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Table of Contents Basic Information • • • • • •

Chemotherapy: Basic Information Blood Counts Preventing Infections Over-the-Counter (OTC) Medicines Chemotherapy in the Hospital: What to Expect Welcome to the Ambulatory Treatment Center (ATC)

Side Effects • • • • • • • • • • •

Fatigue Energy Conservation Tips Sleep: Tips for a Good Night’s Rest Nausea: Tips to Control Diarrhea Constipation Mouth Care for Chemotherapy Patients Mouth and Throat Soreness Relief Hair, Skin and Nails: Potential Changes with Chemotherapy Chemobrain Pain, Nerves and Muscles: Potential Changes with Chemotherapy

Home Care • • • • •

Safe Handling of Chemotherapy at Home: Taking Chemotherapy by Mouth Safe Handling of Chemotherapy at Home: Taking Chemotherapy Infusions Calendar for Chemotherapy Patients ePrescription Food Safety Tips

Sexuality and Fertility • Sexuality and Chemotherapy • Fertility Preservation Options for Men and Women

Resources • • • • •

Resources at MD Anderson Cancer Center Coping and Assistance During Chemotherapy Appearance Information for Patients on Chemotherapy Pharmacy Patient Resources Outside Organizational Resources

Basic Information

Chemotherapy: Basic Information Chemotherapy (chemo) is the use of medicines to treat cancer. It kills or slows growth of the primary tumor. It also works in the body against cancer cells that have moved away (metastasized) from the primary tumor. This book addresses chemotherapy. Some of the other medicines used to treat cancer include biotherapy, targeted therapy or vaccines. Each works differently. So, the action in the body may be very different. The side effects may be different. You may have chemotherapy alone. Or chemo may be given before or after other treatments. Other treatments may include surgery or radiation. You may also receive multiple drugs. Combining drugs and therapies often improves the success of treatment. Chemotherapy can react with other substances. Talk with your oncology team before taking: • Prescription medicine • Non-prescription (over-the-counter) • Nutritional supplements • Vitamins, minerals or herbal products • Street drugs • Alcohol

How Chemotherapy Works Normal body cells grow and divide in a controlled way. Cancer cells are abnormal. They grow and divide in a rapid, uncontrolled way. Chemo attacks all rapidly growing cells in the body. The goal is to kill or stop cancer cells from growing. Chemo drugs may affect cancer cells by: • Breaking down parts of the cell • Stopping the cells from growing • Using up nutrients needed by the cancer cells • Limiting blood vessel growth to the tumor

Questions to Ask Your Doctor You should understand the expected benefits, side effects and risks of chemo before you start.

Chemotherapy: Basic Information The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0363

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Ask your doctor about your treatment plan. This list may help you get started. • What is the goal of chemotherapy for my cancer? (Such as: Will it control the growth of the tumor? Is it to increase comfort? Do we expect the tumor to shrink?) • What are the chances that the chemo will work? • How will I know if the chemo is working? • What are the short and long-term potential risks? • How long will I be given chemotherapy? How often and for how long? How will it be given? • What can I do to prepare myself for chemo and decrease my chance of side effects? • Are there any side effects I should report right away? • How will the treatment affect my diet? Activities? Work? Sexual activity? To help you remember your doctor’s answers, take notes during your appointments. Ask if you can record so you won't miss anything. Consider taking a friend or relative with you. The more you understand, the better choices you can make about your care.

Administration Chemotherapy is given in several ways. These are called routes. You may receive chemo by: • Injection − Into a muscle, under the skin, directly into the cancerous area or into a vein − Into the cerebral spinal fluid (called an intrathecal injection) • Infusion − Through a needle connected to a tube in your arm or through a central venous catheter (CVC or Port) − Into an artery through a catheter inserted directly into the area that has the tumor • Mouth: Pill, capsule or liquid form • Topical application: Creams, ointments or lotions rubbed into the skin Chemo drugs are given in cycles. Your first day of chemotherapy is Day 1 of the treatment cycle. You will receive chemotherapy for 1 or more days. Then you will stop chemo (rest) for 1 or more days. The time between your first day of chemo and your last rest day is one cycle. Some patients go into the hospital for chemotherapy. Others receive chemo in an outpatient clinic. Some patients learn how to give themselves chemo at home. They may use an infusion pump or take it by mouth. The amount of time needed for treatment is different for each person. Your doctor or pharmacist will tell you how long it will take to give your chemotherapy drug(s). Please allow extra time at the clinic. Your blood counts need to be checked before you receive chemo. If these are OK, there is a delay while the chemo is mixed. You may also need other fluids or medicines before treatment. Your treatment nurse can tell you how long your entire treatment should last. Ask your oncology team for the information sheet on your specific chemotherapy medicine.

Chemotherapy: Basic Information The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0363

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Staying on Track with Your Treatment Plan To get the best results, it is important to follow your treatment plan. Stay on schedule. Don’t miss appointments. Here are a few tips to help. • Use a cell phone or watch alarm as a reminder to take your medicine. • Write your appointments in a day planner or calendar. There is a calendar form at the end of this book. • Stay motivated by talking with your doctor about the benefit of your treatment. • Talk with your social worker if you are having problems with finances or transportation. • Track your treatment with a calendar.

Side Effects of Chemotherapy Chemo affects all rapidly growing cells in the body. This includes normal, fast-growing, healthy cells. When this happens, side effects may result. Not everyone responds the same. Areas most often affected by chemo are: • Digestive tract (mouth, esophagus, stomach and intestines) • Bone marrow (where blood cells are made) • Skin and hair • Sex organs • Nervous system (nerves in the hands and feet) Most side effects are temporary. They can often be managed with medicines and proper care. Some side effects can be permanent. Discuss any changes with your oncology team when you first begin to notice them. Many side effects you might experience are addressed in this booklet.

Resources Copies of this booklet are available in The Learning Center. Locations include: • Law Learning Center: Main Building, Floor 4, near Elevator A, Room R4.1100 713-745-8063 • Levit Learning Center: Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120 713-563-8010 Patient education classes are offered for symptom management. Please call Patient Education at 713-792-7128 for days and times. For more information visit the American Cancer Society website: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/understa ndingchemotherapyaguideforpatientsandfamilies/understanding-chemotherapy-a-guide-toc

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Blood Counts Blood carries oxygen and nutrition to the cells of the body. It carries away wastes. Special blood cells fight against infection. Other blood cells help with clotting. There are cells to repair cuts and clear bruises. When you get a blood test, each of these blood cell types is measured. Blood cells are produced mainly in the bone marrow. The marrow is the soft, spongy center part of the bone. It is like a factory that produces blood cells. Chemotherapy, some cancers and radiation can suppress the bone marrow. This may lower the number of blood cells.

Types of Blood Cells There are three main types of blood cells: red blood cells, white blood cells and platelets. Red Blood Cells Red blood cells (RBC) carry oxygen to all parts of the body. They contain hemoglobin which holds the oxygen. A person who does not have enough RBCs is anemic. An anemic person is usually pale, and may feel tired or become short of breath. Anemia may be treated by transfusion. There may be other treatments, depending on the cause. White Blood Cells White blood cells (WBC) are also called leukocytes. They include neutrophils, monocytes and lymphocytes. They protect the body against infection. If your WBC counts drop, your risk of infection rises. Here are ways you can help prevent infection: • Wash your hands often with soap and water. • Avoid people who you know are sick. • Avoid getting cuts or breaks in the skin. • Wear gloves while working in the garden or doing housework. • Bathe daily and practice good mouth care. • Take your temperature as instructed. For a temperature of 101ºF (38.3ºC) or above, or if you have a temperature of 100.5º F (38.1ºC) for more than 1 hour, go to the nearest emergency center. Your oncology team may give you other temperature guidelines. • Do not take aspirin or any other pain reliever such as ibuprofen (Advil® or Motrin®), naproxen (Naprosyn® and Aleve®) or acetaminophen (Tylenol®) unless your doctor says it is okay. These medicines can mask a fever. • Do not use suppositories, rectal thermometers or enemas. If the rectum is injured, bacteria may enter more easily.

Blood Counts The University of Texas MD Anderson Cancer Center ©1984 Revised 01/2014, Patient Education 0103

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Lymphocytes Most cancer patients have normal lymphocyte values. However, if you have too few or if they are not working properly, you may get infections more easily. When your immunity is low, you may also get infections from immunizations that contain live viruses. Follow these guidelines: • Do not receive any immunizations unless they are approved by your health care team at MD Anderson Cancer Center. • Ask if household members may receive live vaccines. • Avoid anyone exposed to measles or chicken pox. If you are exposed to anyone with these diseases, report this to your health care team immediately. • Upon request, a letter can be provided to a school or workplace to explain all precautions that should be taken to protect you. Platelets Platelets are important for blood clotting (to stop bleeding). If your platelet count is low, you may bruise and bleed more easily. You may also notice tiny red dots under your skin. When your platelet count is low: • Avoid vigorous activity, such as contact sports. • Do not use suppositories, enemas or rectal thermometers. They may cause rectal bleeding. • Blow your nose gently. • For any bleeding, apply pressure until bleeding stops (usually 5-10 minutes). If you are still bleeding in 10 minutes, apply ice and pressure and go to the emergency center. • Go to the nearest emergency center if you cough up blood or have bleeding that will not stop. • Do not take any aspirin or other pain relievers such as ibuprofen (Advil® or Motrin®) or naproxen (Naprosyn® and Aleve®) unless your doctor says it is okay. These medicines can affect the way your platelets work and may increase your risk of bleeding. • Tell your healthcare team about any dietary and herbal supplements you are taking. Some increase the risk of bleeding.

Blood Counts Your blood counts will be checked regularly during chemotherapy. Normal Values: • Hemoglobin − Adult male, 14-18 g/dl − Adult female, 12-16 g/dl •

Platelets, 140-440 k/ul

White blood cells , 4-11 k/ul − % Neutrophils, 42-66% (per 100 cells counted) − Absolute Neutrophil Count (ANC), 1.70-7.30 k/ul Image courtesy of National Institutes of Health

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Blood Counts After Chemotherapy Some types of chemotherapy decrease the bone marrow’s ability to make new blood cells. This lowers the number of cells in the blood. When blood counts are lowest, it is called nadir. Recovery depends on treatment and your general health. Infections and some medicines can delay the recovery of blood counts. Before resuming normal activities of daily living (such as returning to work, gardening, having sex), discuss the risks with your health care provider.

Blood Transfusions When blood counts are low, you may receive replacement through intravenous transfusion. You may receive whole blood with all the types of cells. Or you may receive only the cells that are low. Refer to the patient education sheet titled “Blood Transfusion” for more information. Packed Red Blood Cells For low RBCs, you may receive a packed RBC transfusion. This is one or two units of red blood cells. Each is usually given over a two to four hour period. Any symptoms during the transfusion such as chills, hives, itching or breathing problems should be reported to the nurse immediately. Platelet Transfusions Patients may need several platelet transfusions when their platelets fall. Refer to the patient education sheet titled “Platelet Transfusion” for more information.

Blood Donations Many cancer patients have a critical need for blood transfusions. All healthy people are urged to donate blood. Your family and friends can donate whole blood in your name. This earns you replacement credit. Credit is $10 for each unit donated, not to exceed the blood charges. The donor’s blood type does not need to match yours. They must know your name and medical record number to credit your account. Platelets can also be donated. Family members and friends who wish to donate platelets should not donate whole blood, since they would not be able to donate other blood products for eight weeks. There are three blood bank donation locations: • Holly Hall (off-site location), 2555 Holly Hall St. • Main Building, Floor 2, near Elevator D • Mays Clinic, Floor 2, near The Tree Sculpture Contact the MD Anderson Blood Bank at 713-792-7777 for information or questions.

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Resources For more information visit the American Cancer Society website: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/bloodproductdonationa ndtransfusion/blood-transfusion-and-donation-why-cancer-patients-may-need-transfusions http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsympt omsathome/caring-for-the-patient-with-cancer-at-home-blood-counts

Blood Counts The University of Texas MD Anderson Cancer Center Š1984 Revised 01/2014, Patient Education 0103

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Preventing Infections Preventing infection is critical to your health. It is especially important in the hospital. Many people are in close quarters and a sick body doesn’t fight infection as well. The most important way to prevent the spread of infection is through hand washing and using hand sanitizers.

Hand Washing Wet your hands and use enough soap for a good lather. Rub your hands together using friction for 15 to 30 seconds. Scrub all surfaces. Then rinse well with water. Use a paper towel to turn off the faucet to keep your hands clean.

Hand Sanitizer Alcohol-based hand sanitizer kills the germs on your hands. Use it when your hands are not visibly dirty. Apply enough to cover your hands. Rub your hands together using friction for 15 to 30 seconds until the product is dry. If your hands dry in less than 15 seconds, there was not enough sanitizer. Get more and repeat for 15 to 30 seconds.

