Interview with Heather Wakelee, MD
Dr Wakelee is Assistant Professor of Medicine in the Division of Oncology at Stanford University in Stanford, California.
DR LOVE: Now these drugs are given intravenously and I know a lot of patients get a so-called port. Can you explain what that is and when you use it?
DR WAKELEE: Sure. There’s a lot of variability in that, but what it is is a device that is put in by a surgeon that has a reservoir where a needle can be put into that reservoir, which is under the skin and then is put directly into a vein, a large vein. And so what it is is patients just have a bump under the skin, but it’s a bump that if a needle is put in it, the right proper kind of needle, the nurses are able to pull blood out and put the medications in without having to hunt around for a vein and then that access device can be taken out after the completion of chemotherapy.
I’ve found though that for most patients only requiring four months of treatment, so it’s at most eight different times that they’re coming in, most of them don’t require that when we’re talking about this kind of therapy. Most of them are able to get by with just having an IV started each time or something called a PICC – peripherally inserted central catheter – and those are very, very long catheters. They’re basically IV tubes, but they’re started in the elbow region and then it’s very long tunneled into one of the bigger blood vessels. It’s something down as an outpatient and it means that the patients have a – basically a tube sticking out of their arm for that three-month period and you have to be careful when you’re swimming or taking a shower, but pretty easy to take care of for almost everybody and then it’s just taken out. It doesn’t leave any scars or any significant problems. And so there are things that we’re able to do for patients with difficulty with IVs.
When we’re talking about some of the experimental regimens where you need a full year of treatment, that can become more of an issue, but I find that for my patients with metastatic lung cancer where we’re routinely giving care for a year or up to two, many of them don’t need those access devices, especially if they’re younger.