Delivering the drugs
The IP therapy care team includes Ursula Matulonis, MD (left), and nurse practitioner Cathy Earley.
Before admission and again on the first day in the hospital, the patient is thoroughly briefed on the regimen and what to expect in terms of side effects. Prior to the first infusion, she receives intravenous fluids, antinausea medications, steroids and other drugs to prevent allergic reactions, and antacids. After this preparation, the patient gets Taxol in a 24-hour intravenous infusion. On the second day, nurses give the first IP infusion — cisplatin diluted in a large volume of body-temperature saline solution delivered via the catheter.
During the infusion, the patient is asked to roll and change positions to distribute the cisplatin solution completely within the abdomen, washing over every surface that might harbor cancer. On the third day, after being given more fluids and steroids, the patient goes home, where she injects herself with medication to augment her blood counts and takes pills to control nausea. LaBounty found that in the days and weeks following the initial chemotherapy, her biggest hurdle was fatigue: "All I could do was lie on the couch," she says, adding that she felt somewhat peppier in succeeding cycles of therapy.
On the fourth day of the cycle, the patient comes into Dana-Farber for an IV infusion to replace the fluids and essential minerals lost from the body as a result of the chemotherapy. It's an important part of treatment, as the dehydration can make patients feel dizzy and lightheaded when they're going about daily activities.
Day Eight calls for another outpatient visit to Dana-Farber for the second IP infusion of the cycle; this time it's Taxol delivered through the access port and catheter into the abdomen. The next two weeks are free of chemotherapy, until the next cycle begins with another three-day stay at BWH.
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