Chemotherapy at home

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who are considering having chemotherapy at home, or who would like information about it.

Chemotherapy is a treatment used to destroy cancer cells with medicines. In certain situations chemotherapy can be given at home rather than in hospital.

Once you have been referred for chemotherapy treatment at home you will meet the nurse carrying out your treatment to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About chemotherapy

Chemotherapy is used to treat many different types of cancer. Most chemotherapy medicines are given directly into your bloodstream. This is known as intravenous chemotherapy.

Chemotherapy can also be given as:

• tablets or capsules (oral chemotherapy)
• injections - either into a muscle (intramuscular), into the fatty tissue underneath your skin (subcutaneous), into the fluid around your spine (intrathecal) or directly into a body cavity, eg your bladder (intracavitary)
• topical application (applied to your skin as a cream)

Your chemotherapy treatment will be specific to you. Your oncologist (doctor who specialises in cancer care) or haematologist (doctor who specialises in conditions of the blood) will explain it to you. When discussing your chemotherapy your doctor may refer to it as a regimen - this is the treatment plan that you will be receiving.

Intravenous chemotherapy is usually given as several sessions of treatment that can last from as little as 20 minutes to several days. Following each treatment you will have a rest period during which time you won't have any treatment. This will allow your body to recover. Treatment and rest periods make up a chemotherapy cycle. The number of cycles you have will depend on your regimen, the type of cancer you have and how effective the chemotherapy is at treating your cancer.

Intravenous chemotherapy can be given in several ways, including:

• through a thin tube, called a cannula, which is put into a vein in your arm or the back of your hand
• through a thin tube inserted through the skin of your chest into a main vein near your heart (a central line) - this can be left in place for many months
• through a thin tube placed into a vein in the crook of your arm and threaded through until it is inserted into a vein near your heart - this is called a peripherally inserted central catheter (PICC) line and can also stay in place for many months
• through a thin tube put into a vein ending in an opening (port) just under the skin on your arm or chest (called an implantable port or 'portacath') - medicines are passed into the port using needles
• via an infusion pump - this is a portable pump that attaches to a PICC or central line and delivers the correct dose of chemotherapy over a set period of time

About chemotherapy at home

Sometimes an oncology nurse (a nurse who specialises in cancer care) or a chemotherapy nurse can visit you at home to give you intravenous chemotherapy. Oral chemotherapy can also be provided at home, with the medicines being delivered to you rather than you going to hospital.

Clinical evidence shows that having chemotherapy at home is a safe alternative to having it in hospital. People who have chemotherapy at home are often more satisfied with their care. This may be because:

• you're more relaxed in your own environment
• you benefit from one-to-one attention from your nurse
• you don't need to travel to and from hospital
• you can carry on with your normal day-to-day activities at home
• going into hospital makes you anxious

Ask your oncologist whether it's possible for you to have your chemotherapy at home. He or she will be able to tell you whether this is an option for you. If you're able to have chemotherapy at home, your oncologist can arrange this directly.

Preparing for chemotherapy at home

Your oncologist will send your prescription and treatment schedule to your chemotherapy team.

If you're having chemotherapy through a central line, PICC line or implantable port, you will usually need to go into hospital to have this inserted before your home treatment can start.

You may 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. He or she will telephone you to introduce him or herself and arrange a date for a first visit.

During the first visit, your nurse will explain your chemotherapy treatment and answer any questions you may have. He or she will do some tests including taking your temperature, blood pressure and pulse, and will also ask about any symptoms you may have. 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 that your blood count (the number of various blood cells in your blood) is normal.

If you're well enough to have treatment, your nurse will arrange a date for your first treatment session.

What happens during chemotherapy at home

Your chemotherapy medicines will be delivered to your home, usually on the day of your treatment. Don't open any of the packaging unless your nurse has asked you to do so. Make sure your medicines are stored out of the reach of children and pets as they could cause serious harm if taken by accident.

Your nurse will usually insert a cannula into a vein in your arm or the back of your hand. This will be taped securely in place. Your nurse will then attach a clear bag of fluid to the cannula via plastic tubing (drip). The chemotherapy can be given as a bag of medicine (drip) or injected into the rubber bungs of the tubing. Your nurse will stay with you throughout your treatment. If you feel any discomfort or pain while the medicine is being given, let your nurse know.

If you have a central or PICC line already in place, your nurse will give you medicines through this. He or she will flush (clean out) the line before and after you have 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 via an infusion pump over several days, your nurse will set up the pump and then return when it needs to be disconnected. You can usually carry the pump around in a small bag, perhaps attached to your belt or using 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 that medicine is leaking from the pump or tube, phone your nurse straight away.

What to expect afterwards

Your nurse will dispose of the equipment used to give you chemotherapy, or store it away safely.

Before he or she leaves, your nurse will usually arrange a provisional date for your next treatment.

Your nurse may phone you a day or two after your treatment to check how you're feeling. Your nurse will usually call again seven to 10 days later to see how you are. You may also need to have some blood samples taken after your treatment.

If you feel unwell at anytime, phone your nurse or oncologist for advice. You will usually be provided with an out-of-hours number to call.

Your nurse will update your oncologist after each treatment you have so that he or she is aware of your progress.

Recovering from chemotherapy at home

For many people, chemotherapy can have a big impact on everyday life. In particular, tiredness often prevents people from working full-time or doing their usual levels of physical activity. Take things at your own pace and don't over do it, particularly after you've just had a treatment.

What are the risks?

You need to be aware of the possible side-effects of chemotherapy.

The side-effects of chemotherapy are the same regardless of whether you have it at home or in hospital.

Side-effects

These are the unwanted but mostly temporary effects of your treatment.

Chemotherapy can cause various side-effects. Tiredness is the most common side-effect and this can last for a long time. Other side-effects can include:

• feeling sick and vomiting
• diarrhoea or constipation
• thinning of hair or hair loss
• sore mouth, mouth ulcers and changes in your sense of taste

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. Most side-effects are temporary and will eventually pass once treatment is over. However, some chemotherapy medicines can affect your fertility - ask your nurse for more information.

Many side-effects can be controlled using other medicines. For example, sickness can be reduced using anti-sickness medicines. Your oncologist will usually prescribe you some anti-sickness medicines to take alongside your chemotherapy.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.