What to Expect to be Taught By Duke Oncology Nurses

Before a new patient receives chemotherapy, a nurse from the Duke Oncology Treatment Center sits down with the patient and a family member to provide education on the drugs and side effects on a one to one basis.  Each patient will be given printed materials to take home.

Topics:

• Name of each medication to be received
• How the drug will be given
• What medications will be given before the chemotherapy is started
• Common and possible side effects from each drug
• How the patient and family can prepare for any side effects
• When it would be appropriate to call the doctor with side effects
• Answer questions the patient or family may have

What You Might Want to Bring to Your First Doctor & Chemotherapy Visit:

1. A notebook to write down what the doctor has said any questions you have and to make notes on the teaching that will be done that day. It is hard to remember everything you will be told, the best thing to do is write it down. Make it easier on yourself.

2. Bring a calendar to keep track of your future appointments with the doctors and with the Treatment Room. Keep all our information together in something easy for you to carry and make it your Duke Clinic folder or utility bag.

Common Side Effects of Chemotherapy and or the Process of Cancer

• Fatigue
• Nausea
• Decrease in production of blood components

Symptoms of Fatigue

Everyone experiences fatigue from the day to day activities in their lives that is defined as acute fatigue and is usually relieved with rest. The Fatigue that comes with cancer and the treatment of cancer is a chronic fatigue and is not relieved by rest. Not everyone experiences this symptom, and there are different degrees of “tired”. Other symptoms of fatigue may appear through change in your sleep patterns, signs of depression, and inability to concentrate. You need to feel comfortable explaining to your medical provider the type of fatigue symptoms you are having. Tell them if you are not able to care for your family, or even able to walk to the mailbox. By giving definite symptoms or relating them to certain medications helps the medical profession better understand what an impact the Cancer Related Fatigue is having on your life.

Fatigue is the most common reported symptom patients’ experience. Often it may have been one of the first symptoms that sent the patient to their doctor in the first place. There is not a “magic bullet” to prevent or stop the fatigue but the medical profession now understands the effects fatigue can have on the patient, their family, and their ability to handle the treatment of the cancer.

A reduction in your circulating blood volume can also add to your fatigue. Your doctor may decide to add some medication to your therapy that will help increase your hemoglobin level to help reduce that contributing factor to your fatigue.

One of the ways to deal with this chronic fatigue is to develop energy conserving techniques:

• Keep a diary of your energy level
• Pace yourself with your daily chores, spread them out over a longer period of time and build rest periods into your schedule
• Lay your clothes out the night before
• Wear slip on shoes, pull up pants
• If you shower put a waterproof stool/bench in the shower to sit on

Nausea

During the 1990’s new medications were developed to decrease this side effect of chemotherapy. Prior to 1990, many patients had bad experiences and found little to relieve the feeling of nausea or vomiting. Now we have medications that have made this symptom one that is much less intimidating.

Drugs for the control of nausea from chemotherapy are given before the chemotherapy and the doctor will give you a prescription for home if they feel you will need one. Not all chemotherapy drugs are guilty of causing severe nausea, but everyone is different and discuss with your doctor if you have concerns.

Common Medications used to Control Nausea from Chemotherapy

Generic Name (Trade Name)

• Ondancetron (Zofran)
• Granisetron (Kytril)
• Prochlorperazine (Compazine)
• Lorazepam (Ativan)
• Promethazine (Phenergan)
• Thiethyperazine (Torecan)

Affects on Bone Marrow and Your Blood

Standard chemotherapy given in the vein (intravenously) affects the entire body and every organ. Many chemotherapy drugs can affect the bone marrow and cause decrease in the production of several different components of our blood. Red Blood Cells (RBC) that affects the Hemoglobin (oxygen carrying blood cells), Platelets which are important in blood clotting, and White Blood Cells (WBC) that helps the body fight infection.

Your doctor or nurse will discuss this side effect with you and ways for you to protect yourself.

Soon the medical terminology will start to make sense and you will be able to tell how you feel and understand the effect your blood has on your overall symptoms. You learn that some days of the month are “down” days between chemotherapy treatments and how to prepare yourself for them. In the notebook you may be keeping you can write down your blood counts on your visits to t he doctor.

There are many different drugs and each with different side effects and your medical team will review each chemotherapy drug with you and discuss specific areas of concern.

Hair Loss

There is some chemotherapy drugs that will cause you to lose your hair. Not all chemotherapy has that affect. Your doctor or nurse will tell you if the particular medications you will be given will cause your hair to fall out. If that does happen, the peak effect of hair loss occurs 10-14 days after your chemotherapy is given.

Please remember, as hard as it is to watch your hair fall out, after the last chemotherapy treatment your hair will grow back.

Visit the Duke Cancer Patient Support Program for information on the Wig and Turban program, Chemotherapy Orientation program and many more including the Look Good Feel Better program.