Presentation on theme: "Introduction to Chemotherapy: A Presentation for Patients and Families"— Presentation transcript:
1 Introduction to Chemotherapy: A Presentation for Patients and Families Hello everyone, welcome to “An Introduction to Chemotherapy: A Presentation for Patients and Families”.My name is _______________ . I am a Registered Nurse/Pharmacist/Other at _____________________.Introduce other members of the team/volunteers (as required)There are 6 regional cancer centers across British Columbia. It is important for you to know that no matter where a person lives in BC, if they have a diagnosis of cancer they will receive the same treatment anywhere in the province.
2 Welcome and Introduction ReviewGeneral and specific side effectsHow to manage side effectsWhat symptoms to reportHow to report symptomsQuestionsTour of Regional CenterJust a few reminders:If you can’t hear me or if you need clarification at any point - please raise your hand.Please turn cell phone off, or put it on “silence”We would like to keep this session informal, so feel free to ask questions at any point.There will also be time at the end for questions.If you do not already have your Chemotherapy Booklet – please let us know now. (circulate booklets)Read from the slide……
3 Person living with cancer Health Care TeamPerson living with cancerPhysicians:Oncologist,Family DrPatient & Family CounsellorsNursesPharmacistsDieticiansUnit ClerksSecretariesVolunteersThere will be a team of healthcare providers available to you throughout your treatment and into your follow-up care phase. Each care provider has their own unique role to play in supporting you during this time. Some of your team members will work directly with you to provide your treatment and address any care needs you may have. Other members are available to support you and your family with any physical and/or emotional impacts of a cancer diagnosis and treatment.During your cancer treatments – it is very important to stay closely connected to your family doctor – so they can monitor your non-cancer health Your Health Care Team includes:YOUOncologists Family doctor/GP Registered Nurses PharmacistsPatient & Family CounselorsDietitiansVolunteersAlso note Librarians (available for your informational needs)3
4 What is cancer? Disease that starts in our cells Our body’s cells normally grow in an orderly fashionCancer cells do NOT behave like “normal cells”grow to form lumps or tumorsmay spread to other parts of the bodyCancer is named after the part of the body where it startedWhat is cancer?Cancer is a disease that starts in the cells.Our bodies are made up of millions of cells, grouped together to form tissues (such as muscles, nerves and bones) and organs (such as the lungs and the liver).Cell in the body normally grow, reproduce and die.But sometimes the information gets mixed up, causing the cells to behave and grow abnormally. These abnormal cells can then develop into tumours which can spread to other parts of the body.Different types of cancers vary in their signs and symptoms, how fast they grow, and how they respond to different treatments.4
5 What is chemotherapy? Chemotherapy … Medications that destroy cancer cellsAlso known as “chemo”There are over 100 different chemo drugsOne or more chemo drugs may be used to treat a cancer.Chemotherapy is a type of medication that destroys cancer cells.Chemotherapy is a large group of drugs (over 100 different drugs) that we call “cytotoxic” because they kill cells.Other types of cancer drugs such as hormone therapy, biological or targeted therapy, are used to destroy cancer cells as well.You may hear people refer to chemotherapy as “chemo”Chemo – is drug therapy which travels throughout the body via the blood stream – and can affect both cancer cells and normal cells.For some cancers, only one chemo drug is needed to effectively treat the cancer cells. For others, a combination of several chemo drugs are needed. Chemotherapy may also be combined with radiation, hormone and/or targeted therapy.5
