Transcript Chemotherapy Class Participating in Your Care
Chemotherapy Class Participating in Your Care
A New Way of Caring Donna Hafner, RN, MSN, OCN, AOCNS Patient Educator www.VirginiaCancerSpecialists.com
Participating in Your Care
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Class Objectives:
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Provide you with a basic understanding of how chemotherapy works
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Explain the effects of chemotherapy on your blood cells
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Explain the common side effects that can occur during your chemotherapy treatment
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Provide you with information on how to manage your treatment side effects
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Provide you with resources and contact numbers to assist you during your treatment
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How to contact us:
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Main numbers by office location:
• Alexandria: 571-483-1800 • • • • • • • Arlington office and infusion suite: 703-894-3800 Fairfax: 703-280-5390 Gainesville: 571-222-2200 Loudoun: 703-554-6800 Woodbridge: 703-986-1600
Provide the following information when you call:
• First and Last name (PLEASE SPELL YOUR NAME) • • • • Date of birth When you were treated/treatment you are receiving Reason for call Phone number where you can be reached
After hours:
• Dial the main office number • Answering service will contact the on-call oncologist 3
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Pre-chemotherapy Recommendations
• Before treatment begins: • Fill prescriptions • Port/central line placement if prescribed • • Order wig (prescription for cranial prosthesis) See dentist for cleaning/dental work if needed • One to two days before each treatment: • Pre-chemotherapy lab work • Follow-up appointment with oncologist or nurse practitioner • Confirmation of appointment day and time • Day before treatment: • Drink eight – 8 ounce glasses of liquid the day before your treatment • Take pre-medications as ordered if prescribed 4
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• Day of treatment: • Drink two to three 8 ounce glasses of non-caffeinated liquids the morning of your treatment • • • • • • • • Eat healthy breakfast Wear comfortable clothing Take regular medications as ordered unless told otherwise by oncologist May take daily multi-vitamin, iron, calcium and vitamin D supplement Bring your treatment calendar and filled prescriptions with you to your first chemotherapy appointment • Infusion nurse will review calendar and medications with you If you take pain medication for any reason bring pills with you to treatment Bring a lunch if your treatment is several hours or snacks if your treatment is shorter Make sure you have someone drive you to and from your treatment the first time and as needed 5
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During treatment session:
• Wi-Fi is available for your convenience • • • • • • You use your I-Pod, portable DVD player, laptop, read a book, sleep etc.
Blankets and pillows are available One family/friend may accompany/check on you during treatment session • Space is limited in infusion rooms Cell phone use is permitted • Ringer on vibrate • • Quiet conversation Limited connectivity in our building You can eat (snacks and drinks are available) You may use the rest room as needed 6
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General Recommendations
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AVOID:
• Using perfume/cologne or scented lotions when onsite for treatment due to increased sensitivity to smell by others • • • • Aspirin unless ordered by physician Mega-doses of vitamins • Any dosing above the daily recommended amount Alcohol intake 48 hours before, the day of and 48 hours after or as long as you are taking anti-nausea medications Herbal supplements 48 hours before, the day of and 48 hours after treatment • Always talk with your oncologist before taking any herbal supplements as these may interact with chemotherapy agents • Resource: National Institute of Health for Complimentary and Alternative Medicine: http://nccam.nih.gov
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How is chemotherapy administered?
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Chemotherapy drugs can be given in one or more
ways: • Intravenous (IV) – through a vein • • Oral – pill Injection – shot • Route of administration is based on: • Type of cancer • • • • Location of cancer Stage of cancer Effects of agents on normal body functions General health 8
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How does chemotherapy work?
• Affects cells that are rapidly dividing which includes cancer cells and some normal healthy cells • Goal is to kill as many cancer cells without causing too much toxicity to normal healthy cells • Normal cells affected by chemotherapy • Blood cells (white, red, platelets) • Digestive tract lining • • Hair follicles Reproductive cells 9
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Why are White Blood Cells (WBCs) important?
