Chemotherapy Preparation

The nurse who prepares or educates the patient who will be receiving chemotherapy sets the tone for the patient and his experience regarding his initial chemotherapy experience and his chemotherapy course of treatment.

It is important to discuss the side effects of chemotherapy, the chemotherapy protocol, and how the body responds to chemotherapy, the importance of blood test, laboratory tests, diet, exercise and taking your temperature. The patient should be made aware that his team of healthcare professionals will be monitoring him to see how he is feeling and if he is showing any side effects from his chemotherapy treatment.

The patient should be encouraged and know if he has any questions or appears to have any side effects from the chemotherapy at home or on the outside the chemotherapy setting to call and to speak to someone regarding his care.

I always say never assume that a simple nosebleed, is a simple nosebleed. One must speak to a healthcare professional on his team regarding possible side effects.

Furthermore, the nurse should inquire if the patient lives alone, what support systems are in place? What type of work does he do and how will chemotherapy affect his quality of life.

Here are some frequent questions that patients have asked me before they started chemotherapy.
1. What is chemotherapy?
2. Will this chemotherapy work with my cancer? Will it cure me?
3. Am I going to die?
4. How did this happen to me? Why did this happen to me?

I have found the first few questions from patients are more emotional questions. Because the patients are concerned about survival and what will be the outcome.

After I address these emotional concerns about their disease process, then other questions come up:
How long is the course of my chemotherapy therapy?
What are the side effects of the medications?
What will you give me for me nausea?
What can I eat or cannot eat during my chemotherapy day or after?
Does my hair fall out? When will my hair start to fall out?
How long does the infusion chemotherapy take?
What oral chemotherapy do I take? How is that different from an infusion?
What are pre-treatments?
What do I have to do the day before chemotherapy or after my chemotherapy treatment?
Does anything happen while I am receiving chemotherapy?
What do I need to bring to my appointment?
Will my treatment be painful?
Where will I have my treatment?
What will happen when I arrive for my chemotherapy?

At this time the nurse should check to see how well the veins could be access for chemotherapy administration. Perhaps the patient does not have good access and may need to have a port put in place.

Other information that should be included regarding chemotherapy education is:

- Sexuality
- Methods of adherence regarding chemotherapy and medications that are part of the chemotherapy protocol.
- Check to see if the proper test are ordered before the patient under goes chemotherapy
- Know that the patient or their family most likely has been seeking information pertaining to the chemotherapy and the cancer disease process though social media.

You have enough time to prepare without too much time to worry excessively. How are you feeling about the appointment? The fact that you've already found this web site tells us a lot. You're obviously doing research and looking for answers.

There are a million things I could tell you: but the most important thing is to know yourself. How much information do you want? Do you know the medical system, how it all works? Are you comfortable advocating for yourself? Is your general health good? Do you have all your current medications (if any) and the name of your PCP written down as well as your health history? You will write out this information (plus your insurance policy numbers) a million times so you might want to consolidate it all into a word document to make it easy to copy. Take it with you to your appointment.

Here are a few things I've learned and recommend for others:

1) Realize that YOU are in charge. Take strength from that. This is your health, your cancer. No one else can or should make decisions for you. An excellent doctor will listen to your concerns and preferences then make recommendations based on evidence and best practices. If you don't click with the first doctor find another. It's worth the time and anxiety. You need to be able to communicate comfortably with this person; and he/she should listen honestly and sincerely to you.

2) Get a copy of Susan Love's Breast Book, the most recent edition. This is excellent background information about breast health, breast cancer, and an overview of treatments. That's a good place to start.

3) Don't believe everything you read or hear about so & so's aunt or what's her' name's sister. There are many different forms of breast cancer and and an even greater number and combinations of treatments. Not every case is the same. Take information, stories and unwanted advice only as you can accommodate it. It's easy to be overwhelmed.

4) You can get a terrific treatment guide from Livestrong.org here: http://www.store-laf.org/gbj001.html or DM me on Twitter and I'll mail one to you. I found it helpful to have one notebook where I recorded all my information.

5) I also felt empowered by the Livestrong Manifesto, which begins: "We believe in life. Your life....We believe in information. Not pity. And straight, open talk about cancer." http://www.store-laf.org/gbj001.

6) If you are in your child-bearing years and still want to have children talk to your oncologist about protecting your fertility.

7) Was your tissue analyzed by mammaprint or OncotypeDx? These tests can provide some guidance whether or not chemo is necessary.

8) If your oncologist recommends chemo - and you say you don't want it - make sure he/she specifically states why it is considered ESSENTIAL for you. Is your cancer hormone receptor positive? It's important for you to know this, as you know your stage, grade and HER2-new status.

9) I trust that someone is going with you to this appointment? This is very important. Another set of ears is essential. And remember you have TIME to come to a decision you are comfortable with. It took me three weeks to review information, and see four different doctors. The search was worth it. I was diagnosed with a locally advanced breast cancer, had surgery, chemotherapy, radiation and three years of Tamoxifen. This was thirteen years ago. My health is excellent and I've had no recurrence. Wishing the same for you,
Jody

The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately.