Understanding cancer treatment - Walgreenshave a medical question, contact your medical...

URAC

Understanding your oral medications for cancer treatment

URAC All Walgreens specialty pharmacy locations are ACHC and URAC accredited.

Table of contents

Understanding oral chemotherapy...........................................................................................................1

Staying on track with your oral chemotherapy .......................................................................................2

Know what your medication looks like ..................................................................................................2

Know how to take your medication .......................................................................................................3

Know what to do if you miss a dose......................................................................................................6

Make it easy to remember to take your medication ..............................................................................7

Know what to expect .............................................................................................................................8

Tell your doctor about all of your medications.......................................................................................8

Your healthcare team is there to help ....................................................................................................8

Coping with side effects ............................................................................................................................9

Skin reactions ........................................................................................................................................9

Hand-foot syndrome............................................................................................................................12

Nausea and vomiting ...........................................................................................................................12

Other antinausea tips...........................................................................................................................13

Diarrhea................................................................................................................................................14

Fatigue .................................................................................................................................................16

Finding support.........................................................................................................................................20

Expressing emotions ...........................................................................................................................20

Support groups and counseling ..........................................................................................................20

To learn more ............................................................................................................................................22

Sources................................................................................................................................................22

Resources ............................................................................................................................................24

This publication should be used for general educational purposes only and is not intended to be a substitute for professional medical advice. Although it is intended to be accurate, neither Walgreen Co., its subsidiaries or affiliates, nor any other party assumes liability for loss or damage due to reliance on this material. Advances in medicine may cause this information to become outdated, invalid or subject to debate. This information is not intended to create any warranty, and ALL SUCH WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE, ARE HEREBY DISCLAIMED. If you are in need of immediate medical attention or have a medical question, contact your medical professional.

Inclusion of resources in this document does not imply endorsement by Walgreen Co. or any of its subsidiaries. These resources should be used for general information and educational purposes only.

Brand names are the property of their respective owners.

Understanding oral chemotherapy

Until recently, most people who received cancer chemotherapy went to the hospital or a clinic to receive intravenous (IV) infusions. While many cancer drugs are still given by IV, a newer generation of cancer treatment consists of medications that people take orally as tablets or capsules. These medications are often used for long-term treatment to slow the rate of cancer growth or help keep tumors from returning.

Some cancer drugs available in oral form are the same chemotherapy drugs given by IV, but they have been specially formulated so the body can absorb them when taken by mouth. Others, known as targeted treatments, focus on preventing the growth of cancer cells and killing them.

Although oral chemotherapy drugs may not cause some of the severe side effects that traditional chemotherapy does, they do have side effects. And some side effects can make it difficult to stay on track with a treatment plan.

Other concerns may also make it hard to stay on track. The medication schedule for oral chemotherapy medications can be complicated and inconvenient. And many people need to take these medications for months or years. For these reasons, some people stop taking their cancer medication on their own. You should never stop taking your medication without first talking to your pharmacist or doctor. Stopping your medication suddenly may cause your cancer to return or worsen.

We want to help you get the most benefit from your cancer treatment. This booklet has been developed to help you stay on track with your cancer medication and manage the most common and bothersome side effects of oral chemotherapy.

1

Staying on track with your oral chemotherapy

Taking cancer medication on your own at home lets you avoid the needle sticks and the frequent, inconvenient trips to the hospital that are part of IV chemotherapy. But along with this freedom comes responsibilities.

• You may be responsible for following a complicated medication schedule that can involve, for example, 10, 20 or more pills a day.

• You may be receiving combination therapy with multiple medications.

• You may be dealing with unpleasant side effects that interfere with your everyday life. These side effects may make it hard to get into a regular routine with your medication.

Even after you get through the first few weeks with your medication, it may be hard to stay motivated because the benefits may seem like they’re in the distant future while you’re experiencing side effects and inconvenience in the present.

Some people decide on their own to cut back their dose or take a “break” for weeks or even months at a time. If you have done this—or you are considering doing this—talk with your doctor, nurse or pharmacist. Your healthcare team can help you understand why it’s important for you to keep taking your medication as prescribed. This section of the booklet provides key tips that can help you stay on track with your cancer medication.

Know what your medication looks like

Make sure you are taking the right amount of the proper medication. This is very important if you take multiple medications at different times of the day. Many cancer medications come in different strengths. This means there is a different amount of the active ingredient—the actual drug—in the tablet or capsule. Some people may need to take two different strengths at the same time. Taking the wrong tablets or capsules could cause an overdose (too much medication) or an underdose (too little medication).

For example, the cancer medication Tarceva®

(erlotinib) is available in three different strengths— 25 mg, 100 mg and 150 mg. If your doctor prescribes a 125-mg dose, you would have to take two tablets at once—one 25-mg tablet and one 100-mg tablet—to equal the 125-mg dose.

Different strengths of the same medication can differ in the following ways:

• Color

• Letters, words or numbers printed on one or both sides of the tablet or capsule

• Shape

• Size

2

Know your cancer medication

You should know the answers to the following questions without looking at your medication. If you don’t, take a close look at your medication, including the label, until you can answer these questions without looking. The instructions that came with your medication may include photographs and descriptions of the tablets or capsules to call your attention to certain things that will help you recognize them more easily. Be sure to keep the information you received with your medication so you can refer to it in the future.

Fill in the blanks.

Medication 1

Name: ��

Strength: �� mg

Shape: ��

Color of tablet or capsule: ��

Letters or numbers on the tablet or capsule: ��

Color of letters or numbers: ��

Medication 2

Name: ��

Strength: �� mg

Shape: ��

Color of tablet or capsule: ��

Letters or numbers on the tablet or capsule: ��

Color of letters or numbers: ��

Don’t take your medication on “autopilot.” Notice each tablet or capsule as you are preparing to take it and be mindful of what you are doing. This can help ensure you are taking the right medication at the right time. This is especially important when your doctor changes your medication dose or schedule, which may happen from time to time.

