Updated Version 25072019 Uploaded 04112019 Welcome and Introduction Review General and specific side effects How to manage side effects What symptoms to report How to report symptoms ID: 1042883
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1. An Introduction to Systemic TherapyUpdated Version: 25-07-2019 / Uploaded: 04-11-2019
2. Welcome and IntroductionReview General and specific side effects How to manage side effectsWhat symptoms to report How to report symptomsQuestionsTour of Regional Centre
3. Health Care Team
4. What is Cancer?Disease that starts in our cellsOur body’s cells normally grow in an orderly fashionCancer cells do NOT behave like “normal cells”grow to form lumps or tumours may spread to other parts of the bodyCancer is named after the part of the body where it started
5. Cancer TreatmentTreatments for cancer are: SurgeryRadiation therapy Systemic therapy Smoking CessationSmoking Cessation is a part of cancer treatment If you use recreational tobacco: Stop smokingStopping smoking at the time of cancer diagnosis could lower the risk of death by up to 40% Smoking cessation is cancer treatment
6. Stopping Smoking Helps your treatment work better to fight the cancerLowers your chance of having a complication or bad reaction to treatmentCan help your wounds heal faster, less chance of infectionLowers treatment toxicity/severity of your side effectsImproves your prognosis
7. Smoking Cessation SupportFree nicotine replacement (NRT) is available from any pharmacyQuitnow.ca, gives customized programs:smoking cessation counselling quit plansVGH smoking cessation clinic:Appointments with staff trained in tobacco dependence treatmentFirst Nations Health AuthorityTobacco Timeout Challenge Factsheet & resources for NRT through First Nations Health benefitsBC Cancer nursing support - We are here to help!
8. What is Systemic Therapy?Chemotherapy Drugs that destroy cancer cellsImmunotherapyDrugs that activate your own immune system to find and destroy cancer cellsTargeted TherapyDrugs that target specific molecules that stop cancer cells from growing and spreadingHormone TherapyDrugs that change levels of hormones to stop or slow down cancer cell growth.
9. Goals of Systemic Therapy TreatmentEliminate the cancerShrink the tumourPrevent cancer from spreadingRelieve symptoms from cancer, such as pain
10. Systemic Therapy is given by… IntravenousPillsInfusion PumpInjection
11. Side Effects from Systemic TherapyThere are potential side effects for each specific treatmentYou will NOT experience ALL side effectsSome side effects can be managed
12. Potential Side EffectsBone marrow suppressionNausea and vomitingBlood clotsDiarrheaConstipationHair lossFatigueMouth soresSkin changesReproductive / hormonal changesSensory changesThinking, memory and attention changes
13. “Chemotherapy and Other Drug Therapies:A guide for people with cancer”Patient resource
14. Bone Marrow SuppressionBlood cells of the bone marrow:Red blood cells – carry oxygen to body’s cellsWhite blood cells – fight infectionPlatelets – form blood clots/scabsBlood cell levels may decrease following chemotherapyExpected to return to normal by the start of next treatment
15. Checking Blood CellsBlood cells must return to a “safe” level before each treatmentBlood tests are done 1 to 4 days before treatment**Check appointment card and lab requisition**Blood test results may affect treatment
16. Low White Blood Cells (Neutropenia)White cells are your infection fighting cellsMay be lowered for a short time after your cancer treatment Your body will be less able to fight infectionIt is important to recognize the signs and symptoms of an infectionWhat are some signs of infection?
