Chemotherapy and You - AAOS Personal Physician and Group Practice

39 Pages·2002·0.79 MB·English

Chemotherapy and You
A GUIDE TO SELF-HELP
DURING CANCER TREATMENT
NATIONAL INSTITUTES OF HEALTH
National Cancer Institute
Chemotherapy and You
A GUIDE TO SELF-HELP
DURING CANCER TREATMENT
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
Contents
About This Booklet................................................................1 Central Nervous System Problems...........................................25
Infection....................................................................................26
Understanding Chemotherapy............................................2
Symptoms of Infection.............................................................27
What Is Chemotherapy?.............................................................2
Blood Clotting Problems..........................................................30
How Does Chemotherapy Work?...............................................2
How to Help Prevent Problems if Your Platelet Count Is Low.....31
What Can Chemotherapy Do?...................................................3
Mouth, Gum, and Throat Problems.........................................31
Is Chemotherapy Used With Other Treatments?.......................3
Diarrhea....................................................................................34
Which Drugs Are Given?............................................................3
Constipation.............................................................................35
What About Clinical Trials?.......................................................4
Nerve and Muscle Effects.........................................................36
Questions To Ask Your Doctor...................................................6
Effects on Skin and Nails..........................................................37
Radiation Recall........................................................................39
What Can I Expect During Chemotherapy?......................8
Kidney and Bladder Effects.......................................................40
Where Will I Get Chemotherapy?.............................................8
Flu-Like Symptoms...................................................................41
How Often and For How Long Will I Get Chemotherapy?......9
Fluid Retention.........................................................................41
How Is Chemotherapy Given?...................................................9
Effects on Sexual Organs..........................................................41
How Will I Feel During Chemotherapy?.................................12
Feelings About Sexuality...........................................................44
Can I Take Other Medicines While I Am Getting
Chemotherapy?...................................................................13
Eating Well During Chemotherapy..................................47
How Will I Know If My Chemotherapy Is Working?..............13
What If I Don't Like Eating?.....................................................47
Questions To Ask About Side Effects........................................14
Can I Drink Alcoholic Beverages?............................................48
Can I Take Extra Vitamins and Minerals?................................48
Coping With Side Effects....................................................15
What Causes Side Effects?........................................................15
Getting the Support You Need...........................................49
How Long Do Side Effects Last?...............................................15
How Can I Get Support?..........................................................49
Fatigue.......................................................................................17
How Can I Make My Daily Life More Enjoyable?...................52
Nausea and Vomiting...............................................................19
Pain...........................................................................................20 Complementary Therapies.................................................53
Hair Loss...................................................................................22 Biofeedback...............................................................................53
Anemia......................................................................................24 Distraction................................................................................53
About This Booklet
This booklet is for patients who are receiving chemotherapy
Hypnosis...................................................................................54
for cancer. It describes what to expect during chemotherapy and
Imagery.....................................................................................54 what you can do to take care of yourself during and after treat-
Massage Therapy......................................................................54 ment. What can you do? Eat the right foods to build up your
strength. Stay away from people who have colds or the flu. Get
Meditation and Prayer..............................................................55
the rest you need and pace yourself. Talk about your feelings to
Muscle Tension and Release.....................................................55
deal with any sadness, anger, or fear you may have. Work as a
Physical Exercise.......................................................................55
team with your health care providers. Knowing how to help your-
Rhythmic Breathing.................................................................56 self can make you feel more in control. These are just a few of the
Visualization.............................................................................56 ways that you can help yourself and begin to feel in control again.
Yoga...........................................................................................56 This booklet is designed to help you become an informed part-
ner in your care, but it is only a guide. Self-help can never take
Paying for Chemotherapy..................................................57 the place of professional health care. Ask your doctor and nurse
any questions you may have about chemotherapy. Also don’t hes-
What Questions Should I Be Able to Answer
itate to tell them about any side effects you may have. They want
About My Insurance?..........................................................57
and need to know.
Getting Maximum Coverage of Clinical Trials Costs..............58
The table of contents identifies all the topics discussed in
Getting the Most from Your Insurance....................................59
Chemotherapy and You. A glossary at the back of this booklet
explains many terms you may hear during chemotherapy. Many
National Cancer Institute Information Resources..........60
of the words defined in the glossary are printed in bold the first
Telephone..................................................................................60
time they are used in the text.
Internet.....................................................................................60
Fax.............................................................................................60
Other Booklets..........................................................................61
Glossary.................................................................................62
Notes......................................................................................66
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Understanding Chemotherapy What Can Chemotherapy Do?