Know how to take your medication

This is supposed to be the easy part, right? You just swallow the pill, usually with water. That’s true— but it also matters when you take it, what else (if anything) you take along with it and whether you need to swallow it whole.

When to take your medication

Most medications should be taken at the same time each day. This reduces the risk of forgetting a dose and helps ensure that you get the most benefit from your medication.

• Be aware that you must wait a certain number of hours between doses of certain medications.

• Try taking your medication at the same time you do other routine tasks, such as brushing your teeth or getting ready for bed. This will help you connect taking your medication with other daily activities and make you less likely to forget.

• If you are out and about, set an alarm on a watch or cell phone (if you have one) to remind yourself to take your medication.

3

Staying on track with your oral chemotherapy (continued)

How to swallow your medication

Many pills should not be broken, cut or crushed because they lose their effectiveness or because this does not accurately divide the dose as intended. Be especially careful if capsules are accidentally opened or damaged. The contents of some capsules used in oral chemotherapy should not be allowed to touch your skin or mucous membranes, including your nasal passages, because they can be very irritating. Ask your doctor or pharmacist if this precaution applies to the medication you are taking.

Most cancer medications should be swallowed whole and washed down with water unless your doctor has instructed you to do otherwise. If you are having difficulty swallowing your pills, the following tips may help:

• Place the pill on the tip of your tongue, drink some water, tilt your head back and swallow.

• If that doesn’t work, place the pill on the back of your tongue, drink some water, tilt your chin down toward your chest and swallow.

• Take a deep breath before placing the pill in your mouth; this may help stop the gag reflex.

• Always sit up straight when you swallow pills.

• If you can take your medication with food, try taking it with a soft food like applesauce, yogurt or pudding, and swallow both together. Soft foods are often easier to swallow than liquids.

• Drink a whole glass of cold water while swallowing a pill.

If you are still having difficulty after trying these techniques, tell your doctor, nurse or pharmacist.

What to take with your medication

Some medications should be taken with food; others should not. It’s important to know if you can take your medication with food.

• Taking certain medications with food can reduce the risk of side effects.

• For other medications, food can increase your chance of developing side effects.

• A full stomach can also affect how well your body absorbs medication.

• Some medications are unaffected by food.

4

Table 1 provides information about whether some Also, grapefruit and grapefruit juice may affect how common cancer medications should be taken with well some medications work so you may be advised or without food. In most cases, taking a medication to avoid grapefruit products while you are taking a without food means to take it either one hour before particular medication. or two hours after a meal.

Table 1: Food-related instructions for selected cancer medications

Medication Take with food Take without food

Take with or without food Notes

Afinitor® (everolimus) * Avoid grapefruit products.

Gleevec® (imatinib) * Avoid grapefruit products.

Hycamtin® (topotecan) capsules

*

Nexavar® (sorafenib) *

Revlimid® (lenalidomide) * Take with a large glass of water.

Sprycel® (dasatinib) * Avoid grapefruit products.

Sutent® (sunitinib) * Avoid grapefruit products.

Tarceva® (erlotinib) * Avoid grapefruit products.

Targretin® (bexarotene) capsules

* Tell your doctor if you eat or drink a lot of grapefruit products.

Tasigna® (nilotinib) * Avoid grapefruit products.

Temodar® (temozolomide) capsules

*

Thalomid® (thalidomide) * Take one hour after evening meal with a large glass of water.

Tykerb® (lapatinib) * Avoid grapefruit products.

VotrientTM (pazopanib) * Avoid grapefruit products.

Xalkori® (crizotinib) * Avoid grapefruit products.

Xeloda® (capecitabine) *

ZelborafTM (vemurafenib) *

ZytigaTM (abiraterone) *

5


Your medication and food: do they go together?

Choose the best answer and fill in the blanks, if needed.

I should take my cancer medication

�� Right after eating or within 30 minutes after a meal.

�� Either �� hour(s) before or �� hour(s) after eating.

�� With or without food, whichever is easiest for me at the time.

I need to avoid grapefruit and grapefruit juice. �� Yes �� No

The answers to these questions can be found in the information that came with your medication. Not sure? Call your doctor or pharmacist.

Know what to do if you miss a dose

You may forget to take your medication or you may not remember whether you took your most recent dose. Or you might be unsure about what to do if you throw up soon after taking it.

Ask your doctor or pharmacist about what to do if you miss a dose of your medication before it happens so you’ll be prepared. Don’t assume you should skip a dose or take a double dose to “catch up” if something like this happens. Your missed-dose directions may be different, depending on the circumstances. Also, know when to tell your doctor about missed doses. With some medications, you may be asked to notify your doctor if you miss even a single dose.

What to do if you miss a dose

Fill in the blanks.

If I miss a dose and remember it the same day, I should ��.

If I don’t remember a missed dose until the following day or if it is almost time for the next dose, I should ��.

If I can’t remember if I took my medication, I should ��.

If I throw up within �� after I take the medication, I should ��.

The answers to these questions can be found in the information that came with your medication. Not sure? Call your doctor or pharmacist.

6

Make it easy to remember to take your medication

There are many ways to remind yourself to take your medication. Find ways that work for you and your schedule and adjust them to suit your lifestyle.

Organize your medications

• Use a seven-day medication box (pill box) to organize your medication. This can help you see each dose and help you remember if you have taken your medication on a particular day and time.

• If you take medications at different times each day, choose a medication box with extra dividers for morning, evening, bedtime or hourly doses.

• Never put your medication in an unlabeled bottle or combine different medications in a single bottle. Even when you are familiar with what your medication looks like, it’s easy to make mistakes.

