Chemotherapy Class

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Chemotherapy Class

• Participate in Your Care

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Entrance Caring Bridge
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Welcome!
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Meet with your Patient Experience Specialist
Marjorie

• Contacts each new patient prior to first
  appointment to assist with questions, driving and
  parking directions and talks with you to decrease
  your concerns and fears
• Greets new patients and their loved ones and
  provides a tour of the Martin-ONeil Cancer
  Center
• Informs patients of the numerous resources
  available to them throughout their cancer journey
• Listens daily to patient and family needs and
  assures your needs are addressed by the care team
  or herself
• Hears your story. Patients are not a diagnosis
  here. Marjorie learns your unique story, needs,
  preferences and assures these are shared with the
  entire team

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Meet with your Patient Financial Specialist
Barbara

• Accesses current health insurance coverage
• Performs screening for eligibility of entitlement
  programs
• Informs patients/families of available financial
  resources including local, state and federal
  benefits
• Establishes payment contracts with you when
  applicable
• Is an onsite resource when you have questions
  about your bills

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Clinical Navigator- Colleen Winters, LCSW

• Assesses each patients emotional need for care
  and helps them discover their own capabilities
  while empowering them to take action in their
  cancer experience
• Provides personal attention to both patients and
  loved ones, and expert guidance through hospital
  resources such as support groups, resource
  referrals, palliative care, spiritual health
• Assists patients in major points of transition
  such as survivorship, or when needed, end of life
  decisions and care
• Assists patients in navigating between care
  settings, helping patients coordinate specialist
  consultations, care and procedures between the
  Martin-ONeil Cancer Center and outside expertise
• Assists patients with accessing integrative care
  services
• Acts as the Cancer Centers Community Liaison for
  programs such as the American Cancer Society,
  Hospice and the Leukemia and Lymphoma Society
• Our Clinical Navigator, Colleen, is conveniently
  available to you by calling the Martin-ONeil
  Cancer center MondayFriday 707-967-5721, or
  simply ask to see her anytime you are here for an
  appointment

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Patient Infusion Suite
Patient Infusion Suite Comfortable space and
room for loved ones to be with you
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Insight Your Resource Library
Our Patient Resource Specialist, Pamela, is here
Monday Thursday 900 am330pm
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Massage Therapy in our Wellness Center
Harmony Spa and Wellness Center Spiritual
Support and Stress Reduction services available
on site
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Class Objectives

• Provide you with a basic understanding of how
  chemotherapy works
• Explain the effects of chemotherapy on your blood
  cells
• Explain the common side effects that can occur
  during your chemotherapy treatment
• Provide you with information on how to manage
  your treatment side effects
• Provide you with resources and contact numbers to
  assist you during your treatment

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How to Contact us

• Office Hours
• Monday Friday, 800 AM 500 PM
• Phone number 707-967-5721
• Provide the following information when you call
• Name (first and last, please spell name)
• Date of birth
• Treatment you are receiving (name of chemotherapy
  agents)
• When you were treated
• Reason for call
• Phone number where you can be reached
• After Hours
• Evenings, weekends and holidays
• Phone number 707-967-5721

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Pre-Chemotherapy Recommendations

• Before treatment begins
• Fill prescriptions
• Port/central line placement if prescribed
• Order wig (prescription for cranial prosthesis)
• See dentist for cleaning/dental work if needed
• Day before treatment
• Drink eight 8 ounce glasses of liquid the day
  before your treatment
• Take pre-medications as ordered if prescribed

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Day of Treatment

• Drink 2-3 Eight ounce glasses of non-caffeinated
  liquids the morning of your treatment
• Eat a healthy breakfast
• Wear comfortable clothing
• Take regular medications as ordered unless told
  otherwise by oncologist
• Bring your treatment calendar and filled
  prescriptions with you
• Infusion nurse will review calendar and
  medications with you
• If you take pain medication for any reason, bring
  pills with you
• Bring a lunch if your treatment is several hours
  or snacks if your treatment is short.
  Suggestions sandwich, fruit, juice, yogurt

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During Treatment Session

• You can read books, use i-Pod, portable DVD
  player, laptop etc. (wireless service available)
• Blankets and pillows are available upon request
• Family/friends may accompany/check on you during
  treatment session. However children under the
  age of 16 may not accompany you. This is an
  infection control requirement for the health of
  all of our patients.
• Cell phone reception available

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General Recommendations

• WEAR sunblock (SPF 30 or higher)
• Increased skin sensitivity from chemotherapy
• USE contraceptive barrier if of childbearing age
• Applies to females and males
• www.fertilehope.org for information on fertility
• AVOID the following
• Aspirin unless ordered by physician
• Mega-doses of vitamins
• Excessive alcohol ingestion
• Herbal supplements 48 hours before and after
  treatment
• NEVER mask a fever
• CALL OFFICE if temperature is 100.5 or higher

