People with cancer

L I N D A M I L L E R , R N , O C N M E T R O H E A L T H C A N C E R C A R E C E N T E R

Statistics American Cancer Society estimates for 2014  In US 1,665,540 new cases    In US 585,720 deaths In Ohio 67,000 new cases Cancer is the 2 nd most common cause of death in the US, responsible for 1 in 4 deaths

Statistics    By 2030 expect 2.3 million new cases annually in US By 2030 cancer will be leading cause of death People living at least 5 years after cancer diagnosis   1970s 50% Currently 66%

Cancer treatments Modes of treatment  Surgery   Radiation Chemotherapy Treatment with single mode or multiple modes  Example of multi-modal: Breast cancer (radiation to reduce tumor prior to surgery, chemotherapy after surgery)

Chemotherapy      Usually given in outpatient setting Prevents cancer cells from metastasizing Systemic therapy  Given intravenously Destroys good and bad cells Treatments on set schedule

Radiation therapy   Local treatment directed at specific area Treatments scheduled daily, but treatment extends for weeks

Oral chemotherapy   Increasing number of patients receiving oral chemotherapy PRECAUTIONS NEEDED:  Handled with proper protection including chemo gloves  Keep away from others in secure area

Side effects of therapy        Fatigue Nausea/vomiting Diarrhea Fever Skin Pain Other

Side effects of cancer treatment  Fatigue  Most common side effect   Due to decreased red blood cells leading to lower oxygen levels Inability to perform basic tasks   No over-exertion, conserve energy Accommodations  Frequent rest periods  Nutritious foods, plenty liquids

Side effects of therapy  Nausea  Anti-nausea medications can prevent vomiting   Nausea triggers  Perfumes and odors  Fried foods, spicy foods, fatty foods, overly sweet foods  Dehydration Increased risk of nausea  Women  Younger patients  Women with history of morning sickness

Helping people avoid nausea      Provide small frequent meals (nausea occurs on an empty stomach) Avoid strong odors Assure availability of anti-nausea medication, encourage to take as prescribed Provide dry crackers/dry toast Avoid spicy, greasy, fatty foods

Helping people with diarrhea      Imodium BRAT diet – bananas, rice, applesauce, dry toast Avoid high fiber, high fat, greasy, spicy foods Avoid caffeine, milk, alcohol Increase fluids

People with fever    Due to low blood counts, usually 7 to 10 days after chemo Observe for temperature increase  First sign of infection If fever of 100.4°F or 38°C (have thermometer available)  To ER or call oncologist on duty

Infection precautions  Chemotherapy patients can reside in general population shelter, but away from ill people   Dependent on instructions from physician Provide isolation if necessary

Skin problems  Especially for people receiving radiation therapy  Redness of skin  Provide Eucerin, Aquaphor

People with pain  Treat with medication  Opioids  Keep in secure place!

Other side effects Less frequent side effects related to attack on the “good cells”  Alopecia  May use head covering, even at night   Numbness in fingers  Difficulty feeling, holding things Stomatitis

Questions to ask  If a shelter resident identifies as a person being treated for cancer, ask about   Pain medicine Anti-nausea medicine   Oral chemotherapy Personal supplies: ostomy bags, etc.

 Time and place of next treatment

Have available      Rest area Nutritious foods Fluids (water, juice, Gatorade, popsicles, Jell-O) Imodium Thermometer

End of life concerns   Understanding prognosis  patients continue to "hope" - requesting more treatments Ask person (and listen to the answers) what care or treatment will be needed in the shelter and how best to provide the care  Ask if caregiver is with person  Ask about others providing care  Ask about advanced directives

End of life concerns – symptom control      Pain – adequate pain control Secretions – control and/or managing secretions Constipation – adequate hydration, stool softeners Anxiety – medication, comforting environment, caregivers Dyspnea (difficulty breathing) – positioning, oxygen

POD related information  Per CDC – no live vaccines  Herpes Zoster (shingles)   Flu mist (nasal spray) Measles, mumps and rubella (MMR)   Smallpox Yellow fever  Chicken pox

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