6 Goals of chemotherapy Eliminate the cancer Shrink the tumor Prevent cancer from spreadingRelieve symptoms from cancer, such as painGoals of Chemotherapy are:READ the SLIDE6
7 Chemotherapy is given by … IntravenousPillsTake homeInfusion pumpChemotherapy can be administered either by intravenous, pill, injection or through an IV infusion pump.If you are to receive your chemotherapy using an intravenous method you will be given an appointment date and the time will be confirmed closer to that date.A Registered Nurse will administer your treatment and review your treatment plan and potential side effects.Chemotherapy treatments can take several minutes - to several hours - up to a full day depending on the protocol.Some patients go home with a continuous chemotherapy IV infusion pump.If your therapy is to be given in the form of pills – you will be provided with an appt to meet with the pharmacist who will give you your prescription, review the side effects of the chemo pills; and reinforce who and when to call for medical advice.7
8 Side effects from chemotherapy There are potential side effects for each specific chemotherapyYou will NOT experience ALL side effectsSome side effects can be preventedThere is a long list of possible side effects. No one experiences all of these side effects.This information is not meant to scare you – but simply to prepare you if you do experience side effects.Your chemo nurse or pharmacist will discuss the specific side effects related to your particular chemo medicationsWe know some side effects can be preventedSo for example, we know some chemotherapy drugs can cause nausea and vomiting. So we prescribe anti-nausea medications to prevent nausea and vomiting from happening.8
9 Potential side effects Bone marrow suppressionNausea & vomitingDiarrheaConstipationHair lossFatigueMouth soresReproductive/hormonal changesSensory changesThinking, memory & attention changes These are the most common side effects - your chemo nurse or pharmacist will review the particular side effects related to your chemotherapy treatment .If you experience any of these side effects – please contact your health care provider.There is more detailed written information in YOUR PACKAGE and your chemo nurse will review this at your 1st appointment.9
10 “Chemotherapy and Other Drug Therapies: Patient resource“Chemotherapy and Other Drug Therapies:A guide forpeople with cancer”This booklet offers information about chemotherapy treatment. (Make sure everyone has a booklet)
11 Bone marrow suppression Blood cells of the bone marrow:Red blood cells – carry oxygen to body’s cellsWhite blood cells –fight infectionPlatelets – form blood clots/scabsBlood cell levels may decrease following chemotherapyExpected to return to normal by the start of next treatmentYou may hear your nurse, doctor or pharmacist discussing your “blood counts". They are referring to the different blood cells in your blood stream - including your white blood cells, red blood cells and platelets.Each blood cell has a different function in the bodyRead from the slideThese blood cells may decrease in number following chemotherapy – but they are expected to return to normal before the next treatment.
12 Checking blood cellsBlood cells must return to a “safe” level prior to each treatmentBlood tests are done 1 to 4 days prior to treatment**Check appointment card & lab requisition**Blood test results may affect treatmentPrior to each treatment ( and sometimes in the middle of your treatment cycle) you will have a blood test to check the level your blood cells.The results of blood tests will determine whether your blood cells have recovered enough; and whether it is safe to proceed with your chemotherapyIf your blood cells are not fully recovered, your Oncologist may still proceed with treatment – however they may reduce your dose.It is not unusual for your treatment to be delay up to a week if your blood cells are too low.