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Certain Chemotherapy drugs can increase your
sensitivity to sunlight

• Be Sun Smart
• Apply sunscreen everyday Dont save your
  sunscreen for sunny days
• Apply sunscreen with a Sun Protection Factor
  (SPF) of at least 30 and higher
• Apply a sunscreen that provides you protection
  from both UVA and UVB rays
• Apply sunscreen 15-30 minutes prior to going
  outside
• Apply liberally on to the skinparticularly face,
  head, neck, hands and arms
• Avoid doing outdoor chores when sun rays are at
  its strongest1000 AM300 PM
• Remember to stay hydrateddrink water all day
  long, not just when you are thirsty
• Hint Dont forget to wear a Hat, sunscreen can
  only protect you so much.

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Recommendations

• Neutrogena Ultra Sheer Dry Touch - SPF 45, 55, 70
• Coppertone Sunscreen Sport Faces - SPF 50
• Coppertone Continuous Spray - SPF 50, 70
• Blue Lizard Sunscreen - SPF 50
• La Roche-Posay sunscreen - SPF 15

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How does Chemotherapy work

• Affects cells that are rapidly dividing which
  includes cancer cells and some normal healthy
  cells
• Goal is to kill as many cancer cells without
  causing too much toxicity to normal healthy cells
• Can reduce the number of healthy blood cells
  (Myelosuppression)
• Types of healthy blood cells affected
• White Blood Cells (WBCs)
• Red Blood Cells (RBCs)
• Platelets (Plts)

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How are my blood counts monitored

• Lab work is drawn at certain times before and
  during treatment cycles
• Types of labs
• CBC Complete Blood Count
• Drawn day of treatment or 1-2 days before each
  chemotherapy treatment and between cycles
• Measures your WBCs, RBCs, and Plts
• BMP Basic Metabolic Panel or
  
• CMP Comprehensive Metabolic Panel
• Usually drawn once a month or more frequently if
  regimen requires
• Measures your electrolytes (sodium, potassium,
  calcium, etc.)
• Measures your kidney and liver function

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Why are White Blood Cells (WBCs) Important

• Protect your body by fighting infection
• Normal White Blood Cell Counts
• Total white blood count (WBCs)
• Percentage of all circulating WBCs
• Range 4.0 10.5
• Neutrophils (Granulocytes)
• Type of WBCs that fight against bacteria
• Absolute Neutrophil Count (ANC or GRA)
• Percentage of neutrophils or granulocytes
• Range 1.5 6.6

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What Happens if my WBCs are low

• An ANC of lt1.5 is called Neutropenia
• Increases your risk of infection
• Supportive therapy with growth factor
• Stimulates bone marrow to produce more WBCs
• Types of growth factors
• Neulasta Injection
• Subcutaneous injection given the day following
  chemotherapy treatment
• Neupogen Injection
• Subcutaneous injection given daily for 7-10 days
  beginning the day following chemotherapy
  treatment
• Bone aching is common side effect from growth
  factor
• Acetaminophen (Tylenol) can be used to treat
  unless contraindicated
• Chemotherapy may need to be delayed until WBCs
  increase to safe range

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How can I protect myself from Infection?

• Healthy hygiene
• Frequent hand washing
• Use hand sanitizer
• AVOID being around people who are sick
• Keep surfaces clean (door handles, counters,
  phone, keyboard)
• CALL OFFICE if you experience
• Fever of 100.5 or higher
• Signs or symptoms of infection

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Why are Red Blood Cells (RBCs) important?

• Carry oxygen throughout body and help you feel
  energetic
• Normal Red Blood Cell Counts
• Hemoglobin
• Male 13-18 gm/dL
• Female 12-16 gm/dL
• Hematocrit
• Male 42-52
• Female 37-47

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What Happens if my RBCs are Low?

• A decrease in RBCs is called Anemia
• Symptoms of anemia
• Weakness
• Fatigue
• Shortness of breath
• Supportive therapy for symptomatic anemia
• Blood transfusion
• Growth factors if appropriate

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Why are Platelets(Plts) Important?

• Platelets are cells that help clot blood
• Normal Platelet Count 140,000 400,000

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What Happens if my Platelets are low?

• A decrease in Plts is called Thrombocytopenia
• Symptoms of thrombocytopenia
• Increased bruising/petechiae
• lt50,000 increased risk of bleeding
• Watch for bruising, bleeding gums, nose, blood in
  urine or stool
• Supportive therapy for thrombocytopenia
• lt20,000 may need platelet transfusion
• Chemotherapy may need to be delayed if Platelet
  count is lt100,000

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What is a Nadir?

