Good afternoon. My name is ___________,and I will be teaching the chemotherapy class today. This presentation is a basic overview of chemotherapy and it’s side effects: what are some of the things I can do to prevent side effects, what side effects I can manage at home and the side effects I need to call about right away. Because all of you here have different types of cancer and have been prescribed different medications, we won’t be discussing your medications. Feel free to ask any general questions during the presentation. If you have specific questions regarding your chemotherapy regimen, please see me after the presentation. You can also discuss your medications with your clinic nurse, oncologist, pharmacist or the nurse in the day care unit. We work as a team to answer your questions, and give you the best possible care. I’d like to do a quick roll call, just to make sure everyone is here.(do roll call first name only ) It is very important that everyone has their Chemoteaching package with them today. Does every one have their package? Today in class we will be reviewing the contents of this package- a chemotherapy booklet, symptom tracking sheet( your diary) and a letter for you to carry about infections and fevers. We will go over all of this information today.
Pg 3 Type of cancer you have determines the chemotherapy drugs you receive- you may receive one drug or a combination of drugs Chemotherapy is can be used together with surgery, RT, or immunotherapy
Pg 6 It is important for your clinic nurse and oncologist and pharmacist to be kept up to date on any new medications you have been prescribed or any medications you have discontinued so we can monitor side effects. Also, some medications can alter the effectiveness of chemotherapy (and vice versa) If you start on any new medications please indicate it on the clinic forms you fill out prior to every visit Update of medications with pharmacist and clinic There is an ACB information sheet ( in your patient information package ) regarding Natural Health Products and Cancer Therapy. Please note that this information sheet clearly suggests natural health products other than multivitamin and mineral supplements NOT be used for one month prior to starting treatment and for one month following completion of chemotherapy.
You may experience some, none, or all of the side effects
Chemotherapy affects not only cancer cells, but also the normal cells of your body, particularly the fast growing cells in your body We will talk about each of these individually
Pg 7 Neutrophils are one type of white blood cell Neutrophils are like the ‘soldiers’ in your body that help to fight infections. Chemotherapy can decrease your neutrophils making your body less able to fight infections therefore you must be careful to avoid people with colds, flus and infections. As well, we monitor your neutorphil count before your chemotherapy Neutropenia is the term we use to describe when your neutophils are at a low level and unable to fight off infection.
Pg 8 Infection may be localized It is important to watch for the following signs of infection approximately 7 to 14 days following chemotherapy. If you notice any of these symptoms you need to contact the Triage nurse right away. If your neutrophil count is low there are not enough white blood cells to fight bacteria and there is an increased risk of infection It is very very important to call if you have a sign of infection: if it is night at 10:00pm and your temperature is 38°C most people will wait until the morning to see how they feel and then call DO NOT WAIT- call the Cross Cancer Institute night. Do not wait 1 hour to re-check temperature. it is very important to call immediately do not try to bring down your temperature before you call CCI Infections may be life threatening and require hospitalization If the infection progresses in to the blood, it can cause a general infection in the blood stream called sepsis.
to prevent the introduction of germs wash your hands Continue to socialize with family and friends, but use common sense. Do not stay within close distance of someone you know is sick, since your immunity will be down and you will be more susceptible to infection. Frequently asked questions: Waterless hand cleansers are OK Avoid the use of antibacterial soaps Pump soap is better than bar soap, as bacteria can live on a bar of soap for a week
If you do not have a thermometer you need to buy one talk to your nurse. ( Recommended: digital thermometer, battery operated available at any pharmacy for $ 9-12, very reliable and easy to use)
Tylenol can mask an infection, and it is important that we start treating any infection early, to provide you with the best available care and treatment. The phone numbers are included in the chemo book ( page 19) Certain drugs can bring your fever down like Advil, Motrin, Ibuprofen, ASA drugs We do not want you to take any medications or to do anything to bring down your temperature until you contact the triage nurse
We monitor your hemoglobin during chemotherapy. Sometimes if your hemoglobin falls too low, we may give you a blood transfusion or we may talk to you about other options to increase your hemoglobin levels. Some patients may have no sign that they have a low hemoglobin- they may feel fine, but have low levels of hemoglobin that require intervention
Pg 9 This happens at 7-14 days after chemotherapy treatment. If you have a nosebleed that you cannot stop using standard first aid you must call the telephone triage nurse
Dental care Floss if this is your regular activity. If you do not floss regularly now, do not try to start. Flossing your teeth may cause small cuts to your gums which may bleed, or provide the opportunity for infection. If on blood thinners already, continue to monitor for signs of bleeding, and make sure you have your blood checked regularly by your family doctor.
