CHEMOTHERAPYCHEMOTHERAPY AND AND YOUYOU

Lions Gate HospitalLions Gate HospitalThe Dr. Paul Klimo Medical The Dr. Paul Klimo Medical

Oncology ClinicOncology Clinic

TODAY WE WILL FOCUS ON:TODAY WE WILL FOCUS ON:

Chemotherapy side effects Chemotherapy side effects What to expectWhat to expect How to manageHow to manage When to callWhen to call

WHAT IS CHEMOTHERAPY?WHAT IS CHEMOTHERAPY?

The use of drugs to destroy The use of drugs to destroy or control the growth of or control the growth of cancer cellscancer cells

May use one drug or a May use one drug or a combinationcombination

HOW IS CHEMOTHERAPY HOW IS CHEMOTHERAPY GIVEN?GIVEN?

Intravenous (into a vein)Intravenous (into a vein)

Oral ( by mouth)Oral ( by mouth)

Other routesOther routes

IS CHEMOTHERAPY PAINFUL?IS CHEMOTHERAPY PAINFUL?

NO!NO!

If you feel burning, or notice redness or If you feel burning, or notice redness or swelling in the area of the needle, tell your swelling in the area of the needle, tell your nurse immediatelynurse immediately

If you feel pain, or notice redness or If you feel pain, or notice redness or swelling after you are at home, phone the swelling after you are at home, phone the Telephone Triage NurseTelephone Triage Nurse

CAN I TAKE OTHER CAN I TAKE OTHER MEDICATIONS WHILE MEDICATIONS WHILE

I AM ON CHEMOTHERAPY?I AM ON CHEMOTHERAPY?

Check with your cancer doctor Check with your cancer doctor (oncologist) or clinic nurse before starting (oncologist) or clinic nurse before starting any new medications.any new medications.

CHEMOTHERAPY CHEMOTHERAPY SIDE EFFECTSSIDE EFFECTS

NORMAL CELLS AFFECTED BY NORMAL CELLS AFFECTED BY CHEMOTHERAPYCHEMOTHERAPY

Bone marrow (red blood cells, white blood Bone marrow (red blood cells, white blood cells and platelets)cells and platelets)

Lining of the mouth, throat, stomach, intestinesLining of the mouth, throat, stomach, intestines Peripheral nerves (nerve endings)Peripheral nerves (nerve endings) Reproductive systemReproductive system Hair folliclesHair follicles

WHITE BLOOD CELLSWHITE BLOOD CELLS(the cells that fight infection)(the cells that fight infection)

White blood cells may be decreased White blood cells may be decreased following your chemotherapyfollowing your chemotherapy

Neutrophils, a type of white blood cell, Neutrophils, a type of white blood cell, fight bacterial infection fight bacterial infection

SIGNS OF INFECTIONSIGNS OF INFECTION Temperature of 38°C (100.4°F) or higherTemperature of 38°C (100.4°F) or higher Areas of redness or tendernessAreas of redness or tenderness Chills, shakesChills, shakes Sore throat/ mouth soresSore throat/ mouth sores Productive coughProductive cough Itching or burning in genital areaItching or burning in genital area Pain/ burning/ frequent urge to urinatePain/ burning/ frequent urge to urinate

TO PREVENT INFECTIONS :TO PREVENT INFECTIONS :

WASH YOUR HANDS!WASH YOUR HANDS!

FEVERS AFTER FEVERS AFTER CHEMOTHERAPYCHEMOTHERAPY

Remember you are at risk for infection Remember you are at risk for infection after your chemotherapy treatment after your chemotherapy treatment

Take your temperature every 4 hours if Take your temperature every 4 hours if you are not feeling wellyou are not feeling well

FEVERSFEVERS If you have a fever, If you have a fever, 38°C38°C or higher or higher ( 100.4°F or higher), phone the ( 100.4°F or higher), phone the

Chemotherapy Clinician immediately.Chemotherapy Clinician immediately. If you have a fever after 4 p.m. or during the If you have a fever after 4 p.m. or during the

weekend, go to the nearest Emergency weekend, go to the nearest Emergency Department.Department.

DO NOT TAKE ACETAMINOPHEN DO NOT TAKE ACETAMINOPHEN (Tylenol(Tylenol™)™) for your fever until you have for your fever until you have completed the above.completed the above.