• Carry an extra dose of each medication with you just in case you misplace your medication box, drop your medication or otherwise lose the original dose.

Use alarms and alerts

• Set an alarm on a clock, watch or cell phone to remind yourself to take your medication.

• Some medication boxes have built-in alarms.

• Use a computer to set up a daily calendar alert or an email reminder for yourself.

Write it down

• Write your medication schedule on a wall calendar near your medications.

• If you take several medications at different times, it might be helpful to list each medication and when to take it.

• If you write a daily to-do list for yourself, you can include your medication on it, then check it off when you’ve taken it.

Stay on schedule while you are traveling

• When you’re away from home, pack extra medication and bring your medication reminders with you.

• Your daily routine might be different while you’re away; rely on an alarm instead of daily habits or chores to remind you to take your medication.

• If you’ll be crossing time zones, ask your doctor if you need to adjust your medication schedule.

7


Know what to expect

Many people are concerned about side effects of cancer medication. These concerns can make it hard to stay on track with your medication. It’s important to have realistic expectations about how you will feel during your cancer treatment.

• If you have already had IV chemotherapy, you may have certain expectations based on that experience.

• The medication you’re taking now may have fewer or less severe side effects than your IV chemotherapy medication—or it may have entirely different side effects. It’s best not to think of your oral chemotherapy as “more of the same” chemotherapy.

• Learn as much as you can about the side effects of the medication you’re taking now and how to deal with them. It will help you get through your treatment successfully.

• You can learn more about what to expect and ways to cope by reading this booklet and talking with your doctor, nurse, pharmacist and others on your healthcare team.

Tell your doctor about all of your medications

Be sure to tell your doctor about all medications you are taking, including herbals, vitamins, supplements, prescription medications and over-the-counter products. All of these can interfere with your cancer medication or put you at risk for health problems. Don’t take any new medication— even once—without talking with your doctor first. Check with your doctor before starting any new medication, including herbals and all of the other items listed above.

Your healthcare team is there to help

Sometimes people don’t start taking their medication when they’re supposed to. And sometimes they skip doses because they are tired, don’t feel well or don’t want to experience side effects. Depression, anxiety and lack of energy can stop people from taking their medication. If you are dealing with challenges like these, talk with your doctor, nurse or pharmacist. No matter how far off track you may be, tell someone on your healthcare team. Their goal is to help you overcome your medication challenges and to be there for you during your therapy.

8

Coping with side effects

Oral chemotherapy can have many side effects. Your healthcare team can tell you about these side effects and how likely it is that they will affect you. This booklet provides information about the following common side effects experienced by people who take oral chemotherapy medications:

• Skin reactions

• Nausea and vomiting

• Diarrhea

• Fatigue

You may not have any of these side effects. Or you may have others that are not covered in this booklet. Your doctor, nurse and pharmacist are always the best source of information about side effects and your health. Always follow your doctor’s instructions.

Skin reactions

Targeted treatments help stop cancers from growing but they may also cause problems with the skin. These cancer medications target a substance known as epidermal growth factor receptor (EGFR) protein. EGFR, which signals cancer cells to grow and multiply, is also found in normal skin cells. Drugs that target EGFR often affect normal skin cells by turning off the signals for them to grow, making it harder for them to retain moisture. This can result in dry skin and rashes.

Dry skin

Many people notice that their skin becomes dry while they are taking oral chemotherapy medications. Very dry skin is itchy, which is bothersome in itself. And scratching can lead to infection. To help keep your skin from getting dry and itchy, make the following part of your daily routine:

• Instead of showering, take a bath with an oatmeal bath product such as Aveeno®.

• If you do shower, use lukewarm—not hot—water. Don’t take more than one shower per day and keep it short.

• Use an unscented, moisturizing soap. Chemicals used to add fragrances to personal care products can be irritating to the skin.

9

Coping with side effects (continued)

• Apply a hypoallergenic, unscented body cream such as Eucerin® or Aquaphor® while your skin is still damp, to help lock in moisture. Creams have a greater moisturizing effect than lotions. Apply the cream at least twice a day in addition to using it after your shower or bath.

• Wear loose-fitting, comfortable clothing that doesn’t rub against your skin. Avoid fabrics such as wool, which can be irritating to your skin.

• Drink plenty of fluids to keep your skin hydrated.

Rash

Most people who develop a rash as a side effect of oral chemotherapy experience a mild skin eruption that looks like acne and may be itchy.

• The scalp, face, chest and upper back are most commonly affected. In more severe cases, other parts of the body can be involved as well.

• Eventually, the skin crusts and becomes dry and red. Round, flat or raised red spots and whitehead pimples with pus may appear.

• The rash can start seven to 10 days after you start taking the medication but sometimes doesn’t appear for up to six weeks after your first dose.

• The rash may come and go. Sometimes it goes away on its own. It should go away completely within a month after you finish treatment.

Be sure to tell your doctor as soon as you notice signs of a rash because early treatment can help prevent it from getting worse. Other helpful steps you can take on your own include the following:

• Take a bath instead of showering and use oil-based soap or oatmeal bath products such as Aveeno.

• Apply a hypoallergenic, unscented cream such as Eucerin or Aquaphor after a bath, while your skin is still damp.

• Avoid using bandages, dressings or wraps on the skin as these can make the rash worse.

• Don’t treat the rash as acne. Don’t use products such as benzoyl peroxide that are normally used for acne.

• Wear loose-fitting cotton clothing.

• Avoid direct sunlight and use sunscreen with an SPF of at least 30 to protect your skin.

• Wear a hat and sunglasses, even on cloudy days.

10

Table 2 lists various types of medications that are used and lotions to soothe the skin and oral treatments to to treat this type of rash, including medicated creams minimize symptoms and eruptions.

