Cancer technology: The chemo port
“I’ll get you scheduled for a port surgery. Mine came out pretty. You’ll like it.” My doctor’s words landed with a dull thud. Numb, I jotted it down in the pink notebook where I had begun recording details of my medical appointments. In the initial days following my first cancer diagnosis, I wandered around in a fog, trying to grasp the enormity of how my life had changed in the space of a few hours. I understood that the port had relevance to cancer treatment, but I had no idea why I needed one or even that it was connected to chemotherapy. Later, when the scheduler patiently explained the instructions for the procedure, it didn’t occur to me to inquire about its function. If it was “pretty;” I was sold. Little did I know that the chemo port was about to become my best friend.
Until recently, chemo was delivered via an IV in the arm. This approach resulted in much suffering as veins collapse from overuse, and some forms of chemo are so toxic that they burn as they enter the arm. Even before cancer, I developed a reputation as a “hard stick” and was a poor candidate for chemo delivered the old-fashioned way. A vein-finding apparatus and accompanying expert often made an appearance whenever I needed an IV. New technologies have radically altered the landscape for cancer patients, especially those with small or difficult-to-locate veins.
Although there are many places in the world where ports are not available or considered as the standard of care, they are widely used in the US as a vehicle to deliver chemo. Some patients choose to forego a port, perhaps because they have a relatively small number of infusions. Oncology nurses commented that men frequently refuse chemo ports, much to the chagrin of the medical staff who often struggle to find suitable veins. One afternoon I observed several infusion nurses attempt to locate a vein in an older man, and the entire group quickly became exasperated. A nurse quietly mentioned that he had declined a port, which would have avoided the entire fiasco. During the thick of the COVID pandemic, some newly diagnosed patients had a difficult time arranging for a port placement as non-essential surgical procedures were often delayed or canceled. This meant that some who desired a port had to start chemo without it.
Chemo going through veins versus ports is analogous to the difference between rotary telephones, the ones with a curly cord and dial wheel, and today’s sleek cell phones. When I was young, phones were secured to walls or stationed atop desks. Teenagers stretched cords under shut doors in a bid for privacy, sometimes yanking the entire contraption from the wall. We never imagined a communication device the size of a postcard that also contained the wonders of the entire Encyclopedia Britannica, whose volumes once commandeered nearly the entire real estate of the bedroom bookshelf. Cell phones completely changed our lives, in the same way that chemo ports represent a quantum leap for cancer treatment.
The port, implanted just below the skin in my upper chest during a procedure with light anesthesia, administered all infusion chemo through its efficient reservoir, meaning no one wasted time trying to locate a suitable vein in my arm. Power ports, which are built to handle contrast, circumvent the need for an IV for CT scans. This technology proved immensely useful after I developed bilateral lymphedema, and the only option for IV placement was in my foot. Not desirable! I have proudly housed two ports, residing on opposite sides of my chest during each of my two diagnoses. After my first port placement, I awoke from the anesthesia and, while still groggy, told my doctor that I loved her. I DID love her, as she had just saved my life, but I don’t think that is what she expected to hear. MD Anderson Cancer Center in Houston employs the much-loved Dr. Ervin Brown, who sings to his patients during port placement and holds some sort of record for completing an astonishing number of port surgeries. He sang for one of my friends as he implanted her port, later emailing his recordings of “I’ve got you under my skin” and “What a Wonderful World.”
After I completed treatment for the first cancer, the port was extricated amid a cloud of smoke as it had settled into my chest and was reluctant to leave. Implanted devices quickly become at home in the body, nestling within tissue and skin. Under a local anesthetic, I didn’t feel a thing when they “burned” it out of the hollow beneath my clavicle.
Upon my second diagnosis, a next-generation port went in, which was slightly smaller than the first; about the size of a quarter. Because ports are connected to a large vein near the heart, only trained nurses can access them for delivery of pre-meds, chemo, or contrast for scans. The procedure to access them must be completely sterile lest an infection be introduced to a highly vulnerable area of the body. Unwrapping a port access kit takes on a ritual-like quality among the nursing staff. I would be ushered into a small room and the nurse would begin the prep for port access. Tidily packed, each kit includes its own sterile gloves and face mask, a needle that will pierce the port, and a syringe, gauze, dressing and prep pad. A common trick of cancer patients is to apply lidocaine about an hour before port access, covering it up with a piece of saran wrap. By the time the nurse leans over with the needle, the site is numb. The labs necessary for chemo to proceed are extracted via the port, which is left accessed for infusion a few hours later.
On occasion, the port became clogged and I needed “port yoga” to open it up. A typical routine involved leaning as far back as possible in the recliner, lifting my arms and turning my head from one side to the other. I alternately faced the wall and then the nurse. I talked in a random stream of words. I took deep breaths and coughed. I leaned forward with my arms flung back as though I intended to leap from a cliff. I rolled onto my side. By the time we reached this level, a call would go into the Pharmacy to request TPA which arrives frozen and is used to dissolve blood clots that block the port. After sitting quietly for an hour, the TPA always opened things up.
Once ensconced in the infusion chair, the nurses would connect the port with the chemo pole. I often joked that I was “mainlining” toxic medications, although I never experienced any discomfort as they came on board. I occasionally entertained an irrational fear of being attacked by someone who would inject drugs through my port, although the assailant would need to be a trained RN in order to pull it off. Not likely, I would remind myself whenever the thought arose.
I didn’t think much about the origins of my chemo port until I discovered that BD, a company specializing in developing port technologies, maintains a substantial workforce in an office only a few miles from my home. Through various cancer connections, I have met numerous BD employees, people who dedicate entire careers to improving the lives of cancer patients. One year I attended a portion of their sales conference, during which new technologies were highlighted, and sat alongside sales reps as they familiarized themselves with newly designed ports and biopsy tools. As the proud owner of a BD port, I found its backstory fascinating.
My current BD port will hopefully stay put for years to come. With a diagnosis of bilateral lymphedema, blood draws cannot be done from my arms. If I cannot use the port, blood must be drawn from my feet, a procedure dreaded by nurses and patients alike. Some providers have been kicked by patients, and the entire top of my foot turned purple and yellow after one botched blood draw.
There is never a good time for a cancer diagnosis but science and technology have moved the needle to make our treatment experiences easier. A chemo port may not be “pretty” in the conventional sense, but I consider mine a stunning achievement of modern-day craftsmanship.