Depending on the type of cancer and how advanced it is,
chemotherapy can be used for different goals:
(cid:2) To cure the cancer. Cancer is considered cured when the
What Is Chemotherapy?
patient remains free of evidence of cancer cells.
Chemotherapyis the treatment of cancer with drugs that can
(cid:2) To control the cancer. This is done by keeping the cancer
destroy cancer cells. These drugs often are called "anticancer" drugs.
from spreading; slowing the cancer's growth; and killing cancer
How Does Chemotherapy Work? cells that may have spread to other parts of the body from the
original tumor.
Normal cells grow and die in a controlled way. When cancer
occurs, cells in the body that are not normal keep dividing and (cid:2) To relieve symptoms that the cancer may cause. Relieving
forming more cells without control. Anticancer drugs destroy symptoms such as pain can help patients live more comfortably.
cancer cells by stopping them from growing or multiplying.
Is Chemotherapy Used With Other Treatments?
Healthy cells can also be harmed, especially those that divide
quickly. Harm to healthy cells is what causes side effects. These Sometimes chemotherapy is the only treatment a patient
cells usually repair themselves after chemotherapy. receives. More often, however, chemotherapy is used in addition
Because some drugs work better together than alone, often two to surgery, radiation therapy, and/or biological therapy to:
or more drugs are given at the same time. This is called combina- (cid:2) Shrink a tumor before surgery or radiation therapy. This is
tion chemotherapy.
called neo-adjuvant therapy.
Other types of drugs may be used to treat your cancer. These
(cid:2) Help destroy any cancer cells that may remain after surgery
may include certain drugs that can block the effect of your body’s
and/or radiation therapy. This is called adjuvant chemotherapy.
hormones. Or doctors may use biological therapy, which is
treatment with substances that boost the body's own immune sys- (cid:2) Make radiation therapy and biological therapy work better.
tem against cancer. Your body usually makes these substances in
(cid:2) Help destroy cancer if it recurs or has spread to other parts of
small amounts to fight cancer and other diseases. These sub-
the body from the original tumor.
stances can be made in the laboratory and given to patients to
destroy cancer cells or change the way the body reacts to a tumor.
Which Drugs Are Given?
They may also help the body repair or make new cells destroyed
by chemotherapy. Some chemotherapy drugs are used for many different types of
cancer, while others might be used for just one or two types of
cancer. Your doctor recommends a treatment plan based on:
(cid:2) What kind of cancer you have.
(cid:2) What part of the body the cancer is found.
(cid:2) The effect of cancer on your normal body functions.
(cid:2) Your general health.
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Possible benefits of clinical trials include:
(cid:2) Clinical trials offer high-quality cancer care.
(cid:2) If a new treatment approach is proven to work and you are
taking it, you may be among the first to benefit.
(cid:2) By looking at the pros and cons of clinical trials and
other treatment choices, you are taking an active role in a
decision that affects your life.
(cid:2) You have the chance to help others and improve cancer
treatment.
Possible drawbacks:
(cid:2) New treatments under study are not always better than, or
even as good as, standard treatment.
(cid:2) Even if a new treatment has benefits, it may not work for
you.
What About Clinical Trials? (cid:2) In a study, if you are randomly assigned to have standard
treatment instead of the new treatment being tested, it may
Clinical trials, also called cancer treatment studies or research not be as effective as the new approach.
studies, test new treatments in people with cancer. Clinical trials
(cid:2) Health insurance and managed care providers do not
test many types of treatments such as new drugs, new approaches
always cover all patient care costs in a study.
to surgery or radiation therapy, new combinations of treatments,
or new methods such as gene therapy. The goal of this research is
Before deciding to join a clinical trial you will want to ask
to find better ways to treat cancer and help cancer patients. There
important questions such as: What are the possible short- and
are different types of clinical trials, called Phase I, Phase II, and
long-term risks, side effects, and benefits to me? How could the
Phase III trials. Each is one of the final stages of a long and careful
study affect my daily life? Will I have to pay for any treatment,
cancer research process. If your doctor does not suggest you take
tests, or other charges?
part in a clinical trial, you may want to ask about clinical trials as
The National Cancer Institute’s (NCI) booklet Taking Part in
a treatment choice for you.
Clinical Trials: What Cancer Patients Need to Knowlists questions you
may want to ask your doctor and helps answers many of the ques-
tions you may have about clinical trials. It also informs you about
your rights and protections. For example, you are free to leave a
study at any time. You may order the booklet by calling NCI’s Cancer
Information Service at 1-800-4-CANCER (1-800-422-6237). You can
also look on the Internet at http://cancergov/clinicaltrials.
