central catheter (PICC) line already in place for your chemotherapy, your nurse will give your medicines through this. He or she will clean out (flush) the line before and after you’ve had your chemotherapy. If you have an implantable port, your nurse will either use a needle to inject medicine into the port or attach a drip to the port.
If you're having chemotherapy through an infusion pump over several days, your nurse will set up the pump on the first day. They will then return when it needs to be disconnected at the end of the treatment session. You can usually carry the pump around in a small bag attached to your belt or in a shoulder bag. Your nurse will give you a number to call if there are any problems while he or she isn't there. If you notice medicine leaking from the pump or tube, phone your nurse straight away.
After having your chemotherapy at home, your nurse will dispose of the equipment that was used, or store it away safely.
Before they leave, your nurse will arrange a provisional date for your next blood test and treatment.
Your nurse may phone you after your treatment to check how you're feeling. Depending on your treatment regimen, this could be one or two days after or seven to 10 days later. You may also need to have some blood samples taken after your treatment. This is because chemotherapy can cause changes to some of your blood cells so they need to be checked regularly. Your doctor may also arrange to see you at some point before your next dose of chemotherapy is due. This is to find out what the side-effects were like for you and check that you’re well.
If you feel unwell at any time, it’s important that you phone your nurse or doctor for advice. You will also be provided with an out-of-hours number to call.
Your nurse will update your doctor after each treatment you have so they’re aware of your progress. Even if you’re having chemotherapy at home, your doctor and the team at the hospital continue to have responsibility for your overall care. It’s always worth reminding any healthcare professional that you see during your treatment that you’re having chemotherapy. This is because your medical records may not be immediately available.
How fast you recover from chemotherapy will be different for everyone. For many people, chemotherapy can have a big impact on everyday life. In particular, you may feel very tired and not be able to work full-time or manage your usual levels of physical activity. Take things at your own pace and don't overdo it, especially straight after your treatment.
There are some risks associated with chemotherapy. We haven’t included them here because the risks are specific to you and differ for every person. Have a chat with your doctor and ask them to explain how they apply to you.
Side-effects are unwanted but mostly temporary effects you may get during or after your treatment. The possible side-effects of chemotherapy are the same whether you have it at home or in hospital. How much these affect you and how long they last is different for everyone. Some of the most common side-effects include:
- tiredness, feeling weak and lacking energy
- feeling sick and vomiting
- diarrhoea or constipation
- thinning of your hair or hair loss
- sore throat and/or mouth, mouth ulcers and changes in your sense of taste
- skin changes such as a rash, redness or cracked skin
Side-effects vary greatly between the different types of chemotherapy and from person to person. Your nurse will discuss the possible side-effects of your specific treatment with you and advise you about what you should do if you develop them. Most side-effects are temporary and will eventually pass once your treatment is over. Some chemotherapy medicines though, may have permanent effects. These can include problems with your fertility. Speak to your doctor or nurse if you have any questions about how chemotherapy can affect your fertility.
Many side-effects, such as sickness, can be controlled using other medicines. Your doctor will usually prescribe these for you to take alongside your chemotherapy. Your doctor may also adjust the dose of chemotherapy you have depending on the side-effects you have. This can make a big difference to how you feel the next time.
Complications are when problems occur during or after your treatment. Complications that may develop include an infection or blockage in the line through which you’re receiving medicines. It’s important to contact your nurse or doctor immediately if you have any of the following symptoms.
- A burning or stinging pain or a change in the colour of your skin near the central line. This can also happen away from where the central line was inserted.
- Fluid seeping out from your central line.
- Pain or swelling in your chest, neck or arm.
- Feeling generally unwell, including feeling shivery.
- A fever or temperature that’s above what’s normal for you.
It’s also important to contact your nurse or doctor, or seek urgent medical attention, if you have one or more of the following.
- A fever or other symptoms of infection such as shivering or shaking. An infection can be serious if not treated promptly and needs immediate attention.
- A severe allergic reaction. Symptoms include having trouble breathing; swelling of your face, for example your lips and tongue; dizziness or feeling faint; itchy, red skin.
- Bruising caused by bleeding into the skin from damaged blood vessels.
- Severe headaches, especially if they start suddenly.
- A cough, breathlessness or difficulty swallowing.
- Blood in your urine or faeces.