Table 2: Medications used to treat rash

Type of medication Notes

Corticosteroid creams

Topical antibiotics such as erythromycin, clindamycin and metronidazole

• These can reduce inflammation and pain. • Prescription creams are stronger than over-the-counter products. • Your doctor may prescribe different types or strengths of corticosteroids, depending

on the severity of your rash. • Apply the cream after cleaning skin gently with a mild, soap-free cleanser.

• These must be used carefully as they can irritate and dry the skin. Use Q-tips® to apply the medication to the affected area to avoid drying the surrounding skin.

• Your doctor may recommend using topical antibiotics every other day before increasing to daily use.

Oral antibiotics such as • Take only as your doctor recommends. These are often given for two weeks at tetracycline, minocycline a time. and doxycycline • It may take several weeks before you see any benefit.

• These medications increase your sensitivity to the sun. Use sunscreen every day and avoid sun exposure.

Over-the-counter • These can help relieve discomfort. pain relievers such as • Ibuprofen helps reduce swelling. acetaminophen (Tylenol®) and ibuprofen (Advil® , Motrin®)

Antihistamines such • Some antihistamines are available over the counter. as loratadine (Claritin®) • These are used to relieve itching but their effectiveness is limited. and diphenhydramine (Benadryl®)

11


Hand-foot syndrome

Oral chemotherapy drugs can cause a unique skin rash known as hand-foot syndrome (HFS) that affects the palms of the hands and the soles of the feet. If you are taking medications that your doctor thinks may cause HFS, you should take the following steps to help prevent it:

• Avoid pressure on your feet by wearing soft shoes or tennis shoes.

• Avoid standing for long periods of time.

• Check your hands and feet twice a day for early signs of HFS. Painful sensitivity of the hands and feet is often the earliest symptom.

• Don’t wear tight shoes.

• Protect your feet by wearing cotton socks and using gel inserts for your shoes.

• Treat your feet twice a day with creams such as Kerasal® or Udderly Smooth® Extra Care Cream, which are specially formulated with an ingredient called urea. You can also apply the cream overnight and wear socks to keep the cream on your feet and off the bedsheets.

You may also notice dry, peeling skin; calluses; redness that looks like sunburn; and swelling on the palms of the hands and soles of the feet. In severe cases, blisters can develop, open up and become sores. Recognizing and treating HFS early may prevent it from becoming severe.

Tell your doctor about any rashes or changes in your skin. Without treatment, these skin reactions can get worse and may lead to infection, causing your doctor to pause or even stop treatment. Don’t treat your skin with over-the-counter products or stop taking your cancer medication without talking to your doctor first.

If you have been prescribed medication for skin reactions, use it as you have been instructed and tell your doctor if your skin is not getting better.

Nausea and vomiting

Nausea and vomiting are common side effects of cancer medication.

• Nausea is often described as feeling queasy or being “sick to your stomach.”

• Other symptoms may include increased saliva, dizziness or a rapid heart rate.

• Nausea often results in vomiting.

In addition to being unpleasant and difficult to tolerate, nausea and vomiting can cause dehydration (not having enough water in the body), changes in appetite and weight loss that can interfere with your treatment. Together with your doctor and your healthcare team, you can prevent or reduce nausea and vomiting with changes in eating habits, antinausea medications and other treatments.

12

The way to eat now

How, what and when you eat can affect how you feel while you are taking cancer medication. Because there will be times when it is difficult to eat, find nutritious foods that you enjoy and take advantage of times when your appetite is strongest. Many people find that breakfast time is best.

Here are some food-related tips for days when you are feeling nauseated:

• Avoid sweet, fried or fatty foods and foods with strong odors. If cooking odors bother you, ask someone else to cook and take your meal into another room.

• Choose foods and beverages that were easy for you to tolerate during other times in your life when you felt nauseated, such as when you had the flu.

• Don’t force yourself to eat when you feel queasy.

• Eat before you feel hungry.

• Eat foods cold or at room temperature.

• Eat slowly. Take small bites and chew thoroughly.

• Have small meals frequently throughout the day, rather than three large meals.

• Sip fluids throughout the day but limit fluids you drink with meals.

If you are following a special diet related to other medical conditions, such as diabetes, talk with your doctor before making any changes.

Other antinausea tips

• Make a habit of wearing comfortable, loose-fitting clothes.

• Open a window or use a fan to get some fresh air when your stomach feels unsettled.

• Brush your teeth and rinse out your mouth after each episode of vomiting.

• If you have mouth sores (another side effect of chemotherapy) or other discomforts that affect your lips, mouth or throat, ask your healthcare team about oral hygiene.

13


Treating nausea and vomiting with prescription medications

In most cases, changes in eating habits are only part of the solution. Depending on your symptoms, your doctor may prescribe one or more antinausea medications. Table 3 lists medications most commonly used to treat nausea and vomiting experienced by people being treated for cancer. Your doctor will recommend the medications that are best for you.

Call your doctor if your nausea or vomiting is not controlled with dietary changes and medications.

Table 3: Antinausea medications

Diarrhea

Chemotherapy drugs can affect the cells lining the intestine, which leads to diarrhea (loose or watery bowel movements). In severe cases, your doctor may prescribe an antidiarrheal medication. Don’t take any over-the-counter medication for diarrhea without asking your doctor first.

How to follow a clear liquid diet

Changes in your diet can reduce diarrhea or help keep it from getting worse. Even when you don’t feel up to eating, it’s important to replace the fluids that are lost through diarrhea. Choose clear, caffeine-free liquids like these:

Generic name (brand name) Notes

• alprazolam (Xanax®) • lorazepam (Ativan®)

dexamethasone (Decadron®)

diphenhydramine (Benadryl®)

• dolasetron (Anzemet®) • granisetron (Kytril®) • ondansetron (Zofran®)

metoclopramide (Reglan®)

prochlorperazine (Compazine®)

promethazine (Phenergan®)

Source: Nausea and vomiting. American Cancer Society Web site. www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/NauseaandVomiting/ NauseaandVomiting/nausea-and-vomiting-drugs. Accessed July 6, 2010.