13 Low white blood cells (neutropenia) White cells are your infection fighting cellsMay be lowered for a short time after your chemo treatmentYour body will be less able to fight infectionIt is important to recognize the signs and symptoms of an infectionWhat are some signs of infection?There are several types of white blood cells in our circulation, but the main cells that fight infection are called the NEUTROPHILSWhite blood cells are affected by chemotherapy and may be decreased following your treatment. This is called NEUTROPENIA. Your neutrophils will begin recovering prior to your next treatment.When the neutrophil count is low, your body is less able to fight an infection on its own - so you will need to watch for signs of infection.If you develop any signs or symptoms you need to call the cancer center immediately.What are the signs and symptoms to watch for?13
14 Signs & symptoms of infection FEVERFlu like symptoms, e.g. body achesFeeling warm, chilled or shakySore throat and/or mouthProductive cough and/or shortness of breathBurning when urinating/urinating more oftenAreas of redness or tendernessLoose or liquid stoolsREAD SLIDE : LIST THE SIGNS AND SYMPTOMSIf you have any of these signs of infection then check your temperature.*Report any signs and symptoms*14
15 If your temperature is 38°C or more (or 100.4°F or more)… This is a FEVERFever is a sign of infection, even if you don’t have any other signsFever is serious when your white blood cells are lowDo not take medications for fever (e.g. Tylenol®) unless directed by your cancer care teamReport a FEVER IMMEDIATELY!Numbers to call are in your packageTemperature of 38 or higher is a serious medical emergency. Day or night – you must report a fever immediately.Refer to center specific process and numbers.This information will be reviewed again at your first chemo appt.15
16 How you can prevent infection Wash your hands - frequently with soap & waterAvoid people with infectionsWash your handsCheck with your oncologist before having any invasive procedures (e.g. dental or surgical procedure)Avoid skin cuts and nicksThe best way to prevent infections is to WASH YOUR HANDSWash your hands before eating and preparing food, and after using the bathroom, sneezing etc.You can use a waterless cleaner if you do not have access to soap and water.You will see Microsan dispensers throughout the Cancer Center – feel free to use them frequently!When others in your household are sick - have them wash their hands more often to prevent the transmission of germsOnce you learn which days your blood cells may be low…then you may want to be more careful, avoid people with obvious colds; stay away from large crowds in confined areas.Avoid children who have the chicken pox or measles or adults who have shingles.Flu vaccine – is recommended during flu season. Please talk with your oncologist before getting a vaccination.Good oral care is essential - brush your teeth with a soft toothbrush after eating and before bedtime.Consult your nurse Prior to a dental appointment –.Avoid handling pet feces - including fish tanksAvoid skin cutsWater-soluble lubricant and a condom should be used during intercourse.16
17 Do I come to the clinic if I have an infection? Call the Cancer Centre FIRST!If you have an infection (flu) orIf you have been exposed to an infectious illness such as chicken pox or shinglesPatients must call ahead prior to coming to clinic if you havea cold / flu / rashREAD SLIDEIf you are unsure, please call one of the clinic nurses to check that it is safe to come to clinic.Friends and family with infections should stay at home until they have recovered17
18 Low platelets (thrombocytopenia) Platelet cells are responsible for making clotsMay be lowered for a short time after your chemo treatmentYour ability to form a clot will be loweredIt is important to recognize the signs and symptoms of low plateletsREAD off slideWhat are some signs of low platelets?
19 Signs & symptoms of low platelets cut that won’t stop bleedingbruises on bodybleeding from nose and gumsred pinpoint rashblack tarry stoolsblood in urine*Report any signs and symptoms*READ off slide
20 How to manage low platelets use soft tooth brushcontinue regular oral hygiene, caution with flossingblow nose gentlyavoid ibuprofen(Advil) & aspirin(ASA), unless ordered by Doctoravoid high risk activities - BE CAREFULREAD off slide - high risk activities…..fileting a salmon / mountain biking
21 Low red blood cells(anemia)Red cells are responsible for carrying oxygen to the body’s cellsMay be lowered for a short time after your chemo treatmentYour energy level will be affectedIt is important to recognize the signs and symptoms of low red cellsREAD off slideWhat are some signs of low red cells?
