Transcript People with cancer - Cuyahoga County Board of Health

People with cancer
LINDA MILLER, RN, OCN
METROHEALTH CANCER CARE CENTER
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 2nd 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:
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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
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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
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Increased risk of nausea
Women
 Younger patients
 Women with history of morning sickness
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Helping people avoid nausea
 Provide small frequent meals (nausea occurs on an
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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
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First sign of infection
 If fever of 100.4°F or 38°C (have thermometer
available)
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To ER or call oncologist on duty
Infection precautions
 Chemotherapy patients can reside in general
population shelter, but away from ill people
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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
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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
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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
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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
Thank you
 Questions?
 Comments?