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Thread: Chemo through IVs or have a Port installed?

  1. #1
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    Chemo through IVs or have a Port installed?

    One of the first decisions at the start of chemo is attempting the treatments via IVs to the arm veins or to have an infusion port installed. As a starting point I will describe my experience, but am hoping that others will add expertise and experience to help those facing this decision in the future.

    I was diagnosed in Feb with acute AITL stage 3B. The oncologist indicated that untreated that I had 4-6 months and that I needed to immediately have a port installed for 6 cycles of CHOP followed by a stem cell transplant. Since this diagnosis was while we were away from our primary home I was given a megadose of dexamethasone which put things into temporary remission and allowed us to travel home and enter care at what is recognized as one of the leading US healthcare facilities. After their own review of all of the biopsy slides and PET scan results their recommendation was the same, 6 cycles of CHOP and a stem cell transplant. However, their approach was not to install a port but to do the chemo via IVs because of infection risks with a port and because it "looked like I had good veins in my arms and their team was expert in installing IVs".

    What followed has been a challenging experience. The first two infusions in alternating arms were fine and done with one stick. An unfortunate infection followed which required a four day hospital stay during which there were blood draws more than one per day. These were done by a team which frequently needed multiple sticks to hit a vein, sometimes missing two times out of three. This started a downward spiral. My third CHOP cycle required three sticks to find a vein. After the third cycle there is a CT scan with contrast to verify that the protocol is having the intended affect. The contrast agent is injected under pressure. The IV techs were able to find veins and get good blood draws, but when they tested saline injections under pressure the veins would rupture. Evidently this was either due to the weakened condition of my arm veins due to the chemo or the repeated perforations or both. What followed was installing a temporary midpoint port in my upper arm to complete the scan.

    Needless to say an internal infusion port has now been installed and 2 days later used for my fourth cycle of CHOP. The port install went smoothly and accessing it for my infusion was almost painless. Very much regretting that, in my case, I did not have the internal port installed up front, as originally recommended. Given the nature of this disease and the treatment plan and follow up monitoring I have to imagine that I will have frequent blood draws and potential future treatments. My reaction is to leave this port in for a good long time!

  2. #2
    Super Moderator Top User po18guy's Avatar
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    Port. Hands down winner. Had one or the other (different purposes) for 10 years - not a single problem. The chemo is immediately diluted in some of the largest veins in your body. Arm veins are tiny by comparison and suffer much more damage because a much higher concentration of chemo flows through them. A single leak of I. V. chemo outside of your vein can cause necrosis.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
    Moderator Senior User IndyLou's Avatar
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    Jan 2014
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    When I was about to receive my targeted therapy for head and neck cancer (cetuximab, for 8 weekly cycles), I was concurrently receiving a PEG feeding tube, for nutrition. They gave me the choice of whether or not to receive a port; as I already had the feeding tube installed, I didn't want to "have too many devices attached to my body."

    It was an un-scientific decision, based on squeamishness, but I did what I did.

    For the first few weeks, things went fine. I did my weekly blood draw, and then the nurses prepped me for my IV infusion, typically on the inside of my left arm. During the prep for my fourth cycle, I wasn't eating all that well, nor was I fully using my feeding tube like I should have. I was becoming dehydrated, and it was difficult for the nurse to find a vein.

    I'm sure many on these boards are familiar with the IV setup. The catheter was inserted and re-inserted into my vein. We thought the insertion was successful, and then I had a blowout. The nurse kept describing what she was doing--poke, poke, "oh, almost there...it's just not going in!"

    I was miserable, and I asked her to "stop with the play-by-play descriptions." At one point, I could feel the catheter tip rolling off whatever vein was in my arm. The pain was excruciating, but I didn't have the energy to complain. I asked her to go get another nurse with more experience, and she did. Finally, the next nurse got an IV inserted into a vein on the back of my hand/wrist.

    The experience taught me that maybe a port would've been easier, but also to watch my hydration levels, and start using my feeding tube more regularly.
    Age 52 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED
    Spring 2019 - NED

  4. #4
    Regular User
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    Jan 2018
    Posts
    40
    My husband had his RCHOP without a port and had no problems, but he has excellent veins. If you have already had difficulties it might be worth considering a port.

  5. #5
    Regular User
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    Nov 2015
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    20
    Port! No question in my mind! Hopefully I’ll never need mine again, but if something happens I would have a port put in right away!

    Sharon
    Female 58, Diagnosed Sept 2015 DLBCL stage 4b. Liver, breast
    #6 and final R-Chop Jan 5th, 2016.
    3rd and final IV Methotrexate Jan 19th
    Mid cycle CT showed excellent response
    PET Feb 2016 clear. remission
    JUne 2016 routine CT and PET confirmed relapse
    R-ICE July 2016
    R-ICE completed Aug 2016. PET clean after #2.
    5.8 million cells collected for the SCT Sept 6th, 2016
    BEAM starting Sept 20th, 2016
    Autogolous SCT with day 0 Sept 27th, 2016
    2-2017 Lung issues most likely caused by bendamustine
    3+ months of high dose Prednisone. - cleared up the lung issues.
    June 2017 pneumonia
    July- Sept bowel issues, lactose intolerant?
    1year mark SCT, Sept 27th, 2017
    November, 2017 A trip to Sicily
    November 2017, Pneumonia again
    December 4th, 2017 CT still clear
    3 mo. CT scan schedule continues
    March 2018 shingles ( 3 months after stopping acyclovir)
    May - Present 2018 waxing and waining numerous lung nodules - no explanation but closely being monitored

  6. #6
    Regular User
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    Feb 2012
    Posts
    17
    I agree get the port for cemo

 

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