What are ports and vascular access devices? Do I need one?
Vascular access devices (VADs, central venous catheters, ports) can make it easier and safer for you to get your treatment. They are not always necessary, but, if you are like most chemotherapy patients, once you have one, you will like it.
Intravenous chemotherapy and repeated blood draws can make your veins fragile. It often becomes hard for the nurse to find your vein. This can be very stressful and uncomfortable for you. If some chemotherapy drugs leak out of a fragile vein, they can damage your soft tissues. A VAD is a special thin tube (catheter) placed under the skin and inserted into a large vein in your chest. This is an outpatient procedure. A surgeon or radiologist will thread the catheter through a vein in your chest, or sometimes your arm, until it reaches a large vein near the heart. The catheter may be left in place for a number of months or years until it is no longer needed.
Complications are rare, but as with any operation, no matter how minor, complications are possible.
These include:
• Bleeding. This may occur when the catheter is inserted into the vein.
• Collapsed lung (pneumothorax). The risk of a collapsed lung varies with the skill of the person inserting the catheter and the site of placement. It is most likely to happen during placement of a catheter in the chest, although the risk is still small.
• Infection. This risk is present for as long as the catheter is in your body. It may require treatment with antibiotics in the hospital or removal of the catheter.
• Blockage or kinking of the catheter. A kinked or blocked catheter may need to be repositioned or replaced. Regular flushing of the catheter helps reduce blockage.
• Pain. You may experience pain at the place where the catheter is inserted or where it lies under your skin. This usually disappears a few days after the catheter has been in.
• Shifting of the catheter. A catheter that has moved out of place can sometimes be repositioned, but if this does not work, it must be replaced.
There are several different types of VADs. They are: Implantable port-a hollow round disk, about the size of a quarter, is placed under the skin, usually on the chest wall under the collarbone. To access the device, the nurse inserts a special needle through the skin into the port. If this hurts you, she can apply a numbing cream to the skin before she inserts the needle. A nurse must flush the device once a month to prevent it from clotting. No other care is required between treatments. Since this device is completely under the skin, you can shower and bathe with no worries.
Rather than being buried under the skin, the external catheter (Hickman or PICC line) tube exits the chest wall, usually under the collarbone. These catheters require frequent flushing and dressings. Your nurse will teach you how to change this dressing and care for the catheter. Since the end of the catheter is exposed, there is a slightly higher risk of infection than with the implantable catheter, and you will need to take special precautions when you shower or bathe. External PICC lines (peripherally inserted central catheter) are useful for short-term use or as a temporary measure until your doctor can have an implantable port placed.
Long-term external catheters (Hickman) are useful when giving chemotherapy continually or in patients who are “needle phobic” and unable to tolerate the needle sticks required to access an implantable port. In addition to their use in administering chemotherapy, you can get IV fluids, antibiotics, bisphosphonates, and blood products through the VAD. You can usually get blood drawn from the port, so you will be able to avoid frequent needle sticks for blood tests.
Do I have a choice of how I want to get my chemotherapy?
Chemotherapy is usually given in your veins, but sometimes it can be taken by mouth or as an intramuscular injection. You usually do not have a choice as to how it is given. Very few chemotherapeutic drugs are available as pills. Your doctor will pick the best chemotherapy for you based on where your cancer metastases are, your overall medical condition, and past treatment. People usually think that pills have fewer side effects than intravenous treatment, but this is not always the case. In fact, it is sometimes easier to control the dose and the side effects of intravenous chemotherapy. The side effects of chemotherapy depend on the properties of the drug, not on how you take it. Today, capecitabine is the most frequently used oral chemotherapeutic agent in treating breast cancer. Your oncologist decides how many pills you should take based on your height and weight. You usually take capecitabine twice a day for 2 weeks of a 3-week cycle, but your doctor may decide some other frequency is better for you.
The side effects of chemotherapy depend on the properties of the drug, not on how you take it.
What is a chemotherapy cycle?
Oncologists give chemotherapy according to a particular schedule that is based on the type of cancer being treated and the particular drugs being used. Chemotherapy may be given daily, weekly, every 2 to 3 weeks, or monthly. These treatment days are followed by rest days to allow your body time to recover from the effects of chemotherapy. This schedule of treatment and rest days is a cycle. There usually is no choice on the interval or for how many days of the cycle you will receive chemotherapy. Your oncologist will decide how many cycles of chemotherapy to give you based on how well your cancer responds to treatment, and on the side effects that you experience.
They may give it for a set number of cycles, but when treating metastatic breast cancer, oncologists usually continue treatment as long as it is working.
How will the doctors determine if the chemotherapy is working?
It usually takes two or three cycles of chemotherapy before your oncologist will know if it is working. After two or three cycles, your oncologist will repeat your scans to see if your metastases have gotten bigger or smaller. If there are new metastases or the ones that you have now are bigger, your oncologist will stop the treatment that you are taking, and discuss alternative forms of treatment with you. It does not make any sense to continue with a treatment regimen that is not working. You and your oncologist should be thrilled if the size and number of your metastases is smaller, but you should also be pleased if your cancer has not gotten any worse. Without treatment, metastatic breast cancer progresses, and, after a couple of months, if it is stable, it is probably because the chemotherapy has stopped it from growing. It is quite possible that there will be less cancer the next time your doctor repeats the scans.
“Stable or improved disease” is the definition of success that you and your oncologist should use to assess how well the chemotherapy is working. It sometimes takes a couple of months to see this, and that is why you have to wait before you repeat the scans. However, if it is obvious from your doctor’s examination that the cancer is growing at a fast pace, even after one cycle therapy, there is probably no reason to continue it. You or your oncologist might also stop the chemotherapy if you are It is essential that you understand how your oncologist will determine if the chemotherapy is working. You should know when the doctor will make this assessment, and how. It may not always be necessary to do a scan. If, for example, your doctor can feel an enlarged lymph node in your neck, she will measure this with a ruler each time you come for a visit. If you have cancer in your liver, your liver blood tests may be elevated, and your doctor can follow these to know if you are responding to treatment.
Even in these situations, your oncologist will probably want to repeat scans from time to time, so that she can more fully assess your response to chemotherapy. In addition to measuring the amount and size of your metastases, your oncologist may also use your symptoms to know if the chemotherapy is working. If the chemotherapy makes you feel better, this is usually a sign that it is working. Good clinical signs that the chemotherapy is working include pain that improves with chemotherapy, a poor appetite or weight loss that is now better, or feeling less tired.
In summary, the definition of “working” is when the cancer is not getting any worse. Oncologists generally continue giving chemotherapy as long as it is working, or until you have unacceptable side effects. You should expect your doctor to assess this every two to three cycles of chemotherapy. Sometimes this assessment is spread out a bit after you have had more chemotherapy having unusually severe side effects.
“Stable or improved disease” is the definition of success that you and your oncologist should use to assess how well the chemotherapy is working.
Term:
Lymph nodes – Tissues in the lymphatic system that filter lymph fluid and help the immune system fight disease.
