Transcript A Patient`s Guide to Chemotherapy

A Patient’s Guide to Chemotherapy
Zeina Nahleh, MD, F.A.C.P.
Associate Professor of Medicine
And Biomedical Sciences
Chief, Division of Hematology-Oncology
Department of Internal Medicine
TTUHSC - Paul L. Foster School of Medicine
4800 Alberta Ave
El Paso, TX 79905
(915) 545-6618 (office)
(915) 545-6634 (fax)
Dietary Suggestions
…For eating well on the day of the treatment and the day after…
Eating before treatment
We suggest that you eat before receiving chemotherapy. If
you have a late morning afternoon appointment, eat a
snack before your appointment. Otherwise, eat a regular
breakfast or lunch. No fried or greasy foods.
Prevention of Nausea
• After receiving treatment we have found our patients
have less nausea if they are not hungry.
• You may need a mid morning and mid afternoon snack
to prevent nausea.
• You should eat a bedtime snack for 2-3 days after
chemotherapy.
• The best snacks are starchy and bland such as pretzels,
crackers, toast, English muffins, bagels, vanilla wafers,
animal crackers or popcorn that is no greasy.
Eating if you are nauseated
• The above starchy, bland foods
would also be good choices if you
are nauseated.
• Eat small amounts with sips
of clear liquids and increase
amounts slowly.
Morning after chemotherapy
For 2-3 days after chemotherapy you
should take your
medications with food unless
specifically told to take on an
empty stomach.
Drink your fluids
with breakfast, not before.
Foods to avoid the day of treatment and
the day after treatment
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Fatty, greasy or fried food
Red meats-tend to have a bitter taste
Spicy foods-hard to digest
Foods with strong odors especially
if you are cooking.
These foods are generally easy to digest,
but are only a short list possibilities.
• Toast and crackers
• Skinned chicken (baked or
broiled)
• English muffins
• Baked fish
• Animal crackers
• Fruits and vegetables that are
soft or bland, such as canned
peaches
• Yogurt
• Sherbet
• Pretzels
• Beverages sipped slowly
between meals
• Angel food cake
• Pound cake
• Macaroni and cheese
• Oatmeal
• Cereal
• Waffles
• Pancakes
Some Clear Fluid Suggestions
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Water
Grape juice
Apple juice
Cranberry juice (or combinations)
Kool-Aid
Soft drinks
Tea
Chicken soups or broth
Crushed ice
Ice popsicles
Jell-O
Gatorade
General Guidelines
Medications to avoid
• Avoid taking too much aspirin and ibuprofen (such as
Motrin, Advil) because the medications effect your
platelets as does chemotherapy. Platelets are cells in
your blood involved in your blood clotting.
Mouth care Guidelines
Mouth care is very important while you are getting
treatment. Sensitive tissues in your mouth may become
irritated during treatment.
• Use a soft toothbrush only
• Any commercial toothpaste is fine
• Any commercial denture cleanser is fine
• Do not use any commercial mouth wash
• Ask your doctor for a special mouthwash
• Keep your lips moist with something like lipstick,
Chapstick, Vaseline or Blistex.
If you develop mouth soreness
• For mouth soreness swish and gargle with baking soda
mouth wash (mix ½ cup warm water with1/2 teaspoon
baking soda) after meals and at bedtime.
• If your mouth soreness increases, call your physician for
additional instructions, especially if the soreness
interferes with eating or drinking.
For diarrhea lasting longer than 12 hours
Try Kaopectate or Imodium AD (loperamide) tablets.
Please call if the diarrhea continues after another 24 hours,
especially if associated with abdominal pain or cramps.
If you experience any of the following
problems call the office within 24 hours
• Signs and symptoms of infection including fever greater
than 100.5F, shaking chills, burning on urination or
cough productive of dark mucus. Please have a
thermometer available that you can read.
• Vomiting that doesn’t stop with the medicine we have
ordered for nausea.
• Your platelets may be low if you notice any unexplained
bruising or bleeding.
• Severe sudden headache, change in balance, or sudden
change in vision.
• Any unusual physical symptoms that began after
chemotherapy.
To refill your prescription of a medicine
ordered by our office
• Check on the medications you need and ask
for refills during your visit with the doctor.
