Why Does Chemo Take So Long?

by Jane Ashley

Chemotherapy is one of the most feared aspects of cancer treatment. We’re are afraid of the side effects — we are afraid that it may not work — and we don’t understand the process that occurs on “chemo day.”

Chemo Center Wait

After our first infusion, we have a new question, “Why does it take so long to get our chemotherapy?”

Many people work together to ensure that your chemotherapy session is as safe as possible. Once we understand the process, it may be easier for us to understand why our chemo may require three, four or more hours to complete.

Before You Begin Chemo

Before you even begin chemo, work begins on your behalf. Many items have to be coordinated, including:
Additional lab work

• Scheduling implanting a port or PICC line
• Additional imagining scans
• Waiting for biopsy results
• Pre-authorization of patient’s insurance

Patients experience frustration and anxiety when their chemotherapy is delayed. Waiting for biopsy results, port placement or insurance authorization are common reasons that your first chemo may be delayed. Don’t worry about a slight delay — most cancers are slow-growing, and a delay shouldn’t affect your outcome.

Upon Arrival at the Chemo Center

Soon after checking in on chemo day, a nurse gets your vital signs and accesses your port. [What is a Port And Why You Will Want One]

The nurse draws blood for lab results — our blood count numbers have to be within a certain range for us to safely receive our chemo. If our blood counts are too low, the oncologist might cancel our chemo and tell us to come back in a week.

Sometimes, the nurse will also ask for a urine sample — if we have protein in our urine, some chemo drugs can’t be administered. 

Stool Sample Don't forget to offer a "stool sample".

Once all of this is done, patients usually proceed to a “sub-waiting room” — where they wait with other patients as their lab work is completed and given to their oncologist.

Visit with Oncologist or Nurse Practitioner

Once we’re called back to see our oncologist or nurse practitioner, we learn our laboratory results.
I’ll never forget my fourth chemo visit with my oncologist. She walked in and said, “No chemo for you today.” In shock, I asked, “Why not?”

It turns out that my neutrophil (a specialized kind of white cell that fights infection) has fallen dangerously low. The technical term for my condition was neutropenic.  [What is Neutropenia]

I was sent back home on antibiotics and advised to follow a neutropenic diet (not eat unpeeled fruit or raw veggies or rare steak). My oncologist told me to come back the following week, and we’d see if my blood counts had recovered enough to have chemo the next week. For some patients, it only takes a week for blood counts to recover; for others, it takes a full two weeks.

Once cleared for chemo, the oncologist or nurse practitioner sends the medication order to the pharmacy, located on-site but usually not visible to patients.

At the Pharmacy

The chemotherapy pharmacy is a specialized pharmacy where specially-trained oncology pharmacists prepare each patient’s chemotherapy bags. Chemotherapy is mixed under sterile conditions because it’s going directly into your bloodstream. The rooms are called “clean” rooms where even the airflow going into the room is carefully filtered. The actual handling of the chemo drugs is performed in an “isolator.” The pharmacist wears a coverall made of specialized fabric, protective overshoes, a mask and a cap for their head. They must wear two layers of protective gloves. Pharmacists can’t wear make-up. They can’t work if they show any indication that they have an infection.

Mixing Chemo

Continuous monitoring on a daily, monthly and annual basis ensure the safety of this specialized pharmacy. About 30-to-90 minutes is required to make each dose of chemo, depending on how many drugs are needed. (Patients get pre-meds to lessen nausea or prevent other side effects and then one or more chemo or targeted therapy drugs.)

Once you’re cleared to receive your chemo, here are the steps that needed for every chemo patient … day in and day out. Their work is complex and demanding.

1. Your oncologist writes a prescription.
2. Her nurse reviews it and sends it to the pharmacy.
3. The lead pharmacist checks the prescription to be sure it’s correct based on your lab results. Your prescription goes into their computer, and it generates personalized labels for your chemo.
4. A specialized pharmacy tech gathers all of the supplies needed and records lot numbers and expiration dates to ensure accountability of all components of your chemo.
5. The supplies including labels are disinfected before they arrive at the “clean” room.
6. The oncology pharmacist makes your chemotherapy drugs, measures your dosage from the vial and injects it into a bag of fluids. The bag is gently handled to ensure full mixing so that your chemo drugs are evenly distributed throughout the bag of fluids. Then the labels are affixed.
7. Your chemo bags are checked for correctness and sent to chemotherapy room.

Esbe Scientific Chemo Isolator

In the Infusion Room

Once your chemo arrives, your nurse confirms your identity to check against the labels on the chemo bags. Patients receive their pre-meds first … anti-nausea meds and anti-allergy medicines may make you drowsy … steroids might make you peppy and energized. Each person’s chemo cocktail is different, designed for your particular circumstances.

If you’re having more than one chemo drug, they infuse each one separately — if you had all the drugs at once and experienced a reaction, your team would not know which medicine caused the reaction.

Patients usually stay an additional 30 minutes, to be sure that you don’t suffer any reactions. Always have someone to drive you home after your first chemo since you have no idea if you will have any reactions or be too sleepy or tired to drive.

Chemo Nurses

You may notice that some patients who come in after you get their chemo started before you. Most likely, they only had to have one drug mixed or it was one that came pre-mixed. You see some patients who arrived after you that get finished before your infusion is complete. 

Again, that’s because they only had one chemo drug to infuse.

A patient’s first infusion session is likely to be the longest. The chemo nurses prefer to infuse the drugs more slowly the first time to help avoid any allergic reaction.  [24 Survivor's Tips to Better Handle Chemo and Radiation]

The Bottom Line …

So now you know why your chemo session takes so long. Bring along something to read, a doodle pad or a puzzle book. Dress comfortably. Ask your nurse for an extra blanket if you’re cold.  [Be Prepared-22 Things to Bring to Chemo]

Try your best not to be anxious if someone goes into before you or leaves earlier than you. Every patient is different, and our medications are mixed to exacting specifications for us. And now you know — the rest of the story.

Need more information about chemo or first hand experiences from people who have already been through it? Drop in at WhatNext and ask what you need to know. There are lots of people there willing to help you through it.

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