LINDA MILLER, RN, OCNMETROHEALTH CANCER CARE CENTER

People with cancer

Statistics

American Cancer Society estimates for 2014In US 1,665,540 new cases In US 585,720 deathsIn Ohio 67,000 new cases Cancer is the 2nd most common cause of

death in the US, responsible for 1 in 4 deaths

Statistics

By 2030 expect 2.3 million new cases annually in US

By 2030 cancer will be leading cause of deathPeople living at least 5 years after cancer

diagnosis 1970s 50% Currently 66%

Cancer treatments

Modes of treatmentSurgeryRadiationChemotherapyTreatment with single mode or multiple modesExample of multi-modal: Breast cancer

(radiation to reduce tumor prior to surgery, chemotherapy after surgery)

Chemotherapy

Usually given in outpatient setting Prevents cancer cells from metastasizingSystemic therapy

Given intravenouslyDestroys good and bad cellsTreatments on set schedule

Radiation therapy

Local treatment directed at specific areaTreatments scheduled daily, but treatment

extends for weeks

Oral chemotherapy

Increasing number of patients receiving oral chemotherapy

PRECAUTIONS NEEDED: Handled with proper protection including chemo

gloves Keep away from others in secure area

Side effects of therapy

FatigueNausea/vomitingDiarrheaFeverSkinPainOther

Side effects of cancer treatment

Fatigue Most common side effect Due to decreased red blood cells leading to lower

oxygen levels Inability to perform basic tasks No over-exertion, conserve energy Accommodations

Frequent rest periods Nutritious foods, plenty liquids

Side effects of therapy

Nausea Anti-nausea medications can prevent vomiting Nausea triggers

Perfumes and odors Fried foods, spicy foods, fatty foods, overly sweet foods Dehydration

Increased risk of nausea Women Younger patients Women with history of morning sickness

Helping people avoid nausea

Provide small frequent meals (nausea occurs on an empty stomach)

Avoid strong odorsAssure availability of anti-nausea medication,

encourage to take as prescribedProvide dry crackers/dry toastAvoid spicy, greasy, fatty foods

Helping people with diarrhea

ImodiumBRAT diet – bananas, rice, applesauce, dry

toastAvoid high fiber, high fat, greasy, spicy foodsAvoid caffeine, milk, alcoholIncrease fluids

People with fever

Due to low blood counts, usually 7 to 10 days after chemo

Observe for temperature increase First sign of infection

If fever of 100.4°F or 38°C (have thermometer available) To ER or call oncologist on duty

Infection precautions

Chemotherapy patients can reside in general population shelter, but away from ill people Dependent on instructions from physician Provide isolation if necessary

Skin problems

Especially for people receiving radiation therapy Redness of skin Provide Eucerin, Aquaphor

People with pain

Treat with medication Opioids

Keep in secure place!

Other side effects

Less frequent side effects related to attack on the “good cells”Alopecia

May use head covering, even at nightNumbness in fingers

Difficulty feeling, holding thingsStomatitis

Questions to ask

If a shelter resident identifies as a person being treated for cancer, ask about Pain medicine Anti-nausea medicine Oral chemotherapy Personal supplies: ostomy bags, etc. Time and place of next treatment

Have available

Rest areaNutritious foodsFluids (water, juice, Gatorade, popsicles, Jell-

O)ImodiumThermometer

End of life concerns

Understanding prognosis patients continue to "hope" - requesting more

treatmentsAsk person (and listen to the answers) what

care or treatment will be needed in the shelter and how best to provide the care Ask if caregiver is with person Ask about others providing care Ask about advanced directives

End of life concerns – symptom control

Pain – adequate pain controlSecretions – control and/or managing

secretionsConstipation – adequate hydration, stool

softenersAnxiety – medication, comforting

environment, caregiversDyspnea (difficulty breathing) – positioning,

oxygen

POD related information

Per CDC – no live vaccines Herpes Zoster (shingles) Flu mist (nasal spray) Measles, mumps and rubella (MMR) Smallpox Yellow fever Chicken pox

Thank you

Questions?Comments?