• If refills are needed between visits, please call 24 hours
in advance. You can pick up written prescriptions the
next day or they can be mailed to you.
Nutrition
You should consult with your physician or the dietitian at
any hospital if you are using alternative therapies
including high does of vitamins or minerals, herbal
preparations or changing your
diet.
They will evaluate the safety
of these therapies with your
chemotherapy.
Reminder
• You may bring food and something to
drink with you to have during your
treatment
Clinical Trials
Zeina Nahleh, MD, F.A.C.P.
Associate Professor of Medicine
And Biomedical Sciences
Chief, Division of Hematology-Oncology
Department of Internal Medicine
TTUHSC - Paul L. Foster School of
Medicine
4800 Alberta Ave
El Paso, TX 79905
(915) 545-6618 (office)
(915) 545-6634 (fax)
[email protected]
Are you interested in
taking part in a clinical trial?
Would you like more information about clinical trials?
What is a clinical trial?
Clinical trials are research studies that involve patient volunteers to
help find different ways to treat diseases such as cancer. Each study
is designed to answer specific scientific questions and help find
potentially better ways to prevent, diagnose, or treat cancer.
What is “informed consent”?
Informed consent means that patients must be told the key facts
about a clinical trial before deciding whether to take part. If the
patient agrees to take part, the informed consent process involves
signing a form that details the entire clinical trial, possible side
effects, and potential risks and benefits. Participants may withdraw
their decision to participate at any time for any reason.
What happens during a clinical Trial?
When someone chooses to take part in a clinical trial, the care they
receive is much like the care they would otherwise receive. However,
there is often additional monitoring for the purpose of learning about
potential side effects and benefits of the clinical trial. Some trials
simply test a study regimen, and all participants receive this same
regimen.
Other trials may compare a study regimen to the standard treatment.
In this type of study, participants are randomly assigned to receive
one or the other. Neither the participant nor their doctor can choose
which one they will receive for important scientific reasons. Some
people worry that they will not know which drug they are receiving or
that they will receive a placebo, sometimes called a “sugar pill”.
Placebos are never used in place of a treatment that is known to
work. Participants will always be told before agreeing to take part if a
placebo is going to be considered.
Why are clinical trials important?
Clinical trials are a vital part of the process in finding new cancer
treatments. These research studies are conducted to determine if a
study drug is safe and effective. Today’s research will guide the
improvements for tomorrow’s cancer care.
Should I participate in a clinical trial?
The decision to take part in a clinical trial is a personal one. You may
wish to talk to your family and loved ones, as well as members of
your health care team, before deciding. As with all current standard
treatments, there can be possible risks as well as benefits form
taking part in clinical trials. Study drugs may be found to be more or
less effective than current standard treatments and have side effects
not yet known. You will be informed of these risks as much as
possible. Your health care team will give you the information you
need to make the decision that is right for you.
Where can I get more informations regarding clinical trials?
For More Information, visit the National Cancer Institute's education
page about cancer clinical trials
at: http://www.cancer.gov/clinicaltrials/
Since fatigue is the most common
symptom in people receiving
chemotherapy, patients should learn
ways to manage the fatigue. Patients
should be informed about the
following:
• Possible medical causes (anemia, not
enough fluids, breathing problems
etc..)
• To observe their rest and activity
routines
• To identify environmental or activity
changes that may help decrease fatigue
• The importance of eating enough food
and drinking enough fluids
• To schedule important daily activities
during times of less fatigue, and cancel
unimportant activities that cause stress
• To avoid or change a situation that
causes stress
• To engage in attention-restoring
activities
• To observe whether treatments being
used to help fatigue are working
MANAGING FATIGUE
during treatment
Zeina Nahleh, MD, F.A.C.P.
Associate Professor of Medicine
And Biomedical Sciences
Chief, Division of HematologyOncology
Department of Internal Medicine
TTUHSC-PLFSOM
Managing Fatigue During
Treatment
Managing fatigue during treatment
Fatigue is the most common complaint of people with cancer,
especially those receiving treatment for their cancer.
 People with cancer may express it in different ways, such
as saying they feel tired, weak, exhausted, weary, worn-out,
fatigued, heavy, or slow.