Image courtesy of The University of Texas MD Anderson Cancer Center

When to Clean • • • • • •

When your hands are dirty Before and after contact with another patient, family member or health care worker Before eating and drinking Before and after handling food After handling dirty items After blowing your nose, sneezing and going to the restroom

Patients with Increased Infection Risk • • • •

Cancer patients who are receiving treatment Neutropenic patients (patients with a low white blood cell count) Stem cell transplant (SCT) patients Leukemia, lymphoma and myeloma patients (hematologic cancers)

Preventing Infections The University of Texas MD Anderson Cancer Center ©1999 Revised 01/2014, Patient Education

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Other Ways to Protect Against Infections • • • • •

Remind members of your health care team to complete hand hygiene. Do not touch your nose, eyes or mouth with contaminated (unwashed) fingers. Do not share personal items, such as dishes, towels, creams, toothbrushes, etc. Avoid anyone with an infectious illness. Avoid anyone with an acute respiratory illness (sneezing, coughing, sore throat). If this is not possible, you and they should wear masks until their symptoms disappear.

Extra Precautions Ask your health care team if the strategies below are recommended for you: • Wear a mask when outside your hospital room and/or outside your home. • Wear a mask in crowded public areas. • Wear a mask in construction areas. (This includes any area where parts of buildings or streets are being repaired, torn down or constructed. Large amounts of dust and debris may be present in the air.) • Ask your visitors or family members to wear a mask. (In many cases, visitors should always wear a mask while in a patient’s room and should change the mask when it becomes damp.) Avoid the following (if recommended by your health care team): • Peak hours in public areas (theaters, restaurants, indoor playgrounds, etc.) • Animal facilities (zoos, butterfly museums, pet stores) • Pet care (cleaning cat litter boxes, birdcages, dog waste, etc.)

More Information If you have questions concerning how to prevent infections, ask your health care team or call the: Infection Control and Prevention Department 713-792-3655

Preventing Infections The University of Texas MD Anderson Cancer Center ©1999 Revised 01/2014, Patient Education

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Over-the-Counter (OTC) Medicines Check with your doctor or pharmacist before taking any OTC medicines while you are on chemotherapy or targeted therapy. This includes nutritional supplements, vitamins, minerals and herbal products. If you are unsure if you should take an OTC medicine, ask your health care team.

 

Keep in contact with your family doctor during your treatment. They need to know the medicines you are taking for the cancer. Keep a list of all the medicines. Bring the list with you to all appointments. These are some OTC medicines that you may use. They can help manage side effects of chemotherapy.  

If you are experiencing… Constipation

You may consider using… Senokot® (senna), Colace® (docusate)

Diarrhea Sinus congestion

Imodium® (loperamide) Sudafed® (pseudoephedrine or phenylephrine), Afrin® nasal spray (oxymetazoline) Benadryl® (diphenhydramine), Zyrtec® (cetirizine), Claritin® (loratidine), Allegra® (fexofenadine) Robitussin® (guaifenesin), Delsym®(dextromethorphan) Baking soda rinse (1/2 teaspoon baking soda in 8 ounces of water) Simply Saline® Nasal Mist, Ocean® Nasal Spray (saline nasal spray) Pepcid® (famotidine), Zantac® (ranitidine), GasX® (simethicone) Hydrocortisone cream 1%, Benadryl® tablets or liquid (diphenhydramine)

Sinus allergies or itching

Cough Prevention and treatment of mouth sores Nasal congestion or dryness Indigestion/stomach gas Rash

  Medicines are listed by brand name (generic name in parentheses). You may use either the brand or generic version.

 

Follow package directions unless advised otherwise by your doctor.    

Over the Counter (OTC) Medicines The University of Texas MD Anderson Cancer Center ©1997 Revised 01/2014, Patient Education 0572

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Read Labels Some ingredients in OTCs may lower your temperature. Some examples are aspirin or Tylenol. Your health care team needs to know if you have a fever. Some ingredients may affect your blood platelets. Examples are aspirin and ibuprofen, among others. Read the labels of OTC products. Look for the following ingredients: • Salicylates: - Aspirin or aspirin-like compounds - Acetylsalicylic acid, ASA - Bismuth subsalicylate, salicylamide - Methyl salicylate, sodium salicylate - Potassium salicylate, magnesium salicylate, etc. • Ibuprofen: IB, IBU, ibuprofen • Naproxen: naproxen sodium • Ketoprofen • Acetaminophen: APAP, acetaminophen, paracetamol

Do not take OTCs to relieve pain or lower temperature unless your health care team says it is OK to do so.

Resource Visit the American Cancer Society website: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/understa ndingchemotherapyaguideforpatientsandfamilies/understanding-chemotherapy-taking-othermeds

Over the Counter (OTC) Medicines The University of Texas MD Anderson Cancer Center ©1997 Revised 01/2014, Patient Education 0572

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Chemotherapy in the Hospital: What to Expect Before You Come to the Hospital Before you are admitted, you may get a central venous catheter (CVC or port). A doctor inserts the catheter into your arm or under the collarbone. It stays in place for the length of your treatment. We will teach you and your caregiver how to care for the catheter. Depending on the type of catheter, class attendance may be required. Ask your provider for a schedule of class days, times and locations.

While You Are in the Hospital You may have additional diagnostic tests. If so, part of your treatment plan may be determined while you are in the hospital. Health Care Team Many people care for you. This team may include a: • Doctor in charge of your inpatient stay • Fellow (a doctor who is at MD Anderson to learn more about cancer care) • Pharmacist • Nurse practitioner or physician assistant • Nurse • Certified nursing assistant • Dietitian • Social worker and/or case manager The doctors take turns caring for patients who are staying in the hospital. Therefore, your clinic doctor may or may not manage your care when you are in the hospital. Your clinic doctor is still in charge of your overall treatment plan. The doctors communicate with each other about your treatment plan. The inpatient doctor treats your day-to-day needs.

Chemotherapy in the Hospital: What to Expect The University of Texas MD Anderson Cancer Center ©2009 Revised 01/2014, Patient Education 4076

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Comfort Some patients have side effects from chemotherapy. To prepare for this, your doctor has ordered medicines to help you feel better. Not all patients have side effects. Please tell your nurse if you have any problems. Let us know if you have: • Constipation • Diarrhea • Nausea (upset stomach) or vomiting • Problems sleeping • Pain • Mouth sores • Heartburn • Fever or chills Daily Routine During your hospital stay, we will take your vital signs often. Vital signs are pulse, breathing rate, temperature and blood pressure. In the morning, a nursing assistant may weigh you. A lab technician may draw blood. Throughout the day and night, nurses will check on you and give you medicines. You may need blood transfusions. We may give you medicine through a vein, by mouth or by injection. We want to give you the best care possible. Your inpatient doctor may ask other specialists to meet with you. For example, he or she may ask a dietitian to talk to you about what you are eating. The health care team usually sees all inpatients during the day. We encourage you to write down all of your questions for the doctor.

Discharge from the Hospital To get ready to leave the hospital, you will meet with members of the health care team. Some things your team may do: • Ask if you have completed the CVC classes, if needed. • Discuss when you may resume your normal daily activities. • Review your outpatient appointments. • Provide written schedule of appointments and instructions for follow-up. • Talk with you about the medicines or supplies that you will need at home. • Provide new prescriptions or orders, if needed.

Other Information after Discharge If you live out-of-town, contact your local doctor with urgent problems. He or she may call your MD Anderson doctor as needed. Chemotherapy in the Hospital: What to Expect The University of Texas MD Anderson Cancer Center ©2009 Revised 01/2014, Patient Education 4076

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Go to the nearest emergency center if you have any of these signs or symptoms: • Temperature of 101°F (38.3°C) or higher, chills or sweating (If you have any of these symptoms, talk to your team before taking any drugs to lower the fever. Do not wait for your temperature to increase.) • Shortness of breath • Chest pain • Severe abdominal pain • Severe nausea, vomiting or if you cannot keep food, water or medicine in your stomach • Seizures • Pain not relieved by medicine, or pain that gets worse over time • Change in level of awareness or alertness You may be told to avoid large crowds and people who are sick. Remember to wash your hands frequently, especially after: • Using the bathroom • Before preparing food • Before eating

Chemotherapy in the Hospital: What to Expect The University of Texas MD Anderson Cancer Center ©2009 Revised 01/2014, Patient Education 4076

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Welcome to the Ambulatory Treatment Center (ATC) Here’s what you can expect during your treatment in the Ambulatory Treatment Center (ATC).

Overview The Ambulatory Treatment Center in the Main Building has 157 beds. ATC administers Intravenous infusion (IV) therapy for outpatients. The ATC provides treatment to adult patients 18 years and older. ATC services include: • Infusion of: − Standard and investigational chemotherapy − Antibiotics, anti-fungal and anti-viral drugs − Fluids and electrolyte replacements − Immunoglobulin • Transfusion of blood products • Injections - chemotherapy or non-chemotherapy • Ambulatory infusion pump connections and disconnections

What is chemotherapy? Chemotherapy is the use of drugs to treat cancer. It works throughout the body to destroy cancer cells. It also fights cells that have metastasized (spread) to lymph nodes and parts of the body far away from the primary (original) tumor. Chemotherapy can be combined with other treatments such as surgery or radiation. This increases chances that all cancer cells have will be killed. How will I receive chemotherapy in ATC? In the ATC, chemotherapy is given through the vein or by injection. By Vein Intravenous (IV) is the most common route for chemotherapy in the ATC. There are two types of IV lines: 1. Peripheral Intravenous (PIV) line: A small tube is put into a vein of the arm. Tubing connects to bags containing the chemotherapy drugs. The tube is removed at the end of each treatment. 2. Central Venous Catheter (CVC) line: If the patient will receive several chemotherapy Welcome to the Ambulatory Treatment Center (ATC) The University of Texas MD Anderson Cancer Center ©2014 Patient Education 2369

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cycles, the physician may request that a CVC be placed. It is usually put in a major vein in the chest wall or arm. The CVC stays in place for several months or until treatment is completed. There are three different types of CVC. 1. CVC line in the chest: A catheter is put into one of the major veins through the chest wall. It may stay there for many months. Tubing is attached when chemotherapy is needed. 2. Port-a-Cath: A metal or plastic disc known as a "port" is implanted under the skin. When needed, it is accessed with a special “Huber needle.” Then it is connected to tubing for infusion. The needle and outside tubes are removed at the end of the infusion. The port stays inside under the skin. 3. Peripherally Inserted Central Venous Catheter (PICC) line. A special tube is put in the bend of your arm and threaded up to the major vein near your heart. The tube end is covered with a dressing when not used. When needed, chemotherapy is attached. By Injection Injections are named based on where they are given. • Intramuscular (IM): The drug is injected into a muscle. • Subcutaneous (SC): The drug is injected under the skin. Other possible routes: • Intraperitoneal (IP): The drug is injected into the space surrounding the abdomen. • Intrathecal: The drug is injected into the cerebral spinal space. Make sure your lab is done prior to treatment. If platelets are too low, you may receive platelets first. Then, the intrathecal injection. This may require extra time for your treatment.