• Period after chemotherapy when your blood counts
  are at their lowest point
• Usually 7-14 days after chemotherapy
• Can vary depending on your treatment regimen

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Nutrition During Treatment

• Make calories count
• Eat a well-balanced diet
• Protein is needed for cell repair
• Eat small frequent meals
• Refer to American Cancer Society booklet
  Nutrition during cancer treatment
• If you are having any difficulties or start
  losing weight, please ask to see Laura for a
  consultation. She is our Oncology Certified
  Dietician

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Common Side Effects from Treatment

• Loss of appetite
• Causes
• Chemotherapy agents
• Alterations in taste buds
• Metallic taste
• Alterations in smell
• Treatment
• Be open to trying different foods
• Add seasonings to food to increase flavor

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Nausea/Vomiting

• Cause
• Chemotherapy agents
• Treatment
• You will be given anti-nausea medications through
  your IV before you receive your chemotherapy
• You will have anti-nausea medications to take
  after chemotherapy
• Take medications as prescribed
• CALL OFFICE if no relief

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Mouth Sores (Mucositis)

• Cause
• Occur due to changes in the mucous membranes of
  the mouth
• Treatment
• Maintain good mouth care throughout treatment
• Brush and floss teeth
• AVOID harsh toothpaste or mouthwash (avoid those
  that contain alcohol)
• Use sensitive mouth products
• Rinse mouth regularly with salt solution to
  prevent infection improve healing of sore mouth
• 8 oz warm water
• ¼ tsp salt
• ¼ tsp baking soda
• Eat high-protein foods that are soft and bland
• CALL OFFICE if discomfort makes it hard to
  eat/drink
• Magic Mouthwash may be prescribed

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Constipation

• Causes
• Medications
• Some chemotherapy agents
• Pain medications
• Anti-nausea medications
• Changes in eating habits
• Being less active
• Treatment
• Drink plenty of fluids
• Eat high-fiber and bulky foods
• Exercise as tolerated
• Take over-the-counter stool softener/laxative
• Pericolace (docusate/senna) 1 tab in AM and 1 tab
  in PM OR
• Senekot-S (senna)
• IF NO BM in 2 days increase Pericolace or
  Senokot-S to 3 times a day
• CALL OFFICE if no bowel movement in 3 days

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Fatigue

• Causes
• Anemia
• Unknown mechanisms
• Treatment
• Listen to your body
• Rest when needed
• Stay active
• Keeps muscles tone (toned muscles require less
  energy)
• Increases sense of well-being
• Do activities requiring a lot of energy during
  periods of peak energy usually early in the day
• Eat a well-balanced diet
• Maintain a sleep-wake schedule
• Wake-up/go to bed at same time each day
• Have bedtime routine and provide relaxing
• environment

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Diarrhea

• Causes
• Some chemotherapy agents
• Certain foods
• Treatment
• BRAT diet (bananas, rice, apples, toast)
• AVOID foods that exacerbate diarrhea (high-fiber
  and bulky foods, raw vegetables, fruits, caffeine
  etc.)
• Use over-the-counter anti-diarrhea medication /
  Imodium AD (Loperamide)
• CALL OFFICE if no improvement
• Lomotil (diphenoxylate atropine) may be
  prescribed

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Hair Loss (Alopecia)

• Cause
• Hair follicles are rapidly dividing cells
• What happens?
• Hair loss usually occurs 2-3 weeks after your
  first treatment
• Scalp ache usually occurs right before
• Hair will start to re-grow once treatment is
  finished
• Grows 1/2 inch per month
• Initial growth will be fine
• Texture and color may change

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Frequently Asked Questions

• When should I see my physician?
• You should see the oncologist as ordered usually
  about midway between each treatment cycle
• When should I call the office?
• If you have a fever of 100.5 or higher or have
  signs/symptoms of infection
• If you have side effects that are not being
  controlled with current prescribed therapies
• When do I have my labs drawn?
• CBC is same day of treatment or 1-2 days before
  each treatment cycle
• BMP/CMP are usually drawn once a month or more
• frequently depending on treatment regimen

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Relative Does Intensity (RDI)

• RDI the relationship between the actual dose
  and schedule of the chemotherapy delivered
  compared to the intended dose and schedule of the
  standard chemotherapy regimen.
• (What we planned vs. what you received)
• Decreases in RDI are a result of
• Dose delays
• Dose reductions
• When the intention of treatment is cure,
  maintaining RDI is critical to achieve optimal
  survival rates.

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Relative Dose Intensity (RDI)

• Most delays in treatment are due to patient
  request
• Postpone vacations / trips until after treatment
• Make every effort to keep lab / treatment
  appointments
• Your nurse will help with treatment calendars

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Quality, Coordination Compassion

• The staff at Martin ONeil Cancer Center are here
  to help you.
• Thank you for attending!
• Please complete the class evaluation form.

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• Comments /Questions?