• Used to reduce anxiety • Often used with other antinausea medications • Have calming and antinausea effects

Corticosteroid used alone and with other antinausea medications

Antihistamine that helps reduce side effects from other antinausea medications

Similar medications; each works equally well

May be used alone or with other medications



14

www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/NauseaandVomiting

• Apple juice

• Clear broth

• Ginger ale

• Sports drinks such as Gatorade

• Water

• Weak, decaffeinated tea

Also, Popsicles® and Jell-O® are often considered “clear liquids.”

You may find it more tolerable if your drinks are at room temperature. Allow carbonated drinks to lose their fizz before you consume them. And sip beverages throughout the day rather than trying to drink a lot at one time.

Keep in mind that a clear-liquid diet doesn’t provide all the nutrients you need, so you shouldn’t limit your food intake like this for more than three days. If the diarrhea doesn’t improve by then, you may need to go to the emergency room for IV fluids.

Avoid foods and drinks that can worsen diarrhea

Many foods and beverages can irritate a touchy digestive system and make matters worse. The following are some of the worst offenders:

• Acidic drinks such as tomato juice, citrus juices and fizzy soft drinks

• Alcohol, including beer, wine and mixed drinks

• Dried fruit

• Drinks that contain caffeine, such as coffee, caffeinated tea and colas

• Fresh fruit without the skin

• Greasy, fried, spicy or very sweet foods, which can irritate the digestive system

• High-fiber foods such as whole-grain breads and cereals, beans, nuts, seeds, popcorn and vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, corn and peas

• Milk and milk products

• Raw vegetables

Choose foods that are easy to digest

A diet consisting of ripe bananas, rice, applesauce and white-bread toast is easy for most people to tolerate. Often called the BRAT diet for short, this is the first step up from clear liquids. Other foods that are easy to digest include the following:

• Canned, peeled fruits

• Farina and Cream of Wheat®

• Mashed or baked potatoes without the skin

• Noodles

• Plain pasta

• Rice

• Scrambled eggs

• Smooth peanut butter

• Well-cooked vegetables

• White-meat chicken or turkey without the skin

• Yogurt

15


When to call the doctor

The American Cancer Society recommends that you call the doctor if you:

• Have six or more loose bowel movements with no improvement in symptoms in two days

• Have blood in or around the area where stool (solid waste) passes out of your body or in the stool itself

• Lose 5 pounds or more after the diarrhea starts

• Have new abdominal pain or cramps for two days or more

• Do not urinate for 12 hours or more

• Have a fever of 100.5 degrees Fahrenheit or higher when you take your temperature by mouth

• Get a puffy or swollen belly

• Have been constipated for several days and then begin to have small amounts of diarrhea or oozing of liquid stool, which indicates you might have an impaction (severe constipation)

Always follow your doctor’s instructions about when to call with your concerns.

Fatigue

Fatigue—extreme tiredness—can be caused by many things, including cancer medications, poor nutrition or stress. Often, it is a combination of these. Fatigue can occur occasionally or more regularly over a long period of time.

In addition to extreme tiredness or exhaustion, fatigue can cause the following symptoms:

• Difficulty concentrating or feeling motivated

• Feelings of heaviness in your arms and legs

• Feelings of sadness, irritability and frustration

• Difficulty doing everyday things, such as showering

• Lack of energy

• Shortness of breath

Feeling fatigue does not necessarily mean that your cancer is getting worse or that your treatment is not working. And fatigue is not a sign of weakness or a lack of willpower or determination. It’s just another part of cancer and cancer treatment.

But fatigue can have a significant effect on your quality of life. For some, fatigue can affect the ability to work, care for a family or receive cancer treatment. Recognizing and managing fatigue can help you maintain your energy for everyday activities and ongoing treatment. You are the only person who knows how much fatigue is affecting you. It’s up to you to tell your doctor about your fatigue.

16

Once you tell your doctor that you have been feeling fatigued, your doctor may ask you when your fatigue started, whether it has become more severe and what relieves it or makes it worse. Your doctor may check for medical conditions such as anemia (low red blood cell count) and thyroid problems.

The following tips can help you manage fatigue and feel better overall.

Stay active

When you are less active, you actually tend to feel more tired. Exercise can help control feelings of fatigue and restore energy. It may also help you sleep better or regain your appetite.

• Talk to your doctor about how much activity is right for you.

• Choose an enjoyable activity within your abilities.

• Try an activity that is not too strenuous, such as walking or bicycling.

• A physical therapist may be able to help you design an exercise program.

Follow a healthy diet

Fighting cancer affects your ability to convert food into energy. The cancer is competing with the rest of your body for nutrients at a time when you may feel like eating less. It’s easy to see how poor nutrition can contribute to fatigue during cancer treatment. Although your treatment and condition may affect your appetite, it’s important to find ways to keep a balanced diet that meets your body’s needs.

• Try to balance protein, fiber and fat in each meal.

• Avoid sugary foods that may give you an initial jolt of energy but leave you tired afterward.

• Drink plenty of caffeine-free fluids.

• Talk to your doctor or a dietitian to create a diet that will help you manage fatigue.

• Ask your doctor whether you should take a multivitamin.

Prioritize your day

With some careful planning, you can work around your fatigue to accomplish everyday tasks.

• Do the most difficult or most important tasks when you have the most energy. For some, that may be first thing in the morning; for others, it might be in the afternoon.

• Look at your to-do list and eliminate anything that isn’t absolutely necessary.

• Break large tasks into smaller ones.

• Consider the option of cutting back on the number of hours you work.

