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  • Chemotherapy

    Dana-Farber/Brigham and Women's Cancer Care

    Chemotherapy is medicine that is given to help treat cancer. The most common ways to receive chemotherapy are through infusion or through pills you can take at home (oral chemotherapy).

    You may receive your chemotherapy at home, in an outpatient setting, or in the hospital. Your health care team will decide the best place for you to receive treatment.

    Infusion

    If you have chemotherapy by infusion, the medication is delivered to your bloodstream through a needle in a vein from your arm or a central line. You might also receive supportive medications or treatments (such as hydration) by infusion.

    Your first infusion appointment is generally the longest, so plan on a full day. This video can help you understand what to expect and how to prepare for your first appointment:

     

    What to expect at your infusion appointment

    • Laboratory Services: When you arrive for an infusion appointment, you will first visit Laboratory Services, where we will take a blood sample. This sample helps us determine your dose of chemotherapy and any other needed medicines.
    • Exam visit: After your blood sample is taken, you will meet with your health care team. This may include your physician, nurse practitioner, or physician assistant. Your team will review your treatment plan and check your bloodwork before prescribing your medications for the day. The nursing staff will check and recheck your height and weight. This is another important step that helps determine the dose of chemotherapy.
    • Waiting during preparation: Chemo is made to order every time you visit. This means it cannot be prepared ahead of time, so you may spend an hour or more in the waiting area. You may feel like nothing is happening, but this step is important for your safety. Our pharmacy and nurses are working together behind the scenes to prepare your medicine. It is prepared in a sterile environment and may need to be thawed or mixed with other medicines. After your medicine is prepared, it is checked and double-checked as it goes from pharmacy, to your infusion nurses, and then to you.
    • Infusion: When your chemo is ready, a member of the nursing staff will help you get settled in an infusion area. To begin the process, you may get premedication or fluids. These medications can help with side effects like nausea. The actual infusion process can take several hours, but you can use this time for your own activities, such as reading, watching TV, browsing the Internet, or even taking a nap.
    • After infusion: When your treatment is done, you may need to stay and be observed for a short time, to make sure you feel OK. Your nurse will meet with you to review potential side effects, tell you what to expect at home, and know what to do if you have a side effect.
    • Before you go home: Make sure you have a list of your future appointments and the doctor's phone number. You may have questions and need to call us. We have nurses who work with your doctor, are knowledgeable about your treatment plan, and can help with your questions.
    clinician with a patient receiving infusion  

    Tips to remember

    • Bring a friend or family member with you to your infusion appointment. This is important, because you may feel tired at the end of the day. It's good to have someone who can get you home safely. All infusion areas have a seat for a friend or family member.
    • Drink plenty of fluids and wear layers of comfortable clothing. Consider wearing short sleeves if you will need to get an IV in your arm. If you have a central line, such as a port, wear a button-down shirt.
    • Bring items from home to help pass the time – like books, headphones, or a laptop. All patient areas have wireless Internet access and reading materials. Some have snacks. We also offer iPads for patients to borrow during treatment visits.
    • Helpful resources: If you get your chemo in one of Dana-Farber's infusion areas, your nurse will give you a folder with educational materials about chemotherapy, including two booklets from the National Cancer Institute: Chemotherapy and You and Eating Hints. These are also available from the Blum Patient and Family Resource Center on the first floor of Dana-Farber's Yawkey Center for Cancer Care.
    • Friends or family members who are sick should not accompany you to infusion appointments. If friends or family are sick, please ask them to stay at home. This includes persons who have a cold or flu and persons exposed to a contagious illness, such as chicken pox. Talk with your cancer team if you have questions.
     

    Oral Chemotherapy

    doctor and patient at Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Medical Center  

    What is oral chemotherapy?

    Oral chemotherapy is a cancer-fighting drug given by mouth in tablet, capsule, or liquid form. It is prescribed by your doctor, nurse practitioner, or physician's assistant, and has the same benefits and risks as chemotherapy given by infusion.

    Today, many cancer patients receive oral chemotherapy as a treatment. This method is sometimes easier than getting chemotherapy by infusion at the hospital or clinic, because the medicine can be taken at home. It's important to understand that these pills can be just as strong as the intravenous form of chemotherapy.

