Cancer Treatment and Symptom Management

1. Cancer Treatment and Symptom Management Native Families Cancer Caregiver WorkshopMay 28-30, 2008

2. Objectives • Describe the basics types of cancer treatment and their major side effects • Describe the symptoms often experienced by people with cancer and ways a caregiver can manage these symptoms

3. Treatment and Side Effects

4. Surgery • Remove Diseased Tissue • Check Lymph Nodes • Remove Diseased Lymph Nodes • Do Additional Biopsies • Reconstruct Normal Tissue • Function • Appearance

5. Postoperative CareStarts In Hospital Continues At Home With Caregiver

6. What Happens In Hospital? • Wake Up • Stabilize Vital Signs • Deep Breathing And Coughing • Prevent pneumonia • Work legs • Prevent blood clot • Begin To Resume Normal Activities

7. Anything Else? • Moving About • Sitting up in bed • Moving to chair • Walking • Eating • Sips of clear liquids (broth, clear juice) • Full liquid diet or soft foods • Regular diet

8. What Else? • Pain Management • Intravenous pain medication at first—or shots • Then oral pain medications (pills) • Assess pain—how bad is it? 0-10

9. What Else? • Elimination • May have urinary (bladder) catheter at first • Bowels will be sluggish • Resume normal function • Watch for urinary retention (no pee) • Watch for constipation (no BM for more than 2 days)

10. Is That All? Not Yet! • Prevent Complications • Keep incision (wound) clean • Keep bandages clean and dry • Continue deep breathing and coughing • Exercise feet and legs—keep blood moving • Doctor may prescribe antibiotics

11. Postoperative Care At Home • Continue All Of The Above • Family Caregiving Extremely Important • May Have To Gently Push Patient • Remember— • Good communication • Humor

12. How Many Caregivers Are Needed? • One Main Caregiver Is Ideal • With supporting caregivers for specific activities • If More Than One Caregiver • Communication • Coordination • All pull together

13. Remember-- The Caregiver May Need To Help A Lot At First Stepping Back As The Patient Recovers Is Important

14. Radiation: What Is It? • Beam Of Energy Aimed At Cancer Tumor To Destroy It • Can Irritate Or Damage Normal Tissue Too • Goal: • Take exact aim • Destroy cancer tumor • Save normal tissue

15. Planning appointment with radiation oncologist • Measure • Mark Skin • Make A Mask Or Shield

16. How Often Is Radiation Given? • Radiation Treatments Given Frequently • Every day? • Twice a day? • Five times a week? • Each Treatment Lasts Just A Few Minutes

17. For How Long? • It Varies--Usually 1-6 Weeks • Doctor Will Recommend Best Approach

18. For Best Results:Stick With Recommended Schedule Try Not To Skip Appointments

19. What Are The Side Effects? • Not Much At First • Build Up Over Time • Side Effects Depend On Part Of Body Treated

20. What Are The Most Common Side Effects? • Fatigue**— • most common, may be severe • “Sunburn” of Skin • may not see on darker skin so check closely • Mouth Sores • Diarrhea

21. How Can Caregivers Help? • Support and spiritual care • Encouragement to keep going • Mark progress • Encourage rest • Plan enjoyable, low energy activities • Save energy for most important things • Attend doctor visits with patient (once a week usually)

22. Caregivers May Need To Help More As Time Goes On

23. Support for Caregiver • Appreciation! • Spiritual and emotional support • Help around the house • Get plenty of rest and eat well • Take a break at least once a week • Enlist supporting caregivers (driving, chores)

24. Question for Discussion Johnny Running Bear is getting radiation for lung cancer. His sister Mary is his main caregiver. She takes Johnny to Sioux City every day for his radiation treatment. Johnny is so tired from the radiation that he sits around the house all day and sleeps a lot. His spirits are low.

25. What can Mary do to help Johnny? What does Mary need to do for herself?

26. Chemotherapy: What Is It? • Medication That Kills Cancer Cells • Chemotherapy Travels Through Bloodstream To The Whole Body • It Can Kill Cancer Cells That Have Spread • It May Be Used “Just In Case” Cancer Has Spread

27. How Is Chemotherapy Given? • Usually Intravenously • May Have A “Port” Put In • Sometimes Given By Mouth • Most Is Given As Outpatient • A Few Types of Chemotherapy Are Given In Hospital

28. Goals For Treatment with Chemotherapy • Give Just Enough To Destroy Cancer • Keep Side Effects To A Minimum • Manage Side Effects To Maintain Quality Of Life

29. Chemotherapy Schedules • Tailored For Each Individual Patient • Usually Lasts For Several Months • One Day Every Three Weeks? • Five Days A Week Every Three Weeks? • One Long Treatment And Three Short Ones Every Three Weeks? • There Are Many Kinds Of Chemotherapy Schedules!