Tylenol or acetaminophen is the drug of choice on chemotherapy for pain management. Take acetaminophen (Tylenol ® ) for aches and pains Check your temperature prior to taking Check temperature regularly if on regular pain medication with acetaminophen Aspirin interferes with the production of platelets. It can increase the potential for bleeding, even more so when platelets are already low. if you are taking Tylenol regularly (e.g.. Every 4-6 hours-) take your temperature just before your next dose is due We do not want you to be in pain-.take pain meds as directed by your physician
Lab will be 30-60 minutes prior to your clinic appointment with your nurse and doctor to ensure your lab results will be ready for your appointment External lab work must be done before 10:00am the day before your appointment to ensure that we receive results on time External lab work can be done if you are from OUT of town >100 km. It requires arranging ahead of time-speak to your clinic nurse to see if it can be arranged for you.
Important that your counts recover for your next cycle, as the counts will drop again A delay usually means 1 week off before starting the next cycle of chemo
Pg 10 2 nd bullet – your doctor may have given you a prescription for anti-nausea medications. Have your prescription filled at your local pharmacy and take your anti-nausea medications regularly and as directed. Degree of N/V varies between chemotherapy drugs
Examples of bland foods in book pg 10 , also list of diet suggestions at the back of the class
Pg 11Eat lighter meals and foods. Try puddings or jellos and Ensure. Rinse your mouth before eating using water, baking soda or club soda mouth rinses Handouts at the back of the room
Pg 12 Two kinds of dental work: Planned expensive and emergency very expensive. We want to know about both! Do not make an appointment without talking to your nurse or doctor first. Dental work can cause irritation or cuts to the gums and mouth allowing for the potential for infection to start. Your doctor may prescribe antibiotics to prevent infection. Blood work and antibiotics may be required both prior to and after dental work Dental work should be planned a day or 2 prior to chemotherapy treatments when possible
Baking soda recipe is in your booklet on page 12 Do not use over the counter mouthwashes as they contain alcohol which can dry out the mouth Even if your mouth feels fine, mouth care is really important. Start mouth care early and prevent problems an ounce of prevention is worth a pound of cure!. M.D. can prescribe mouth rinses or pain meds if they are needed. Examine your mouth daily (look for redness or sores)
Refer to page 13-14 Drinking (or gulping) fluids quickly can increase bowel motility and make diarrhea worse. 4th bullet- and reintroduce slowly when diarrhea resolved. (250ml or 8 ounces) over 1 hour
Pg 15 May be cumulative It is important to have a routine exercise helps keep your muscles strong and helps with endurance Take short rest periods through the day – example 20 to 30 minutes. Longer naps will interrupt your nighttime sleep routine and increase daytime fatigue. Fatigue Management Coordinator may be consulted
Depends on the type of chemotherapy given Pregnancy (NOT SEX) must be avoided while on chemotherapy Discuss birth control methods with your family physician May experience the loss of sexual desire due to stress and chemotherapy If questions or concerns contact your nurse or the department of Psychosocial and Spiritual Resources
Pg 17 Hair loss may vary for individual Head wear/wig services are available through Volunteer Services Refer to hair loss booklet at back of class
Skin may be more sensitive to the sun higher chance of skin burning over much shorter time During chemo treatment, and lifelong protection. Muscle weakness may be temporary Nerve changes may be temporary but may be permanent- let us know! Let us know if you experience these symptoms- we will monitor them. Symptoms may subside over time.
This slide shows the timing of many common side effects. It is important to remember that you may not experience any or all of the side effects we are discussing. Summary of timing Important to keep track of your symptoms in your diary
Refer to page 18 in your chemotherapy guide.
Refer to patient letter (available at OPD area desks) and CCI business cards…make sure patients know when to call. Keep information in your wallet, by telephone and/or on the frig. Important that patients understand that there is no telephone triage available between 11 pm and 8 am and that, if the situation warrants (outlined on page 34-previous slide), they should go to the nearest hospital emergency room.