    Oral chemotherapy is not just any pill.

    Dana-Farber — a leader in patient safety and an innovator in the safe administration of chemotherapy by infusion — is committed to educating patients and their families about the benefits and risks of oral chemotherapy. We apply the same safeguards to oral chemotherapy that we do for infusions. Patient education is central to this mission.

    Oral chemotherapy is a serious treatment. When taking oral chemotherapy at home, patients must understand special instructions, precautions, and side effects. Following these instructions will help you receive the most benefit from the drug.

    Note: The oral chemotherapy animated video series below won a Silver Quill Award from the International Association of Business Communicators and a Digital Health Award from the Health Information Resource Center (HIRC).

     

    Mire este vídeo en español (watch this video in Spanish)
    Assista esse vídeo em Português (watch this video in Portuguese)
    觀看此視頻 (watch this video in Mandarin)
    Смотрите этот видеоролик по-русски (watch this video in Russian)
    شاهد هذا الفيديو (watch this video in Arabic)

    What information should you gather before you begin oral chemotherapy?

    • Your doctor, nurse, or pharmacist will give you instructions for how and when to take your oral chemotherapy. Please follow instructions carefully, and keep them close by for future reference.
    • Be familiar with both the trade name and generic name of the drug.
    • Understand the dose and frequency of the drug. Always double- and triple-check the dose before taking. You may need to take several pills of different strengths to make the total dose.
    • Know the best time of day to take the drug.
    • Understand whether you should be taking the drug before or after a meal or snack.
    • Review all other medicines or supplements you take with a member of your oncology team. Some medications can interfere with how well the oral chemotherapy works.
    • Know what to do if you miss a dose, vomit, or take an extra dose by mistake.
    • If you are in a clinical trial, you might have special instructions.

    Communicate with your other health care providers. Be sure your primary care physician, dentist, and other caregivers are informed about the oral chemotherapy you are taking.

    Prepare for your start date:
    • Find out if your oral chemotherapy can be filled at your local pharmacy or ordered by mail.
    • Allow enough time for your prescription to be filled, and have it on hand before your intended start date.
    • Talk with your oncology team in advance if you have concerns.
    Oral chemotherapy can be costly, so:
    • Check with your insurance company regarding your coverage and co-payments for oral chemotherapy.
    • Learn more about treatment-related medication co-payments by calling Dana-Farber Patient Assistance and Community Resources at 617-632-3301. You may also visit NeedyMeds for help with the cost of medicine.

    How do I handle oral chemotherapy safely at home?

    Most oral chemotherapy medicine is stored at room temperature, away from heat or moisture. Your doctor or nurse will tell you if your medication needs special storage or handling.

    Storage
    • Keep your medicine in its original container.
    • Keep it away from other medications and beyond the reach of children or pets.
    • Do not store oral chemotherapy pills in a bathroom with a shower, or on your windowsill.
    Handling
    • Wash your hands thoroughly before and after you take the pills.
    • Do not crush, break, or chew your pills.
    • Caregivers should be extra cautious when administering the drug.
      • Avoid handling with bare hands.
      • Empty pill(s) into cap lid or small plastic cup for dispensing.
      • You may wear latex gloves, if contact is unavoidable.
      • The only person exposed to the drug should be the patient.
       
    Disposal
    • If you have oral chemotherapy pills left over, please return them to the pharmacy where the prescription was filled.
    • Do not flush them down the toilet, pour them in the sink, or throw them away in the trash.

    For more information about oral chemotherapy handling, storage and disposal, see Dana-Farber's oral chemotherapy fact sheet.

     

    Mire este vídeo en español (watch this video in Spanish)
    Assista esse vídeo em Português (watch this video in Portuguese)
    觀看此視頻 (watch this video in Mandarin)
    Смотрите этот видеоролик по-русски (watch this video in Russian)
    شاهد هذا الفيديو (watch this video in Arabic)

    How can I be sure to take my oral chemotherapy pills at the right time?

    Remembering to take your medication at the right time of day is not as easy as it may sound, especially if you have an active life.