17


Ask for help

Though it may feel difficult at first, it’s important to ask others for help. Don’t be embarrassed to seek assistance—your family and friends want you to be well and are often willing to help. They may be able to help you with many things, including:

• Shopping for groceries and preparing meals

• Driving you to and from doctor’s appointments

• Housework, yardwork or childcare

Manage stress

Cancer and cancer treatment are stressful. Worry and anxiety can cause mental and physical fatigue and leave you feeling wiped out. Learning how to control stress can help you feel better.

• Talk to a counselor or join a cancer support group.

• Don’t be afraid to ask your doctor questions about your treatment.

• Try to avoid situations that cause you to become stressed.

• Find ways to relax such as sitting in a park, gardening or walking in a pleasant setting.

Get enough sleep

Getting enough sleep is important in managing fatigue. Think of rest as an important part of your treatment and schedule it into your daily routine.

• Aim for at least eight hours of sleep each night.

• Take short naps (no longer than an hour).

• At bedtime, eliminate distractions such as tv to allow for more restful sleep.

• If you wake up often during the night or you have trouble falling asleep, tell your doctor or nurse so they can help you solve this problem.

Ask about medications for treating fatigue

Sometimes fatigue may be caused by conditions that do not improve through lifestyle.

• Fatigue experienced by people receiving chemotherapy may be caused by anemia, which can be a side effect of chemotherapy.

• To treat anemia, your doctor may prescribe blood transfusions or a medication that helps the body create more red blood cells.

• To help manage fatigue that is not related to anemia, your doctor may prescribe

other medications.

18

Have a flexible approach

You’ll be better able to manage fatigue if you work with your doctor and your healthcare team to find strategies that help.

• Not every approach works the same way for all people.

• You might also notice that a strategy that used to help you feel better may not work as well over time.

• Make a note of what helps and what doesn’t.

• Discuss any patterns you notice with your doctor and adjust your activities as needed.

When to call the doctor

The American Cancer Society recommends talking with your doctor as soon as possible if you experience any of the following symptoms:

• Your fatigue does not get better, keeps coming back or becomes severe.

• You are more tired than usual during or after an activity.

• You are feeling tired and it is not related to an activity.

• Your fatigue is not relieved by rest or sleep.

• You become confused or cannot concentrate.

• You can’t get out of bed for more than 24 hours.

• Your fatigue disrupts your work, social life or daily routine.

Always follow your doctor’s instructions about when to call with your concerns.

19

Finding support

Dealing with cancer and its treatment is often difficult and stressful. It can be tiring, both emotionally and physically, and it’s important to have help when you need it. By building a network of family, friends and others, you can surround yourself with people who can understand your challenges and provide you with support throughout your treatment. Family members and friends often know you best, and they can see how cancer affects your everyday life. They can help you cope with the challenges cancer brings.

Expressing emotions

It’s normal for people going through cancer treatment to feel depressed, angry, scared or helpless. Sharing your emotions with those closest to you is healthy and

can sometimes help you feel better. But know that not everyone will respond to your emotions in the same way. And not every loved one will be able to provide the kind of emotional support you need at all times. In fact, you may decide not to talk about your cancer with certain family members or friends.

Some might try to be overly cheerful. Others might respond with what you feel are negative or unhelpful comments. Keep in mind that they may also be struggling with their own emotions about your health.

Support groups and counseling

Even if your family members are very supportive, you may still want to share your concerns and express your feelings in a setting away from home. Talking with others can help improve how you feel.

Support groups

Support groups can offer camaraderie and practical advice about how to deal with the way cancer has changed your life. There are many types of support groups. Your doctor, nurse, social worker or clergy member may be able to recommend one for you.

Some support groups are led by healthcare professionals, others are led by clergy and still others are led by cancer patients and survivors. Some focus on specific types of cancer or certain age groups. It’s important to consider whether a support group is right for you.

Before joining a support group, consider the following:

• Are you comfortable discussing your emotions with others?

20

• Are you able to listen to other people’s fears and worries without becoming too overwhelmed?

• Do you prefer a structured or informal discussion?

• Would you like a family member or friend to attend with you?

• Do you want religion or faith to be a part of the discussions?

If you prefer to be more anonymous or aren’t able to attend group meetings, you might consider joining a web- or phone-based support group. Many reputable national cancer organizations host virtual support groups that can help you connect with others as much or as little as you would like.

Individual counseling and therapy

You might feel that certain issues lend themselves best to a one-on-one conversation. Talking with a counselor or therapist on your own may make it easier to share concerns that seem more personal or private. Ask your healthcare team for a referral to a counselor who is experienced in talking with cancer patients and survivors.

Oral chemotherapy is a newer, more convenient treatment option that can help slow the rate of cancer growth or help keep tumors from returning. We recognize that it can be difficult to stay on track with your cancer medication, especially when treatment regimens are complicated or side effects are bothersome. We hope that you have found this booklet helpful and we encourage you to work closely with your healthcare team to get the support you need to be successful with your medication therapy. You may also wish to visit the websites of the organizations listed on the next page.

21

To learn more

The more informed you are, the better you can manage your health. Our specialty pharmacy Care Team provides personalized, supportive and dependable care to help you achieve the best results from your prescribed therapy.

Sources

The following sources were used in the development

of this booklet.

Afinitor [package insert]. Novartis Pharmaceuticals

Corporation, East Hanover, NJ; 2011.

Anemia. American Cancer Society Web site.

www.cancer.org/Treatment/

TreatmentsandSideEffects/PhysicalSideEffects/ Anemia/index. Accessed September 9, 2011.

Cancer treatment—diarrhea and chemotherapy.

Brigham and Women’s Hospital Web site. http:// healthlibrary.brighamandwomens.org/HealthCenters/ Cancer/86,P07180. Accessed September 9, 2011.

