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Understanding chemotherapy

guide for cares of children on chemotherapy

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Understanding chemotherapy

  2. 2. What is Cancer? <ul><li>CANCER: A disease of the body’s cells </li></ul><ul><li>Normal: body constantly making new cells- to enable us to grow , to replace worn out cells or to heal damaged cells after an injury </li></ul><ul><li>Cells grow uncontrolled- tumor/leukemias </li></ul>
  3. 3. Treatment of Cancer <ul><li>Surgery </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Radiotherapy </li></ul>
  4. 4. Chemotherapy <ul><li>Use of drugs to kill or slow the growth of cancer cells </li></ul><ul><li>Many different types of chemotherapy drugs </li></ul><ul><li>Commonly used drugs in ALL </li></ul><ul><ul><li>Prednisone </li></ul></ul><ul><ul><li>Vincristine </li></ul></ul><ul><ul><li>Doxorubicin </li></ul></ul><ul><ul><li>L-asparaginase </li></ul></ul><ul><ul><li>Cytarabine </li></ul></ul><ul><ul><li>Cyclophosphamide </li></ul></ul><ul><ul><li>Methotrexate </li></ul></ul><ul><ul><li>6 mercaptopurine </li></ul></ul>
  5. 5. Why have chemotherapy? <ul><li>Cure </li></ul><ul><ul><li>Sometimes in combination with surgery and radiotherapy </li></ul></ul><ul><li>Adjuvant </li></ul><ul><ul><li>To make the cancer smaller so the other treatment can be more effective </li></ul></ul><ul><li>Palliative </li></ul><ul><ul><li>Relief of symptoms </li></ul></ul><ul><ul><li>For people with advanced cancer who cannot be cured but want to live comfortable and without undue pain </li></ul></ul>
  6. 6. How chemotherapy works <ul><li>Stop cancer cells from growing and multiplying </li></ul><ul><li>Affects also normal cells that multiply rapidly – hair cells, cells lining the mouth and blood cells </li></ul>
  7. 7. Fear of Chemotherapy <ul><li>Natural to be worried </li></ul><ul><li>Terrible stories </li></ul><ul><li>BUT!!! </li></ul><ul><li>Everyone is different and reacts differently to chemotherapy </li></ul><ul><li>Tailored therapy </li></ul>
  8. 8. How chemotherapy is given <ul><li>Intravenous </li></ul><ul><li>By mouth (tablets </li></ul><ul><li>Injection into a muscle (IM) </li></ul><ul><li>Injection under the skin (SQ) </li></ul><ul><li>Injection into the fluid around the spine (IT) </li></ul>
  9. 9. Intrathecal Chemotherapy
  10. 10. Does it hurt? <ul><li>IV chemotherapy- Like having blood taken </li></ul><ul><li>It should not hurt after the initial injection </li></ul>
  11. 11. Chemotherapy is time consuming <ul><li>Waiting and waiting </li></ul><ul><li>Read a book or magazine </li></ul><ul><li>Listen to music </li></ul><ul><li>Talk to a companion </li></ul><ul><li>Write in a journal </li></ul><ul><li>Do crafts </li></ul>
  12. 12. Managing Side Effects <ul><li>Most important effect of chemotherapy: it kills cancer cells </li></ul><ul><li>Can also affect normal cells - cause unwanted side effects </li></ul><ul><li>Usually start during the first few weeks of treatment </li></ul><ul><li>Most can be managed and go away in time </li></ul>
  13. 13. Side Effects of Chemotherapy <ul><li>Vary greatly </li></ul><ul><li>Some will have no side effects </li></ul><ul><li>Complimentary/Alternative medicine? </li></ul>
  14. 14. Common Side Effects of Chemotherapy <ul><li>Feeling tired and lacking energy </li></ul><ul><li>Feeling sick or vomiting </li></ul><ul><li>Constipation or diarrhea </li></ul><ul><li>Mouth sores </li></ul><ul><li>Hair loss and scalp problems </li></ul><ul><li>Itchy skin and other skin problems </li></ul><ul><li>Nerve and muscle effects </li></ul><ul><li>Change in hearing </li></ul><ul><li>Effects on the blood and immune system </li></ul><ul><li>Fertility problems </li></ul>
  15. 15. Feeling tired and lacking energy <ul><li>Exhausted, tired, sleepy, drowsy, confused, impatient </li></ul><ul><li>TIPS: </li></ul><ul><ul><li>Plan your day </li></ul></ul><ul><ul><li>Save energy. Don’t do more than you can comfortably do </li></ul></ul><ul><ul><li>Take short naps or breaks </li></ul></ul><ul><ul><li>Take short walks or do light exercise </li></ul></ul><ul><ul><li>Let other people help you </li></ul></ul>
  16. 16. Feeling sick or vomiting <ul><li>Not everyone </li></ul><ul><li>Usually starts a few hours after treatment and may last many hours </li></ul><ul><li>If continues for a few days – go to your doctor </li></ul><ul><li>Changes to eating pattern </li></ul>
  17. 17. Feeling sick or vomiting <ul><li>TIPS </li></ul><ul><ul><li>Eat a light meal before the treatment </li></ul></ul><ul><ul><li>Drink small but frequent fluids. </li></ul></ul><ul><ul><li>Small but frequent food </li></ul></ul><ul><ul><li>Avoid food that usually upset stomach </li></ul></ul><ul><ul><li>Eat slowly and chew well </li></ul></ul>