    Tips to keep in mind:
    • Try to take your pill at the same time and under the same circumstances every day.
    • Use the reminder features on your smart phone or home computer to prompt you to take the drug as prescribed.
    • If you travel, make sure you have enough pills on hand for unexpected delays.
    • Keep a diary (either on paper or an e-calendar) that records the time, date, and how you are feeling. A diary is a good tool to verify that you are taking the drug correctly; it will also help you recall exactly how you where feeling during the weeks or months between appointments.
    • Bring the diary to your next appointment at Dana-Farber.
    • Ask a family member or friend to call or visit you periodically to review your drug diary.
    • Leave your drug diary in a prominent place so you will see it and complete it every day.
     

    Mire este vídeo en español (watch this video in Spanish)
    Assista esse vídeo em Português (watch this video in Portuguese)
    觀看此視頻 (watch this video in Mandarin)
    Смотрите этот видеоролик по-русски (watch this video in Russian)
    شاهد هذا الفيديو (watch this video in Arabic)

    How do I manage symptoms and side effects of oral chemotherapy?

    • Be sure you understand what the drug is intended to do and how it acts in your body.
    • General side effects from oral chemotherapy include:
      • Fatigue
      • Skin changes (especially to palms of hands or soles of feet)
      • Nausea or vomiting
      • Flu-like symptoms
      • Mouth, hair, and nail changes
       
    • Become familiar with the most common side effects of your drug. Find the fact sheet for your specific drug on the Medications A-Z page of Dana-Farber's Health Library.
    • Keep information about side effects where you can refer to it often.
    • Record in your diary 3-4 times per week the side effects you are feeling. Use a few words, or check off side effects from a list provided by a member of your clinical team.
    • Be sure to share this information with your clinical team during your next Dana-Farber appointment.
     

    Mire este vídeo en español (watch this video in Spanish)
    Assista esse vídeo em Português (watch this video in Portuguese)
    觀看此視頻 (watch this video in Mandarin)
    Смотрите этот видеоролик по-русски (watch this video in Russian)
    شاهد هذا الفيديو (watch this video in Arabic)

    Don't wait to call your oncology team.

    woman on the phone  

    Depending on the type of oral chemotherapy you are taking, you might experience some unique side effects. It's important to keep in close contact with your oncology team. Plan ahead: Keep contact numbers for your doctor or nurse, along with your drug information, in a prominent place.

    Oral chemotherapy is becoming more common to treat many types of cancers. Partnering with your oncology team and communicating any concerns is an important part of your treatment plan:

    • Contact a member of your clinical team immediately if side effects prevent you from taking your drug doses as prescribed.
    • Skin changes can be difficult to treat without direct observation. If you develop an unusual skin rash after taking the drug, call your nurse or doctor.

    Other resources

    Better Coverage for Oral Chemo: Why It Matters
    Chemotherapy Related Neuropathy: Managing This Nerve Wracking Problem
    Oral chemotherapy fact sheet
    Tips for Managing Neuropathy

     
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  • Medications A – Z

  • How Does Chemotherapy Work?

    • Chemotherapy drugs work in many different ways to kill cancer cells to cure the disease, slow its growth, or reduce its symptoms. Learn all about how they work in this post on our Insight blog. 
  • Oral chemo diaries

    • open pill bottleAre you taking chemotherapy in pill form? These printable diaries can help you keep track of your doses and side effects to share with your doctor.
  • Starting Chemotherapy: What to Expect

    • Starting Chemotherapy video screenshot Joanna, a Dana-Farber breast cancer patient, describes her initial fears about starting chemotherapy, and talks about what the actual experience was like.
  • Tips for Taking Oral Chemotherapy

    • Cancer treatment increasingly takes place at home, as patients receive oral chemotherapy or other types of anti-cancer drugs through pills, tablets, and liquids. Read Thomas Kochanek, PhD's blog post, Tips and Advice for Taking Oral Chemotherapy.
  • Caring for Your Central Line Catheter

    • screenshot from video on central line catheters Central line catheters are used to take blood for tests and give fluids, nutrition, medicines, and blood products during cancer treatment. Find out how to care for your central line catheter through our instruction sheets, video demonstrations and more.
  • Managing Symptoms during Chemotherapy

    • lemons and ginger Finding nutritious foods that taste good while experiencing chemo-related side effects may present challenges. But there are many ways to keep your body healthy and your immune system supported by eating certain foods during treatment.