Chemotherapy, nausea and vomiting: prevention is

best defense. Mayo Clinic Web site. www.mayoclinic. com/health/cancer/CA00030. Accessed

September 9, 2011.

Coping. American Society of Clinical Oncology Web

site. www.cancer.net/patient/Coping . Accessed

September 9, 2011.

Diarrhea. American Cancer Society Web site. www. cancer.org/Treatment/TreatmentsandSideEffects/ PhysicalSideEffects/DealingwithSymptomsatHome/ caring-for-the-patient-with-cancer-at-home-diarrhea.

Accessed July 6, 2010.

Dictionary of Cancer Terms. National Cancer

Institute Web site. www.cancer.gov/dictionary.

Accessed July 6, 2010.

Fatigue. American Cancer Society Web site. www.cancer.org/Treatment/ TreatmentsandSideEffects/PhysicalSideEffects/ Fatigue/index. Accessed September 9, 2011.

Fatigue (PDQ®). National Cancer Institute Web site. www.cancer.gov/cancertopics/pdq/supportivecare/ fatigue/Patient/page6. Accessed September 10, 2008.

Find support programs and services in your area. American Cancer Society Web site. http://www. cancer.org/Treatment/SupportProgramsServices/ index. Accessed September 9, 2011.

Gleevec [package insert].Novartis Pharmaceuticals Corporation, East Hanover NJ; 2011.

How to find resources in your own community if you have cancer. National Cancer Institute Web site. www.cancer.gov/cancertopics/factsheet/Support/ resources. Accessed September 9, 2011.

Hycamtin capsules [package insert]. GlaxoSmithKline, Research Triangle Park, NC; 2011.

The importance of taking your pills everyday on schedule. Cancer Care Inc. Web site. www.cancercare.org/publications/111-the� importance�of�taking�your�pills�everyday�on� schedule. Accessed September 9, 2011.

Managing follicular rash related to chemotherapy and monoclonal antibodies. Community Oncology Web site. www.communityoncology.net/journal/ articles/0403157.pdf. Accessed September 19, 2008.

Managing your medication supply. National Jewish Medical and Research Center Web site. www.nationaljewish.org/disease-info/treatments/ manage-meds.aspx. Accessed March 15, 2008.

Medicines: use them safely. National Institute on Aging Web site. www.nia.nih.gov/HealthInformation/ Publications/medicines. Accessed July 1, 2010.

22

www.nia.nih.gov/HealthInformationwww.nationaljewish.org/disease-info/treatmentswww.communityoncology.net/journalwww.cancercare.org/publications/111-the�www.cancer.gov/cancertopics/factsheet/Supporthttp://wwwwww.cancer.gov/cancertopics/pdq/supportivecarewww.cancer.org/Treatmentwww.cancer.gov/dictionarywww.cancer.net/patient/Copingwww.mayoclinicwww.cancer.org/Treatment

Nausea and vomiting. American Cancer

Society Web site. www.cancer.org/Treatment/ TreatmentsandSideEffects/PhysicalSideEffects/ NauseaandVomiting/NauseaandVomiting/ index?sitearea=MBC. Accessed July 6, 2010.

Nausea and vomiting (PDQ®). National Cancer

Institute Web site. www.cancer.gov/cancertopics/ pdq/supportivecare/nausea/Patient/page1.Accessed

September 10, 2008.

Nexavar [package insert]. Bayer HealthCare

Pharmaceuticals, Inc., Wayne, NJ; 2011.

Psychotherapy. American Cancer

Society Web site. www.cancer.org/ Treatment/TreatmentsandSideEffects/ ComplementaryandAlternativeMedicine/ MindBodyandSpirit/psychotherapy?sitearea=ETO. Accessed July 6, 2010.

Revlimid [package insert]. Celgene Corp.,

Summit, NJ; 2010.

Side effects of targeted therapy drugs. American

Cancer Society Web site. http://www.cancer. org/Treatment/TreatmentsandSideEffects/ TreatmentTypes/TargetedTherapy/targeted-therapy

side-effects. Accessed September 9, 2011.

Skin reactions and cancer therapy: guidelines for

identifying and managing skin-related side effects

during your therapy [patient booklet]. Bayer

Pharmaceuticals Corporation, West Haven, CT; 2006.

Sprycel [package insert]. Bristol-Myers Squibb,

Princeton, NJ; 2010.

Sutent [package insert]. Pfizer Labs, New York, NY; 2011.

Taking time: support for people with cancer. National Cancer Institute Web site. www.cancer.gov/ cancertopics/takingtime/page4. Accessed October 7, 2008.

Talking with friends and relatives about your cancer.

American Cancer Society Web site. www.cancer.org/ Treatment/UnderstandingYourDiagnosis/Talking aboutCancer/talking-with-friends-and-relatives-about

your-cancer. Accessed September 9, 2011.

Tarceva [package insert]. Genentech USA, Inc.,

South San Francisco, CA; 2010.

Targretin capsules [package insert]. Eisai Inc.,

Woodcliff Lake, NJ; 2011.

Tasigna [package insert]. Novartis Pharmaceuticals

Corporation, East Hanover, NJ; 2011.

Temodar capsules [package insert]. Schering

Corporation, Whitehouse Station, NJ; 2011.

Thalomid [package insert]. Celgene Corp.,

Summit, NJ; 2010.

Tykerb [package insert]. GlaxoSmithKline,

Research Triangle Park, NC; 2011.

Votrient [package insert]. GlaxoSmithKline,

Research Triangle Park, NC; 2010.

What to do when you feel weak or tired (fatigue).

National Cancer Institute Web site. www.cancer.gov/ cancertopics/wtk/fatigue. Accessed

September 19, 2008.

What should I look at if I decide on a support group?

