1. LINDA MILLER, RN, OCN METROHEALTH CANCER CARE CENTER People with cancer

2. 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 2 nd most common cause of death in the US, responsible for 1 in 4 deaths

3. 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%

4. 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)

5. Chemotherapy Usually given in outpatient setting Prevents cancer cells from metastasizing Systemic therapy  Given intravenously Destroys good and bad cells Treatments on set schedule

6. Radiation therapy Local treatment directed at specific area Treatments scheduled daily, but treatment extends for weeks

7. Oral chemotherapy Increasing number of patients receiving oral chemotherapy PRECAUTIONS NEEDED:  Handled with proper protection including chemo gloves  Keep away from others in secure area

8. Side effects of therapy Fatigue Nausea/vomiting Diarrhea Fever Skin Pain Other

9. 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

10. 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  Increased risk of nausea  Women  Younger patients  Women with history of morning sickness

11. Helping people avoid nausea Provide small frequent meals (nausea occurs on an 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

12. 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

13. People with fever Due to low blood counts, usually 7 to 10 days after chemo Observe for temperature increase  First sign of infection If fever of 100.4°F or 38°C (have thermometer available)  To ER or call oncologist on duty

14. Infection precautions Chemotherapy patients can reside in general population shelter, but away from ill people  Dependent on instructions from physician  Provide isolation if necessary

15. Skin problems Especially for people receiving radiation therapy  Redness of skin  Provide Eucerin, Aquaphor

16. People with pain Treat with medication  Opioids  Keep in secure place!

17. 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

18. Questions to ask If a shelter resident identifies as a person being treated for cancer, ask about  Pain medicine  Anti-nausea medicine  Oral chemotherapy  Personal supplies: ostomy bags, etc.  Time and place of next treatment

19. Have available Rest area Nutritious foods Fluids (water, juice, Gatorade, popsicles, Jell-O) Imodium Thermometer

20. 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 Ask if caregiver is with person Ask about others providing care Ask about advanced directives

21. 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

22. 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

23. Thank you Questions? Comments?