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Chemotherapy Orientation
Agenda/Overview
• Oncology Team
• Chemotherapy Guidelines
• Potential Side Effects
• Questions and Answers
We are …..
• 12 Oncologists/Hematologists • 1 Physician Assistant • 30 Nurses (all chemo-certified) • 3 Nurse Case Managers • 1 Social Worker • 12 Oncology pharmacists/2 technicians • 20 Medical Assistants
We do ….
• Chemotherapy treatments • Injections • IV fluid hydration • Blood transfusions • Management of central lines
About the Infusion Center
We have
• 30 Infusion Stations • Free Wi-Fi access and TVs available • Space for 1 person to be with you
during your infusion
Infusion Center Phone and Hours
• 408-851-4325 • Open 7 days a week except major
holidays • Monday thru Friday 9AM- 7:00PM • Sat and Sun 9AM – 5 PM
On the day of the treatment
• Wear loose clothing so the nurse can access your arm for IVs
• Check in at Dept 440 and a staff member will take you to the infusion chair
• Juice and crackers for snacks are available • We do not provide meals but you may bring
in food and beverage
Patient Information and Guidelines for Chemotherapy
• What is chemotherapy? • Chemo cycle • M.D. appointments • Blood Tests/Labs • Liquids • Anti-nausea medications • Symptoms to report
Chemotherapy
• Any drug(s) used to treat cancer • Many chemotherapy drugs are infused into
the vein through an IV • Others are given by mouth or by injection • Treatments are individualized and your
doctor will discuss the best treatment for you
Chemotherapy dosing
• Based on your height and weight • You will be weighed each time you
come to the Infusion Center. Your dose will be adjusted for any weight change of more than 10% from original dose
What is a chemo cycle? A cycle may involve several treatments.
Some examples of a cycle:
• One treatment every 2-4 weeks
• Every week for 2 – 3 weeks followed by one week of rest
• Daily treatment for 5-7 days every 3-4 weeks
M.D. Appointments
• MD Appointments generally at different time than chemotherapy treatment
• If you have problems during treatment, let your doctor know or ask for an appointment to see your MD
• A family member, significant other or support person is welcome at your appointments
Blood Work • Usually necessary before each treatment to
make sure your blood counts have recovered • To be completed 2 days before treatment • Lab work can usually be done at any Kaiser
facility (Homestead, Milpitas, Campbell, Mountain View) EXCEPT blood transfusion labs need to be done at the Homestead facility
• No lab slip needed. Orders are transmitted electronically
Liquids • Drink two quarts of fluids a day • Any type of fluid
– Soup, juice, bouillon, Jell-o®, sports drinks like Gatorade®, non-caffeinated teas
• Important one day before and two days after chemotherapy
• Fluids flush the system • Avoid beverages with caffeine/alcohol • Stay well hydrated
Dealing with the side effects of chemotherapy
• Low blood counts • Hair loss • Nausea • Mouth sores • Fatigue • Loss of appetite • Neuropathy • Skin changes
Effects of chemotherapy on Blood Counts (CBC)
• Low WBC, puts one at risk for infection • Low RBC, makes one anemic • Low platelets, puts one at risk for bleeding
Things to know about low white blood counts
• Hand-washing • People who are ill • Crowds • Temperature (call if >100.5 F) • Dentist appointment (check with your doctor
before scheduling dental appointment) • Pets • Use Common Sense • Fruits/Vegetables
Food Handling Safety
• Thoroughly wash hands & food preparation area
• Wash all raw fruits & vegetables, water ok. • Avoid raw or undercooked meats, poultry,
fish, seafood, and eggs • Some foods best avoided: raw vegetable
sprouts, food from salad bars and deli counters, moldy or out dated packaged foods.
How do you know you are anemic?