22 Signs & symptoms of low red blood cells Low energy / fatigueShortness of breathChest tightness / chest painPale appearance*Report any signs and symptoms*READ off slide
23 FatigueFatigue is the most common symptom during and after chemotherapy treatmentsSigns/symptomsfeeling of weariness, tiredness, or lack of energy that does NOT always improve with restMay affect your ability to do daily activitiesOften overlooked, but it is real and can be managedFatigue is a feeling of weariness, tiredness, or lack of energy that does NOT improve with rest.Fatigue is one of the most common symptoms during chemotherapy treatment.It usually occurs in the first week after chemotherapy treatmentAs the number of chemotherapy cycles increases, fatigue may get worse or last longerThe fatigue experienced by a person with cancer is different from fatigue of everyday life.Cancer treatment-related fatigue can appear suddenly, and be overwhelming. It is not always relieved by rest. It can last after treatment ends.It may affect an individual's mood or emotions. It may also affect a person's ability to do usual activities and can make it hard to concentrate.Talk to the Registered Nurse about what can be done to preserve quality in your life.23
24 Talk to your cancer care team if concerned How to manage fatigueDo regular light exerciseBalance physical and social activities with restListen to your body and rest when neededStick to a regular sleep patternEat a well balanced dietDrink plenty of fluidsAllow friends and family to help youTalk to your cancer care team if concernedabout fatigueREAD off slideInform your Registered Nurse or oncologist if you are having difficulty managing fatigue.Resource: Your Bank to Energy Savings “Helping People with Cancer Handle Fatigue”24
25 Not all people receiving chemotherapy experience nausea and vomiting Nausea = an unpleasant, queasy feeling or feeling sick to your stomachVomiting = throwing upNot all people receiving chemotherapy experience nausea and vomitingREAD off slide25
26 Medications to prevent nausea & vomiting Physician will give you a prescription to help prevent nausea and vomitingFill your prescriptions at your community pharmacyBring the medications with youUnless advised, do not take these pills prior to coming to your Chemo appointment.If cost is a concern:Patient & Family Counseling can assistYour physician will prescribe anti-nausea medication to help prevent nausea and vomiting. This prescription needs to be filled at your community pharmacy – we ask you bring the pills with you for your first chemo appt.These prescription can be costly - let your doctor or Registered Nurse know if you need help financially.If you need more information or assistance, contact the Patient and Family Counseling Program.
27 How to manage nausea and vomiting Stay well hydrated - 8 cups of fluidEat frequent, small, light meals (esp. on treatment day)Keep your mouth clean: brush at least twice dailyAvoid:Hot, spicy, greasy foodsHeavy meals immediately after treatmentStrong odorsResource: “Food Choices to Help Control Nausea”READ off slide27
28 Resource: “Suggestions for Dealing with Constipation” When you are not having bowel movements as often as you used toCaused by:Some chemotherapy drugsSome anti-nausea drugsMost pain medicationsReduced fluid or fiber intakeStressLack of exerciseResource: “Suggestions for Dealing with Constipation”READ off slide
29 How to manage constipation It is normal to have a bowel movement at least every 2-3 days (even when little food is eaten)How to prevent:Increase your fluid intake – 8 glasses/dayWarm fluidsIncrease your fiber intakeBe as physically active as possibleIf you have not had a bowel movement in 3 days please talk to your cancer care teamREAD off slide
30 DiarrheaWhen your bowel movements are more frequent or more watery than normalCan be serious if not managedSome causes:chemotherapy drugsAntibioticsbowel surgeryradiation to the pelvisREAD off slide.Maybe associated with urgency, cramping and bloating
31 How to manage diarrheaIf prescribed by your oncologist – use your anti-diarrhea medications as instructedEat small/frequent mealsChoose foods with less fiberAvoid:foods that may aggravate diarrheaspicy/greasy foodsResources: “Food ideas to help manage Diarrhea” & “Dietary fiber content of common foods”READ off slide
32 Diarrhea lasting more than 24 hours - contact your cancer care team DehydrationDehydration can be a result of untreated diarrheacan be dangerous if not prevented/managedHow to prevent/manage:drink 8 to 10 glassesUse “anti-diarrhea” medications - as instructed by your health care teamWhen you feel better, eat foods high in calories and proteinDiarrhea lasting more than 24 hours - contact your cancer care teamREAD off slide
