There are three basic goals of therapy.
o To manage the lymphoma as needed with minimal toxicity (management intent)
o To achieve a durable remission or possible cure (curative intent)
o To relieve symptoms or to address a tumor that is dangerous or impacting on your quality of life (palliative intent)
It’s important to understand and agree with the intent or goal of therapy; the most appropriate goal depending on many factors, including the type of lymphoma, its aggressiveness, where it presents, your treatment history, age, performance and other factors.
Treatments may be systemic - delivering drugs into the blood to reach cancer cells anywhere in the body, or localized - to treat a specific area of the body.
Almost all treatment agents are selective to some degree. That is, they are designed to affect the targeted cells (cancer cells) more than the normal cells. For example, many chemotherapy drugs affect rapidly dividing cells and will therefore damage mainly cancer cells, but also some normal cells that divide rapidly.
The experience of cancer treatment can vary a lot. Some will experience little discomfort and be able to continue work and family activities with little disruption. But sometimes the experience of treatment requires close monitoring and extensive after care.
Additionally, the following factors can influence the treatment experience and the outcomes:
o Your age and health status
o The treatment agents
o The unique sensitivities you may have to treatments
o How closely you follow doctor’s instructions
o How honestly and promptly you report problems
Try to be positive about the chosen treatment. Sometimes your anxiety about treatment can disrupt life more than the therapy, and can make recovery more challenging than it need be.
Learn what you can do to manage or prevent side effects and complications (the focus of what follows), so that you will have the best chance to have a great outcome.
o For readable information about each of the drugs you will be receive.
o What symptoms or side effects are expected, and which require:
· Immediate attention?
· A call the next day?
o How you can contact him?
o If drugs to control nausea will be needed?
o If nausea medicines are needed, please provide a prescription several days prior to the first treatment. (Prior approval may be required by your insurance company.)
o Ask about dietary and prescription guidelines, such as any foods or drugs to avoid when receiving treatment. Provide a list for your doctor of allergies you may have, along with a list medications and supplements you take, including over-the-counter types.
Getting Ready
Preparations - getting ready for treatment:
o Talk to your doctor about dental problems and chronic infections; address before treatment if possible.
o Ask about ways to help with the administration of therapies, such as ports
o Let neighbors, family, and friends help with your everyday preparations and tasks.
o Notify employees, family, and friends that you will need to be careful to avoid infections.
o Make preparations (lists, shopping, complete responsibilities) to minimize what you will have to do when treatment starts.
o Prepare a journal of your activities, body functions, symptoms and side effects; bring to your doctor's appointment. Write down your questions. Set goals.
o Prepare your favorite music and reading to help you relax.
About Therapy and Blood Counts
Many therapies can lead to decrease blood cell counts (cytopenias):
o Fatigue from low red blood cells (Anemia)
o Increased risk of bleeding from low platelets (Thrombocytopenia)
o Increased risk of infection from low granulocyte levels (Granulocytopenia)
o And from low lymphocytes and neutrophils counts (Lymphopenia and Neutropenia) also known as low White Blood Counts or WBC.
These risks will decrease as your blood counts return to more normal levels.
o Keep physically active; discuss also your limits with your doctor.
o Ask your doctor about growth factors (Neupogen® and Leukine®) that may help your granulocytes to recover more quickly.
o Avoid taking supplements without consulting with your oncologist.
o Avoid very hot baths to decrease the risk of Hand/Foot Syndrome and infection.
o Avoid uncooked foods; and thoroughly wash vegetables and fruits, including the skins.
o Record side effects and share with your doctor. We don't all react to the same drugs in the same way and sometimes protocols have to be changed or modified based on individual reactions.
o Talk to other patients; join a supportive group.
o Maintain hydration
o Drink plenty of water daily to keep tissues hydrated, reduce constipation, and to help remove toxins from your bladder, liver and kidneys.
o For each cup of coffee, tea, cola drink, or cocoa, take an extra cup of water. Chocolate also requires extra water.
o Avoid alcohol because it's also dehydrating and adds unnecessary toxicity.
o Ask your doctor about laxatives and stool softeners.
Have available small portions of food and drink, which require little or no preparation: broth-based soups, canned fruit, crackers, fruit juice. Treatment may increase the need for sources of digestible protein.
Minimizing oral complications:
o Avoid sticky, crunchy foods; and foods that are hot, spicy, or high in acid, like citrus fruits and juices.
o To help with swallowing, soften your food with gravy, sauces, broth, yogurt, or other liquids.
o Avoid toothpicks and tobacco products.
o When your mouth hurts, call or fax your doctor or nurse.
o Use extra-soft toothbrush after meals and at bedtime. Soften in warm water.
o Use a fluoride toothpaste; avoid mouthwashes that contain alcohol.
o Gently floss your teeth daily. Avoid areas that are bleeding or sore. If your blood counts are low check with doctor or nurse before flossing.
o Rinse several times daily with solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in one cup of warm water. Follow with a plain water rinse.
o Suck on ice cubes to relieve sores - be sure that the water is pure (boil if from a well).
o Discuss with your doctor or dentist about your dentures that don't fit.
Constipation management:
o Contact your doctor if it persists or worsens.
o Keep hydrated (drink water) and avoid caffeine.
o Include fiber in your meals (such as whole grains).
o Get regular exercise (such as walking).
Nausea management:
o Avoid foods that are high in fat, which tend to remain in the stomach longer than other foods and may contribute to nausea.
o Chew slowly, take small bites, sip liquids with meals; avoid offending foods and odors - breath through your mouth when needed.
o Try smaller, more-frequent meals.
Cross contamination - reduce risk of infection while your counts are low:
o Be aware of sources of contamination: public places, raw foods, cutting boards, plates, dish towels, door knobs, counter tops, and sponges.
o Wash hands often with warm soapy water; avoid touching your face, mouth, and eyes.
o Wash after touching door knobs, dish towels, raw foods
o Use separate cutting boards for fresh produce and raw meat. Use separate dish towels when handling raw meat; use disposable types.
o Get adequate rest, take naps as needed.
o Try relaxation techniques during treatment, such as mediation or prayer.
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