Editing Chemotherapy (section)

=== Delivery ===
[[File:Pediatric patients receiving chemotherapy.jpg|thumb|Two girls with [[acute lymphoblastic leukemia]] receiving chemotherapy. The girl on the left has a [[central venous catheter]] inserted in her neck. The girl on the right has a [[peripheral venous catheter]]. The arm board stabilizes the arm during needle insertion. Anti-cancer IV drip is seen at top right.]]
Most chemotherapy is [[Route of administration|delivered]] [[intravenous therapy|intravenously]], although a number of agents can be administered orally (e.g., [[melphalan]], [[busulfan]], [[capecitabine]]). According to a recent (2016) systematic review, oral therapies present additional challenges for patients and care teams to maintain and support adherence to treatment plans.<ref>{{cite journal | vauthors = Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF | display-authors = 6 | title = A Systematic Review of Adherence to Oral Antineoplastic Therapies | journal = The Oncologist | volume = 21 | issue = 3 | pages = 354–76 | date = March 2016 | pmid = 26921292 | pmc = 4786357 | doi = 10.1634/theoncologist.2015-0405 }}</ref>

There are many intravenous methods of drug delivery, known as vascular access devices. These include the [[Winged infusion set|winged infusion device]], [[peripheral venous catheter]], midline catheter, [[peripherally inserted central catheter]] (PICC), [[central venous catheter]] and [[implantable port]]. The devices have different applications regarding duration of chemotherapy treatment, method of delivery and types of chemotherapeutic agent.<ref name=Wood2005/>{{rp|94–95}}

Depending on the person, the cancer, the stage of cancer, the type of chemotherapy, and the dosage, intravenous chemotherapy may be given on either an [[inpatient]] or an [[outpatient]] basis. For continuous, frequent or prolonged intravenous chemotherapy administration, various systems may be surgically inserted into the vasculature to maintain access.<ref name=Wood2005/>{{rp|113–118}} Commonly used systems are the [[Hickman line]], the [[Port-a-Cath]], and the [[PICC line]]. These have a lower infection risk, are much less prone to [[phlebitis]] or [[extravasation]], and eliminate the need for repeated insertion of peripheral cannulae.<ref>{{Cite journal |last1=O'Grady |first1=Naomi P. |last2=Alexander |first2=Mary |last3=Burns |first3=Lillian A. |last4=Dellinger |first4=E. Patchen |last5=Garland |first5=Jeffrey |last6=Heard |first6=Stephen O. |last7=Lipsett |first7=Pamela A. |last8=Masur |first8=Henry |last9=Mermel |first9=Leonard A. |last10=Pearson |first10=Michele L. |last11=Raad |first11=Issam I. |last12=Randolph |first12=Adrienne G. |last13=Rupp |first13=Mark E. |last14=Saint |first14=Sanjay |date=2011-05-01 |title=Guidelines for the Prevention of Intravascular Catheter-related Infections |journal=Clinical Infectious Diseases|volume=52 |issue=9 |pages=e162–e193 |doi=10.1093/cid/cir257 |issn=1058-4838 |pmc=3106269 |pmid=21460264}}</ref>

[[Isolated limb perfusion]] (often used in [[melanoma]]),<ref name="pmid20348274">{{cite journal | vauthors = Moreno-Ramirez D, de la Cruz-Merino L, Ferrandiz L, Villegas-Portero R, Nieto-Garcia A | title = Isolated limb perfusion for malignant melanoma: systematic review on effectiveness and safety | journal = The Oncologist | volume = 15 | issue = 4 | pages = 416–27 | year = 2010 | pmid = 20348274 | pmc = 3227960 | doi = 10.1634/theoncologist.2009-0325 }}</ref> or isolated infusion of chemotherapy into the liver<ref name="pmid18722924">{{cite journal | vauthors = Verhoef C, de Wilt JH, ten Hagen TL, Eggermont AM | title = Isolated hepatic perfusion for the treatment of liver tumors: sunset or sunrise? | journal = Surgical Oncology Clinics of North America | volume = 17 | issue = 4 | pages = 877–94, xi | date = October 2008 | pmid = 18722924 | doi = 10.1016/j.soc.2008.04.007 }}</ref> or the lung have been used to treat some tumors. The main purpose of these approaches is to deliver a very high dose of chemotherapy to tumor sites without causing overwhelming systemic damage.<ref name="pmid10421507">{{cite journal | vauthors = Hendriks JM, Van Schil PE | title = Isolated lung perfusion for the treatment of pulmonary metastases | journal = Surgical Oncology | volume = 7 | issue = 1–2 | pages = 59–63 | year = 1998 | pmid = 10421507 | doi = 10.1016/S0960-7404(98)00028-0 }}</ref> These approaches can help control solitary or limited metastases, but they are by definition not systemic, and, therefore, do not treat distributed metastases or [[micrometastasis|micrometastases]].{{citation needed|date=December 2021}}

Topical chemotherapies, such as [[5-fluorouracil]], are used to treat some cases of [[non-melanoma skin cancer]].<ref>{{cite journal | vauthors = Chitwood K, Etzkorn J, Cohen G | title = Topical and intralesional treatment of nonmelanoma skin cancer: efficacy and cost comparisons | journal = Dermatologic Surgery | volume = 39 | issue = 9 | pages = 1306–16 | date = September 2013 | pmid = 23915332 | doi = 10.1111/dsu.12300 | s2cid = 597295 }}</ref>

If the cancer has [[central nervous system]] involvement, or with meningeal disease, [[intrathecal]] chemotherapy may be administered.<ref name=Corrie />