RED BLOOD CELLSRED BLOOD CELLS(HEMOGLOBIN)(HEMOGLOBIN)

Feel tiredFeel tired Feel short of breath with activityFeel short of breath with activity Have a headacheHave a headache Have no symptomsHave no symptoms

If your red blood cell count is low you If your red blood cell count is low you may:may:

PLATELETSPLATELETS(the cells that help the blood to clot)(the cells that help the blood to clot)

Bruises or small purple spots on your Bruises or small purple spots on your body body

Nose bleedsNose bleeds Bleeding gumsBleeding gums Blood in your urine or stoolBlood in your urine or stool

If your platelet count is low you may If your platelet count is low you may notice:notice:

TO PREVENT BLEEDINGTO PREVENT BLEEDING

Use a soft toothbrushUse a soft toothbrush Blow your nose gentlyBlow your nose gently Use the bowel routine recommended Use the bowel routine recommended

to prevent constipationto prevent constipation Talk to your oncologist about blood Talk to your oncologist about blood

thinners and aspirin-thinners and aspirin-based drugsbased drugs

PAIN MANAGEMENTPAIN MANAGEMENT

Do not use ASA (aspirin) or ASA based drugs Do not use ASA (aspirin) or ASA based drugs for pain – discuss use of ASA drugs with for pain – discuss use of ASA drugs with oncologist ( daily heart/stroke prevention)oncologist ( daily heart/stroke prevention)

Talk to your oncologist about pain relief Talk to your oncologist about pain relief optionsoptions

Ibuprofen (advil) is okay to use occasionally Ibuprofen (advil) is okay to use occasionally

BLOOD WORK PRIOR TO BLOOD WORK PRIOR TO CHEMOTHERAPYCHEMOTHERAPY

Blood work should be done within 2 days Blood work should be done within 2 days of each chemotherapy treatment of each chemotherapy treatment

If you live out of town, blood work may be If you live out of town, blood work may be arranged in your home communityarranged in your home community

CHEMOTHERAPY DELAYSCHEMOTHERAPY DELAYS

Chemotherapy may be delayed if:Chemotherapy may be delayed if: Blood counts are too lowBlood counts are too low You have other side effectsYou have other side effects If blood work is not done prior to If blood work is not done prior to

treatmenttreatment

NAUSEA AND VOMITINGNAUSEA AND VOMITING

Nausea is Nausea is notnot a side effect of a side effect of every drugevery drug

It may be immediate or delayedIt may be immediate or delayed Fill your prescription at your local Fill your prescription at your local

pharmacypharmacy

MANAGING NAUSEA AND MANAGING NAUSEA AND VOMITINGVOMITING

Take anti-nausea pills as directed !!Take anti-nausea pills as directed !! Eat frequent, small meals (6-8 times a Eat frequent, small meals (6-8 times a

day)day) Eat bland foodEat bland food Drink 8-10 glasses of fluids dailyDrink 8-10 glasses of fluids daily

LOSS OF APPETITE (ANOREXIA)LOSS OF APPETITE (ANOREXIA) Taste and smell may be changed by Taste and smell may be changed by

chemotherapychemotherapy Eat small meals often (6-8 meals a day)Eat small meals often (6-8 meals a day) Eat food high in protein and caloriesEat food high in protein and calories Consult dietitian if neededConsult dietitian if needed

MOUTH PROBLEMS:MOUTH PROBLEMS:Dental workDental work

Let your dentist know you are receiving Let your dentist know you are receiving chemotherapychemotherapy

Discuss any dental work that needs to be Discuss any dental work that needs to be done with your clinic nurse or doctordone with your clinic nurse or doctor

Get regular dental cleaningGet regular dental cleaning

MOUTH PROBLEMS:MOUTH PROBLEMS:Sore MouthSore Mouth

If you have tender gums or a sore mouth, If you have tender gums or a sore mouth, look at your mouth in the mirrorlook at your mouth in the mirror

Rinse your mouth with baking soda and Rinse your mouth with baking soda and water / or salt and warm water after eating water / or salt and warm water after eating and as often as you can (every 2-4 hours)and as often as you can (every 2-4 hours)

Use a soft toothbrushUse a soft toothbrush

Do Do notnot use over the counter use over the counter mouthwash!mouthwash!

DIARRHEADIARRHEA Drink fluids slowly Drink fluids slowly Eat small, frequent mealsEat small, frequent meals Eat bland foodEat bland food StopStop dairy products if diarrhea dairy products if diarrhea

developsdevelops Take medications as prescribedTake medications as prescribed Call if diarrhea lasts longer than Call if diarrhea lasts longer than

24 hours24 hours

CONSTIPATIONCONSTIPATION

Follow suggestions in the constipationFollow suggestions in the constipation booklet. The nurse will be able to give you booklet. The nurse will be able to give you a handouta handoutSpeak to the nurse or oncologist in clinicSpeak to the nurse or oncologist in clinicCall if no bowel movement in three days Call if no bowel movement in three days Increase fluids, fiber and fruits and Increase fluids, fiber and fruits and vegetablesvegetables

FATIGUEFATIGUE Plan regular bedtime and Plan regular bedtime and

wakeup timeswakeup times Pace yourselfPace yourself Delegate responsibilitiesDelegate responsibilities Plan a regular exercise Plan a regular exercise

programprogram Inform your Physician/nurse at Inform your Physician/nurse at

your next appointmentyour next appointment

REPRODUCTIVE SYSTEM REPRODUCTIVE SYSTEM CHANGESCHANGES

Changes may be temporary or permanentChanges may be temporary or permanent WomenWomen