The ATC Set-Up • •

There are two Ambulatory Treatment Center locations: one in the Main Building and one in the Mays Clinic. ATC in the Main Building is located on Floor 2 between Elevators B and C. The Main Building ATC has 2 units: the ATC Main and the Transfusion Unit. ATC Main is open 7 a.m. - 11 p.m., 7 days a week. In Mays Clinic, the ATC is on Floor 8 by Elevator T. Mays Clinic ATC has 4 units: Blue, Green, Purple and Tan. They are open 7 a.m. – 9:30 p.m., Monday – Friday, and closed on weekends. The units have both private and semi-private rooms. Each room has a telephone (for local calls only), television, bed and visitor’s chair. Only one caregiver can be with the patient inside the treatment room. You will be given a free lunch or dinner and snacks during your chemo treatment. Your caregiver may order from the menu, but will have to pay. You are encouraged to bring snacks and drinks for easy access. Your nurse will instruct you on what you may or may not eat or drink while receiving your treatment. Please bring all your current medications, especially your pain, blood pressure and diabetic medications. Your home clinic should have instructed you on what medications to hold or take while receiving your chemotherapy. Your medication list will be checked on each visit

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to keep your care team up-to-date on any medication changes. Also, bring any equipment or home supplies you may need on your visit. Examples include change of clothing, ostomy supplies, portable oxygen and/or tube-feeding supplies. The Check-in Process • When you arrive in the ATC, you will be greeted by one of our Patient Service Coordinators (PSC). You will fill out a short form with your name, medical record number, local contact information, etc. • You will be given an ID wristband and a pager. The PSC will tell you if you need to go to the lab for blood tests or wait in the waiting area. • To prevent delays, please have your blood work done 1.5 hours before coming to your chemotherapy appointment. This may not be what is printed on your schedule. • The PSC creates a chart and checks orders. The chart is reviewed by a nurse to make sure it is complete. Laboratory results are checked to be sure you can receive your chemotherapy. • Unfortunately there are sometimes delays in appointments. Some of the reasons may include: waiting for laboratory results, unsigned treatment orders, missed lab draws or financial block. If this happens, your nurse will take care of the issue and guide you. The nurse will inform you of the reason(s) and keep you updated. • Please come only for a scheduled appointment. Coming in at unscheduled times causes delays for others. • Once the nurses determine you are chemo “ready,” they assign you a room. You will be paged and taken to the vital signs room. Blood pressure, pulse, respirations, temperature and weight are recorded. You will then be given a warm blanket and shown to your room. • It is a good idea to wear loose-fitting clothing for comfort. Bring extra layers. What to Expect During Treatment • You will be told about your medications: side effects, adverse drug reaction and food/drug interactions. • The treatment procedure and length of treatment will be explained. • You will be oriented to the unit: location of restrooms, ice machines, call button, bed controls, medical equipment (Alaris Pump) and how to unplug the Alaris cord when using the restroom. Please use call button to reach the nurse when you need help or when your pump is beeping. • An IV will be started. If it’s difficult for the nurse to get your peripheral IV access, you will be sent to the Infusion Therapy Team (ITT) after registering at the front desk. They are experts with difficult IV starts. • Complementary meal service is available (noon-2 p.m. and 5-7 p.m.). • The patient must stay in the unit while receiving treatment. This allows nurses to watch you closely, quickly see any problems and manage them for your safety. • “First time transfusion” may require longer wait time. Extra labs may be needed for type and cross match and presence of antibodies in the blood. • You will be told about reactions that may occur for specific chemotherapy agents. Some reactions/side effects may happen after you go home. • Please bring any “as needed” (PRN) medications with you. For instance pain, nausea, blood

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• •

• • • • • • •

pressure meds and insulin. You can bring your glucometer if you are diabetic. If you will have a lumbar puncture, you need to stay for one hour and lie flat on your back. If this is the first time your central line is being used at MD Anderson, you will go to ITT in the Main Building, Floor 8, near Elevator C or in the Mays Clinic, Floor 8, near Elevator T. After that first check, ATC nurses can access your port. For your safety, if no recent chest X-ray is on file, they will order a chest X-ray to confirm proper placement. If you are not sure, ask the front desk and they can confirm if your line needs to be reviewed by ITT. Please report any pain or redness at the IV site. Language assistance is available for all non-English-speaking patients. You may eat, drink and move around during treatment. Your nurse will inform you of any restrictions. If your infusion cannot complete before the clinic closes, we can reschedule. Request a copy of your next appointment before leaving the treatment center. There are ways to minimize side effects of treatment. That and more is found in your “Guide to Managing Chemotherapy Side Effects” book. Please call your clinic and speak with your clinic nurse for questions and problems (not the ATC). You can call the ATC for questions related to your ambulatory infusion pump if you are getting chemotherapy at home.

ATC Discharge Checklist • •

• • •

Request a copy of your next appointment before leaving the treatment center. If applicable, be sure you receive infusion pump instructions on: − Self-disconnect information − Chemotherapy spill kit and educational handouts − Infusion pump troubleshooting handouts − ATC contact numbers − The ambulatory infusion pump video to watch before you go home − For all patients wishing to disconnect pumps at home: 2 separate classes are required by the infusion therapy team. You or your caregiver may wish to attend these classes. Ask your nurse about the schedule. Self-care education (neutropenia, bleeding, nausea/vomiting, fatigue) Identify nearest emergency center if MD Anderson is not closest to home. Verify with clinic if labs are needed prior to next visit. If labs are needed, please make sure they are scheduled before next appointment.

Resources For information about chemotherapy, ask to see video #250. Ask your nurse for the helpful book “Chemotherapy Guide.”

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Notes The University of Texas MD Anderson Cancer Center Š2008 Reviewed 09/2014, Patient Education 2157

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Notes The University of Texas MD Anderson Cancer Center Š2008 Reviewed 09/2014, Patient Education 2157

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Side Effects

Fatigue Fatigue means feeling tired physically or mentally. Cancer or cancer treatments can cause fatigue. Cancer-related fatigue can be overwhelming. Your caregiver can also become fatigued.

Causes Fatigue may have many causes:  The cancer itself  The treatment  Persistent pain  Untreated symptoms or side effects from anemia or medications  Other medical conditions: such as hypothyroidism or heart problems  Stress from other factors: family problems, divorce or work  Depression that lasts for more than two weeks  Inadequate rest  Poor diet  Insufficient fluids  Lack of exercise  Lack of support from family and friends

Symptoms Some of the signs of fatigue are:  A weak feeling over the entire body  Difficulty concentrating  Waking up tired after sleep  Lack of energy or decreased energy  Lack of motivation to be physically active  Increased irritability, nervousness, anxiety or impatience  No relief from fatigue, even with rest or sleep

Prevention Here are some things that may help manage feelings of fatigue:  Prioritize your activities. Complete the most important tasks when you have the most energy.

Fatigue The University of Texas MD Anderson Cancer Center ©2009 Revised 01/2014, Patient Education 0096

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        

Delegate activities when you can. Place things that you use often within easy reach to save energy. Treat any medical problems that may contribute to fatigue. Drink enough fluid. Eat a balanced diet. Include plenty of protein: fish, lean meat/poultry, low-fat dairy, eggs/egg whites and legumes. Exercise. Take short walks or other physical activity. Before you start any exercise program, discuss it with your health care team. Manage stress: exercise, relaxation, visual imagery, meditation, talking with others and counseling. Balance rest and activities.

Report to Your Doctor Apply the above tips first. Talk with your doctor if:  Fatigue does not get better, keeps coming back or becomes severe. Signs of severe fatigue include spending all day in bed and inability to do daily activities.  You are much more tired than you should be after an activity. Or if feeling tired has nothing to do with any activity.  Fatigue cannot be relieved by rest or sleep. Fatigue disrupts your social life or daily routine. Depending on the cause of your fatigue, there may be prescription medications to help reduce it. Your doctor may refer you to the Fatigue Clinic.

Resources Ask for “Energy Conservation” and “Sleep: Tips for a Good Night’s Rest.” Or, request “A Patient Guide for Managing Cancer-Related Fatigue.” Watch the video “Cancer-related Fatigue”. You can see it at The Learning Center or view on myMDAnderson (https://my.mdanderson.org) under Videos. A Cancer-related Fatigue Class meets every first and third Thursday of the month, from noon-1 p.m. Call Patient Education at 713-792-7128. The Fatigue Clinic phone number is 713-563-7100.

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Energy Conservation Tips Conserving energy during regular daily activity helps decrease fatigue. How you stand, walk and move your body, as well as the spacing of your work area, can affect your energy use. The following information provides helpful tips for conserving energy. Saving energy may decrease your level of fatigue.

Planning and Organizing Alternate tasks that take lots of energy with those that take less. Plan activities daily as well as weekly to better alternate tasks. Delegate as much as possible. This helps you get tasks done. It also allows others, who want to help, to feel useful. Eliminate steps or tasks that are not essential by combining chores or errands. Arrange your household so that most activities can be done on one level of the house. Organize ahead of time so you don’t have to rush.

Pacing Balance activities so you are doing, resting, doing, resting. Stop to rest before you get tired, even if it means stopping in the middle of a task. Do not rush to do everything in one day. Overdoing it on one day may make you so tired that you need more than one day to recover. Try to avoid spurts of activity; this can drain energy. Pace activities on good days as well as bad days. Develop a routine to prevent overdoing.

Positioning Sit to do activities whenever possible. Use assistive devices to help you maintain good posture while walking or moving about. Examples of assistance devices are walkers, scooters, canes, handrails, crutches and grab bars. This equipment can save energy by allowing you to do things without having to bend or reach. Avoid heavy lifting such as children, groceries and laundry. Use carts or wagons to move things from room to room or place to place. Wear a fanny pack, carpenter’s belt, a jacket or sweater with pockets to carry things.

Prioritizing Focus on things you enjoy doing. Be realistic with yourself about how much you can do. For example, make a list of all your activities for the day, then number them according to priority. Perform activities with the highest priority first. Energy Conservation Tips The University of Texas MD Anderson Cancer Center ©1997 Revised 01/2014, Patient Education 0094

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When You’re Too Tired to Eat When the thought of cooking or eating a meal makes you tired, try these hints: Let others help prepare or bring food. Family or friends usually like to help! Use canned, frozen, or other prepared foods or order out. On days when you feel well, cook extra food. Freeze it in small containers. Heat this food on days when you are tired. Ask about community resources that deliver prepared meals. • Eat small, frequent meals rather than several large meals each day. Have snack foods readily on hand. Keep favorite foods and beverages in a cooler near you so you can eat while resting. Make quick meals with a microwave or blender.

Activities to Preserve Energy Basic Activities • Dressing - Loose-fitting clothes are easier to get on and off. - Bring your foot to your knee to put on socks and shoes so you won’t have to lean over. - Wear slip-on shoes or shoes that have Velcro or elastic shoelaces. - Use a long-handled shoe horn or sock aid. - For women, fasten bra in front and turn it to back. - Wear clothes that button in front rather than pullovers or clothes with back buttons. - Use a reacher or dressing stick to help with zippers in back. - Place chairs throughout home to allow rest stops. • Bathing and Grooming - Wash your hair in a shower rather than over a sink. - Use a terrycloth robe instead of towels to dry off. - Use organizers to keep items within reach. - Use a chair in the shower or tub. - Use a long-handled sponge or brush to reach your back and feet. - Rest your elbows on a computer or dressing table to avoid leaning unsupported. - Use long-handled brushes or combs to avoid holding arms overhead. - Use liquid soap or soap on a rope. - Use an elevated toilet seat. • Miscellaneous - Install and use ramps. - Use a lift chair. - Use cruise control when driving.

  Energy Conservation Tips

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Advanced Activities • Housework - Spread tasks out over the week or month. - Hire help. - Use long-handled dusters, mops and dustpans. - Use an automatic washer and dryer, if possible. - Use a lightweight iron. • Shopping - Make a list. - Organize list by store aisle. - Request store assistance. - Have groceries delivered, if possible. - Shop at less busy times. • Meal Preparation - Assemble all ingredients before starting. - Use mixes or pre-packaged foods. - Use cookware you can serve from. - Use small, lightweight appliances. - Use labor-saving devices. - Buy utensils that fit comfortably in the hand. - Store frequently used items at chest level to minimize bending or reaching. - Line ovens and drip pans with foil for easier cleanup. - Let dishes soak rather than scrubbing them. - Let dishes air-dry. • Childcare - Plan activities or outings at a place that will allow sitting or lying down. - Take advantage of day care programs. - Teach children to make a game of household chores. • Work - Plan your work around your best times of the day. - Organize work centers so equipment is within easy reach. - Create shortcuts. - Take rest breaks. - Work partial days, if possible. • Leisure - Plan activities that allow you to sit or lie down. - Plan social events at your peak energy time.

Resources Read the American Cancer Society’s booklet: http://www.cancer.org/acs/groups/cid/documents/webcontent/002842-pdf.pdf

  Energy Conservation Tips

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Sleep  

 

   

   

   

   

Tips for a Good Night’s Rest To help you sleep during the night, you may want to do the following:

During the Day Exercise regularly. Even a 20-minute walk during the day can help you relax. Don’t exercise in the evening. Limit naps if you can. If you must sleep, limit your nap to 30 minutes.

Before Bedtime Avoid alcohol, caffeine, chocolate and nicotine in the late afternoon and evening. Limit liquids in the evening before going to bed. Turn off the TV one hour before bedtime; listen to quiet music or take a warm bath. If you worry or “can’t turn your brain off” when you try to sleep, make a list of things you need to do the next day. That will allow you to not worry about forgetting anything and you will be able to relax.

At Bedtime Go to bed and get up at the same time every day, even on weekends. A bedtime snack of warm milk, turkey or a banana may make you sleepy. Use your bedroom for sleep and intimacy only. Don't read, watch TV or work in the bedroom. If you are a “clock watcher,” turn the clock around. To fall asleep, lie in the position that you normally find yourself in when you wake up. Your partner should go to bed at the same time.  

If You Can’t Fall Asleep or Wake Up During the Night If you haven’t fallen asleep in 15 minutes, go to another room. Listen to quiet music. Avoid things that provide mental stimulation (TV, exciting books). Go back to bed when you feel sleepy. If you still can’t fall asleep, get up again and repeat these steps as necessary. Sleep: Tips for a Good Night’s Rest The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0095

 

Nausea Tips to Control Some chemotherapy (chemo) medicines cause nausea and/or vomiting. This usually happens within 24 hours of receiving chemo. You may have nausea for a few days after chemo is completed. This is referred to as “delayed” nausea. After repeated chemo, some people worry that they will have nausea. So they begin to feel it even before the treatment starts. This is called anticipatory nausea. Not all chemotherapy causes nausea and vomiting. When these discomforts are felt there are medicines and methods to ease the feelings. If you have nausea and vomiting and are having a difficult time eating, ask for a consult with a dietitian.