• Protect your body by fighting infection • Normal White Blood Cell Count •
Total white blood count (WBCs)
• Percentage of all circulating WBCs • Range 4.0 – 10.5
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Neutrophils (Granulocytes)
• Type of WBCs that fight against bacteria germs •
Absolute Neutrophil Count (ANC or GRAN)
• Percentage of neutrophils or granulocytes • Range 1.5 – 6.6
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What happens if my neutrophils (type of WBC) are low?
• Increases your risk of infections • An ANC or GRAN of <1.5 is called
Neutropenia
• Supportive therapy with growth factor • • • • • • Stimulates bone marrow to produce more WBCs
Neulasta Injection
• Subcutaneous injection usually given the day after chemotherapy treatment • Stays in your body for 14 days
Neupogen Injection
• Subcutaneous injection given daily for 7-10 days usually beginning the day following chemotherapy treatment Bone aching is common side effect from growth factor • Pain reliever can be used to treat unless contraindicated Antibiotics may be used to help prevent infection Chemotherapy may need to be delayed until WBCs increase to safe range 11
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How can I protect myself from infection?
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Prevention
• Frequent hand washing • • • • • Use hand sanitizer Good oral hygiene Keep surfaces clean (door handles, counters, phone, keyboard) Wash, scrub, peel raw fruits and vegetables Use gloves when cleaning or outdoor work •
AVOID
• • • • • • Being around people who are sick Children who have recently been immunized (Nasal H1N1, oral polio) Eating uncooked meats, fish and raw eggs Changing of litter boxes, birdcages, fish tanks, cleaning up animal waste (wear gloves if you must) Manicures, pedicures, acrylic nails Hot tubs and Jacuzzis 12
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What are the signs and symptoms of infection I should report?
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CALL TRIAGE NURSE or ON-CALL ONCOLOGIST if after hours
if you experience: • • • Fever of 100.5 or higher or shaking/chills NEVER mask a fever with fever reducing medicine Other signs of infection: • Cough/sore throat • • • • • Pain, burning on urination or blood in urine Diarrhea Abdominal pain Swelling or redness at surgical site or scrape/cut Vaginal itching or discharge 13
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Why are Red Blood Cells (RBCs) important?
• Carry oxygen throughout body and helps you feel energetic and remove waste products from body’s tissues • Normal Red Blood Cell Count •
Red Blood Cells
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Male 4.5-6.0 M/ul
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Female 4.2-5.4 M/ul
• Hemoglobin – • protein on RBCs that carries oxygen
Male 13-18 gm/dL
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Female 12-16 gm/dL
• Hematocrit – • measure of how much of the blood is made up of RBCs
Male 42-52%
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Female 37-47%
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What happens if my RBCs are low?
• A decrease in RBCs is called
Anemia
• Symptoms of anemia • Weakness • • • • Fatigue Shortness of breath Rapid heart rate Dizziness • Supportive therapy for symptomatic anemia • Iron supplement if appropriate • Blood transfusion • Growth factor if appropriate 15
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Why are Platelets (Plts) important?
• Platelets are cells that help clot blood • Normal Platelet Count • 140,000 – 400,000
What happens if my Platelets are low?
• A decrease in platelets is called
Thrombocytopenia
• Symptoms of low platelet count • Bruising/small red/purple pin sized dots on skin • • • • • Red or pink urine Black or bloody stool Bleeding from your gums or nose Heavy bleeding during your menstrual period Headaches or changes in vision • • • DO NOT: • Play contact sports or do activities where you could injure yourself • • Use tampons Use straight edged razor Supportive therapy for thrombocytopenia • Platelet transfusion if below 20,000 Chemotherapy may need to be delayed if Platelet count is <100,000 16
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How are my blood counts monitored?
• Lab work is drawn at certain times during your treatment • All patients must have labs drawn ~1-2 days prior to each treatment cycle • Types of labs: •
CBC = Complete Blood Count
• Drawn ~1-2 days before each chemotherapy treatment and between cycles • Measures your WBCs, RBCs, and Plts • •
BMP = Basic Metabolic Panel or CMP = Comprehensive Metabolic Panel
• • • Usually drawn once a month or more frequently if regimen requires Measures your electrolytes (sodium, potassium, calcium, etc.) Measures your kidney and liver function 17
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What is a Nadir?