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Questions To Ask Your Doctor
About Chemotherapy About Contacting Medical Staff
(cid:2) Why do I need chemotherapy? (cid:2) How do I contact a health professional after hours, and
when should I call?
(cid:2) What are the benefits of chemotherapy?
Hints for Talking with Your Doctor
(cid:2) What are the risks of chemotherapy?
(cid:2) Are there any other possible treatment methods for my These tips might help you keep track of the information
type of cancer? you learn during visits with your doctor:
(cid:2) What is the standard care for my type of cancer? (cid:2) Bring a friend or family member to sit with you while you
talk with your doctor. This person can help you under-
(cid:2) Are there any clinical trials for my type of cancer? stand what your doctor says during your visit and help
refresh your memory afterward.
About Your Treatment
(cid:2) Ask your doctor for printed information that is available
(cid:2) How many treatments will I be given? on your cancer and treatment.
(cid:2) What drug or drugs will I be taking? (cid:2) You, or the person who goes with you, may want to take
notes during your appointment.
(cid:2) How will the drugs be given?
(cid:2) Ask your doctor to slow down when you need more time
(cid:2) Where will I get my treatment? to write.
(cid:2) How long will each treatment last? (cid:2) You may want to ask if you can use a tape recorder
during your visit. Take notes from the tape after the visit
is finished. That way, you can review your conversation
About Side Effects
later as many times as you wish.
(cid:2) What are the possible side effects of the chemotherapy?
When are side effects likely to occur?
(cid:2) What side effects are more likely to be related to my type
of cancer?
(cid:2) Are there any side effects that I should report right away?
(cid:2) What can I do to relieve the side effects?
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What Can I Expect During How Often and For How Long Will I Get
Chemotherapy?
Chemotherapy?
How often and how long you get chemotherapy depends on:
(cid:2) The kind of cancer you have.
(cid:2) The goals of the treatment.
Some people with cancer want to know every detail about their (cid:2) The drugs that are used.
condition and their treatment. Others prefer only general infor- (cid:2) How your body responds to them.
mation. The choice of how much information to seek is yours,
You may get treatment every day, every week, or every month.
but there are questions that every person getting chemotherapy
Chemotherapy is often given in cycles that include treatment peri-
should ask.
ods alternated with rest periods. Rest periods give your body a
This list is just a start. Always feel free to ask your doctor,
chance to build healthy new cells and regain its strength. Ask
nurse, and pharmacist as many questions as you want. If you do
your health care provider to tell you how long and how often you
not understand their answers, keep asking until you do.
may expect to get treatment.
Remember, there is no such thing as a "stupid" question, especially
Sticking with your treatment schedule is very important for the
about cancer or your treatment. To make sure you get all the
drugs to work right. Schedules may need to be changed for holi-
answers you want, you may find it helpful to draw up a list of
days and other reasons. If you miss a treatment session or skip a
questions before each doctor’s appointment. Some people keep
dose of the drug, contact your doctor.
a "running list" and jot down each new question as it occurs to
them. Sometimes, your doctor may need to delay a treatment based
on the results of certain blood tests. (See the sections on Fatigue,
Infection, and Anemia.) Your doctor will let you know what to do
Where Will I Get Chemotherapy?
during this time and when to start your treatment again.
Chemotherapy can be given in many different places: at
home, a doctor's office, a clinic, a hospital's outpatient depart-
How Is Chemotherapy Given?
ment, or as an “inpatient” in a hospital. The choice of where you
get chemotherapy depends on which drug or drugs you are get- Chemotherapy can be given in several different ways: intra-
ting, your insurance, and sometimes your own and your doctor's venously (through a vein), by mouth, through an injection
wishes. Most patients receive their treatment as an “outpatient” (shot), or applied on the skin.
and are not hospitalized. Sometimes, a patient starting
(cid:2) By vein (intravenous, or IV, treatment)
chemotherapy may need to stay at the hospital for a short time so
that the medicine's effects can be watched closely and any needed Chemotherapy is most often given intravenously (IV), through
changes can be made. a vein. Usually a thin needle is inserted into a vein on the hand
or lower arm at the beginning of each treatment session and is
removed at the end of the session. If you feel a coolness, burning,
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or other unusual sensation in the area of the needle stick when
the IV is started, tell your doctor or nurse. Also report any pain,
burning, skin redness, swelling, or discomfort that occurs during
or after an IV treatment.