Antiemetics Antiemetics are medicines that help control nausea and vomiting. They are most effective if given before chemo. Antiemetics may be given by mouth, in the vein or by other routes. You may be given an antiemetic to use at home. You may be told to take this medicine around the clock. Or, you may take it as needed. Some patients are asked to take their antiemetic at home before coming in for chemo. You may need to try more than one antiemetic before you get relief. Do not give up. Tell your health care team if your nausea is not controlled. It is not unusual to take two or more different medicines to prevent or relieve nausea and vomiting.

Prevention • • • • • • •

Take your nausea medicine as directed. Don’t wait until nausea is a problem before taking medicines. Avoid an empty stomach. Avoid strong smells and unpleasant odors. Drink enough liquids so that your urine is light colored. Practice good mouth care. Wear loose-fitted clothing. Sit or recline with your head elevated for at least 30-60 minutes after eating.

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Treatment • • • • • • • • • • •

Take antiemetic(s) as directed. Apply a cool wet rag to your forehead or neck. Eat dry foods (such as crackers, toast, etc.) when you awaken, before moving around. Move slowly. Open a window or use a fan to feel fresh air movement. Sip room temperature carbonated drinks such as cola or ginger ale. Don’t force yourself to eat. Drink enough liquids so that your urine is light colored. Pay attention to which foods trigger and/or soothe nausea. Use distraction: focus on music, puzzles, games, TV, reading, etc. Learn relaxation techniques.

Resources From the National Comprehensive Cancer Network: http://www.nccn.org/patients/resources/life_with_cancer/managing_symptoms/preventing_nause a.aspx

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Diarrhea Diarrhea (also called liquid stool) is a symptom that can be caused by many things. It is important to treat the cause of diarrhea. This handout explains some of the causes of diarrhea. It also shares self-care and treatment options.

Causes and Treatment Radiation Radiation treatment to the abdomen affects the lining of your colon. This may cause diarrhea. Treat with loperamide (brand name Imodium®, available without a prescription). You can also get Lomotil® by prescription. These medicines slow the movement of stool through the intestine. Surgery Surgery that removes part of the intestine may result in frequent stools. Often these stools are soft and formed, not liquid. To help slow down stools, take Imodium or Lomotil at the time your doctor or nurse suggests. Taking medicinal fiber, such as psyllium (Metamucil®) or methylcellulose (Citrucel®) with 2 ounces of water slows the movement in the gastrointestinal (GI) tract. The fiber absorbs excess fluid like a sponge. Hold liquids for 1 hour after taking medicinal fiber. When you take the right amount of psyllium, other medicines may not be needed. As you increase the dose of psyllium, decrease the dose of Imodium or Lomotil. Spicy foods, deep fried foods and hot liquids can cause frequent stooling after surgery. The BRAT diet is helpful in slowing movement in the GI tract. The BRAT diet includes: bananas, white rice, applesauce and dry toast. Chemotherapy (Chemo) Certain types of chemo drugs cause diarrhea. Ask your doctor how to control diarrhea. You may be told to take Imodium. Do not take Imodium if you are being checked for C-difficile or other bacteria. When taking Imodium, do not take more than 8 tablets (16 milligrams) per day. Read the label on the package. Do not take over-the-counter medicine for diarrhea unless your health care team says it is OK. If you took fiber before you started chemo, this may not be needed during chemo. Ask your health care team.

Diarrhea The University of Texas MD Anderson Cancer Center ©1996 Revised 01/2014, Patient Education 0037

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Medicines Some medicines can cause diarrhea. Ask your doctor, nurse or pharmacist before taking these. • Antacids that are magnesium based • Laxatives • Aldomet (methyldopa) • Non-steroidal drugs • Theophylline • Reglan (metoclopramide) • Cytotec (misoprostol) • Medicines with artificial sweeteners (sorbitol or xylitol) Food Allergies Eating foods that you are allergic to can cause diarrhea. You should stop eating any foods that cause diarrhea. Discuss your food allergies with your health care team. ®

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Lactose Intolerance You may have diarrhea if your body cannot digest milk. Some people do not have the needed enzyme to break down milk. Milk products include yogurt, cheese, cottage cheese and ice cream. If you get gas or bloating from milk or milk products, you can take the enzyme. Take Lactaid® when eating or drinking milk or milk products. Or, you can stop eating or drinking milk products. Infections and Parasites Certain types of bacteria and parasites can cause diarrhea. Your doctor may request a stool specimen to know which medicine will work. Antibiotic Therapy Antibiotics (medicines to treat an infection) may cause diarrhea by destroying the bacteria that normally live in the intestine. If you have diarrhea when you take antibiotics, try these tips: • Eat two servings of yogurt that contain acidophilus or live cultures daily. Avoid yogurt that can cause your gastrointestinal (GI) tract to become more active (such as those containing bifidus regularis). • Drink buttermilk. • Take acidophilus or lactobacillus in pill form if approved by your health care team. You can get it in pharmacies or health food stores. Ask about over-the-counter products that can help with diarrhea that is caused by antibiotics. Impaction An impaction is the collection of a large amount of body waste (called stool) in the colon. A severe impaction can cause diarrhea. Diarrhea occurs when liquid stool seeps around the blockage. Do not take anti-diarrhea medicine because the impaction will get worse. Other Causes • Alcohol, caffeine and enteral nutrition supplements • Gastroenteritis - inflammation of the stomach • Diverticulitis - inflammation of areas in the intestine • Irritable bowel syndrome • Adding medicinal fiber too fast to your diet may increase diarrhea, cramping and bloating. Read the handout “Medicinal Bulk-Forming Fiber” for more information. Diarrhea The University of Texas MD Anderson Cancer Center ©1996 Revised 01/2014, Patient Education 0037

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Unknown Causes If you have diarrhea and don’t know the cause, talk to your health care team. Your treatment will vary depending on the cause of the problem.

Nutrition and Diarrhea Regardless of the cause of diarrhea, follow these tips: • Drink 8 -12 glasses (8-ounces each) of fluids every day. Diarrhea can make you dehydrated if you don’t drink enough. If your urine is dark, you are not drinking enough. • Sodium and potassium are lost when you have diarrhea. Eat salted crackers, pretzels or broth to replace sodium. Include high potassium foods such as orange juice, potatoes (no skin) and bananas as tolerated. Low carbohydrate electrolyte drinks also help replace electrolytes. Some examples include half strength Gatorade® or Powerade® (equal parts of drink and water), Pedialyte® and CeraLyte-70®. • Eat small frequent meals. • Limit high-fiber foods. Examples are peas and beans, seeds, whole grains and high-fiber fruits and vegetables or those with thick peels/skins. • Limit high-fat foods. Examples are fried foods, rich desserts (pies, cakes and cookies) and excessive amounts of butter, oil and cream. • Hot fluid (including soups) may make diarrhea worse. Allow hot fluids to cool to room temperature before eating. • Avoid alcohol, caffeine and spicy foods which cause food to move more quickly though the intestines. • For some people, milk and other dairy products make diarrhea worse. You may need to limit or avoid these foods until the diarrhea stops. Cultured milk products such as yogurt, buttermilk and hard cheeses may be better tolerated. Lactose free milk or the use of lactase enzyme supplements (Lactaid®) may be used instead of limiting milk and other dairy products. • Limit use of sugar-free gums and candies that contain sorbitol or xylitol.

Self-Care • • • • •

Keep track of the amount and frequency of bowel movements. Clean the anal area with mild soap after each bowel movement. Rinse well with warm water. Pat the skin dry. Or, use baby wipes to clean after each bowel movement. Apply a water-repellent ointment, such as A&D Ointment® or petroleum jelly to the anal area. Sit in a tub of warm water or a sitz bath to reduce anal discomfort. Protect the bed and chairs. Use pads with plastic backing under the buttocks where the patient will lie down or sit.

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Report to your Doctor • • • • • • • •

If 6 or more loose bowel movements a day with no improvement in 2 days Blood in or around anal area or in stool 5 pounds or more weight loss after the diarrhea starts New belly pain or cramps for 2 days or more No urine for 12 hours or more Unable to drink liquids for 24 hours or more Puffy or swollen belly Constipation for several days followed by diarrhea, which could suggest an impaction (severe constipation)

Resources You may benefit from a visit with a dietitian. Ask for a referral. Visit the American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsympt omsathome/caring-for-the-patient-with-cancer-at-home-diarrhea

Diarrhea The University of Texas MD Anderson Cancer Center ©1996 Revised 01/2014, Patient Education 0037

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Constipation Constipation is the infrequent or difficult passing of hard dry stool. It may cause pain and discomfort. This handout explains some of the causes of constipation. It also shares self-care and treatment options.

Causes Pain Medicine Many of the medicines used for pain control slow the gastrointestinal (GI) tract. This may cause constipation. Ask your doctor, nurse or pharmacist if your medicine puts you at risk. It is important to control pain, so take pain medicines as needed. When pain is controlled, you move better, breathe more deeply and rest better. However, you may want to begin stool softeners or laxatives to prevent constipation. Stool softeners hold water in the stool to keep it soft. Laxatives stimulate movement through the GI tract. A medicine that has both a laxative and a softener is Senokot-S®. You do not need a prescription for this. It is available in most grocery and drug stores. You can safely take up to 8 Senokot-S pills per day. Start with 2 doses per day or as directed by your doctor or nurse. Gradually increase the dosage until you have soft-formed stools on a regular basis. However, do not take more than 500 milligrams of docusate sodium (stool softener) per day. ®

Decreased Activity Many people feel tired and do not move around as much during chemotherapy (chemo) treatment. This slows down the GI tract. Be as active as you can. Poor Oral Intake If chemo causes nausea or vomiting you may not be able to eat and drink as much as normal. This can cause constipation. Ask your nurse for tips to manage nausea and vomiting.

Nutrition and Constipation Regardless of the cause of constipation, these tips may help: • Drink 8 to 12 glasses (8-ounces each) of fluids every day. Getting enough liquid helps keep stools soft. If your urine is dark, you are not drinking enough. • Eat small frequent meals. • Eat high-fiber foods. Examples are peas and beans, seeds, whole grains, and high-fiber fruits and vegetables or those with thick peels/skins.

Constipation The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0041

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• •

Drink warm or hot fluid (including soups). This stimulates the GI tract. Add fiber to your diet every day unless you have been told to limit fiber. Examples of high fiber-foods are: − High-fiber cereals − Fresh vegetables − Fresh fruits with skins, especially prunes − Whole grains − Legumes (beans) – very high in fiber Read labels for grams of fiber, especially non-soluble fiber. Non-soluble fiber helps keep bowel movements (BMs) soft. Adult Fiber Needs

Limit your intake of foods that cause you gas or bloating. This may help your comfort. Examples are fizzy drinks and cabbage.

Self-Care • •

• • • • •

Keep track of your bowel movements (BMs). Do not wait to take action about constipation. Fiber supplements: It may be difficult to meet daily fiber needs with food alone. For instance, 1 apple with skin has 4 grams of fiber, bran flakes have 5 grams. Ask about fiber supplements, if you cannot eat enough fiber. Adding medicinal fiber too fast to your diet may cause cramping and bloating. To prevent this, gradually add fiber in 1 teaspoon increments every 5 days. Walk as much as you can. The movement of walking stimulates the GI tract. Do not ignore the urge to have a BM. Holding stool results in harder and larger stool that is more difficult to pass. Find out which foods make your constipation worse. Some people find cheese constipating for instance. Avoid those foods. If you have fewer than 3 BMs per week, drink 4 ounces of prune juice at room temperature. Immediately drink a hot liquid. If you do not have a bowel movement by bedtime, take 2 tablespoons or 2 caplets of milk of magnesia with 8 ounces of water. If you do not have a BM after breakfast the next day, repeat the dose of milk of magnesia. If you have kidney problems, ask your doctor before you take milk of magnesia. Do not use enemas and suppositories if your platelet or white blood cell counts are low or if you are taking blood thinners.

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Report to Your Doctor • • • •

If you go 3 days without a BM. If you had constipation for several days followed by diarrhea. This might indicate an impaction (severe constipation) which needs attention. If there is blood in the stool. If you have cramps or vomiting that does not stop.

Resources You may benefit from a visit with a dietitian. Ask for a referral. Ask for the handouts “Nausea: Tips to Control,” “Nausea and Vomiting: Tips for Coping,” “High Fiber Diet” and “Medicinal Bulk-Forming Fiber.” Visit the American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsympt omsathome/caring-for-the-patient-with-cancer-at-home-constipation

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Mouth Care for Chemotherapy Patients Chemotherapy (chemo) treatment may affect your mouth. Please use the information here to help manage mouth care.