Telephone triage will find out why the appointment is being cancelled, and try to help you problem solve. If necessary, will also arrange for you to be seen by MD if you are unwell. Many chemo medications are very expensive, and can cost thousands of dollars per treatment, and affects not only the pharmacy, but nurses who administer treatments, and other patients who need treatment
Family members should also have the flu shot because we want both you and your family members to do everything possible to stay healthy.
If you have questions or concerns regarding your cancer or treatment, discuss with your oncologist. For any other concerns such as blood pressure medications, etc. discuss with your family physician.
Cancer patients are more at risk for infectious diseases, and we take more precautions than other facilities to protect all our patients An infectious disease can be shingles, TB, SARS,MRSA, VRE, superbugs etc do not walk into the Cross Cancer Institute unless we are aware and necessary precautions have been taken We will take precautions to protect all our patients- gowns goggles gloves, etc…as patients who have had cancer treatment may be more at risk to these infections.
Social worker: available for financial assistance, accommodation Psychology : available to talk with patients and families about coping, use of art therapy, Arts and Medicine program, Children's program , group and individual counseling Pastoral care: chaplains available to discuss spiritual needs Physiotherapy and Occupational health- referral from physicians for specific needs Dietician: for dietary consults, nutrition counseling
Lights on , talk time
Chemotherapy treatment education
CHEMOTHERAPY AND YOU Lions Gate Hospital The Dr. Paul Klimo Medical Oncology Clinic
TODAY WE WILL FOCUS ON: <ul><li>Chemotherapy side effects </li></ul><ul><ul><li>What to expect </li></ul></ul><ul><ul><li>How to manage </li></ul></ul><ul><ul><li>When to call </li></ul></ul>
WHAT IS CHEMOTHERAPY? <ul><li>The use of drugs to destroy or control the growth of cancer cells </li></ul><ul><li>May use one drug or a combination </li></ul>
HOW IS CHEMOTHERAPY GIVEN? <ul><li>Intravenous (into a vein) </li></ul><ul><li>Oral ( by mouth) </li></ul><ul><li>Other routes </li></ul>
IS CHEMOTHERAPY PAINFUL? <ul><li>NO! </li></ul><ul><li>If you feel burning, or notice redness or swelling in the area of the needle, tell your nurse immediately </li></ul><ul><li>If you feel pain, or notice redness or swelling after you are at home, phone the Telephone Triage Nurse </li></ul>
CAN I TAKE OTHER MEDICATIONS WHILE I AM ON CHEMOTHERAPY? <ul><li>Check with your cancer doctor (oncologist) or clinic nurse before starting any new medications. </li></ul>
NORMAL CELLS AFFECTED BY CHEMOTHERAPY <ul><li>Bone marrow (red blood cells, white blood cells and platelets) </li></ul><ul><li>Lining of the mouth, throat, stomach, intestines </li></ul><ul><li>Peripheral nerves (nerve endings) </li></ul><ul><li>Reproductive system </li></ul><ul><li>Hair follicles </li></ul>
WHITE BLOOD CELLS <ul><li>(the cells that fight infection) </li></ul><ul><li>White blood cells may be decreased following your chemotherapy </li></ul><ul><li>Neutrophils, a type of white blood cell, fight bacterial infection </li></ul>
SIGNS OF INFECTION <ul><li>Temperature of 38°C (100.4°F) or higher </li></ul><ul><li>Areas of redness or tenderness </li></ul><ul><li>Chills, shakes </li></ul><ul><li>Sore throat/ mouth sores </li></ul><ul><li>Productive cough </li></ul><ul><li>Itching or burning in genital area </li></ul><ul><li>Pain/ burning/ frequent urge to urinate </li></ul>
TO PREVENT INFECTIONS : <ul><li>WASH YOUR HANDS! </li></ul>
