Lymphoma

Chemotherapy

For many people chemotherapy has an emotive association with cancer. As one woman said, the first treatment was 'when it really hit me what was really happening to me'. Chemotherapy is the use of cytotoxic drugs to destroy cancer cells. Because cancer cells are dividing quickly they are particularly susceptible to chemotherapy. Chemotherapy is the first line treatment for most types of lymphoma and is sometimes used in combination with radiotherapy or immunotherapy.

A combination of several drugs is normally given over several days followed by a gap of a few weeks (known as a 'cycle' of treatment). It allows the body and blood cells time to recover from any side effects before the next treatment. Treatment will probably last for several months with regular check-ups.

Many different cytotoxic drugs exist and often a combination of several is used. These 'combination chemotherapies' are known by abbreviations such as ABVD, a combination chemotherapy used for Hodgkin lymphoma, and CHOP a combination chemotherapy for non-Hodgkin lymphoma (NHL). (For a list of combination chemotherapies for Hodgkin and non- Hodgkin lymphoma see Macmillan Cancer Support). Chemotherapy may also be used to treat relapsed disease and in high dose form as preparation for stem cell transplants (see 'High dose therapy and stem cell transplantation').

People with advanced low grade NHL may be treated with chemotherapy in tablet form, which can be taken at home. One woman said that the pills were also a visible aid in explaining to her four-year-old child about her illness and its treatment. A typical treatment regimen involves taking tablets daily for two weeks followed by two weeks' break, and repeating this pattern for about six months. Some people we spoke to were treated with a combination of tablet and intravenous chemotherapy.

Intravenous chemotherapy is most commonly given in an outpatient clinic, but some people are kept in overnight. Patients who are very ill may be treated in hospital. Outpatient treatment typically involves spending a few hours in hospital having blood counts checked (see 'Blood cell counts and infection risk') followed by infusion of the drugs from a syringe or a bag into a vein in the hand or arm. The large size of the syringes alarmed some people.

Different drugs take different times to infuse and some are infused more slowly the first time. For some people it took 30 - 60 minutes, others were at the hospital most of the day. Some people saved time by having their blood taken at their GP's surgery the day before treatment. A typical treatment regimen would be one dose of chemotherapy every 2 - 3 weeks for six months. People were often anxious before their first treatment session because they didn't know what to expect, and some young people came to their first treatment session accompanied by several family members. People who lived close enough to walk to the hospital were glad because they wouldn't have felt able to drive home after treatment. One man did drive but had to get home quickly before he started to feel the effects of treatment.

The planned chemotherapy regimen didn't always work and some people had to have more treatments than originally planned or were started on a different drug combination. One person had fewer treatments than expected. A man who lived in a rural area had a treatment delayed because his car broke down and he could not get to the hospital. A woman became anxious when her treatment started late because a doctor hadn't signed a consent form, and again during another treatment when she had hoped to get away promptly but her drip kept falling out.

With repeated use veins collapse and harden and several people said that staff had difficulty inserting needles. Some people had a 'central line' (e.g. a Hickman or PICC) inserted into a vein in the chest or arm, which avoids repeated needles and makes it easier to give drugs and take blood samples. Problems can occur during insertion or removal of central lines, for example a man had one of his lungs accidentally punctured when his Hickman line was removed, though he recovered quite quickly. Central lines were usually left in throughout the treatment period and had to be regularly cleaned with a sterile liquid. Some people attended clinic weekly for this while others learned how to clean their central line themselves. Central lines commonly became infected and had to be flushed with an antibiotic or removed and replaced. One woman told us that her central line broke before her last treatment and her doctor wanted to give the treatment through a fine plastic cannula in her arm. She didn't like needles and was grateful that a nurse insisted on fitting a new line. 

Some people had their chemotherapy administered from a pump attached to their central line so that they could go about their daily business while the drugs were infused, but a woman said the regular noise of the pump made it difficult to sleep. Others said dressing was difficult with a central line in place and that they had to avoid getting it wet. Swimming was therefore banned and a young man was also told he should not play football but he did so anyway, with care, in order to feel normal. Many people said they had not originally liked the idea of having a central line but appreciated the benefits. 

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A central line can make people feel vulnerable. One woman's central line was very exposed and she hated having 'a tube hanging out of my boob'. When treatment finishes people often want the line removed as soon as possible. A man whose line was not scheduled to be removed quickly decided to have it done privately because he was 'so desperate' to have it removed. 

Chemotherapy can also be given using an implantable port, which is sometimes called a portacath or subcutaneous port. It consists of a thin flexible tube placed in a large vein, connected to a small chamber or “port” implanted under the skin of the chest, or sometimes the upper arm. Implantable ports are often used to give chemotherapy treatment and/or other medicines to both adults and children with cancer

Some kinds of NHL may involve the brain and spinal cord and can be treated by injecting chemotherapy into the fluid that surrounds the spinal cord using a technique called a lumbar puncture. Several people had alternate doses of this 'intrathecal' chemotherapy and intravenous chemotherapy. A man had to be sedated because of difficulties inserting the needle in his spine, but he enjoyed being able to sleep for the first few hours after treatment when he would otherwise be feeling at his worst.

Several people said that the chemotherapy treatment units had a friendly atmosphere and that the nurses were very helpful and supportive. They could also get refreshments if they wanted them. Many enjoyed chatting to other patients and sharing a joke and likened it to having a little support group or family. One said, 'It really was a happy place considering what was going on there', and another declined the offer of a single room preferring to be with other people. A woman met two people she already knew among the other patients. 

For more information see our Resources.

Last reviewed February 2016.
Last updated February 2016.

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