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May 2-6 2011 FUND FORUM

Breast Cancer Supportive Care. May 2-6 2011 FUND FORUM. Symptoms and Prognosis. Challenge of symptom management: block toxicity without compromising efficacy. Supportive Care Toxicity Targets. Neurologic Peripheral neuropathy Cognitive Pulmonary Renal Cutaneous Alopecia Rash.

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May 2-6 2011 FUND FORUM

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  1. Breast Cancer Supportive Care May 2-6 2011 FUND FORUM

  2. Symptoms and Prognosis • Challenge of symptom management: • block toxicity without compromising efficacy

  3. Supportive Care Toxicity Targets Neurologic Peripheral neuropathy Cognitive Pulmonary Renal Cutaneous Alopecia Rash • Hematologic • Myelosuppression • Gastrointestinal • Nausea/vomiting • Constipation/diarrhea • Mucositis • Cardiovascular • Thrombosis • Cardiac

  4. Gastrointestinal: Nausea and Vomiting • Chemotherapy • Radiation therapy-especially brain, abdomen, pelvis • Brain mets • Bowel obstruction • Electrolyte imbalance • Other medication

  5. Perception of Chemotherapy (1983) Nausea and vomiting are the two most feared toxicities of chemotherapy Coates, Eur J Cancer Clin Oncol 19:203, 1983

  6. Nausea and Vomiting • Physiologic process • Body’s normal response to expel toxins • Delayed Nausea • Occurs days after therapy with certain chemotherapy agents • Anticipatory Nausea • occurs before treatment in patients who have previously vomited after chemotherapy

  7. The best way to manage nausea and vomiting caused by cancer therapy is to prevent it.

  8. Natural History of Delayed Nausea and Vomiting Percent with nausea or vomiting Hours after cisplatin Kris, J ClinOncol 3:1379, 1985

  9. Expectation vs Reality Moderately Emetogenic Chemotherapy Percent of patients Grunberg, Cancer 100:2261, 2004

  10. Levels of Emetogenicity Modifying Factors • Age • Younger patients vomit more than older patients • Gender • Women vomit more than men • Alcohol history • Patients with a history of heavy alcohol use vomit less than those without such a history • Nausea/vomiting history • Patients with a history of morning sickness or motion sickness are more likely to vomit

  11. Antiemetic Consensus Guidelines - 2008 Adapted from Koeller, Support Care Cancer 10:519, 2002

  12. Effect of Physician Education on Antiemetic Guideline Compliance • Lecture by visiting expert No change in behavior • Distribution of written guidelines Improved compliance x 2 months • Direct feedback of patient experiences Improved compliance x 4+ months Mertens, J ClinOncol 21:1373, 2003

  13. Levels of Emetogenicity • Highly Emetogenic Chemotherapy (HEC) (> 90%) • Cisplatin • Mechlorethamine • Moderately Emetogenic Chemotherapy (MEC) (30-90%) • Cyclophosphamide • Doxorubicin • Low Emetogenic Chemotherapy (10-30%) • Paclitaxel • 5-Fluorouracil • Minimally Emetogenic Chemotherapy (< 10%) • Vincristine • Bleomycin

  14. Highly emetogenic (>90%) DRUGS • AC • Cisplatin • Higher dose Cyclophosphamide TREATMENT 3 drugs • Dolasetron (Anzemet; oral), granisetron (Kytril), ondansetron (Zofran), or palonosetron (Aloxi) • Dexamethasone for one to three days • Aprepitant (Emend) for three days

  15. Moderately emetogenic: 30-90% DRUGS • Carboplatin • Cyclophosphamide • Doxoubicin • epirubicin TREATMENT two-drug combination • Dolasetron (Anzemet; oral form), granisetron (Kytril), ondansetron (Zofran), or palonosetron (Aloxi) • Dexamethasone, for one to three days

  16. Low risk emetogenic-10-30% DRUGS • Docetaxel • Paclitaxel • Methotrexate • 5-fluoriuracil • Gemcitabine • Methotrexate • Topotecan • trastuzumab TREATMENT ONE drug • dexamethazone

  17. Minimally emetogenic (less than 10%) Drugs Vinorelbine Treatment • No treatment required unless the patient has previously experienced vomiting with this treatment.

  18. With appropriate medications, nausea and vomiting can be prevented in nearly all patients undergoing cancer treatment.

  19. NEUTROPENIA • Fever (temperature of 38 C or higher) • Chills or sweating • A sore throat or sores in the mouth • Any redness, swelling, or pain, especially around a cut, wound, or an intravenous (IV) catheter site • Abdominal pain • Diarrhea or sores around the anus • Pain or burning when urinating or frequent urination • A cough or breathlessness • Unusual vaginal discharge or itching

  20. PREVENT INFECTION • Delay the next round of chemotherapy or recommend a lower dose. • Prophylactic antibiotics • Neutropenic fever • Consider white blood growth factors during subsequent cycles of chemotherapy. • filgrastim (Neupogen), pegfilgrastim (Neulasta), or sargramostim (Leukine or Prokine).

  21. Advice for Patients • REST • AVOID CROWDS • AVOID People who are ill • Do not share personal items-utensils, toothbrushes • No Raw food; wash foods well • Good dental care • Keep clean, use skin lotion (avoid dry, cracked skin) • Use care with sharp objects • WASH your hands • Use gloves to garden and clean • Do not handle animal waste

  22. CANCER-RELATED FATIGUE • Persistent sense of tiredness or exhaustion • Small effort, such as walking across a room, can seem like too much • Affects ability to work, be involved with their family, or socialize. • May cause people to avoid or skip cancer treatments • May even affect their desire tolive.

  23. Fatigue management • Exercise regularly • Conserve energy • Manage other conditions • Pain • Depression • Sleep disorders

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