FEVERS AFTER CHEMOTHERAPY <ul><li>Remember you are at risk for infection after your chemotherapy treatment </li></ul><ul><li>Take your temperature every 4 hours if you are not feeling well </li></ul>
FEVERS <ul><li>If you have a fever, 38°C or higher </li></ul><ul><li>( 100.4°F or higher), phone the Chemotherapy Clinician immediately. </li></ul><ul><li>If you have a fever after 4 p.m. or during the weekend, go to the nearest Emergency Department. </li></ul><ul><li>DO NOT TAKE ACETAMINOPHEN (Tylenol ™) for your fever until you have completed the above. </li></ul>
RED BLOOD CELLS (HEMOGLOBIN) <ul><li>Feel tired </li></ul><ul><li>Feel short of breath with activity </li></ul><ul><li>Have a headache </li></ul><ul><li>Have no symptoms </li></ul>If your red blood cell count is low you may:
PLATELETS (the cells that help the blood to clot) <ul><li>Bruises or small purple spots on your body </li></ul><ul><li>Nose bleeds </li></ul><ul><li>Bleeding gums </li></ul><ul><li>Blood in your urine or stool </li></ul>If your platelet count is low you may notice:
TO PREVENT BLEEDING <ul><li>Use a soft toothbrush </li></ul><ul><li>Blow your nose gently </li></ul><ul><li>Use the bowel routine recommended to prevent constipation </li></ul><ul><li>Talk to your oncologist about blood thinners and aspirin- based drugs </li></ul>
PAIN MANAGEMENT <ul><li>Do not use ASA (aspirin) or ASA based drugs for pain – discuss use of ASA drugs with oncologist ( daily heart/stroke prevention) </li></ul><ul><li>Talk to your oncologist about pain relief options </li></ul><ul><li>Ibuprofen (advil) is okay to use occasionally </li></ul>
BLOOD WORK PRIOR TO CHEMOTHERAPY <ul><li>Blood work should be done within 2 days of each chemotherapy treatment </li></ul><ul><li>If you live out of town, blood work may be arranged in your home community </li></ul>
CHEMOTHERAPY DELAYS <ul><li>Chemotherapy may be delayed if: </li></ul><ul><ul><li>Blood counts are too low </li></ul></ul><ul><ul><li>You have other side effects </li></ul></ul><ul><ul><li>If blood work is not done prior to treatment </li></ul></ul>
NAUSEA AND VOMITING <ul><li>Nausea is not a side effect of every drug </li></ul><ul><li>It may be immediate or delayed </li></ul><ul><li>Fill your prescription at your local pharmacy </li></ul>
MANAGING NAUSEA AND VOMITING <ul><li>Take anti-nausea pills as directed !! </li></ul><ul><li>Eat frequent, small meals (6-8 times a day) </li></ul><ul><li>Eat bland food </li></ul><ul><li>Drink 8-10 glasses of fluids daily </li></ul>
LOSS OF APPETITE (ANOREXIA) <ul><li>Taste and smell may be changed by chemotherapy </li></ul><ul><li>Eat small meals often (6-8 meals a day) </li></ul><ul><li>Eat food high in protein and calories </li></ul><ul><li>Consult dietitian if needed </li></ul>
MOUTH PROBLEMS: Dental work <ul><li>Let your dentist know you are receiving chemotherapy </li></ul><ul><li>Discuss any dental work that needs to be done with your clinic nurse or doctor </li></ul><ul><li>Get regular dental cleaning </li></ul>
MOUTH PROBLEMS: Sore Mouth <ul><li>If you have tender gums or a sore mouth, look at your mouth in the mirror </li></ul><ul><li>Rinse your mouth with baking soda and water / or salt and warm water after eating and as often as you can (every 2-4 hours) </li></ul><ul><li>Use a soft toothbrush </li></ul><ul><li>Do not use over the counter mouthwash! </li></ul>
DIARRHEA <ul><li>Drink fluids slowly </li></ul><ul><li>Eat small, frequent meals </li></ul><ul><li>Eat bland food </li></ul><ul><li>Stop dairy products if diarrhea develops </li></ul><ul><li>Take medications as prescribed </li></ul><ul><li>Call if diarrhea lasts longer than 24 hours </li></ul>
CONSTIPATION <ul><li>Follow suggestions in the constipation </li></ul><ul><li>booklet. The nurse will be able to give you a handout </li></ul><ul><li>Speak to the nurse or oncologist in clinic </li></ul><ul><li>Call if no bowel movement in three days </li></ul><ul><li>Increase fluids, fiber and fruits and vegetables </li></ul>
