Methods to administer cancer drugs in young adults

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.  

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  

These 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)  

These catheters 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. 

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. 

Peripherally inserted central catheter (PICC) line 

Another option is a peripherally inserted central 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 device periodically flushed. Your doctor will give you a plan for flushing your device as well as the frequency in which you should do so.  

Orally 

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 setting reminders to take medications—using medication calendars, planners, or timers—are useful.  

Download or order a copy of A Medication Resource for Blood Cancer Patients. 

Intramuscular injection 

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 injection 

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. 

Intrathecal therapy 

Certain types of leukemia and lymphoma have a tendency to spread to the nervous system. To prevent or treat this, your doctor will deliver 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. Your doctor then removes the spinal fluid, which is examined for cancer cells, and then injects fluid containing chemotherapy drugs, usually cytarabine or methotrexate. 

If you need multiple 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 Omaya reservoir in place. 

View the interactive 3D model to help you visualize and better understand how intrathecal therapy works. Click the "Interact in 3D" button to begin. 

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