Period after chemotherapy when your blood counts are at their lowest point
• Usually 7-14 days after chemotherapy • Can vary depending on your treatment regimen
Chemo starts Next Chemo cycle Blood counts decrease Recovery Period Nadir ~7-14 days
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Why is it important to stay on my planned chemotherapy treatment schedule?
• Your treatment regimen is planned to provide the maximum benefit for treating your disease based on dosing of the chemotherapy agents over a specified amount of time. •
What we planned vs. what you received
• Dose delays and/or dose reductions can impact treatment outcome •
Causes
• • • Low counts Illness Missed appointments 19
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Nutrition during treatment
• Make calories count • • • • Eat a well-balanced diet • Protein is needed to help repair cells Stimulate your appetite • Eat small frequent meals • • Keep snacks close at hand Try different flavors Choose foods that are easy to eat • • Eat food that are warm or at room temperature Avoid greasy, fatty or fried foods Tailor your diet as needed to meet your needs 20
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Common Side Effects from Treatment
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Loss of appetite
• Causes: • Chemotherapy agents • • • • • Alterations in taste buds Metallic taste Alterations in smell Dry mouth Treatment: • Be open to trying different foods • • • • • Add seasonings to food to increase flavor Eat small frequent meals Get daily exercise Drink 8-10 glasses of liquid a day Eat foods high in moisture (soups, casseroles, fruits) 21
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Nausea/Vomiting
• Cause: • Chemotherapy agents • Treatment: • You will be given anti-nausea medication(s) through your IV before you receive your chemotherapy • • You will have oral anti-nausea medication(s) to take at home • Take medications as prescribed • Prescription medications you may be given are: • Prochlorperazine - Start with prochlorperazine, if not affective then take lorazepam if prescribed - Do not take prochlorperazine at same time as lorazepam • Lorazepam/ATIVAN
CALL TRIAGE NURSE
if no relief or if nausea/vomiting persists after take anti-nausea medication(s) 22
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Mouth and Throat Changes
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Cause:
• Some chemotherapy agents can affect the fast growing cells of the mouth, throat, lips which can affect your teeth, gums, lining of your mouth and the glands that make saliva • Can cause increased sensitivity in mouth • Treatment: • Maintain good mouth care throughout treatment • Brush with soft toothbrush and gently floss teeth with waxed floss • AVOID harsh toothpaste or mouthwash • Use sensitive mouth products such as Biotene or Sensodyne • • • Check your mouth and tongue daily • Look for mouth sores or white patches Rinse mouth regularly with salt/baking soda solution to prevent infection and improve healing of sore mouth • 8 oz warm water • • ¼ tsp salt ¼ tsp baking soda Eat high-protein foods that are soft and bland AVOID rough, sharp, spicy foods that can irritate mouth •
CALL TRIAGE NURSE
if you develop mouth pain, sores or white patches in your mouth • Magic Mouthwash may be prescribed 23
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Constipation
• Causes: • Medications • Certain chemotherapy agents • Pain medications • • Anti-nausea medications Changes in eating habits • • Decreased fluid intake Being less active •
Prevention:
• Drink plenty of fluids • • Eat high-fiber and bulky foods Exercise/activities as tolerated 24
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Treatment for Constipation:
• Add more fiber to your diet • Take over-the-counter medications •
Fiber supplement
• Psyllium/METAMUCIL •
Stool softeners
• Docusate/COLACE •
Laxatives
• MIRALAX • • • • • • Docusate casanthranol/PERICOLACE Senna/SENOKOT Senna docusate/SENOKOT-S Magnesium hydroxide/MILK OF MAGNESIUM DO NOT use suppositories or enemas
CALL Triage Nurse
if no bowel movement in 3 days 25
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Diarrhea
• Causes: • Some chemotherapy agents – onset 24-96 hours after chemo • • Certain foods Infection •
Treatment:
• Drink fluids (water, clear broth, ginger ale, sports drinks) • • • • BRAT diet (bananas, rice, apples, toast) AVOID foods that exacerbate diarrhea (high-fiber and bulky foods, raw vegetables, fruits, caffeine etc.) Use over-the-counter anti-diarrhea medication •
Loperamide/IMODIUM AD
• Take 2 tablets after first loose stool and 1 tablet after each additional stool up to 8 tablets a day
CALL TRIAGE NURSE
if no improvement or you feel dehydrated 26
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Fatigue
• Causes: • Anemia • Unknown mechanisms • Treatment: • Listen to your body • Rest when needed • • • • Stay active • Keeps muscles toned (toned muscles require less energy) • Increases sense of well-being Do activities requiring a lot of energy during periods of peak energy • Usually early in the day Eat a well-balanced diet Maintain a sleep-wake schedule • Wake-up/go to bed at same time each day • Have bedtime routine and provide relaxing environment 27
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Hair Loss (Alopecia)
• Cause: • Some chemotherapy agents • Hair follicles are rapidly dividing cells which are affected by chemotherapy agents • •
What happens?