Chemotherapy can also be delivered by IV through catheters,
ports, and pumps.
Catheters. A catheter is a soft, thin, flexible tube that is
placed in a large vein in the body and remains there as long as it
is needed. Patients who need to have many IV treatments often
have a catheter, so a needle does not have to be used each time.
Drugs can be given and blood samples can be drawn through this
catheter. Sometimes the catheter is attached to a port — a small
round plastic or metal disc placed under the skin. The port can be
used for as long as it is needed. A pump, which is used to control
how fast the drug goes into a catheter or port, is sometimes used.
There are two types of pumps. An external pump remains outside
the body. Most are portable; they allow a person to move around
while the pump is being used. An internal pump is placed inside
the body during surgery, usually right under the skin. Pumps con-
tain a small storage area for the drug and allow people to go about
their normal activities. Catheters, ports, and pumps cause no pain
if they are properly placed and cared for, although a person is (cid:2) By mouth (orally).
aware they are there.
The drug is given in pill, capsule, or liquid form. You swallow
Catheters are usually placed in a large vein, most commonly to the drug, just as you do many other medicines.
your chest, called a central venous catheter. A peripherally insert-
ed central catheter (PICC) is inserted into a vein in the arm. (cid:2) By injection.
Catheters can also be placed in an artery or other locations in your A needle and syringe are used to give the drug in one of
body, such as: several ways:
• Intrathecal (IT) catheter. Delivers drugs into the spinal • Intramuscularly, or IM. (Into a muscle)
fluid.
• Subcutaneously, or SQ or SC. (Under the skin)
• Intracavitary (IC) catheter. Placed in the abdomen,
• Intralesionally, or IL. (Directly into a cancerous area in
pelvis, or chest.
the skin)
(cid:2) Topically.
The drug is applied on the surface of the skin.
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How Will I Feel During Chemotherapy? Can I Take Other Medicines While I Am Getting
Chemotherapy?
Most people receiving chemotherapy find that they tire easily,
but many feel well enough to continue to lead active lives. Each Some medicines may interfere or react with the effects of your
person and treatment is different, so it is not always possible to chemotherapy. Give your doctor a list of all the medicines you
tell exactly how you will react. Your general state of health, the take before you start treatment. Include:
type and extent of cancer you have, and the kind of drugs you are
(cid:2) the name of each drug
receiving can all affect how well you feel.
You may want to have someone available to drive you to and (cid:2) the dosage
from treatment if, for example, you are taking medicine for nausea
(cid:2) the reason you take it
or vomiting that could make you tired. You may also feel especial-
ly tired from the chemotherapy as early as one day after a treat- (cid:2) how often you take it
ment and for several days. It may help to schedule your treatment
Remember to tell your doctor about all over-the-counter reme-
when you can take off the day of and the day after your treat-
dies, including vitamins, laxatives, medicines for allergies, indiges-
ment. If you have young children, you may want to schedule the
tion, and colds, aspirin, ibuprofen, or other pain relievers, and any
treatment when you have someone to help at home the day of
mineral or herbal supplements. Your doctor can tell you if you
and at least the day after your treatment. Ask your doctor when
should stop taking any of these remedies before you start
your greatest fatigue or other side effects are likely to occur.
chemotherapy. After your treatments begin, be sure to check with
Most people can continue working while receiving chemother- your doctor before taking any new medicines or stopping the ones
apy. However, you may need to change your work schedule for a you are already taking.
while if your chemotherapy makes you feel very tired or have
other side effects. Talk with your employer about your needs and
How Will I Know If My Chemotherapy Is Working?
wishes. You may be able to agree on a part-time schedule, find an
area for a short nap during the day, or perhaps you can do some of Your doctor and nurse will use several ways to see how well
your work at home. your treatments are working. You may have physical exams and
Under Federal and state laws, some employers may be required tests often. Always feel free to ask your doctor about the test
to let you work a flexible schedule to meet your treatment needs. results and what they show about your progress.
To find out about your on-the-job protections, check with a social Tests and exams can tell a lot about how chemotherapy is
worker, or your congressional or state representative. NCI's publi- working; however, side effects tell very little. Sometimes people
cation Facing Forward: A Guide for Cancer Survivors also has infor- think that if they have no side effects, the drugs are not working,
mation on work-related concerns. or, if they do have side effects, the drugs are working well. But side
effects vary so much from person to person, and from drug to
drug, that side effects are not a sign of whether the treatment is
working or not.
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