• Dizziness especially when you stand too quickly • Shortness of breath especially with walking • Pale-looking • May cause chest pain-Contact your doctor ASAP for
chest pain • Fatigue (but this could be from chemotherapy or cancer
itself) • Rapid heart rate Your doctor may talk to you about blood transfusions or
injections to stimulate red blood cell production
Low Platelets
• Unexplained bruising • Nose bleeds • Bleeding gums • Avoid aspirin-like products (Ibuprofen, Motrin,
Advil, Aleve). May use acetominophen (Tylenol) for pain or fever. If not effective, contact your doctor
• Talk to your doctor about using aspirin or aspirin-like products
Hair Loss (alopecia)
• Hair loss is temporary (not all chemo causes hair loss)
• Usually starts between the first and second treatment (the first sign is tingling of the scalp)
• Hair loss can occur on all parts of the body • Will start to grow back within several weeks after
stopping chemo and should be fully back about 3-4 months after stopping treatment
• Hair may come back curlier than your usual hair but will eventually regain characteristics of the hair you had before chemo
Tips to deal with hair loss
• Shop for hair covers/wigs before hair loss starts • Natural hair wigs are more expensive and
require more work to maintain • Use hair net at night to contain hair • May want to cut your hair short before it falls out • Hair dyes or perms not recommended while on
chemo--wait six months. Do a patch test first! • Use gentle cream or lotion on your scalp when it
is dry • Use soft hair brushes
Nausea
• Take your prescribed meds at the first sign of nausea. You may need to take two or more kinds of nausea medications
• Eat small meals/crackers/dry toast • Avoid fatty/fried foods • Stay well hydrated • Avoid unpleasant odors/tastes
Anti-Nausea Drugs • If you have questions regarding your anti-
nausea meds, bring them to first chemotherapy session
• Take all medications as directed • Many are constipating, to combat use: Colace (stool softener), Senokot (senna),
Miralax Increase fluids/fiber Do not use enemas unless last resort
Mouth sores prevention • Use soft toothbrush • Floss very gently • Rinse mouth frequently • Salt water rinses every two to four hours
– 8 oz warm water – ¼ tsp salt and baking soda
• Avoid alcohol-based mouth washes (such as Listerine)
Fatigue and Activity • Many treatments can cause fatigue
• Be as active as you can
• May need planned rest periods
• Pace your activities • Listen to your body (if you are tired,
rest; if you feel good, resume normal activities)
Problems Eating
• Appetite often decreases while on chemo
• Weight loss not good while on treatment
• Need to still eat to keep up energy and strength
• Eat healthy food containing protein and Calories
• Talk to a dietitian if you have problems eating
Neuropathy
• Numbness and Tingling in the hands and feet
• Some chemotherapy drugs, not all, can cause this side effect
• This side effect can persist for a long time after treatment
• Tell your oncologist if you start to have this side effect
Skin Changes • Skin may be more
sensitive to the UV rays of the sun.
• Skin may become dryer. • Some chemo can cause
skin or nails to become discolored or darker.
• Some chemo can cause acne-like rash.
• Some chemo can cause temporary flushing and redness.
• When in the sun, wear protective clothes or sunscreen of at least 15.
• Use alcohol-free moisturizers.
• Skin and nail discoloration eventually resolves.
• Acne-like rash best treated with alcohol-free moisturizers.
Symptoms to report
• Fever over 100.5 (also chills without fever can be a sign of infection)
• Diarrhea not controlled with Imodium • Constipation not improve using laxatives • Mouth sores • Vomiting not relieved with anti-nausea meds • No fluid intake for over 12 hours while awake • Shortness of breath • Extreme dizziness
Multivitamins/ Supplements • Mega doses of Vitamin and Mineral supplements
usually not necessary unless recommended by physician.
• Generally, One-A-Day type Vitamin and Mineral supplement OK to continue.
• Check with physican if OK to continue any Herbal supplement you may be taking.
Final Notes
Thank you for watching this
presentation. Hopefully by
knowing the guidelines and what
to expect, your chemotherapy
experience will be an easier one.
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