Possible Problems • • • • • • • • •

Sores in the mouth or throat (ulcers) Infected sores Painful mouth and/or gums Burning, peeling or swelling of the tongue Changes in consistency of saliva Dry mouth Changes in taste Painful swallowing Difficulty eating and talking

You can see or feel most of these problems. Check your mouth every day.

 

Mouth Care Ideally, visit your dentist a month or two before starting chemo. Inform your dentist and oncology team if you’ve had mouth or dental problems. These may include: • Bleeding gums when brushing • Broken teeth or fillings • Sensitive teeth • Gum disease (periodontal disease/pyorrhea) • Loose teeth • Persistent irritation from dentures

All images in this document are courtesy of National Institutes of Health

The dentist will do a complete exam.

Use a soft toothbrush. Use fluoride toothpaste. Do not use toothpaste with tartar/whitening control. Brush your teeth and tongue after each meal and at bedtime. Even if you are not eating, brush your teeth to remove the film and bacteria. After brushing your teeth, rinse your mouth with baking soda solution. Mix 1/2 teaspoon baking soda in 8-ounces of water. Swish gently and spit. Leukemia patients ask your nurse for special baking soda rinse instructions. Do not use store-bought mouthwashes. They may contain alcohol or other chemicals that can irritate your mouth. If you floss daily, use waxed floss. If flossing is not one of your routine habits, speak to your  

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doctor before beginning to floss. Do not floss if your platelets are below 50,000 (50k/ul). Dentures or Partials Be careful when putting in or taking out dentures or partial dentures. If your dentures/partials do not fit well, do not wear them. Wearing them may injure your oral tissues, potentially delaying your treatment. At bedtime, soak dentures in a store-bought denture soak. Rinse them well with water before putting in your mouth. Remove your dentures on the days you receive chemo.

 

Dentures may increase nausea and vomiting with chemo. Do not wear dentures if your blood counts are low. Your oncology team will talk to you about your blood counts and tell you when you should leave your dentures out.

 

Preventing Dry Mouth and Lips • • • • • •

Rinse your mouth with water and/or baking soda solution as instructed. Drink 8 to 12 eight-ounce glasses of non-alcoholic, non-caffeinated fluids each day. If you are drinking enough, your urine will be light colored or clear. Suck (do not chew) on ice chips or popsicles. Chew sugar-free gum. Use saliva substitute if needed. Use lip balm as needed. Do not use petroleum jelly (like Vaseline™).

Food Considerations Soft foods with fewer spices are usually easier to tolerate. Avoid temperature extremes. Lukewarm or cool foods are less irritating. Take small bites of food. Chew slowly. Sip liquids with meals. Choose soft, liquid, blended or moist foods. For example: • Scrambled eggs • Finely ground meats with gravy • Oatmeal or other cooked cereals • Nutrition drinks • Milkshakes • Puddings Avoid foods that may irritate your mouth. For example: • Acidic, such as oranges or other citrus • Spicy, such as hot peppers • Hard foods, such as potato chips or toast

Sipping liquids with your meals will make eating easier.

Resource For more information visit the National Institutes of Health: http://www.nidcr.nih.gov/OralHealth/Topics/cancertreatment/chemotherapyYourMouth.htm  

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Mouth and Throat Soreness Relief Treatment may cause soreness in your mouth and throat. Some chemotherapy causes oral mucositis. This is a red, sore mouth. There may be open ulcers. Tell your doctor or nurse if you have sores in your mouth. Report any bleeding or white patches on your tongue.

Topical Treatments Sometimes mouth rinses provide relief. Ask your oncology team if you should use any of these: •

Baking soda rinse − Each day, make your own baking soda solution. Mix 1 teaspoon of baking soda with 12 to 14 ounces of water. − Swish 1 to 2 ounces in your mouth for 30 seconds and then spit it out. − You may also gargle with the rinse for several seconds. Then spit it out. − Rinse every 2 or 3 hours while you are awake. Rinse after meals and at bedtime. Do not rinse with the baking soda more than 6 times a day. Salt and soda rinse − In 1 cup (8 ounces) of warm water, add 1 teaspoon of salt and 1 teaspoon of baking soda. Stir until dissolved. − Swish and spit 2 tablespoons, 4 times each day. Mucosa coating agents − This is a thick, colored liquid. You need a prescription for it. − Swish to coat the inside of your mouth. Swallowing it soothes the throat too. If you are nauseated and can’t swallow it, you may spit it out. − Do not drink for at least 15 minutes after. Topical anesthetics − Comes in thick liquids, gels or sprays. − You need a prescription. Follow directions for use.

Diet Eating may be difficult. You may need to pay attention to food texture and temperature. Eat what is most comfortable for you. •

Choose soft, moist foods that are easy to swallow. Avoid rough-textured, acidic, tart and spicy foods that may cause irritation.

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• • • • •

Cut foods into small bites to reduce chewing. If spoons or forks cause pain, drink blended meals from a cup. Puree or liquify foods with a blender or food processor. Drink liquids through a straw to help push the food past painful areas. Avoid extremely hot and cold foods. Drink fluids and eat foods that are at room temperature. Use liquid nutrition supplements. Examples include Boost , Ensure and Carnation Breakfast Essentials . These help you get enough calories and protein. Limit caffeine. Drink plenty of fluids to prevent dehydration and dry mouth. Practice good mouth care every day. Keep your lips and mouth moist: drink often, suck on ice chips and enjoy sugar-free popsicles. Use lip balm, as needed. ®

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Resources For more information call Clinical Nutrition at 713-563-5167. You can make an appointment with a dietitian in your clinic. Visit the National Cancer Institute: http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/HealthProfessional /page5

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Hair, Skin and Nails Potential Changes with Chemotherapy Side effects such as hair loss, changes in skin color or texture, or cracked or brittle nails may occur during chemotherapy (chemo). Some chemo medicines cause these changes, others do not. If you have any of these changes, ask your oncology team if your medicines may be the reason.

Hair Loss or Thinning Hair loss (known as alopecia) can occur on any part of the body. That includes the head, face, arms, legs, underarms or pubic areas. It may involve mild thinning or complete hair loss. Hair loss does not normally happen right away. It can start from 7 to 21 days after chemo begins. Hair loss is usually temporary. Hair can grow back a different color or texture after chemo is done. It can also return to its original appearance. If you have hair loss, keep your scalp clean and moisturized to prevent skin breaks. Use sunscreen, sun block, a hat, scarf or wig to protect your scalp from the sun. Some health insurance policies pay for the cost of a wig during chemo treatment. MD Anderson’s Beauty and Barber Shop provide shampoos, shaves, wigs, scarves and hats at no cost to patients. They are open Monday – Friday from 7:30 a.m. to 4:30 p.m. Take Elevator F to Floor 6 in the Main Building. Call 713-792-6039 for more information. Image courtesy MD Anderson Cancer Center

Other tips:  Use mild shampoos and soft hair brushes. Avoid overheating your hair with blow dryers, irons and hot rollers. If you must use them, use the lowest heat setting. Pat hair dry.  Consider a shorter hairstyle. Shorter hair styles often appear thicker and fuller.  If you decide to use a wig, get one before you lose a lot of hair. You can more closely match your original style and color prior to your hair loss.

Skin 

Dry skin  Bathe in lukewarm water. Avoid long, hot showers and bubble baths.  Use mild soaps without perfume or fragrance. Consider a body wash which tends to be more moisturizing.

Hair, Skin and Nails: Potential Changes with Chemotherapy The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0101

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 Pat yourself dry instead of rubbing  Keep your skin moisturized. Use hypoallergenic creams without fragrance. Examples ® ® ® ® include Eucerin , CeraVe ,Vanicream or Aquaphor after you bathe.  Avoid perfume, cologne or aftershave lotion. These products often contain alcohol which dries and irritates skin.  Drink enough liquid that your urine is light colored or clear. This means your body has enough fluid. Sensitivity to sunlight  You may sunburn more easily. Sun may also cause a skin rash.  Avoid prolonged exposure to sunlight. Do not use sunlamps or tanning beds.  Use a PABA-free sunscreen (SPF 30 or greater) and lip balm, no matter what your skin tone. You may need to avoid direct sunlight completely. Image courtesy of  Wear sun protective clothing (i.e. long-sleeved cotton shirts, hats, National Institutes of Health sunglasses and/or pants) when outside. Skin rash or itching  Report any rash, blisters, itching, redness or peeling to your doctor or nurse immediately.  Ask for medicines to relieve itching.  Bathe with body washes such as Dove® or Oil of Olay®.  Wear loose fitting clothing. Acne  Talk with your doctor about over the counter or prescription medicine that may help.

Nails Changes in fingernails or toenails may occur from chemo. Your nails may become darkened, or develop white streaks or ridges. They may become brittle, dry and cracked. Nails may lift up from the nail bed. These changes are temporary, and will take time to grow out. Protect your hands and feet if these changes occur. If you do not, the chance of infection and nail loss increases.  Gently trim or file nails. Do not cut too close to the nail bed.  Do not get professional manicures or pedicures unless your oncology team says it is OK.  Use lotions and creams to keep your nails and cuticles healthy.  Wear gloves while working around the house or yard.  Do not use nail-strengthening products. They may irritate your skin or nails.  Talk with your oncology team about artificial nails. They can breed fungal infection. They also may mask nail changes due to treatment.  Report redness, pain or other changes that occur around your cuticles.

Resources Visit the American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/understa ndingchemotherapyaguideforpatientsandfamilies/understanding-chemotherapy-common-sideeffects-hair-loss Hair, Skin and Nails: Potential Changes with Chemotherapy The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0101

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Chemobrain Patients may have changes in thinking skills from cancer or chemotherapy (chemo). Changes may range from subtle to severe. Sometimes these changes are called “chemobrain.”

Symptoms • • • • • • •

Slower recall of names, words or numbers Trouble concentrating Problems with memory Confusing dates and appointments Misplacing objects Having trouble doing more than one thing at a time Feeling mentally slower than usual

These changes may result from other causes. Examples include low blood counts, other medications, anxiety or depression. Symptoms generally fade after chemo ends. However, each patient is different. Some take a year or more after treatment to feel normal again. Others do not regain full cognitive function.

Coping Tips • • • • • • • • • •

Get adequate rest and nutrition. Manage fatigue. Stay physically and mentally active. Practice relaxation. Use memory aids (i.e. smartphone, day planner or calendar). Create a daily task list. Set audible alerts (i.e. the alarm on your smartphone or watch) for reminders. Use a “memory station”: always place important items, such as keys, in the same place. Minimize distractions. Manage depression and anxiety. Easing stress and elevating mood can ease symptoms.

If you have these problems, ask for a referral to the Section of Neuropsychology. Call 713-792-0708. They can assess your strengths and weaknesses. This can lead to treatments to help, such as tools and memory aids. In some cases, certain medicines may be helpful.

Chemobrain The University of Texas MD Anderson Cancer Center ©2014 Patient Education 3646

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Resources Ask to see the video “Q&A: Understanding Cognitive Testing in Cancer Care.” It describes the purpose of the evaluation. It shows what to expect during an assessment. http://www.youtube.com/watch?v=l_t8GbxSMss or at http://www3.mdanderson.org/streams/FullVideoPlayer.cfm?xml=cfg%2FNeuropsychA-QA Visit the National Cancer Institute website: http://www.cancer.gov/cancertopics/coping/physicaleffects/chemo-side-effects This brochure tells more about neuropsychological assessment: http://www.div40.org/pdf/NeuropscyhBroch2.pdf

Chemobrain The University of Texas MD Anderson Cancer Center ©2014 Patient Education 3646

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Pain, Nerves and Muscles Potential Changes with Chemotherapy It is not uncommon for patients to feel pain. The tumor itself can cause pain. Sometimes treatments result in pain. However, pain can be managed to provide a level of comfort that allows daily activities. We want you to understand about pain and how to control it.

Why Pain Should Be Treated Pain can affect you in many ways. It can keep you from being active, from sleeping well, from enjoying family and friends and from eating. Pain can make you feel afraid or depressed. Pain may also prevent your full participation in your care and may slow your recovery from treatment. Most cancer pain is manageable with treatment. When there is less pain, you will probably be more active and interested in doing things you enjoy. Tell your doctor or nurse right away if you are feeling pain. Getting help for your pain early on can make pain treatment more effective.

Causes There are many causes of cancer pain. Most cancer pain occurs when a tumor presses on bone, nerves or body organs. Cancer treatment can also cause pain. You may also have pain that has nothing to do with your illness or its treatment. Like everyone else, you can get headaches, muscle strains and other aches and pains. If you are taking medicine for cancer treatment or pain, talk with your doctor or nurse about what you can take for these everyday aches and pains. Other conditions, such as arthritis, can also cause pain. Pain from these other conditions can be treated along with cancer pain. Again, talk to your doctors and nurses about your medical history. They will be able to tell you how each condition can be treated and what is best for you.

