Download Chemotherapy and You - The Ottawa Hospital

Chemotherapy and You
The Ottawa Hospital Cancer Centre
Adapted from Chemotherapy and You,
Cross Cancer Inst. January 2007
Outline
Introduction
What is Cancer?
How is Cancer Treated?
How Does Chemotherapy Work?
How is Chemotherapy Given?
What are Some Chemotherapy Side Effects & How Can They be Managed?
• Facing Emotional/Social Challenges
• Points to Remember
• Questions You May Have
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What Is Cancer?
• A group of more than 120 different diseases
• Common factor: cells that are growing rapidly and in an uncontrollable pattern
• The cancer is named according to the part of the body where the cells originate
• More information available from the Ninon Bourque Library
How is Cancer Treated?
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Depends on the type and stage of cancer
Surgery Chemotherapy Radiation Therapy
Hormone Therapy
Immunotherapy
How Does Chemotherapy Work?
• Systemic treatment
– Goes through the blood stream
– Reaches all parts of the body
– Interferes with the way cells divide
• Combination treatments
– Different medications together
– Different routes (oral, intravenous)
– Chemo combined with radiation therapy
• Affects rapidly dividing cells
– Healthy and cancerous cells
How is Chemotherapy Given?
• Orally – by mouth
• Intravenously
• Combination
Treatment Time • Can last anywhere from 15 minutes to 6 hours depending on the medications
What are Some Chemotherapy Side Effects?
• Side effects vary
– Depends on: • The person
• The type of treatment
• Common side effects can be managed
Bone Marrow Suppression
What is bone marrow:
– Bone marrow makes blood cells • White cells
– Protect the body against infection • Red Cells – Provide the body with oxygen
• Platelets
– Help blood to form clots to stop bleeding
Low White Blood Cells
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White blood cells (WBC’s)attack different viruses, allergens and bacteria
Neutrophils are the most common WBC
– Neutrophils protect your body from bacterial infection
– Can be lowered by chemotherapy
– Low neutrophils = high risk for infection
How Can Infection be Prevented?
• Not always possible
• Practice excellent and frequent hand washing
• Perform frequent oral hygiene • Continue to floss between teeth if this is your normal practice
– Floss gently to prevent cutting the gums
• Avoid being around people who have an illness that is infectious (eg. flu)
• Avoid cleaning bird cages & litter boxes
What is the Most Important Sign of Infection?
• Fever!
– Shaking with chills may also be present
• If You Start to Feel Unwell
– Check your temperature with an oral thermometer
– If your temperature is >38º C (100.4ºF), call your Patient Designated Nurse (PDN) / Satellite Nurse or go to the Emergency Dept (General Hospital site or your local ER outside of Ottawa).
• DO NOT take Tylenol, Aspirin or any other anti‐fever medications before you are assessed by the nurse or physician
If you go to the emergency department..
Critical Information
• I have a fever/signs of infection
• I am a cancer patient
• I have recently received chemotherapy
• Date of last treatment
• Names of medications
• Name of your oncologist
What will happen to me in the Emergency Department?
• You will be assessed by the Emergency Department Physician
• Blood test will be done
• Based on results, your treatment will be decided
• Hospital admission may be necessary
• Expect to receive intravenous or oral antibiotics
Other Signs & Symptoms of Infection
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Areas of redness/tenderness
Rash
Sore throat or mouth
Productive cough
Need to pass urine frequently / burning
Burning/itching in genital area
Low Red Blood Cells/ Anemia
Chemotherapy can cause your red cell count to drop
• Usually a slow, gradual drop
• You may become anemic
Anemia/⇩RBC’s can cause weakness, tiredness, dizziness, headaches and shortness of breath
Low Platelets
May result in:
• Nose or gum bleeding
• Blood in urine or stools
• Small red spots on skin
If your platelets are low:
• Do not take medicine with aspirin
• Use caution with sharp objects
• Soft toothbrush
• Continue to floss between teeth if this is your normal practice
– Floss gently to prevent cutting the gums
• Notify Patient Designated Nurse (PDN) / Satellite Nurse of unusual bruising or bleeding
Pre Treatment Blood Tests
• Blood tests need to be done within 48 hours before each chemotherapy treatment.