FATIGUE <ul><li>Plan regular bedtime and wakeup times </li></ul><ul><li>Pace yourself </li></ul><ul><li>Delegate responsibilities </li></ul><ul><li>Plan a regular exercise program </li></ul><ul><li>Inform your Physician/nurse at your next appointment </li></ul>
REPRODUCTIVE SYSTEM CHANGES <ul><li>Changes may be temporary or permanent </li></ul><ul><li>Women </li></ul><ul><ul><li>May or may not menstruate </li></ul></ul><ul><ul><li>May experience symptoms of menopause </li></ul></ul><ul><li>Men </li></ul><ul><ul><li>May have decreased sperm count </li></ul></ul>
HAIR LOSS <ul><li>May have total hair loss, thinning or no loss at all </li></ul><ul><li>Depends on the chemotherapy drug </li></ul><ul><li>Usually occurs within 3 weeks after your first treatment </li></ul>
SKIN – MUSCLE – NERVE CHANGES <ul><li>Skin </li></ul><ul><ul><li>use sunscreen SPF 30 </li></ul></ul><ul><ul><li>wear a hat and keep covered outdoors </li></ul></ul><ul><li>Muscle </li></ul><ul><ul><li>muscle weakness </li></ul></ul><ul><li>Nerve </li></ul><ul><ul><li>numbness or tingling in your </li></ul></ul><ul><ul><li>hands or feet, ringing in the ears </li></ul></ul>
TIMING OF COMMON CHEMOTHERAPY SIDE EFFECTS Fatigue Neutropenia Chemo 5 10 15 20 25 Days Nausea/ Vomiting Mouth Sores Hair Loss
When to Contact the LGH Oncology Clinic <ul><li>Fever of 38º C/ 100.4 º F </li></ul><ul><li>Chills, shaking </li></ul><ul><li>Mouth sores and/or pain on swallowing </li></ul><ul><li>Severe constipation or diarrhea </li></ul><ul><li>Abnormal bleeding </li></ul><ul><li>Bruising or small purple or red spots </li></ul><ul><li>Unrelieved shortness of breath </li></ul><ul><li>Marked pain or soreness at injection site </li></ul><ul><li>Any new rashes or lumps </li></ul><ul><li>Any unusual strong or new pain </li></ul>
APPOINTMENTS <ul><li>If you cannot attend your chemotherapy appointment as scheduled, call the </li></ul><ul><li>LGH Oncology Clinic Booking Office 604-984-5753 </li></ul>
FLU VACCINE <ul><li>Flu vaccines are recommended for cancer patients and their families </li></ul><ul><li>Vaccinations are offered October to December by your family physician or local public health clinic </li></ul><ul><li>Discuss the timing of your vaccine with your clinic nurse or oncologist </li></ul>
DOCTORS RESPONSIBLE FOR YOUR CARE <ul><li>Your oncologist (cancer doctor) is responsible for your cancer treatment </li></ul><ul><li>Your family doctor is responsible for all non-cancer related health problem </li></ul>
INFECTIOUS DISEASES <ul><li>You MUST call the Telephone Triage Nurse before your next visit if you think you have been exposed, or have been diagnosed with an infectious disease </li></ul>
Living with Cancer <ul><li>Support Services available at LGH Oncology Clinic: </li></ul><ul><ul><li>Pharmacy </li></ul></ul><ul><ul><li>Social Work </li></ul></ul><ul><ul><li>Counselling </li></ul></ul><ul><ul><li>Pastoral Care </li></ul></ul><ul><ul><li>Dietary </li></ul></ul><ul><ul><li>Symptom Management/Drug Reimbursement Nurse </li></ul></ul>
Chemotherapy is a hazardous waste <ul><li>Chemotherapy takes 48 hours to clear your body </li></ul><ul><li>Chemotherapy is excreted in your urine, stool, vomit, sperm, and vaginal fluids </li></ul><ul><li>Please take precautions to protect your family members. </li></ul>
Acknowledgment <ul><li>The Lions Gate Hospital Oncology Clinic thanks the Cross Cancer Institute for permitting reproduction of this presentation for teaching purposes. </li></ul><ul><li>This power point presentation is available on our website at </li></ul><ul><li>www.coastalpalliativecare.ca </li></ul>