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
• Class Objectives:
• Provide you with a basic understanding of how chemotherapy works
• Explain the effects of chemotherapy on your blood cells
• Explain the common side effects that can occur during your chemotherapy
treatment
• Provide you with information on how to manage your treatment side effects
• Provide you with resources and contact numbers to assist you during your
treatment
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• How to contact us:
• Main numbers by office location:
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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
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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
• Provide the following information when you call:
• After hours:
• Dial the main office number
• Answering service will contact the on-call oncologist
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• Pre-chemotherapy Recommendations
• Before treatment begins:
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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
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• Day of treatment:
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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
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• During treatment session:
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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
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• General Recommendations
• 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 antinausea 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?
• 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:
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Type of cancer
Location of cancer
Stage of cancer
Effects of agents on normal body functions
General health
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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
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Blood cells (white, red, platelets)
Digestive tract lining
Hair follicles
Reproductive cells
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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
• 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
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• How can I protect myself from infection?
• Prevention
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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
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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
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• What are the signs and symptoms of infection I should report?
• 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:
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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
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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
• Male 4.5-6.0 M/ul
• Female 4.2-5.4 M/ul
• Hemoglobin – protein on RBCs that carries oxygen
• Male 13-18 gm/dL
• Female 12-16 gm/dL
• Hematocrit – measure of how much of the blood is made up of RBCs
• Male 42-52%
• Female 37-47%
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• What happens if my RBCs are low?
• A decrease in RBCs is called Anemia
• Symptoms of anemia
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Weakness
Fatigue
Shortness of breath
Rapid heart rate
Dizziness
• Supportive therapy for symptomatic anemia
• Iron supplement if appropriate
• Blood transfusion
• Growth factor if appropriate
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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?
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A decrease in platelets is called Thrombocytopenia
Symptoms of low platelet count
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Supportive therapy for thrombocytopenia
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Chemotherapy may need to be delayed if Platelet count is <100,000
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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
• Play contact sports or do activities where you could injure yourself
• Use tampons
• Use straight edged razor
• Platelet transfusion if below 20,000
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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
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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
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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
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• Common Side Effects from Treatment
• Loss of appetite
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Chemotherapy agents
Alterations in taste buds
Metallic taste
Alterations in smell
Dry mouth
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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)
• Treatment:
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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)
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• Mouth and Throat Changes
• 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
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• 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
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Magic Mouthwash may be prescribed
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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
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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
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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
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• Diarrhea
• Causes:
• Some chemotherapy agents – onset 24-96 hours after chemo
• Certain foods
• Infection
• Treatment:
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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
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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
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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:
• Causes:
• Some types of chemotherapy agents
• Symptoms:
• Skin changes
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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
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• Skin and Nail Changes cont.:
• 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
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• Eye Changes:
• 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 if your vision gets blurry or your eyes water more than usual
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• Changes in Reproduction and Sexuality
• 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
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• Sleep Disturbances
• Types:
• Insomnia (inability to fall or stay asleep)
• Disruption of sleep-wake cycle
• Excessive sleepiness
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Emotional distress
Experiencing side effects, especially pain
Hot flashes/night sweats
Chemotherapy drugs affect chemical balance, hormone levels
Steroids
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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)
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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
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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
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• Treatment for Cognitive Dysfunction
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Talk with your oncologist or nurse practioner
Treat underlying conditions if known
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Exercise your brain
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Train yourself to focus
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Set-up and follow routines
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Organize your environment
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Anemia
Fatigue
Pain
Sleep disturbances
Nutrition
• Keep your mind active
• Stimulate your mind
• Develop ability to concentrate
• Establish concentration
• Increase concentration
• Create notebook to keep papers organized
• Set-up calendar of activities/appointments
• Decreases distractions/frustrations
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• Peripheral Neuropathy
• Condition where the nerves outside the brain and spinal cord (peripheral) are damaged
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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
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• Treatment for Peripheral Neuropathy
• 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
• Avoid
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• Effective in treating nerve pain
Alcohol – can further damage nerves
High-blood sugar
Bare feet
Extreme temperature changes
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Frequently Asked Questions
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When will I see my oncologist?
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How should I prepare for my appointment with the oncologist?
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When should I call the office?
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When do I have my labs drawn?
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You should see your oncologist or the nurse practitioner as ordered; usually about midway between each treatment cycle
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
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
CBC is approximately 2 days before each treatment cycle
BMP/CMP are usually drawn once a month or more frequently depending on treatment regimen
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• Additional services available:
• 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
• 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
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• Additional services available (cont.):
• Case Management
• Collaboration with insurance companies to help coordinate plan of care that has been decided by
you and your oncologist
• Practice refers patient
• Patient consent obtained by insurance company
• Nurse from insurance company assigned to work with you
• Focus is on delivering personalized services to improve care by:
• Coordinating ancillary services/resources
• Obtaining pre-authorizations
• Providing additional education
• Brochure available
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• Helpful Resources:
• 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!
Please complete the
class evaluation form.
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