May or may not menstruateMay or may not menstruate May experience symptoms of May experience symptoms of

menopausemenopause MenMen

May have decreased sperm countMay have decreased sperm count

HAIR LOSSHAIR LOSS

May have total hair loss, May have total hair loss, thinning or no loss at allthinning or no loss at all

Depends on the Depends on the chemotherapy drugchemotherapy drug

Usually occurs within 3 weeks Usually occurs within 3 weeks after your first treatmentafter your first treatment

SKIN – MUSCLE – NERVE SKIN – MUSCLE – NERVE CHANGESCHANGES

SkinSkin use sunscreen SPF 30use sunscreen SPF 30 wear a hat and keep covered outdoorswear a hat and keep covered outdoors

MuscleMuscle muscle weaknessmuscle weakness

NerveNerve numbness or tingling in your numbness or tingling in your hands or feet, ringing in the earshands or feet, ringing in the ears

TIMING OF COMMON TIMING OF COMMON CHEMOTHERAPY SIDE EFFECTSCHEMOTHERAPY SIDE EFFECTS

FatigueFatigue

NeutropeniaNeutropenia

Chemo 5 10 15 20 25

Days

Nausea/ Nausea/ VomitingVomiting Mouth SoresMouth Sores Hair LossHair Loss

When to Contact the When to Contact the LGH Oncology ClinicLGH Oncology Clinic

Fever of 38º C/ 100.4 º FFever of 38º C/ 100.4 º F Chills, shakingChills, shaking Mouth sores and/or pain on swallowingMouth sores and/or pain on swallowing Severe constipation or diarrheaSevere constipation or diarrhea Abnormal bleedingAbnormal bleeding Bruising or small purple or red spotsBruising or small purple or red spots Unrelieved shortness of breathUnrelieved shortness of breath Marked pain or soreness at injection siteMarked pain or soreness at injection site Any new rashes or lumpsAny new rashes or lumps Any unusual strong or new painAny unusual strong or new pain

CONTACT NUMBERSCONTACT NUMBERSLGH Main Desk:LGH Main Desk: 604-984-5753604-984-5753Nurse ClinicianNurse Clinician 604-984-5831604-984-5831PharmacistPharmacist 604-988-3131 ext 4488604-988-3131 ext 4488Social WorkerSocial Worker 604-984-3709604-984-3709DietitianDietitian 604-988-3131 ext 4719604-988-3131 ext 4719NS CommunityNS Community 604-986-7111604-986-7111

APPOINTMENTSAPPOINTMENTS

If you If you cannotcannot attend your chemotherapy attend your chemotherapy appointment as scheduled, call the appointment as scheduled, call the

LGH Oncology Clinic Booking Office LGH Oncology Clinic Booking Office 604-984-5753604-984-5753

FLU VACCINEFLU VACCINE

Flu vaccines are recommended for cancer Flu vaccines are recommended for cancer patients and their familiespatients and their families

Vaccinations are offered October to Vaccinations are offered October to December by your family physician or December by your family physician or local public health cliniclocal public health clinic

Discuss the timing of your vaccine with Discuss the timing of your vaccine with your clinic nurse or oncologistyour clinic nurse or oncologist

DOCTORS RESPONSIBLE DOCTORS RESPONSIBLE FOR YOUR CAREFOR YOUR CARE

Your oncologist (cancer doctor) is Your oncologist (cancer doctor) is responsible for your responsible for your cancercancer treatment treatment

Your family doctor is responsible for all Your family doctor is responsible for all non-cancernon-cancer related health problem related health problem

INFECTIOUS DISEASESINFECTIOUS DISEASES

You You MUSTMUST call the Telephone Triage call the Telephone Triage Nurse Nurse beforebefore your next visit if you think your next visit if you think you have been exposed, or have been you have been exposed, or have been diagnosed with an infectious diseasediagnosed with an infectious disease

Living with CancerLiving with Cancer Support Services available at LGH Oncology Support Services available at LGH Oncology

Clinic:Clinic: PharmacyPharmacy Social WorkSocial Work CounsellingCounselling Pastoral CarePastoral Care DietaryDietary Symptom Management/Drug Reimbursement Symptom Management/Drug Reimbursement

NurseNurse

Chemotherapy is a hazardous wasteChemotherapy is a hazardous waste

Chemotherapy takes 48 hours to clear your Chemotherapy takes 48 hours to clear your bodybody

Chemotherapy is excreted in your urine, Chemotherapy is excreted in your urine, stool, vomit, sperm, and vaginal fluidsstool, vomit, sperm, and vaginal fluids

Please take precautions to protect your Please take precautions to protect your family members.family members.

AcknowledgmentAcknowledgment

The Lions Gate Hospital Oncology Clinic thanks the Cross Cancer The Lions Gate Hospital Oncology Clinic thanks the Cross Cancer Institute for permitting reproduction of this presentation for Institute for permitting reproduction of this presentation for

teaching purposes.teaching purposes.

This power point presentation is available on our This power point presentation is available on our website atwebsite at

www.coastalpalliativecare.ca www.coastalpalliativecare.ca