17. Signs and Symptoms of InfectionFEVERFlu-like symptoms, e.g. body achesFeeling warm, chilled or shakySore throat and/or mouthCough and/or shortness of breathBurning when urinating/urinating more oftenAreas of redness or tendernessLoose or liquid stoolsSevere dizziness*REPORT all Signs and Symptoms*
18. If your temperature is 38°C or more (or 100.4°F or more)…This is a FEVER Fever is a sign of infection, even if you don’t have any other signsFever is serious when your white blood cells are lowDo not take drugs for fever (e.g. Tylenol®) unless directed by your cancer care teamReport a FEVER IMMEDIATELY! Numbers to call are in your package
19. How you can prevent infectionWash your hands - frequently with soap and waterAvoid people with infections Wash your handsCheck with your oncologist before having any invasive procedures (e.g. dental or surgical procedure)Avoid skin cuts and nicksWash your hands
20. Do I come to the clinic if I have an infection?Call the Cancer Centre FIRST!If you have an infection (flu) or If you have been exposed to an infectious illness such as chicken pox or shinglesFriends and family with infections should stay at home until they have recovered
21. Low Platelets (Thrombocytopenia)Platelet cells are responsible for making clotsMay be lowered for a short time after your systemic therapy treatment Your ability to form a clot will be loweredIt is important to recognize the signs and symptoms of low plateletsWhat are some signs of low platelets?
22. Signs and Symptoms of Low PlateletsCut that won’t stop bleedingBruises on bodyBleeding from nose and gumsRed pinpoint rashBlack tarry stools Blood in urine*Report any signs and symptoms*
23. How to Manage Low PlateletsUse soft tooth brushContinue regular oral hygiene, caution with flossingBlow nose gentlyAvoid ibuprofen(Advil) & aspirin(ASA), unless ordered by DoctorAvoid high risk activities - BE CAREFUL
24. Low Red Blood Cells (Anemia)Red cells are responsible for carrying oxygen to the body’s cellsMay be lowered for a short time after your systemic therapy treatment Your energy level will be affectedIt is important to recognize the signs and symptoms of low red cellsWhat are some signs of low red cells?
25. Signs and Symptoms of Low Red Blood CellsLow energy / fatigueShortness of breathPale appearanceChest tightness / chest pain*Go to the nearest emergency if you have chest tightness or chest pain**Report any signs and symptoms*
26. FatigueFatigue is the most common symptom during and after cancer treatmentsSigns and symptomsFeeling of weariness, tiredness, or lack of energy that does NOT always improve with restMay affect your ability to do daily activitiesOften overlooked, but it is real and can be managed
27. How to Manage Fatigue Do regular light exercise Balance physical and social activities with rest Listen to your body and rest when needed Stick to a regular sleep pattern Eat a well balanced diet Drink plenty of fluids Allow friends and family to help youResource: Your Bank to Energy Savings “Helping People with Cancer Handle Fatigue”
28. Blood clotsA blood clot is a clump of blood that is semisolid. Patients with cancer on systemic therapy are at risk for blood clots.Signs and Symptoms Sudden severe shortness of breathSwelling of one legPainful blue fingers/toesHeart attack or stroke (very uncommon) Sudden confusion, trouble speaking, trouble seeingSudden numbness or weakness in face, arm or legChest tightness or chest pain.*If you experience any of these symptoms, go to the nearest emergency room*
29. Nausea and VomitingNausea = an unpleasant, queasy feeling or feeling sick to your stomachVomiting = throwing upNot all people will experience nausea and vomiting
30. Medications to Prevent Nausea and VomitingDoctor will give you a prescription to help prevent nausea and vomitingFill your prescriptions at your community pharmacyBring the medications with youUnless advised, do not take these pills prior to coming to your appointment.If cost is a concern: Patient & Family Counselling Services can provide information and referrals
31. How to Manage Nausea and VomitingStay well hydrated - 8 cups of fluid Eat frequent, small, light meals (esp. on treatment day) Keep your mouth clean: brush at least twice dailyAvoid:Hot, spicy, greasy foodsHeavy meals right after treatmentStrong smellsResource: “Practical Tips to Help Manage Nausea”
32. ConstipationWhen you are not having bowel movements as often as you used to.Caused by: Some cancer drugsSome anti-nausea drugsMost pain medicationsResource: “Food Choices to Help Manage Constipation”Reduced fluid or fiber intakeStressLack of exercise
33. How to Manage ConstipationIt is normal to have a bowel movement at least every 2-3 days (even when little food is eaten)How to prevent:Increase your fluid intake – 8 glasses/dayWarm fluidsIncrease your fiber intakeBe as physically active as possibleIf you have not had a bowel movement in 3 days please talk to your cancer care team