Treatment Cancer pain is usually treated with medicine. Radiation treatment, surgery and other treatments can be used along with medicine to give even more pain relief. Ask your doctor or nurse how other treatments can help you.

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There are many ways to decrease pain without medicine too. Non-drug treatments include relaxation techniques, biofeedback, prayer, distraction and imagery. Treat pain early. Waiting until it is very bad requires more medicine. Check with your doctor, nurse or pharmacist before taking over-the-counter pain relievers. Ask for the “Guide to Managing Cancer Pain,” “Pain Rating Scales” and “Pain Management Log.”

Nerves and Muscles It is not uncommon for people on chemotherapy (chemo) to experience nerve and muscle-related side effects. Some chemo drugs (i.e. Taxane®) can cause "peripheral neuropathy." This condition causes tingling, burning or numbness in the hands or feet. Other nerve-related symptoms can include dizziness, lightheadedness, loss of balance and clumsiness. There may be difficulty picking up objects and or walking. Some people feel shaking or trembling. There may be changes in vision or hearing. In addition, certain anti-cancer drugs can lead to weak, tired or sore muscles. In most cases, these problems are temporary and get better with time. Sometimes they persist after chemo. Nerve and muscle symptoms may indicate serious problems that need medical attention. Tell your doctor or nurse if you experience any nerve or muscle symptoms. To manage nerve or muscle related side effects:  For dizziness or lightheadedness, change position slowly.  For numbness or tingling in the hands or feet:  Wear shoes or slippers when walking.  Test bath water temperature with your elbow.  Hold hot mugs by the handle, not the cup.  Use caution with sharp objects.  For balance or muscle strength problems, use handrails when going up or down stairs.

Resources Ask for a copy of “Peripheral Neuropathy.” Visit the American Cancer Society website: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffe cts/peripheralneuropathy/index

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Notes _____________________________________________________________________________

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Notes The University of Texas MD Anderson Cancer Center Š2008 Reviewed 09/2014, Patient Education 2157

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__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _____________________________________________________________________________

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Notes The University of Texas MD Anderson Cancer Center Š2008 Reviewed 09/2014, Patient Education 2157

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Home Care

Safe Handling of Chemotherapy at Home Taking Chemotherapy by Mouth You are receiving chemotherapy (chemo) pills at home to treat your cancer. Oral treatment is convenient, but you and your family must take special precautions to work safely with these medicines. These drugs may cause harm to normal body cells. Follow these instructions to handle chemo during treatment and for 48 hours after you take your last pill. If you follow these precautions, the people you live with and the environment, are safer from the drug.

  Supplies • • •

Latex powder-free gloves If allergic to latex, then use latex-free gloves Leak-proof plastic bags

• • •

Keep chemo pills in a safe place, out of the reach of children and pets. Follow your nurse’s or pharmacist’s instructions for storing the chemo pills. If refrigeration is needed, store the chemo pills in a separate leak-proof container away from the food. Or put it in a crisper bin with no other items. Do not store food below the chemo. Do not place the chemotherapy in or near the freezer. Label containers that hold chemo to indicate that they are dangerous. Do not store chemotherapy pills in the bathroom (too much moisture). Do not store in areas with temperatures that are very hot or very cold.

  Storage

• •

Handling Chemotherapy Pills • • • • • • •

Do not crush, break or chew the pills. Swallow them whole. Only adults should handle chemo pills. Do not touch the chemo pills with your bare hands. Pregnant women or children should not handle chemo or body waste at any time. Wash your hands well with soap and water before and after handling chemo pills. Wear two pair of disposable gloves when handling any type of chemo drugs. You can buy these gloves at any drug store. Once used, do not use these gloves for any other activity such as cleaning surfaces or changing bed linens. Remove the gloves after use. Put them inside the large chemo waste

Safe Handling of Chemotherapy at Home: Taking Chemotherapy by Mouth The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2014, Patient Education 2967

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bag in your spill kit. Do not use torn gloves or gloves with small holes in them.

Handling Body Waste During Chemotherapy Treatment and 48 Hours After Finishing the Last Dose Safe handling guidelines should be used anytime you or another person might touch body waste, such as urine or feces. This includes touching toilets, bedside commodes, bedpans, vomit pans, urinals, ostomy bags or other body waste containers. • You may use the toilet (septic tank or sewer). Close the toilet lid and then flush twice during treatment and for 48 hours after receiving the last dose of chemo. • Wash your hands well with soap and water after you use the toilet. Wash your skin if urine or feces gets on it. • Your family may use the same toilet if it is clean. • If you cannot control your bowel or bladder, use a disposable, plastic-backed pad, diaper or sheet to soak up the urine or feces. Change the diaper immediately when soiled and wash your skin with soap and water. If you use diapers, use disposable diapers and place the used diapers inside two sealable, leak-proof plastic bags for disposal. This is called “doublebagging.” • Try to avoid splattering urine. For example, men should urinate by sitting down. • Wear two pairs of powder-free latex or latex-free gloves when emptying or cleaning toilets, body waste containers or changing diapers for children or adults. • Empty containers of body waste into the toilet. Empty the contents close to the water to avoid splashing. • Clean body waste containers after each use with soap and water. Rinse well. Ostomy bags only need to be cleaned once a day and emptied as needed. • Clean the toilet bowl in the usual manner. Clean up splashes with soap and water. • Flush the toilet twice with the lid down after cleaning. • Remove the gloves after use and put them inside of two plastic bags. Seal the bags and throw them in the trash. Then wash your hands.

Handling Laundry Wash your clothes or bed linens as usual unless they become soiled with chemo or body waste. Wash soiled laundry separately from other laundry items. Follow these guidelines to care for soiled laundry: • Wear two pairs of gloves to handle soiled laundry. Carry the soiled laundry away from your body or place in a plastic bag for transport. Place soiled laundry in the washer by itself. Then remove the gloves and wash your hands. • Use normal detergent and hot or warm water. • Soiled laundry should be washed right away. If it can’t be washed right away or you do not have a washer, put it in a plastic bag until it can be washed. Wash it as soon as possible. Safe Handling of Chemotherapy at Home: Taking Chemotherapy by Mouth The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2014, Patient Education 2967

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Handling Trash Wear gloves to handle trash that has been in contact with chemo pills or body waste. Wear gloves to throw away soiled trash. Wash your hands after you remove the gloves. • Use the small chemo waste bag for soiled trash. Then put this bag inside the large chemotherapy waste bag and tie. • Seal containers with tape. Close and seal plastic bags with ties or rubber bands when full. Label the bag “not for recycle.” • Designate an area away from children and pets where filled containers and bags can await trash pick-up. • Place in household trash.

 

Sexual Activity •

You must use some type of birth control if you are a woman of childbearing age and have sexual intercourse during treatment. Your doctor can help you decide what kind of birth control is best for you. Most patients are able to continue sexual activity during chemo, but sometimes special precautions are needed. Traces of chemo may be present in vaginal fluid and semen for up to 48 hours after you finish treatment. Ask your health care provider if you or your partner should use a condom. Activities such as hugging and kissing do not require special precautions.

Resources From the American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/oralchemotherapy

Safe Handling of Chemotherapy at Home: Taking Chemotherapy by Mouth The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2014, Patient Education 2967

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Safe Handling of Chemotherapy at Home Taking Chemotherapy Infusions  

 

You are receiving chemotherapy (chemo) infusions at home to treat your cancer. Outpatient treatment is convenient, but you and your family must take special precautions to work safely with these medicines. These drugs may cause harm to normal body cells. Follow these instructions to handle chemotherapy during treatment and for 48 hours after you complete your infusion. If you follow these precautions, the people you live with and the environment, are safer from the drug.

  Supplies  

You will be given your chemotherapy in a bag, a pump and a leakproof clear plastic bag. Your nurse will give you a spill kit with the following contents: • Two pairs of nitrile glove (Latex powder-free gloves but if you are allergic to latex, then use latex-free gloves) • Mask • Gown • One large chemo waste bag with tie • One small chemo waste bag If your infusion will last through the night, you will need: • Disposable rags or paper towels • A plastic-backed mattress pad

  Storage   • •

• • • •  

Keep chemo drugs and equipment (such as needles, syringes, IV bags and IV tubing) in a safe place, out of the reach of children and pets. If refrigeration is needed, store the chemo in a separate leakproof container away from the food. Or put it in a crisper bin with no other items. Do not store food below the chemo. Do not place the chemotherapy in or near the freezer. Label containers that hold chemo to indicate that they are dangerous. Do not store chemotherapy infusions in the bathroom (too much moisture). Do not store in areas with temperatures that are very hot or very cold. Check infusion containers for damage or leaks. Do not open or use any damaged products. Return any damaged product to the hospital in a leakproof, sealed container such as a plastic bag or a container with a lid.

Safe Handling of Chemotherapy at Home: Taking Chemotherapy Infusions The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2013, Patient Education 2966

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Handling Chemotherapy Infusions

 

 

Only adults should handle chemotherapy infusions or the body waste of people who are receiving chemo. Pregnant women or children should not handle chemo or body waste at any time. Wash your hands well with soap and water before and after handling chemotherapy infusions or containers that the chemo comes in. Wear two pair of disposable gloves when handling any type of chemotherapy drugs that go into the vein or in the muscle. You can buy these gloves at any drug store. Do not use these gloves for any other activity such as cleaning surfaces or changing bed linens. Remove the gloves after use. Put them inside the large chemo waste bag in your spill kit. Do not use torn gloves or gloves with small holes in them.

Handling Body Waste During Chemotherapy Treatment and 48 Hours After Finishing the Last Dose  

Safe handling guidelines should be used anytime you or another person might touch body waste, such as urine or feces. This includes touching toilets, bedside commodes, bedpans, vomit pans, urinals, ostomy bags or other body waste containers.  

• • • •

• • • • • • •

 

You may use the toilet (septic tank or sewer). Close the toilet lid and then flush twice during treatment and for 48 hours after receiving the last dose of chemo. Wash your hands well with soap and water after you use the toilet. Wash your skin if urine or feces gets on it. Your family may use the same toilet, if it is clean. If you cannot control your bowel or bladder, use a disposable, plastic-backed pad, diaper or sheet to soak up the urine or feces. Change the diaper immediately when soiled and wash your skin with soap and water. If you use diapers, use disposable diapers and place the used diapers inside two sealable, leak-proof plastic bags for disposal. This is called “double-bagging.” Try to avoid splattering urine. For example, men should urinate by sitting down. Wear two pairs of powder-free latex or latex-free gloves when emptying or cleaning toilets, body waste containers or changing diapers for children or adults. Empty containers of body waste into the toilet. Empty the contents close to the water to avoid splashing. Clean body waste containers after each use with soap and water. Rinse well. Ostomy bags only need to be cleaned once a day and emptied as needed. Clean the toilet bowl in the usual manner. Clean up splashes with soap and water. Flush the toilet twice with the lid down after cleaning. Remove the gloves after use and put them inside of two plastic bags, seal the bags, and throw in the trash. Then wash your hands.

Safe Handling of Chemotherapy at Home: Taking Chemotherapy Infusions The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2013, Patient Education 2966

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Handling Laundry Wash your clothes or bed linens as usual unless they become soiled with chemo and/or body waste. Wash soiled laundry separately from other laundry items. Follow these guidelines to care for soiled laundry: • Wear two pairs of gloves to handle soiled laundry. Carry the soiled laundry away from your body or place in a plastic bag for transport. Place soiled laundry in the washer by itself. Then remove the gloves and wash your hands. • Use normal detergent and hot or warm water. • Soiled laundry should be washed right away. If it can’t be washed right away or you do not have a washer, put it in a plastic bag until it can be washed. Wash it as soon as possible.

Handling Trash Wear gloves to handle trash that has been in contact with chemo drugs or body waste. Wear gloves to throw away soiled trash. Wash your hands after you remove the gloves. • Use the small chemo waste bag for soiled trash. Then put this bag inside the large chemotherapy waste bag and tie. • For sharp or breakable items such as syringes or needles, use a puncture-proof container. A sturdy plastic laundry detergent container with a lid works well. Do not break or recap needles or crush syringes. Label the container “Not for Recycle.” • Seal containers with tape. Close and seal plastic bags with ties or rubber bands when full. • Designate an area away from children and pets where filled containers and bags can await trash pick-up.

Sexual Activity • •

You must use some type of birth control if you are a woman of childbearing age and have sexual intercourse during treatment. Your doctor can help you decide what kind of birth control is best for you. Most patients are able to continue sexual activity during chemo, but sometimes special precautions are needed. Traces of chemo may be present in vaginal fluid and semen for up to 48 hours after you finish treatment. Ask your health care provider if you or your partner should use a condom. Activities such as hugging and kissing do not require special precautions.