33 Signs and symptoms of dehydration *Report any signs and symptoms* FatigueExtreme thirstNauseaDry mouthLow urine outputDark colored urineREAD off slide*Report any signs and symptoms*
34 *Report any signs and symptoms* Mouth soresOccur within a few days after treatmentOn the tongue, gums, sides of the mouth, lips and throatSigns and symptoms:PainBleeding gumsDifficulty chewing and swallowingCan lead to an infection*Report any signs and symptoms*Chemotherapy can cause mouth sores that may occur a few days after treatment.Mouth sores can occur on the tongue, gums, the sides of the mouth, lips, and in the throat.Mouth sores or bleeding gums can lead to an infection, and difficulty eating and swallowing34
35 How to manage mouth sores Inspect mouth regularlyPractice good oral hygieneRinse 3 to 4 times/day - baking soda in warm waterUse a soft toothbrushAvoid mouthwash with alcoholMake sure dentures fit wellAvoid extreme hot or cold; spicy foodsResource: “Food Ideas to Try with Mouth Sores”READ off slide35
36 Skin changes Skin is body’s first line of defense against bacteria Signs and symptoms:Rednessrash / acneItchingpeelingDrynessREAD off slide
37 How to manage skin changes wash skin oftenwarm water and gentle soapmoisturizers – alcohol/fragrance freelanolin based lip balms and creamsprotect against sun exposure (clothing or SPF 30)protective eye wear and hatselectric razorREAD off slide
38 Hair loss Some chemo drugs Begins approx 2-3 weeks after 1st treatment Scalp could feel tender when hair starts to fall outSome people prefer to cut their hair shortWe suggest not to cut your hair until you come to your 1st chemo appointmentYour hair will begin to grow back 3-4 weeks after final treatmentHair loss is a common side effect of chemotherapy, but not all drugs cause hair lossHair loss is temporaryWhen your hair does begin to grow back, it may be a different texture or colour38
39 Resources for hair loss “Prescription” for a wig from the oncologistVisit a wig shop before you lose your hairDonated wigs at Canadian Cancer SocietyLook Good Feel Better Program – register at your cancer centerResources:Information can be found on the BCCA Website (Coping with Cancer), Volunteer Services and Patient & Family CounsellingPrior to losing your hair, you may want to visit a wig shop to match your hair colourGently-used donated wigs are available through the Canadian Cancer Society please call for nearest location
40 Sensory changes Senses potentially affected by chemo Touch – Muscles and NervesSound – HearingTasteSmellSightREAD off slide
41 Taste changes Foods may not taste the same Described as “metallic” or “cardboard” tasteCan affect your appetiteUse of sweet and salty flavorings - can helpChanges are temporaryResource:“Coping with Taste Changes” and “Food Ideas to Cope with Taste and Smell Changes”READ off slide
42 Resources: BCCA website Coping with Cancer Memory changesSome memory changesconcentration“chemo-brain” or “brain fog”Difficulty thinking and focusingMay be caused by chemo, fatigue, stress, insomniaHow to manage memory changes:Plan activitiesMake listsAsk for helpResources: BCCA website Coping with CancerChanges in your memory and concentration can be very subtle or they can be quite bothersome.These side effects may disappear after chemotherapy is completed.If you are concerned about these changes – please contact Patient and Family Counselling to speak with a counselor42
43 Reproductive and hormonal changes Chemotherapy may cause changes in hormone levels or reproductive organs:may affect your fertilitymay cause early menopausemay change your sexual desireTalk to your cancer care team for more informationTalk to Patient and Family Counseling for supportResources: Sexuality and CancerInformation below can be used to help answer questions:Chemotherapy may cause changes to hormonal system; men may decrease the sperm countFor some men, sperm banking may be appropriate prior to starting treatment. If unsure, speak with your doctorBirth control is very important for BOTH men and women. Pregnancy MUST be avoided while on chemotherapyIf you need guidance with concerns about intimacy and your relationships, contact Patient and Family Counseling43