This information is intended to help you understand the advantages and disadvantages of having chemotherapy at home compared to hospital. Think about how important each particular issue is to you and discuss them with your doctor. That way, you can work together to make a decision that’s right for you. Your decision should be based on your doctor’s expert opinion and your personal values and preferences.
- You will be able to carry on with your normal daily routine more easily, with less travel to and from appointments and less time spent in hospital waiting rooms.
- Your treatment will be more personalised, with one-to-one attention from your nurse.
- Patients receiving chemotherapy at home report fewer serious side-effects from chemotherapy.
- You will not have your treatment alongside other people with cancer – you may prefer this, as you can choose who to be with when having your treatment.
- There may be a reduced risk of getting an infection from being in hospital.
- If you don’t like visiting hospital, you may feel less anxious at home. • Evidence shows that people who have chemotherapy at home rather than in hospital are often more satisfied with their care.
- Your home may need to be adapted to your treatment, for example you may need medical equipment kept at home.
- You will not have your treatment alongside other people with cancer – you may miss having people to talk to who are going through the same as you.
- You may have less contact with the doctor looking after you.
- The responsibility of helping you with your treatment may be time-consuming, stressful or difficult for members of your family or friends.
- You may have less privacy at home.
- Having more responsibility for your treatment, for example managing a pump or looking out for side-effects, may increase your anxiety.
- You may feel that having chemotherapy at home blurs the divide between your normal life and your treatment. Some people prefer to keep the medical side of things somewhere else.
Will I have the same nurse throughout my treatment?
Ideally, yes, although this may not always be possible.
Teams that deliver chemotherapy at home will usually do their best to make sure that you see the same nurse throughout your treatment. But this isn't always possible as nurses work different shifts, and annual leave and sickness absence need to be taken into account. You may also have a secondary nurse allocated to you who regularly takes care of you if your usual nurse isn’t available.
Can I choose a particular time of day to have my chemotherapy?
You will usually be able to say when you would prefer to have your treatment.
Your nurse will do their best to come at a time that’s convenient for you. However, it may not always be possible to accommodate.
Will I still need to go into hospital for check-ups?
Yes, you will usually need to continue having check-ups with your doctor.
Your nurse will keep your doctor constantly informed of your treatment and progress. You will usually need to carry on seeing your doctor for check-ups. This is because the team at the hospital still have responsibility for your care even if you have chemotherapy at home. How regularly you need these will depend on your condition and how your treatment is going. Your doctor will let you know how often you're likely to need check-ups.
Going into hospital for check-ups may also give you the opportunity to access other services and to meet with other people having chemotherapy. This can be a useful source of support during your treatment.
Is it safe to have chemotherapy at home rather than in hospital?
Yes, having chemotherapy at home is as safe as having it in hospital.
Evidence shows that having chemotherapy at home is a safe alternative to having it in hospital, provided it’s suitable for you. This depends on which medicine you’re receiving and your own personal circumstances.
Your nurse will explain exactly what your treatment will involve beforehand and what to do if you’re worried about anything. Depending on your treatment, they may stay with you. So if there are any problems, they will be close by to help. Your nurse will carry medicines and equipment with him or her in case of an emergency. If you're having chemotherapy through an intravenous pump over several days, your nurse may not be with you for the entire time. You will be given a number to call in case you have any problems or concerns while your nurse isn't there.
- General aspects of chemotherapy. PatientPlus. www.patient.co.uk/patientplus.asp, published 21 May 2010
- Chemotherapy. Cancer Research UK. www.cancerresearchuk.org, reviewed 19 March 2013
- Safety and acceptability to patients of home chemotherapy: a review of published clinical studies. Bupa. www.bupa.com, published 2011
- Longmore M, Wilkinson IB, Davidson EH, et al. Oxford Handbook of Clinical Medicine. 8th ed. Oxford: Oxford University Press; 2010:528 (printed version)
- Tadman M, Roberts D. Oxford Handbook of Cancer Nursing. 1st ed. Oxford: Oxford University Press; 2007:222 (printed version)
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 12 May 2014
- Simon C, Everitt H, van Dorp F. Oxford Handbook of General Practice. 3rd Ed. Oxford University Press; 2007:1084 (printed version)
- Map of Medicine. Improving cancer patient experience. England view. London: Map of Medicine; 2013
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Reviewed by Dylan Merkett, Bupa Health Information, November 2014.
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