Used Chemotherapy Disposal If you have not been shown how to stop the infusion and disconnect the tubing: when the infusion is done, clamp the tubes and go to the Ambulatory Treatment Center (ATC). The nurses will disconnect tubes, flush lines and dispose of used equipment. If you have been shown how to stop the infusion: follow the pump instructions you received. To dispose of the used equipment, follow these steps: 1. Wash your hands and put on two pairs of clean, disposable gloves, one on top of the other. 2. Disconnect the IV tubing from patient’s catheter. Place the end of the IV tubing in the palm of  

Safe Handling of Chemotherapy at Home: Taking Chemotherapy Infusions The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2013, Patient Education 2966

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your gloved hand. 3. Pull the outer glove over the tubing. This prevents any chemo from dripping out the end of the tube. You still have one pair of gloves on. 4. Gather all the used tubing, IV bag and pump. Place in a zip-lock bag. You may use the bag that the chemo came in. Remove and discard the second pair of gloves in the bag. Close the bag. Wash your hands. 5. Bring the zip-lock bag of used equipment back to the ATC on your next visit.

 

Handling a Chemotherapy Spill at Home  

   

Intravenous or injectable chemo drugs may be accidentally spilled or splashed. Also, the IV tubing may become loose or disconnected, or an IV bag may leak. If this happens, the spill should be carefully cleaned up. Follow these guidelines: • Do not touch the spill with your bare hands. • Keep other people and pets away from the spill area. • Remember pregnant women and children do not clean spills. • Get your spill kit. • Put on first pair of gloves. • Put on the gown. • Put on second pair of gloves, covering the cuff of the gown. • Put on the mask. • Turn off the pump and clamp the catheter. • If you have a central venous catheter or implantable access system (Port-a-Cath) in place, disconnect the catheter from the IV tubing before cleaning the spill. Clean the catheter and cap it according to the way you were taught. • Put your chemo infusion pump and chemo bag in the clear leak proof bag and seal the bag. • Use disposable rags or paper towels to blot up as much of the spilled chemo as possible. • Put used clean-up materials directly into the small chemo waste bag and seal it. Place this in the large chemotherapy waste bag. • While still wearing gloves, wash the area covered by the spill three times with soap and warm water. Use disposable rags or paper towels. Put them in the large chemo waste bag with other waste. – Do not use a mop to clean up the spill. – Put all contaminated materials (including gloves and gown), into the large chemo waste bag and tie the bag. • Wash your hands with soap and water. • If the spill occurs on sheets or clothing, wash the items in hot water, separate from other laundry. • If chemotherapy gets on your skin, remove any wet clothing and wash the skin area with soap and water. If your skin stays red for more than an hour or becomes irritated, call your doctor. • If chemotherapy splashes in your eye, flush the eye with large amounts of water for 15 minutes, then go to the nearest emergency center. • Patients on 24-hour infusions should use a plastic-backed mattress pad to protect the mattress from a chemo spill. Call the ATC during open hours to report the spill. (See list below for centers and their open Safe Handling of Chemotherapy at Home: Taking Chemotherapy Infusions The University of Texas MD Anderson Cancer Center ©2008 Revised 01/2013, Patient Education 2966

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hours). Bring back the large chemo waste bag and the clear plastic bag with the chemotherapy and the infusion pump to the ATC as soon as possible. Your nurse will evaluate the spill and dispose of contaminated materials. Plans will be made to replace the spilled chemo so the treatment can be completed. If you plan to be out-of-state during infusions, ask your nurse for special arrangements in case of spill.  

Resources If you have any questions about your pump or your medication, call the Ambulatory Treatment Center (ATC) at 713-792-2310 or 713-792-2312.

 

If you have any questions about your intravenous catheter, call the Infusion Therapy Team (ITT) in the Infusion Therapy Clinic.

 

Ambulatory Treatment Centers (ATC) Main Building Floor 2, near Elevator C Monday-Friday, 7 a.m.-11 p.m. Saturday, 7 a.m.-11 p.m.; Sunday, 7 a.m.-5:30 p.m. 713-792-2310 Mays Clinic Floor 8, near Elevator T Monday-Friday, 7:30 a.m.-10 p.m. 713-745-1000 Pediatric Ambulatory Treatment Center Main Building, Floor 9, Elevator F Monday-Friday, 7:30 a.m.-6 p.m. Closed weekends and holidays; call in-patient at 713-792-5173 after 6 p.m. or on weekends 713-792-6613 Bay Area Monday-Friday, 8 a.m.-5 p.m. 713-563-0670 Katy Monday-Friday, 8 a.m.-5 p.m. 713-563-9600 The Woodlands Monday-Friday, 8 a.m.-5 p.m. 713-563-0050  

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Sugar Land Monday-Friday, 8 a.m.-4.30 p.m. 281-566-1900 Infusion Therapy Clinics Main Building Floor 8, near Elevator C Monday-Friday, 7:30 a.m.-6 p.m. Saturday, Sunday and holidays, 8 a.m.-4:30 p.m. 713-792-2316 Mays Clinic Floor 8, near Elevator U Monday-Friday, 7:30 a.m.-6 p.m. 713-563-7277 Weekdays, weekends, and holidays after usual working hours, call the page operator at 713-792-7090 and ask to speak to the Infusion Therapy Team charge nurse. From the American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/chemothe rapyprinciplesanin-depthdiscussionofthetechniquesanditsroleintreatment/chemotherapyprinciples-safety-precautions

 

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Calendar for Chemotherapy Patients Month: Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Calendar for Chemotherapy Patients The University of Texas MD Anderson Cancer Center ©1997 Revised 01/2014, Patient Education

ePrescription There is an easier way to get prescriptions: ePrescription. An electronic prescription is not written by hand. Instead the doctor sends the order to your pharmacy using the computer. Most neighborhood drug stores can receive ePrescriptions.

Benefits ePrescriptions are: • Fast. The order gets to the drug store quickly. • Easy. There is no written prescription to take to the store. You only go once to pick it up when it is ready. • Safe. The doctor is typing the order, not writing by hand. Less chance for errors. It also provides a prescription history for safety. • Convenient. Refills and renewals are often handled automatically.

Your Role • • •

Provide the name, address and phone number for your drug store. Your medicine bottles have that information printed on them. Understand that some drugs can’t be ordered this way. Also, not all neighborhood drug stores use ePrescription. Ask about ePrescription at your next clinic visit.

If you use an MD Anderson pharmacy, ePrescription will not handle refills automatically. Please give 3-5 days notice that you need a refill.

References This website has more information: http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/ElectronicPrescribing/benefitsep res.html

ePrescription The University of Texas MD Anderson Cancer Center ©2013 Patient Education 3803

Food Safety Tips Everyone should use proper food handling methods. When you receive chemotherapy, you are more at risk for infection.

Shopping • • • • •

Place raw meat and poultry packages in plastic bags before putting them in the shopping cart with other fresh foods. Choose fruits and vegetables that can be scrubbed well. For instance, avoid raspberries or sprouts. Choose hard cheeses. Avoid soft cheese or cheeses with live cultures. Do not purchase foods from shared bins in grocery stores or from street vendors. Buy and consume only pasteurized milk, cheeses, yogurts and juices.

Food Storage Refrigerate food promptly after shopping (and after cooking). Store foods in containers away from insects, rodents or pets. Maintain safe temperatures for your refrigerator and freezer. Check about every 6 months: − Refrigerator: 20 to 40 degrees Fahrenheit − Freezer: 0 degrees Fahrenheit or lower • Cover foods on refrigerator shelves. • Do not store raw meat, poultry or fish in direct contact with prepared foods. Always place cooked foods above raw foods in the refrigerator to prevent contamination. • Suggested storage times for refrigerated foods: − Raw fish and seafood: 1 to 2 days − Raw meat, chicken, or turkey: 2 to 3 days − Leftovers: 3 to 4 days − Luncheon meats: 4 to 7 days − Milk: 5 days Images courtesy of Food and − Raw fruits and vegetables: 7 days Drug Administration − Eggs: 7 to 14 days • Observe expiration dates on foods. Throw away any food which looks or smells rotten, slimy or moldy. • • •

Food Safety Tips The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0610

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Food Preparation • • • • •

• •

Wash hands with warm soapy water for 15 seconds before preparing, cooking or eating food. Clean counter tops by washing with hot soapy water and rinsing well. Sanitize with a solution containing chlorine bleach. (1 part bleach to 10 parts water). Use one cutting board for raw vegetables/fruits. Use a different cutting board for raw meats. Clean each board thoroughly after use. Wash all fruits and vegetables thoroughly before cutting. Use a vegetable brush designed for this purpose. Thaw meat and poultry in the refrigerator, not at room temperature. Cover thawing meats and place them on bottom shelf separate from other foods. Use clean utensils and knives. Use a clean knife every time you cut a different food. Use a different spoon for tasting food; not the one used to stir the food. Keep the microwave clean. Food debris can grow bacteria.

Meal Times • • • •

Eat fully cooked meats, poultry, fish and eggs. Meat should be cooked to 160° Fahrenheit and poultry to 180° Fahrenheit. Avoid eating dishes that contain raw eggs or fish, such as Caesar salad dressing, sushi, raw cookie dough and cake batter, hollandaise sauce and homemade eggnog or ice cream. Avoid open salad bars at restaurants. If drinking water from a private well is approved by your doctor, test the water every year. The health department or local water department can tell you how to test it.

Resources For more information, contact the National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603155/

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Sexuality & Fertility

Sexuality and Chemotherapy Is it safe to have sex during chemotherapy? Most patients are able to have sexual activity during chemotherapy (chemo). However there is a greater risk for infection. Practice good personal hygiene. Bathe daily. Wash your hands and genitals before and after sexual activity. Some treatments may lower a man's sperm count. They may cause a woman's periods to stop. However, pregnancy may still be possible. Some treatments may cause birth defects. Discuss your risks of pregnancy with your doctor. Talk to your doctor or nurse about the best method of birth control for you. Practice safe sex if you or your partner have sex with more than one person. Latex condoms and/or dental dams help prevent infections from body fluids. If you use a lubricant with latex condoms, choose one that is water-based. Do not use a lubricant that contains oil (i.e., baby oil or petroleum jelly). Oil weakens the condom.

How does chemotherapy affect sexuality? During chemo, some men and women feel less interested in sexual intimacy. For some, fatigue makes sex difficult. Chemo may, but does not always, affect hormone levels. These changes may affect sexual organs and functioning. Men During treatment, men may have trouble getting or maintaining an erection. This usually returns to normal after treatment. Chemo may reduce a man's sperm cell count. This can affect his ability to father children. It does not affect the ability to have sexual intercourse. A low sperm count may be temporary or permanent. It depends on the dose of chemo, the type of medicines and the man’s age. Ask your doctor about the long-term effects of your treatment plan. Women Chemo may change the function of the ovaries. Menstrual periods may become irregular. They may stop completely. Changes can be temporary or permanent. Sometimes chemo may cause a woman to enter menopause. Common symptoms include hot flashes and vaginal dryness or itching. Vaginal dryness can be relieved by using vaginal moisturizers. Use them regularly. Sexuality and Chemotherapy The University of Texas MD Anderson Cancer Center Š2012 Revised 01/2014, Patient Education 3658

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Vaginal lubricants can make sexual activity more comfortable. You can buy these over the counter. For more information, ask for a copy of “Vaginal Dryness.” Chemo causes vaginal mucositis in some women. This is a painful irritation of the lining of the vagina. If you develop vaginal pain, tell your doctor. Many factors affect a woman's ability to have children after treatment. These include the type and dose of chemo received. Age at the time of treatment is another factor. Ask your doctor about the long-term effects of your treatment plan.

Where can I get more information or help? MD Anderson has providers who specialize in sexual health services. Ask for a referral. For information and questions about sexual health services at MD Anderson, call Andrea Bradford, M.D., at 713-745-4466. For more information on sexuality and cancer, ask for a copy of the patient information sheet “Sexuality and Your Cancer Treatment.”

References •

Sexuality for the Man with Cancer. American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffe ctsinmen/sexualityfortheman/index. Sexuality for the Woman with Cancer. American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffe ctsinwomen/sexualityforthewoman/index.

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Fertility Preservation Options for Men and Women Before starting cancer treatment, men and women who may want to have a child in the future should consider fertility preservation options. Talk with your doctor.

Men For men, fertility means being able to produce healthy sperm cells that can make a woman pregnant. Cancer treatment may affect sperm cells and increase the chance of infertility. Some men may not be affected at all. Some may only be affected during treatment. Others may be affected permanently. It depends on the type of treatment and the amount given. Sperm banking is an option for men who may want to have a child in the future. Banking sperm includes freezing a semen sample. The sample can later be thawed and used to make a woman pregnant. Most health insurance plans do not pay for sperm banking. Some sperm banks have payment plans for patients with cancer. There are also financial assistance programs that can lower the cost of banking and storage. The sample is collected at an infertility clinic or sperm bank. To get the sample, a man must ejaculate through masturbation. The clinic will test the semen for sperm count and motility. Then the sample is divided into small amounts and frozen. Frozen samples may be stored for a long time. Men who are unable to provide a semen sample or those who have low sperm counts may be able to have sperm collected through an outpatient surgical procedure. For more information on sperm banking, please ask for a copy of the patient information sheet, “Fertility Options for Men Who Need Cancer Treatment (Sperm Banking).”