• Hair loss usually occurs 2-3 weeks after your first treatment • All body hair will be affected • “Scalp ache” usually occurs right before hair loss • Hair will start to re-grow once treatment is finished • Grows ~1/2 inch per month • • Initial growth will be fine Texture and color may change Resources: • • American Cancer Society • www.cancer.org
Look Good…Feel Better Program • www.lookgoodfeelbetter.org
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Skin and Nail Changes:
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Causes:
• Some types of chemotherapy agents •
Symptoms:
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Skin changes
• Dryness • • • • • • • Itching Redness Peeling
Photosensitivity to sun
• Can cause severe burning and blistering
Darkening
• Increased pigmentation (melanin) along veins
Acne
• Blemishes • Increase potential if history of acne
Nail changes
• Darkening of nail beds • Usually occurs 2-3 weeks after treatment starts • • • Cracking Brittleness Loosening 29
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Skin and Nail Changes cont.:
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Treatment:
• Apply sunblock SPF 30 or higher on any exposed areas • • • • Reapply as needed • Wear protective clothing including hat • Avoid direct sun exposure as much as possible Keep skin clean Use moisturizer • Do not use perfume, cologne or aftershave lotion that has alcohol • Use products to strengthen nails • Avoid acrylic nails
CALL TRIAGE NURSE
if you experience: • Severe sun burn or rash 30
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Eye Changes:
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Causes:
• Some chemotherapy agents •
Symptoms:
• • • • Trouble wearing contacts • Irritation to eyes Blurry vision • Clogged tear ducts Watery eyes • Chemotherapy can seep out in your tears and can cause eyes to water more than usual
CALL TRIAGE NURSE
water more than usual if your vision gets blurry or your eyes 31
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Changes in Reproduction and Sexuality
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Sexuality changes
• Cause: • Chemotherapy can cause changes in hormone levels, body image and self–esteem • Management: • Support a positive self-image • Communicate with your partner and your oncologist/NP/nurses •
Reproductive changes
• Cause: • Chemotherapy can damage the reproductive organs affecting hormone, sperm or egg production • Treatment: • Talk with your oncologist before you begin treatment • May consult a reproductive specialist for fertility sparing options • www.fertilehope.org
for information on fertility • Use contraceptive barrier throughout treatment • Must prevent pregnancy during treatment • Need to protect your partner from being exposed to chemotherapy 32
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Sleep Disturbances
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Types:
• • • Insomnia (inability to fall or stay asleep) Disruption of sleep-wake cycle Excessive sleepiness • Possible causes: • Emotional distress • • • • Experiencing side effects, especially pain Hot flashes/night sweats Chemotherapy drugs affect chemical balance, hormone levels Steroids •
Management:
• Maintain wake-sleep routine • • • Exercise Avoid stimulants late in the day, long naps, large meals at bedtime Sleep aids (discuss with oncologist or nurse practitioner) 33
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Cognitive Dysfunction
• Also called chemo brain or mental fogginess • Difficulty with memory that may occur during and after cancer treatment. Causes: • Some chemotherapy agents • Can affect be toxic to neurons or nerves in brain • Body’s response to chemotherapy agents (inflammatory) • • • Hormone suppression Other factors (i.e. anemia, fatigue, pain, nutrition) Unknown causes Symptoms: • Forgetfulness; memory lapses • • • • Difficulty concentrating/staying focused on task Trouble remembering details like names, dates, or events Difficulty multi-tasking Taking longer to complete a task 34
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Treatment for Cognitive Dysfunction
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Talk with your oncologist or nurse practioner
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Treat underlying conditions if known