American Cancer Society Web site. www.cancer.org/ Treatment/ChildrenandCancer/ HelpingChildrenWhenaFamilyMemberHasCancer/ UnderstandingPsychosocialSupportServices/ understanding-psychosocial-support-services-support

groups. Accessed September 9, 2011.

Xalkori [package insert]. Pfizer Labs, New York, NY; 2011.

Xeloda [package insert]. Genentech USA, Inc., South San Francisco, CA; 2011.

23

http:www.cancer.orghttp:www.cancer.govhttp:www.cancer.orghttp:www.cancer.govhttp://www.cancerhttp:www.cancer.orgwww.cancer.gov/cancertopicswww.cancer.org/Treatment

To learn more (continued)

Zelboraf [package insert]. Genentech USA, Inc., South San Francisco, CA; 2011.

Zytiga [package insert]. Centocor Ortho Biotech Inc., Horsham, PA; 2011.

Resources

American Cancer Society

800-227-2345 www.cancer.org

Medline Plus®

www.nlm.nih.gov/medlineplus/cancer.html

National Cancer Institute

800-422-6237 www.cancer.gov

National Comprehensive Cancer Network

www.nccn.com

OncoLink®

www.oncolink.com

24

http:www.oncolink.comhttp:www.nccn.comhttp:www.cancer.govwww.nlm.nih.gov/medlineplus/cancer.htmlhttp:www.cancer.org

Notes

25

Wa4J~ There's a way

©2011 Walgreen Co. All rights reserved. 11SP0153-1011

Structure BookmarksArtifactUnderstanding your oral medications for cancer treatment URAC ArtifactArtifactKnow your cancer medication You should know the answers to the following questions without looking at your medication. If you don’t, take a close look at your medication, including the label, until you can answer these questions without looking. The instructions that came with your medication may include photographs and descriptions of the tablets or capsules to call your attention to certain things that will help you recognize them more easily. Be sure to keep the information you received with your medicatArtifactMedication Take with food Take without food Take with or without food Notes Afinitor® (everolimus) * Avoid grapefruit productsŁ Gleevec® (imatinib) * Avoid grapefruit productsŁ Hycamtin® (topotecan) capsules * Nexavar® (sorafenib) * Revlimid® (lenalidomide) * Take with a large glass of waterŁ Sprycel® (dasatinib) * Avoid grapefruit productsŁ Sutent® (sunitinib) * Avoid grapefruit productsŁ Tarceva® (erlotinib) * Avoid grapefruit productsŁ Targretin® (bexarotene) capsules * Tell your doctor if you eat or driYour medication and food: do they go together? Choose the best answer and fill in the blanks, if needed. I should take my cancer medication ŁŁŁ Right after eating or within 30 minutes after a meal. ŁŁŁ Either ŁŁŁ hour(s) before or ŁŁŁ hour(s) after eating. ŁŁŁ With or without food, whichever is easiest for me at the time. I need to avoid grapefruit and grapefruit juice. ŁŁŁ Yes ŁŁŁ No The answers to these questions can be found in the information that came with your medication. Not sure? Call your doctoWhat to do if you miss a dose Fill in the blanks. If I miss a dose and remember it the same day, I should ŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁ. If I don’t remember a missed dose until the following day or if it is almost time for the next dose, I should ŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁ. If I can’t remember if I took my medication, I should ŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁ. If I throw up within ŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁ after I take the medication, I should ŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁŁ. The answers to these questions canArtifactTell your doctor about all of your medications Be sure to tell your doctor about all medications you are taking, including herbals, vitamins, supplements, prescription medications and over-the-counter products. All of these can interfere with your cancer medication or put you at risk for health problems. Don’t take any new medication— even once—without talking with your doctor first. Check with your doctor before starting any new medication, including herbals and all of the other items listed above. ArtifactArtifactArtifactType of medication Notes Corticosteroid creams •. These can reduce inflammation and pain. •. Prescription creams are stronger than over-the-counter products. •. Your doctor may prescribe different types or strengths of corticosteroids, depending on the severity of your rashŁ •. Apply the cream after cleaning skin gently with a mild, soap-free cleanser. Topical antibiotics such as erythromycin, clindamycin and metronidazole •. These must be used carefully as they can irritate and dry the skin. Use Q-tips® toHand-foot syndrome Oral chemotherapy drugs can cause a unique skin rash known as hand-foot syndrome (HFS) that affects the palms of the hands and the soles of the feet. If you are taking medications that your doctor thinks may cause HFS, you should take the following steps to help prevent it: •. Avoid pressure on your feet by wearing soft shoes or tennis shoes. •. Avoid standing for long periods of time. •. Check your hands and feet twice a day for early signs of HFS. Painful sensitivity of the hands and feOther antinausea tips •. Make a habit of wearing comfortable, loose-fitting clothes. •. Open a window or use a fan to get some fresh air when your stomach feels unsettled. •. Brush your teeth and rinse out your mouth after each episode of vomiting. •. If you have mouth sores (another side effect of chemotherapy) or other discomforts that affect your lips, mouth or throat, ask your healthcare team about oral hygiene. Generic name (brand name) Notes •. alprazolam (Xanax®) •. lorazepam (Ativan®) •. Used to reduce anxiety •. Often used with other antinausea medications •. Have calming and antinausea effects dexamethasone (Decadron®) Corticosteroid used alone and with other antinausea medications diphenhydramine (Benadryl®) Antihistamine that helps reduce side effects from other antinausea medications •. dolasetron (Anzemet®) •. granisetron (Kytril®) •. ondansetron (Zofran®) Similar medications; each works equally well metoArtifactArtifactArtifactArtifactArtifactArtifact

1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 1_2: 2_2: 3_2:

Understanding cancer treatment - Walgreenshave a medical question, contact your medical...

Documents

Transcript of Understanding cancer treatment - Walgreenshave a medical question, contact your medical...