  18. 18. Feeling sick or vomiting <ul><li>TIPS </li></ul><ul><ul><li>Jellies, weak tea, fresh fruit juices, ice cubes </li></ul></ul><ul><ul><li>Eat dry toast or crackers </li></ul></ul><ul><ul><li>Avoid odors – cooking smell, perfume, alcohol </li></ul></ul>X
  19. 19. Feeling sick or vomiting <ul><li>Don’t do anything strenuous after a meal </li></ul><ul><li>Elevate head after eating </li></ul><ul><li>Try breathing thru the mouth when you feel sick </li></ul><ul><li>Ask for medications </li></ul><ul><li>Let your child wear loose clothing </li></ul><ul><li>Bring plastic bags </li></ul><ul><li>Use distractions – TV, music, games </li></ul>
  20. 20. Constipation <ul><li>Eat more high-fibre foods such as wholegrain bread and pasta, fruit and vegetables </li></ul><ul><li>Drink plenty of fluids </li></ul><ul><li>Get some light exercise </li></ul><ul><li>Eat small, frequent snacks instead of big meals </li></ul>
  21. 21. Diarrhea <ul><li>May need admission </li></ul><ul><li>Drink plenty of fluids </li></ul><ul><li>Take: clear broth and toast, biscuits and cheese or cooked rice </li></ul><ul><li>Avoid: spicy foods, fatty or fried foods, rich gravies and sauces, raw fruit or vegetables with skins or seeds </li></ul>X
  22. 22. Mouth Sores <ul><li>Soft toothbrush. </li></ul><ul><li>Mouthwash without alcohol </li></ul><ul><li>Gargle 4 x a day: 1 teaspoon of salt + 1 glass of water </li></ul><ul><li>Dry mouth: Sip fluids, eat soft foods, blend food, soups, ice cream, moisten foods with butter </li></ul>
  23. 23. Hair Loss and Scalp Problems <ul><li>Varies from person to person </li></ul><ul><li>Usually starts 2 to 3 weeks after the first treatment </li></ul><ul><li>Wear a wig or a scarf </li></ul>
  24. 24. Hair Loss and Scalp Problems <ul><li>Keep it clean </li></ul><ul><li>Use mild shampoo – baby shampoo </li></ul><ul><li>Comb using a large comb or brush with soft bristles </li></ul><ul><li>Use hat or scarf to protect head from the sun </li></ul><ul><li>Use cotton pillowcase </li></ul><ul><li>Avoid hair perms and dyes </li></ul><ul><li>Limit use of dryers </li></ul>
  25. 25. Hair Loss and Scalp Problems <ul><li>Emphasize that it temporary and that it will grow back </li></ul><ul><li>Hair loss is quite variable </li></ul><ul><li>Separate your feelings from your child’s </li></ul><ul><li>Let it okay to be bald </li></ul>
  26. 26. Itchy skin and other skin problems <ul><li>Skin may darken, peel or become dry and itchy </li></ul><ul><li>May be sensitive to the sun </li></ul><ul><li>Protect your skin from the sun </li></ul><ul><li>Dust cornflour over the itchy part </li></ul><ul><li>Use lotion or cream to stop the dryness </li></ul>
  27. 27. Effects on the Immune Blood and Immune System <ul><li>The bone marrow makes 3 kinds of blood cells </li></ul><ul><ul><li>White blood cells </li></ul></ul><ul><ul><li>Red blood cells </li></ul></ul><ul><ul><li>Platelets </li></ul></ul><ul><li>Chemotherapy can lower your blood count </li></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Bleeding </li></ul></ul><ul><ul><li>Anemia </li></ul></ul>
  28. 28. What is ANC? <ul><li>This provides an indication of the child’s ability to fight infection </li></ul><ul><li>To get ANC, multiply percentage of neutrophils by the total WBC </li></ul><ul><li>Example </li></ul><ul><ul><li>Total WBC = 1000 </li></ul></ul><ul><ul><li>Neutrophils = 50% </li></ul></ul><ul><ul><li>ANC = 500 </li></ul></ul>
  29. 29. How to protect the child with a low ANC? <ul><li>Thorough hand washing for every member of the family </li></ul><ul><li>Make sure all medical personnel wash their hands before touching your child </li></ul><ul><li>Keep child’s diaper area clean and dry </li></ul><ul><li>Whenever your child needs a needle stick, make sure the technician cleans the skin thoroughly with alcohol </li></ul>
  30. 30. How to protect the child with a low ANC? <ul><li>Small cuts – wash with soap and water and rinse with hydrogen peroxide </li></ul><ul><li>No rectal thermometers, no rectal suppositories </li></ul><ul><li>No routine immunizations </li></ul><ul><li>Siblings should not be give live vaccines </li></ul>X
  31. 31. Urgent! <ul><ul><li>Fever over 38 C or chills </li></ul></ul><ul><ul><li>Sweating esp at night </li></ul></ul><ul><ul><li>Easy bruising or any unusual bleeding </li></ul></ul><ul><ul><li>Sore throat </li></ul></ul><ul><ul><li>Mouth ulcers </li></ul></ul><ul><ul><li>Persistent or severe vomiting more than 24 hours after treatment </li></ul></ul>
  32. 32. Urgent! <ul><ul><li>Severe constipation, diarrhea or abdominal pain </li></ul></ul><ul><ul><li>Burning or stinging on passing urine </li></ul></ul><ul><ul><li>Tenderness, redness, or swelling in the injection site </li></ul></ul><ul><ul><li>Any unexpected side effects of sudden deterioration in health </li></ul></ul>
  33. 33. Thank You