34. DiarrheaWhen your bowel movements are more frequent or more watery than normal Can be serious if not managedSome causes:Cancer therapy drugsAntibioticsBowel surgeryRadiation to the pelvis
35. How to Manage DiarrheaEat small/frequent mealsChoose foods with less fiberIf prescribed by your oncologist – use your anti-diarrhea drugs as instructed.Avoid:Foods that may aggravate diarrheaSpicy/greasy foodsResources: “Food Choices to Help Manage Diarrhea” and “Low Fibre Food Choices”
36. DehydrationDehydration can be a result of untreated diarrheaCan be dangerous if not prevented/managedHow to prevent/manage:Drink 8 to 10 glasses of fluid Use “anti-diarrhea” drugs - as instructed by your health care teamWhen you feel better, eat foods high in calories and proteinDiarrhea lasting more than 24 hours - contact your cancer care team
37. Signs and Symptoms of Dehydration*Report any signs and symptoms*FatigueExtreme thirst NauseaDry mouthLow urine outputDark colored urine
38. Mouth SoresOccur within a few days after treatmentOn the tongue, gums, sides of the mouth, lips and throatSigns and symptoms:Pain Bleeding gumsDifficulty chewing and swallowing Can lead to an infection*Report any signs and symptoms*
39. How to Manage Mouth SoresLook in your mouth regularlyPractice good oral hygieneRinse 3 to 4 times a day - baking soda in warm water Use a soft toothbrushAvoid mouthwash with alcoholMake sure dentures fit wellAvoid irritating foods and liquids (acidic, spicy, salty, dry, alcohol-based, rough, extreme hot or cold)Resource: “Food Ideas to Try with a Sore Mouth”
40. Skin ChangesSkin is body’s first line of defense against bacteriaSigns and symptoms:RednessRash / acneItchingPeeling Dryness
41. How to Manage Skin ChangesWash skin often Warm water and gentle soapMoisturizers – alcohol/fragrance freeLanolin based lip balms and creamsProtect against sun exposure (clothing or SPF 30)Wear protective eye wear and hatsUse electric razor
42. Some drugs may cause your hair to fall out or to change colour. Hair loss starts about 2-3 weeks after 1st treatmentScalp could feel tender when hair starts to fall outSome people prefer to cut their hair shortWe suggest not cutting your hair until you come to your 1st treatment appointmentYour hair will begin to grow back 3-4 weeks after final treatmentHair Loss
43. Resources for Hair Loss“Prescription” for a wig from the oncologist Visit a wig shop before you lose your hairDonated wigs at Canadian Cancer Society Look Good Feel Better Program – call local Canadian Cancer Society office to register.Resources: Information can be found on the BC Cancer Website (Coping with Cancer), Volunteer Services and Patient & Family Counselling Services
44. Sensory ChangesSenses potentially affected by treatment:Touch – Muscles and Nerves Sound – HearingTasteSmellSight
45. Taste ChangesFoods may not taste the sameDescribed as “metallic” or “cardboard” tasteCan affect your appetiteUse of sweet and salty flavorings - can helpChanges are temporary Resource: “Food Ideas to Cope with Taste and Smell Changes”
46. Memory ChangesSome memory changesConcentration“chemo-brain” or “brain fog”Difficulty thinking and focusingMay be caused by treatment, fatigue, stress, insomniaHow to manage memory changes:Plan activitiesMake listsAsk for help: Patient & Family CounsellingResource: Coping with Cancer pages on BC Cancer Website
47. Reproductive and Hormonal ChangesTreatment may cause changes in hormone levels or reproductive organs:may affect your fertilitymay cause early menopausemay change your sexual desireTalk to your cancer care team for more informationTalk to Patient & Family Counselling Services for support Resource: “Sexuality and Cancer”
48. Tips for Treatment DayLength of treatments can varyWear comfortable clothing (sleeves that roll up)No perfume / fragrance for patients or support people: due to sensitivities to smell Eat a light meal before and after treatmentTake your regular medicationsTransportation:Arrange a ride to and from your appointmentParking:BC Cancer - please bring money for the parking meter
49. More TipsBring:Snacks & drinks (no strong smells)Support person - 1 support person at a time (children are not allowed in treatment areas)Magazines, books, music with headphonesNew Patient PackageQuestionsAnti-nausea pillsPrescriptions:Approved cancer treatment drugs are filled by the BC Cancer PharmacyYour anti-nausea prescriptions are filled in your community pharmacy
50. Why do we mention to “drink plenty of fluids”?Water and fluids are important to healthStaying hydrated helps with:NauseaDry mouthDiarrhea or ConstipationFatigueDry skinEasier to start your IV
51. Natural Health Products (NHPs): Are they safe during cancer treatment?BC Cancer Recommendations: NHPs are NOT recommended during cancer treatment.There is not enough scientific evidence at this time about the safety of using NHPs during cancer treatment.Please contact your doctor, pharmacist, nurse or dietitian for further discussion.
