31. TIMING OF COMMON CHEMOTHERAPY SIDE EFFECTS Fatigue Neutropenia Chemo 5 10 15 20 25 Days Nausea/ Vomiting Mouth Sores Hair Loss
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Hinweis der Redaktion
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 5
Pg 6
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 14
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
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