30. Does Chemotherapy Ever Change? • Schedule May Change Over Time • The Medications May Change Over Time • Doctor Evaluates Patient Response And Adjusts Chemotherapy Accordingly

31. What About The Side Effects Of Chemotherapy? • Some Start Right After Treatment • Some Build Up Over Time • Each Type Of Chemotherapy Has Its Own Side Effects • The Most Common Ones are: • Nausea/Vomiting, Loss of Hair, Fatigue, Constipation or Diarrhea, Loss or taste/Strange Taste, and Loss of Appetite

32. Symptom Management Tips for Caregivers

33. What are “symptoms”? • Symptoms are uncomfortable feelings that may occur any time during the cancer journey • We don’t talk about “curing” symptoms, but we can make a person with cancer feel better

34. What does “management” mean? • “Management” refers the activities caregivers do every day to reduce symptoms • Symptom management has to be done regularly to be effective

35. Caregivers Are Very Important In Symptom Management!

36. How Can Caregivers Help? • Spiritual And Emotional Support • Help Patient Manage Symptoms • Maintain Normal Life Whenever Possible • Need For Help May Wax And Wane

37. Support For Caregiver • Appreciation! • Spiritual And Emotional Support • Help Around The House • Get Plenty Of Rest And Eat Well • Take A Break At Least Once A Week • Enlist Supporting Caregivers— • Driving • Chores

38. Communication with Healthcare Providers in Urgent Situations • When to call • Sudden change in condition • Unrelieved discomfort • Fever • Bleeding • Confusion

39. What To Say When You Call A Healthcare Provider • Your name • Who you are calling about (patient’s name) • Who the regular doctor is (if you are talking to an “on-call” doctor) • What you are concerned about • What you have observed—be as specific as possible • When the problem started • What you have tried to do • Request advice on what to do

40. “Sunburn” of the Skin • Lukewarm water and mild soap when bathing/showering • Avoid rubbing, scratching • Avoid heating pads or ice-packs • Loose-fitting comfortable clothing • Discuss using creams, lotions, perfumes, etc. with the healthcare provider • Avoid exposure to the sun

41. Mouth Sores • Prepare foods that are easy to eat or chew, moist, and served warm/cool • Soft toothbrush and be careful with mouthwashes • Avoid smoking, chewing tobacco, or drinking alcohol • Rinse mouth with warm salt water every 1 to 2 hours as needed • Ask your doctor or nurse about medicines to help treat mouth sores and control pain while eating

42. Nausea And Vomiting • Can Almost Always Be Prevented • Take Anti-nausea Medicine As Directed • Do Not Let It Get Out Of Control • May Have “Pre-meds” To Take Before Treatment • New Medications Have Really Helped Control Nausea

43. Nausea/Vomiting • Cool fluids throughout the day and between meals • Foods with mild aroma served cool or at room temperature • Relaxation techniques • A clear liquid diet (broth and juices) or bland foods that are easy to digest, such as dry toast and jello • Avoid eat 1-2 hours before the treatment if nausea occurs during radiation or chemotherapy treatments

44. Loss Of Hair • Does Not Always Occur • Ask Nurses What To Expect • Plan Ahead • Get Wig Or Scarves Or Hats In Advance • Usually Starts Within Two Weeks After First Treatment

45. Fatigue • Very, Very Common • Not “Normal” Fatigue—Sleep Does Not Relieve It • Can Be Severe • Rest May Help • Exercise May Help, Too! • Injections For Anemia May Help

46. Constipation or Diarrhea • Treat Immediately! • Do Not Let It Get Out Of Control • Doctor May Recommend Over-The-Counter Medications • Or Give A Prescription

47. Tips on Managing Diarrhea • Fluids in small amounts frequently, and small meals often • Clear liquids (e.g., chicken broth, weak tea, Jello, Gatorade) • Low-fiber foods (e.g., bananas, rice, mashed potatoes, dry toast) • Avoid fatty foods, acidic foods, fried foods, foods that cause gas • Be careful with dairy and foods/drinks with caffeine (e.g., coffee, pop, chocolate)

48. Tips of Managing Constipation • Exercising/activity as possible • Make sure to provide fluids • High fibers foods (whole grains, fresh fruits) • Have your loved one drink warm liquids (half hour before normal bowel movement and coffee is good for constipation) • Provide stool softeners with meals or pain medications

49. Loss Of Taste, Loss Of Appetite, Strange Tastes • Trial And Error—What Tastes Good? • What Tastes Good May Change Often • Keep Trying • Maintaining Weight Important • But Don’t “Force” Patient To Eat • Be Creative!

50. Other Symptoms or Side Effects?