• Anemia • Fatigue • • • Pain Sleep disturbances Nutrition
Exercise your brain
• Keep your mind active • Stimulate your mind • •
Train yourself to focus
• Develop ability to concentrate • • Establish concentration Increase concentration
Set-up and follow routines
• Create notebook to keep papers organized • Set-up calendar of activities/appointments •
Organize your environment
• Decreases distractions/frustrations 35
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Peripheral Neuropathy
• Condition where the nerves outside the brain and spinal cord (peripheral) are damaged •
Causes:
• Some chemotherapy agents • • • Radiation therapy Surgery Other health conditions such as diabetes •
Symptoms:
• Usually occurs in hands and feet • • Tingling, burning, numbness, pain Difficulty with coordination • • • Buttoning clothes Dialing phone Walking 36
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Treatment for Peripheral Neuropathy
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Report symptoms
• When it started • • Where it occurred How long it lasted • • •
Non-drug treatments
• Relaxation techniques • Sit down when possible (if in feet)
Treatment with medications
• Pain medications • Steroids • Antidepressants or anticonvulsants • Effective in treating nerve pain
Avoid
• Alcohol – can further damage nerves • • • High-blood sugar Bare feet Extreme temperature changes 37
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Frequently Asked Questions When will I see my oncologist?
• You should see your oncologist or the nurse practitioner as ordered; usually about midway between each treatment cycle
How should I prepare for my appointment with the oncologist?
• Write down any new or changing symptoms or side effects • Write down your questions • Check to see if you need any prescription refills and get them at the time of your visit
When should I call the office?
• If you have a fever of 100.5 or higher, shaking/chills or have signs/symptoms of infection • If you have side effects that are not being controlled with current prescribed therapies
When do I have my labs drawn?
• CBC is approximately 2 days before each treatment cycle • BMP/CMP are usually drawn once a month or more frequently depending on treatment regimen 38
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Additional services available:
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Advanced Care Planning
• Helps ensure your care is customized to reflect your personal preferences, health needs, as well as meet your social, cultural and religious preferences • • Certified Nurse Practitioners available at all sites By appointment • •
Genetic Services
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Genetic Screening
• Breast, Colon, Ovarian, Melanoma • By appointment •
Genetic Counseling
• Certified Genetic Counselor • • Arlington and Fairfax Offices only By appointment
Patient Benefits Specialists
• Contacts insurance company to verify benefits • • Helps you understand your benefits Answers questions regarding benefits 39
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Additional services available (cont.):
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Case Management
• • • • Collaboration with insurance companies to help coordinate plan of care that has been decided by you and your oncologist Practice refers patient • • Focus is on delivering personalized services to improve care by: • Coordinating ancillary services/resources • Obtaining pre-authorizations • Patient consent obtained by insurance company Nurse from insurance company assigned to work with you Providing additional education Brochure available 40
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Helpful Resources
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VIRGINIA CANCER SPECIALISTS
• www.virginiacancerspecialists.com
• LIFE WITH CANCER (part of Inova Cancer Services) • www.lifewithcancer.org
• • • 703-776-2841
AMERICAN CANCER SOCIETY (ACS)
• www.cancer.org
• 1-800-227-2345 (1-800-ACS-2345) Local Office: 703-938-5550 •
NATIONAL CANCER INSTITUTE
• www.cancer.gov
• 1-800-422-6237 (1-800-4CANCER) •
AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO)
• www.cancer.net
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The staff at Virginia Cancer Specialists are here to help you.
Thank you for attending!
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