 Fatigue may affect how the person feels about him-or herself,
his or her daily activities and relationships with others, and whether
he or she continues with cancer treatment.
 Patients receiving some cancer treatments may miss
work, withdraw from friends, need more sleep, and, in some cases,
may not be able to perform any physical activities because of fatigue.
 Fatigue is complex , and has biological, psychological, and behavioral causes
Patients should tell their doctors when they are experiencing fatigue and
ask for information about fatigue related to underlying causes and treatment
side effects.
Causes of Cancer Fatigue
The causes of fatigue in people
with cancer are not always known.
Fatigue can occur for many reasons.
• The extreme stress that people with cancer
experience may be all that is needed to
trigger Fatigue.
• However, there may be other reasons. Patients
should be educated that Fatigue is a common
side effects of cancer treatment: cancer
treatment like radiation therapy or
chemotherapy commonly causes fatigue due
to collection of toxic substances produced by
cells or the increased energy needed to repair
damaged skin tissue . Medications to treat
pain, depression, vomiting and other
conditions are also common causes of fatigue
in patients with cancer.
Treatment of Cancer Fatigue
To determine the cause and best treatment for fatigue,
the person’s fatigue pattern must be determined, and
all of the factors causing the fatigue must be identified.
The following factors must be evaluated :
• Fatigue pattern, including how and when it started, how
long it has lasted, and its severity, plus any factors that
make fatigue worse or better.
•Type and degree of disease and of treatment-related
symptoms and/or side effects.
•Treatment history.
•Current medications.
•Sleep and/or rest patterns and relaxation habits.
• Eating habits and appetite or weight changes.
•Effect of fatigue on activities of daily living and lifestyle.
• Psychological profile, including an evaluation for
depression.
•Complete physical examination
•Other factors (for example, anemia, breathing problems,
decreased muscle strength).
Treating The Common Causes of Cancer Fatigue
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 Nutrition factors
Fatigue often occurs when the body needs
more energy than the amount being supplied
from the patient’s diet. In people with cancer, 3
major factors may be involved: a change in the
body’s ability to process food normally, an
increased need by the body for energy (due to
tumor growth, infection, fever, or problems with
breathing), and a decrease in the amount of
food eaten (due to lack of appetite, nausea,
vomiting, diarrhea, or bowel obstruction).
Special attention to nutrition is necessary. Diet
supplementation with iron, vitamins and
proteins may be needed
 Anemia Anemia may be a major factor in
cancer-related fatigue and quality of life in
people with cancer. Anemia may be caused by
the cancer, cancer treatment, or may be related
to other medical causes.
Sleep disorder and inactivity
– Disrupted sleep, poor sleep
habits, less sleep at night,
sleeping a lot during the day, or
no activity during the day may
contribute to cancer-related
fatigue. Patients who are less
active during the daytime and
awaken frequently during the
night report higher levels of
cancer-related fatigue. Sleep
disorder and insomnia should be
addressed and may require
medications.
– Exercise , including light walking
helps many people with cancer,
leading to more energy, better
appetite, and improved quality of
life
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Activity and Rest People with cancer should set priorities and
keep a reasonable schedule. Any changes in daily routine require
the body to use more energy. An activity and rest program should
be discussed with the health professionals to make the most of a
patient’s energy. Practicing sleep habits such as not lying down at
times other than for sleep, taking short naps no longer than one
hour, and limiting distracting noise during sleep may improve
sleep and allow more activity during the day.
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Addressing the Psychological Factors: Anxiety and depression are the most common
psychological disorders that cause fatigue. Depression may be a disabling illness that
affects approximately 15% to 25% of people who have cancer. Patients experiencing
depression may have loss of interest, difficulty concentrating, mental and physical
tiredness, and feelings of hopelessness. The fatigue from physical causes can become
worse and last longer than usual, even after the physical causes are gone. Antidepressants
might be needed.
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Decreased attention span and difficulty
understanding and thinking are often
associated with fatigue. Attention
problems are common during and after
cancer treatment. Attention may be
restored by activities that encourage
relaxation like gardening, meditation,
prayers. In addition, sleep is also
necessary.