44 Tips for treatment day length of treatments can vary wear comfortable clothing (sleeves that roll up)No fragrance – due to sensitivities to smell (this also applies to support people accompanying you to your appointments)eat a light meal before and after treatmenttake your regular medicationsTransportation:arrange a ride to and from your appointmentVolunteer Drivers - see your New Patient PackageParking:BCCA please bring money for the parking meterREAD off SlideEach cancer centre can talk about cafeterias etc.44
45 …more tips Bring: snacks & drink (no strong odors) support persons - 1 person at a time (not appropriate place for children)magazines, books, music with headphonesNew Patient PackageQuestionsPrescriptions:our anti-nausea prescriptions are filled in your community pharmacybring your anti-nausea pills with youREAD off slide45
46 Why do we mention to “drink plenty of fluids”? Water and fluids are vital to healthStaying hydrated helps with:NauseaDry mouthDiarrhea or ConstipationFatigueDry skinEasier to start your IVIt is important to stay well hydrated to prevent some of the potential side effects and symptoms – READ off slide
47 Natural Health Products (NHPs): Are they safe during cancer treatment? BCCA Recommendations:NHPs are NOT recommended during chemotherapy (radiation and surgical treatments)Please inform your oncologist about the use of NHPA Pharmacist is available to counsel and answer questionsREAD off slide
48 “Disposal of Waste at Home After Chemotherapy” Safety precautionsKeep chemotherapy out of reach of childrenIt takes approximately 48 hours for your body to filter the chemo outDuring that time, your body fluids (urine, vomit or semen) carry small amounts of drug wasteExposure to this drug waste can irritate your skin and be harmful to others & petsResource:“Disposal of Waste at Home After Chemotherapy”READ off slide
49 “Chemotherapy and other Drug Therapies” & “Sexuality and Cancer” …more precautionsFlushing toilet - lid down to prevent splashingIf chemotherapy or body wastes splash on your skin - wash the area with soap and waterUse a condom during intercoursePregnancy and breast feeding should be avoidedResources:“Chemotherapy and other Drug Therapies” &“Sexuality and Cancer”READ off slide
50 When to call? CALL if you have problems such as: CALL: Fevers (≥ 38°C) and/or shaking, chillsMouth sores, mouth painUncontrolled nausea or vomitingUncontrolled diarrheaConstipationAbnormal bleeding or bruisingPainful IV site…and if you are not sure…CALL:Telephone Nursing Line during clinic hoursOn-call Doctor after clinic hoursCall us immediately for the following symptoms:If you develop a sustained fever of 38 degrees CelsiusIf you develop mouth sores that make difficult to eat a soft diet or drink fluidsIf you develop diarrhea, 6 or more loose stools in a 24 hour periodIf you have not had a bowel movement in 3 days (constipation),If you experience vomiting lasting for more than 24 hoursYou have nausea that lasts for more than a few days:feel lightheaded or dizzyIf you develop abnormal bleeding or bruising, such as a nosebleed,After you return home, if you notice pain, redness or swelling in the area where the medication was given through the IV50
51 Pharmacy services Drug Information Side Effects Drug Interactions Natural HealthProductsDrug InteractionsOur pharmacists are an excellent resource and have a wealth of information about:Chemotherapy drugs. You will be given an appointment to speak with a pharmacist about your particular chemo pills.Chemo side effectsHerbal informationDrug interactionsThey are very happy to discuss any questions about your prescriptions or natural health products.
52 Patient and Family Counselling services Support and counselling are a vital part of copingIndividuals, couples and familiesSupport groups and programsInformation and referral to community servicesAssistance and information about practical and financial concernsREAD off slideOffer any local information as required.Resources:
53 Nutrition services Oncology Dietitian available at each Cancer Center Able to support you with difficulty eating, drinking, swallowing or maintaining your weightAsk your nurse or doctor for referralResources:BCCA Website - Coping with CancerNutritional Support: BC Cancer AgencyHealth Link BC (formerly Dial-A-Dietitian)Dial for general nutrition questions orSpeak with a specialized Oncology DietitianResource: “Eating Well When You Have Cancer”Read off slideOffer any local information as required.
54 Library services Librarian available at each Cancer Center Resources: Books, pamphlets, audio and videotapesCancer, treatment, coping with cancer, care-giving, healing, relaxation, sexuality and other topics of interestRead off slide