• If the counts are low, your treatment may be delayed
• Review the “Blood Work Fact Sheet” (included in the “New Patient” package)
Hair Loss
• Amount of hair loss depends on the chemo medication used
• Occurs 2 – 3 weeks after treatment started
• Almost always temporary
• Consider:
– Cutting your hair very short
– Shopping early for a wig
– Wear head covering for warmth
– Avoid perms/colouring during this time
– Attending “Look Good, Feel Better” program
Mouth Sores
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Caused by:
– Certain chemo medications
To prevent or relieve:
– Arrange for dental work before starting chemotherapy treatments
• Check with your oncologist first if major dental work is planned
– Rinse every 2‐4 hours with salt/baking soda mixture
– Use a soft toothbrush
– Avoid commercial mouthwashes
– Avoid alcohol and tobacco • dries out the lining of the mouth
– Avoid foods that may irritate
• Hot, cold, spicy, dry toast, hard candies
Call your PDN / Satellite Nurse if white spots are seen inside your cheeks & a coating is present on your tongue
Nausea and Vomiting
Severity depends on the type of chemotherapy used
To prevent or relieve:
• Take your anti‐nausea medications as prescribed
• Do not wait for the nausea to get worse
• Eat small meals during the day
• Avoid spicy, fatty, sweet, or strong smelling food
• Drink 6 – 8 glasses of water/day
• Avoid alcohol
Constipation
• Caused by: Some chemo medications
– Some anti‐nausea medications
– Some pain medications
– Reduced fibre or fluid intake
– Stress or lack of exercise
• To prevent or relieve:
– Increase fibre
– Increase fluid (8 – 10 glasses of water per day)
– Increase activity
– Call your PDN / Satellite Nurse if no bowel movement after 3 days
Diarrhea
• Caused by:
– Some chemo medications
– Bowel surgery
– Some types of radiation
– Some antibiotics
• To prevent or relieve:
– Eat low fibre foods (bananas, rice, dry toast, apple sauce), avoid milk products
– Avoid bowel stimulants or foods that cause gas
– Call if more than 6 stools/day for 24 hours
Fatigue
• Most common side effect
• To prevent or relieve:
– Short 20 – 30 minute rest periods
– Balance rest, physical activity
– Light exercise
– Prioritize regular activities
– Allow friends and family to help
– Work within your own limits
Photosensitivity
• Caused by:
– Many types of chemotherapy
• To prevent or relieve:
– Use sunscreen (SPF 30)
– Cover up when outdoors
Sexuality
• Hormonal System
– Decreased sperm count
– Premature menopause
– Pregnancy must be avoided
– Use condoms while either partner is receiving chemotherapy
• Sexual desire
– Reduction in sexual desire is common
– Maintain open and supportive communication
Emotional/Social Challenges
• Continue to do your regular activities as you feel able to
• Focus on what you can do
• Surround yourself with positive people
• Ask for help
• Keep your ability to laugh
• Find out what works best for you • Ask for the assistance of a Social Worker
Points to Remember
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Bring a book or company for the waiting room
Bring a cozy blanket and/or small pillow for the treatment room A blood test will be needed
Side effects can be managed
Write down your questions
Use a Health Care Diary to:
– Keep track of your medication, test results, & appointments
Your family doctor is on the team too
Let us know about alternative therapy
Keep a balanced life
When coming for your treatment
– Bring only one family member or friend
– No children allowed
Why Does My Chemotherapy Nurse Wear Gloves & a Gown?
• Chemotherapy is “tailor made” for the persons requiring treatment. It is for their benefit.
• Nurses can potentially be exposed to many chemotherapy treatments each working day. This is not to their benefit.
• The Nurse will experience the side effects of chemotherapy if enough medications are accidentally absorbed through the skin
Are Extra Measures Required at Home?
• Yes‐ for the first 48 hours after chemotherapy treatment because “what goes in, must come out”
• Inside the body, chemotherapy kills the cancer but some of it comes out “un‐used”
• Therefore:
– Flush the toilet twice after use, with the lid down
– Wash linens soiled with vomit or urine twice in your washing machine & separate from other laundry
– Cutlery, dishes, etc can be washed in the usual manner
• CHIPP patients who experience a chemo spill, are to call their home visiting nurse for assistance
Know When to Call for Help
• Call 911 for an ambulance to bring you to the nearest emergency department for:
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New or worsening shortness of breath
Sudden, new chest pain
A decreased level of consciousness
Sudden onset of bleeding
New back pain with difficulty walking
Call Your Patient Designated Nurse/Satellite Nurse
• During regular clinic hours (Mon – Fri between 9am and 4pm), if you experience:
Fever (temperature above 380C (100.40F) or shaking with chills
Vomiting that lasts for more than 24 hours
Inability to drink for more than 24 hours
Diarrhea (more than 6 loose bowel movements in 24 hours)
Blood present in urine or stool
New swelling, discoloration, pain or change in temperature of your legs, arms or neck
– New or worsening pain not responding to treatment
– Mouth sores
– Redness, swelling and increased pain at the chemotherapy injection site
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• After Hours / Holidays go to the General Campus Emergency Department. Patients living outside of Ottawa should go to their nearest Emergency Department
Questions?