What happens during a chemotherapy session?

So the day has arrived and your date with chemotherapy is here.  Are you scared, worried, relieved that something is happening and have no clue what to expect?  Welcome to the Club!  I was petrified!  I would suggest you take somebody with you - to be a chemo buddy.  My husband came to every one apart from one time when my best friend stepped in.  It's really reassuring to have another set of eyes and ears with you because you probably won't take everything in.  After treatment you may also feel a bit wobbly or tired so it's advised you don't drive yourself home.  In truth, I think I probably could drive home as my side effects don't kick in for a few hours BUT I'd rather not chance it and would suggest you don't either.  You will probably be at the hospital for around 3 hours for each treatment (but most of this is preparation and the chemo itself is only about 30 minutes to an hour).

Let me walk you through what will happen - obviously hospitals do things differently but broadly speaking this is what will happen.

  • You may already have met your Chemotherapy nurse but you may not have done.  Chemotherapy nurses are worth their weight in gold.  They've seen people at their most vulnerable and they understand that you're scared.  You won't be the first or the last to cry all the way through your first or other sessions.  One thing about chemotherapy nurses is that they are usually really personable.  They will try to put you at ease.  If you're lucky, you'll have the same one each time (or a combination of a few). 
  • You will be shown to a room (it may be on your own or with others) but there will be a comfy reclining chair or a bed and usually you will have your blood taken - sometimes you have to go the day before to have this done but it can also be done on the day of chemotherapy.  No treatment will start until your blood comes back because that will tell the doctor and nurses whether you are strong and well enough for chemo.  (By the way, I never see my oncologist at these appointments - I only see the nurses but they are in constant contact with him so if they (or you) are worried about something the oncologist can normally be contacted).  With your blood, the levels they are looking at are your red and white blood cells, platelets and something called Neuts.  You will also be given a chemotherapy book that you take to each appointment and the nurses will write in it what you've had and the results of your blood work.  There's also a red/amber/green chart that tells you what to do if you get any side effects (don't be alarmed when reading that chart - it can be a bit daunting).
  • When your bloods are back and they're ok, you will have your "obs" taken ie your blood pressure, temperature and weight (and height if it's your first appointment).
  • Now the order of what comes next may vary depending on your treatment plan (ie the type of chemotherapy you're having).  If you don't have a port or line in, the nurses will find a suitable vein for the chemotherapy (usually your arm that hasn't had nodes removed).  If blood is taken on the same day they'll only put a line in once and will take the blood out and later put the chemotherapy in.  If you have got a Picc/Hickman or Portacath line, this will be flushed so it's ready to receive the chemotherapy - this is done by attaching a syringe to your line/port and literally flushing it through with saline.  You don't usually feel this but the thought of it is a bit yuck!  I had my first two cycles in my arm but I have bouncy veins and they had trouble accessing them so the Nurses wanted me to have a Portacath put in (I'll detail that elsewhere).  I'm very glad I have got the port because after my second chemo treatment the vein in my arm that was used collapsed.  One day, overnight, it suddenly looked dark brown and as I moved my arm it was sore, pulled and felt very tight.  Unfortunately chemo can damage veins (although they do recover but could take a few years) so if you're offered a line or portacath I would suggest going for it.  It does make life easier (and safer) for you.  A Picc/Hickman or Portacath can be left in during all of your treatment and beyond if necessary so it's a one time pain but for long term gain!
  • Okay, so you've got a line in (whether temporary for the day or a more permanent one) so you will probably have saline attached via a drip and you'll be hydrated through that.  It probably takes about 30 minutes but you can sit there, read a book, chat to friends or watch some telly.  You may also want to eat and drink and that's fine.  I always make sure I drink all the way through my treatment to help move the chemo around my body.
  • Around this time you will be given anti-sickness drugs and steroids (either in tablet or drip form).  Steroids are given to most patients because they dampen down the side effects so you're more comfortable during the first few days after treatment.  They can make you feel quite awake though and a common side effect is trouble sleeping for a night or two.  As I'm diabetic, I'm not given steroids so my side effects kick in a few hours after each session.
  • Up until this point on my first cycle of chemotherapy, I  held it together but then came the time for chemo.  I was scared stiff.  Not just scared actually - terrified.  This is normal.  Absolutely normal.  If you think about it, you're being injected (willingly) with a poison HOWEVER that poison is going to save your life so as I told myself "suck it up cupcake"! 
  • For FEC and EC (although it may be different for other drugs), the nurse has a few syringes full of the different drugs (quite big syringes) and he/she will sit with you while injecting into your line.  They will chat with you all the time and when it's over, you'll wonder what all the fuss was about (until the next time when you'll probably panic again).  I can't stress enough that THE NURSES ARE WITH YOU ALL THE TIME.  You are in safe hands!
  • Once the chemo is in your body, the drip is changed to flush things through again and then the line will be taken out (or the line/port disconnected) and you're free to go home. 
  • If you've had the "E" part of chemotherapy, Epirubicin, it's a red colour - and you'll see that in the syringe - but one side effect is that you wee out red for the first time after you go to the toilet.  Don't be alarmed - it's normal! 
  • For some other chemotherapy drugs, they aren't injected via a syringe but they're in a bag attached to a drip - so in some ways, it just feels like saline is going in!
  • You may also have an injection into your tummy after treatment.  This helps you to fight off infection and build up your blood work.  However this is only given with some regimes so you may not have this.  It doesn't hurt actually and is surprisingly quick.  After you've had chemo you probably won't care anyway when they approach you with another needle!  What you may need to be prepared for is that at some hospitals, you may be given injections to take home for you to self administer.  Now I can tell you from experience of being a diabetic, being asked to self inject is like being asked to stick pins in your eyes!  It's not something that you'd willingly want to do lol!  However, let me give you some tips - if you're injecting into the tummy area, when you put the needle in, if it hurts (like a nasty pin prick), take the needle out again (without injecting).  Move the needle about an inch to the right or left and try again.  You may find that it slides in without hurting.  I promise you, you will get used to this.
  • You've done it!  It's over!  The nurses will give you anti sickness medication to take home and also instructions on how to contact the if you're worried (there's always a chemo hotline for each hospital).  YOU ARE NOT ON YOUR OWN WHEN YOU GO HOME.  The chemo nurses/hotline are always there for you.  My Nurse phoned me the day after chemo to see how I was and I kept in touch by text for a few days as well.  You will feel "odd" and apprehensive but just look at it this way ..... at any one time there are loads of people going through chemotherapy.  If you have any side effects, the nurses can give you tablets for them and if the tablets give you side effects, they have more tablets for that too!  Don't be afraid to ask.