52. Safety PrecautionsKeep all drugs out of reach of childrenIt may take approximately 48 hours for your body to filter the drugs outDuring that time, your body fluids (urine, vomit or semen) may carry small amounts of drug wasteExposure to this drug waste can irritate your skin and be harmful to others & petsResource: “Guidelines for Handling Cancer Drugs and Body Fluids in the Home”
53. More PrecautionsFlushing toilet - lid down to prevent splashingIf treatment drugs or body wastes splash on your skin - wash the area with soap and waterUse a condom during intercoursePregnancy and breast feeding should be avoidedResources: “Chemotherapy and other Drug Therapies” and “Sexuality and Cancer”
54. When to Call?CALL if you have problems such as:Fevers (≥ 38°C) and/or shaking, chillsMouth sores, mouth pain Uncontrolled nausea or vomitingDiarrhea CALL: Telephone Regional Centre’s Nursing Line during clinic hours (see new patient package for numbers)On-call Doctor after clinic hoursConstipationAbnormal bleeding or bruisingPainful IV site…and if you are not sure…
55. Drug InformationNatural HealthProductsSide EffectsDrug InteractionsPharmacy Services
56. Identification Required for Drug Pick-upPatient ID required for every prescription Two identifiers each time – e.g.. birth date, addressOne primary piece of IDe.g.. Driver’s license, BC provincial identity card, passportOr two pieces of secondary IDe.g.. BCCA identification card, BC Care Card, birth certificate When someone else picks up your drugs:Letter signed by patient indicating permissionOr two pieces of patient’s ID as indicated above
57. Patient and Family Counselling ServicesSupport and counselling are a vital part of copingIndividuals, couples and familiesSupport groups and programs Information and referral to community services Assistance and information about practical and financial concernsResources: BC Cancer booklet “Financial Information for Cancer Patients”
58. Nutrition ServicesOncology Dietitian available at each Cancer CentreAble to support you with difficulty eating, drinking, swallowing or maintaining your weight Ask for a referralResources:BC Cancer Website - Coping with CancerNutritional Support: BC Cancer Health Link BC Dial 8-1-1 for general nutrition questions or Speak with a specialized Registered Dietitian Resource: “Eating Well When You Have Cancer”
59. Speech-Language PathologyCancer and its treatments can affect voice, swallowing, speech, language, and quality of life. Speech Language Pathologists can help you manage communication and swallowing issuesPatients with head and neck cancer may benefit from doing swallowing exercises before beginning treatment.Can help if you are having difficulty swallowing pillsAsk your nurse or doctor for a referralResource: BC Cancer website – Coping with Cancer Speech Language Pathology
60. Library ServicesLibrarian available at each BC Cancer CentreResources:Books, pamphlets, audio and videotapes Cancer, treatment, coping with cancer, care-giving, healing, relaxation, sexuality and other topics of interest
61. QUESTIONS?