Women For women, fertility means being able to become pregnant and carry a pregnancy successfully to a live birth. Cancer therapy may damage a woman’s ovaries, which produce eggs. The amount of damage depends on the type of treatment and the amount given. Women who want to have a child in the future have options of freezing eggs, embryos (fertilized eggs) or tissue from the ovaries before cancer treatment. The frozen tissue can be used later to conceive a child. Frozen embryos and eggs can be stored indefinitely.

Fertility Preservation Options for Men and Women The University of Texas MD Anderson Cancer Center ©2012 Revised 01/2014, Patient Education 4007

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The most successful way to preserve fertility is to freeze embryos or eggs. To do this, a woman will take hormones to stimulate the ovaries to grow several eggs at once. Then the eggs are removed in a minor, outpatient surgery. Once the eggs have been removed, they can be frozen immediately or fertilized in the lab with sperm. Eggs that fertilize and form embryos are frozen and stored for future use. This process is called in vitro fertilization (IVF). IVF and other methods of fertility preservation may be expensive. Most health insurance plans do not cover the cost. However, there are financial assistance programs that can help decrease the costs. For more information on fertility preservation, please ask for a copy of the patient information sheet “Fertility Options for Women Who Need Cancer Treatment.”

Resources MD Anderson Cancer Center, Oncology Fertility Clinic 713-792-6810 Services for men and women: • Fertility assessment • Fertility education and counseling • Fertility preservation methods • Financial assistance program - LIVESTRONG Fertility • Options for parenthood Baylor College of Medicine Medical Center, Scott Department of Urology 713-798-4001 Services for men include: • Semen analysis • Sperm Banking • Financial assistance program - LIVESTRONG Fertility - Hero’s for Children

Fertility Preservation Options for Men and Women The University of Texas MD Anderson Cancer Center ©2012 Revised 01/2014, Patient Education 4007

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Resources

   

 

Resources at MD Anderson Cancer Center  

 

Appearances 713-563-8200 Appearances is a retail shop. It offers special products and services such as breast prostheses and head coverings. Find sun protective clothing and clothing for mastectomy and surgery patients. They also have cosmetics and motivational materials. It is located in the Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1502. Beauty/Barber Shop 713-792-6039 The Beauty/Barber Shop offers patients shampoos, haircuts and shaves. You can also find wigs, scarves and hats. Services are provided by Volunteer Services at no charge. Appointments are not necessary. The shop is in the Main Building, Floor 6, near Elevator F, Room G6.3253. Child Visitation 713-563-6545 Short-term drop-in child care is available for children ages 2 months to 12 years. Children must be healthy and current on immunizations. Hours from 7:30 a.m.-5:30 p.m. It is located in the Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1510.

  Emergency Center In case of an emergency call 911 or go to the nearest emergency center. MD Anderson’s Emergency Center is open 24 hours a day, every day. From Holcombe Boulevard, turn at Entrance Marker 3. The entrance is on Bates Street near Garage 2. From inside the Main Building, go to Floor 1, near The Café Corner, Room P1.3100. For non-emergencies during business hours, please call your care center. Ethics Consultation Service 713-792-8775 The Ethics Consultation Service helps patients, families and staff make difficult decisions about medical treatments and patient care. These decisions may involve moral values, religious beliefs or professional duties.

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Integrative Medicine Center 713-794-4700 The Integrative Medicine Center works collaboratively with your primary oncology team. They help to personalize your care plan. Topics and services include diet, massage, music, meditation, acupuncture, yoga, tai chi, dance and others. Two locations:  Main Building, Floor 1, outside of The Aquarium main entrance  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1041

  The Learning Center The Learning Center provides the latest information about health and cancer. You can get help finding the information you need. The Learning Center also provides computers, websites, medical journals, books, videos and more. Printers, copier and fax machine are available. Two locations:  Main Building, Floor 4, near Elevator A, Room R4.1100, 713-745-8063  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120, 713-563-8010

  Leisure Areas There are places within the hospital to allow quiet or leisure time. Among them:  The Park- Located in the Main Building, Floor 2, near Elevator D. Natural light from the skylights give this indoor area an outdoor courtyard feel. It is a welcome retreat from the hospital room and hallways. Plus, it is close to a coffee shop, gift shop and Kim's Place.  Kim’s Place- A recreation area for patients and visitors age 15-30. Enjoy TV, Wii games, pool table, jukebox, mini-kitchen, computers, video games, two basketball free-throw machines or quiet areas. Find Kim’s Place in the Main Building, Floor 2, in The Park.  Observation Deck- In the Main Building, take Elevator F high-rise to Floor 22, then to Floor 24. You can see panoramic views of Houston, play the piano or watch TV.  

myCancerConnection 713-792-2553 or 800-345-6324 A group of current and former cancer patients are ready to reach out. They provide resources, support and hope. You can call and talk with a cancer survivor with your same diagnosis and treatment. You can also visit the myCancerConnection volunteers. There are two Hospitality Center locations:  Main Building, Floor 2, near The Sundial, 713-794-1055  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1002, 713-563-8299 Patient/Family Center 713-745-8000 The Patient/Family Center is a place to relax. Computers with Internet access, a printer, fax machine and copier are available. A quiet side is provided. It has recliners, pillows, blankets and dim lights for napping. Volunteers will wake you in time for your appointment. You can get help with navigation, print schedules and learn about other resources. It is located in the Main Building, Floor 2, near Elevator D, Room B2.4314. Hours: weekday 8 a.m.-8 p.m., weekend 9 a.m.-4 p.m.

  Patient/Family Library 713-792-1080 The Patient/Family Library offers books, magazines and newspapers. It also has puzzles, games, audiobooks and CD players. There are some books in foreign languages, too. It is located in the Main Building, Floor 1, near The Aquarium, Room R1.221.   Resources at MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center ©2001 Revised 01/2014, Patient Education 0746

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Pharmacy MD Anderson has three outpatient retail pharmacies to serve you. Pharmacy locations are:  Main Building, Floor 2, near Elevator C, R2.2315, 713-792-6125  Main Building, Floor 10, near Elevator B, R10.1888, 713-745-7180  Mays Clinic, Floor 2, near The Tree Sculpture, ACB2.1930, 713-563-8222  

Release of Medical Information 713-792-6710 The Release of Medical Information is where you can obtain copies of your medical records. You must provide a signed Authorization for Release of Information form, available at the office.  Main Building, Floor 3, near Elevator D, Room B3.4362  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1613  

Social Work 713-792-6195 Social Work provides free short-term individual and group counseling and information on support groups, community resources (i.e. housing), advance directives (Medical Power of Attorney, Living Wills) and other special programs. Social Work is located at the following locations:  Main Building, Floor 2, near The Park, Room B2.4650  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.2135 Spiritual Care and Education 713-792-7184 Spiritual Care and Education offers spiritual support. All patients, family members and staff are welcome. Services include prayer, chapel services and sacramental ministry. Meditation/Prayer Rooms are located throughout the campus. There is a Muslim Prayer Room in the Main Building, Floor 3, near Elevator E. Two locations make it easy for you:  Main Building, Floor 1, near The Café Corner, Room R1.2800  Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1035

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Coping and Assistance During Chemotherapy Cancer can cause a lot of changes in the lives of patients and their loved ones, but it is important for you to know that you are not alone. There are resources at MD Anderson that can help.

Talk About Your Feelings Talking about your feelings can help decrease stress. Sometimes it is easier to talk to someone outside of friends or family. Social work counselors offer counseling to patients and their loved ones at no cost. Another option to think about is joining a support group. In a support group, the members are often going through similar things. This is where they share stories, concerns and helpful tips with each other. Call 713-792-6195.

Talk With Children Do you ever wonder how to talk with your children and teens about cancer? Giving them clear information can help them cope. The KIWI program (Kids Inquire, We Inform) offered by Social Work can provide you with information, support and resources. Call 713-792-6195.

Advance Care Planning Receiving chemotherapy can give you of time to think. You may wonder about what types of care you may or may not want, or who would make health care decisions for you if for some reason you are unable to make them for yourself. These things are important, and are important for you to document. Social work counselors can help guide you through this process. Call 713-792-6195.

Financial Concerns The financial impact of cancer can be stressful. Social work counselors can help you look for resources that offer help with housing, transportation and parking. Often, the hardest part is building up courage to ask for help.

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Child Visits MD Anderson has a child visitation room. It offers free short-term child care for children who are ages 2 months to 12 years. Toys, movies and video games are available. It is not meant for routine child care. Call 713-745-0577.

Caregiver Needs Providing care can be satisfying when you are meeting needs for the one you love. They would do the same for you if roles were reversed. It can also be difficult and tiring. Consider asking family and friends for help. Accept offers for help. Have a list of needs ready so you can you can give them specific tasks. Items may include: run errands, prepare meals, do housework, pay bills, take your loved one to an appointment or care for children after school. Services for caregivers: • Support groups: 713-792-6195 • Counseling: 713-792-6195 • Support from other caregivers through myCancerConnection. Call toll free 800-345-6324.

Relaxation Relaxation resources are available: •

Social Work: 713-792-6195 Social work counselors provide counseling at no cost. This helps with stress reduction, pain management and anxiety. Integrative Medicine Center: 713-794-4700 Works with your oncology team. Services include: diet counseling, massage and acupuncture. Group classes, such as yoga, tai chi and meditation are available at no charge. Patient and Family Library: 713-792-1080 Books (including foreign language books), magazines, newspapers, puzzles, audiobooks and CD players can be checked out. Main Building, Floor 1, near The Aquarium, Room R1.2212

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Appearance Information for Patients on Chemotherapy It’s important to take good care of yourself during your chemotherapy treatment. This includes your appearance. When you look your best, you feel better. When you feel better it may be easier to cope with cancer and chemotherapy (chemo). These resources may help you. Beauty/Barber Shop Main Building, Floor 6, near Elevator F, Room G6.3253 Hours are 7:30 a.m. to 4:30 p.m., Monday through Friday. All services are offered on a first come, first served basis. Come and get a shampoo, haircut, shave or scalp treatment. You may receive one free wig. Hats, scarves, turbans and bandanas for men and women are also provided (one per patient). "Look Good...Feel Better" program The “Look Good…Feel Better” program is free for women undergoing cancer treatment. It deals with coping with the appearance-related side effects of treatment. It is held the first Thursday of the month. For more information or to register call 713-792-6039. Appearances Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1502, 713-563-8200 Appearances is a retail shop. It offers special products and services such as breast prostheses and head coverings. Find sun protective clothing and clothing for mastectomy and surgery patients. They also have cosmetics and motivational materials.

Appearance Information for Patients on Chemotherapy The University of Texas MD Anderson Cancer Center ©1997 Revised 01/2014, Patient Education 0749

 

Pharmacy Patient Resources Patients who do not have enough insurance, have met their insurance limits or whose insurance will not pay for their medicine(s) may need help. Pharmacy Patient Resources (PPR) provides tools and guidance. They help with prescription prior authorizations that are filled at MD Anderson pharmacies and with the patient assistance programs. PPR staff are available at each of the MD Anderson pharmacies.  Main Building, Floor 2, near Elevator C, R-2 Clinic Pharmacy, R2.2315 8 a.m.-8 p.m., Monday through Friday 8 a.m.-6 p.m., Saturdays and holidays 8 a.m.-5 p.m., Sunday 713-792-6125  Main Building, Floor 10, near Elevator B, R-10 Clinic Pharmacy, R10.1888 8 a.m.-8 p.m., Monday through Friday Closed Saturdays, Sundays and holidays 713-745-7180 

Mays Clinic, Floor 2, near The Tree Sculpture, ACB 2.1930 8 a.m.-6 p.m., Monday through Friday Closed Saturdays, Sundays and holidays 713-563-8325 Bring your insurance card, tax return and social security statement.

Prior Authorizations Certain drugs and services must be approved by your insurance company before you can get them. This is called prior authorization. The goal is to make sure medicines and services are given correctly. A pharmacy resource specialist will call your insurance company for prior authorization. Sometimes they must fill out a form and fax it to the insurance company. This may take up to three days. If you are approved, you will get the medicine.

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If you are not approved, you have other choices:  You can appeal. Your doctor may write a letter or talk with your insurance company for approval.  Ask the resource specialist about patient assistance programs.  Pay for the drug.  Ask your doctor if your insurance will pay for a different medicine.

Insurance Appeals You may fill out the forms for an appeal if your insurance company denied your medicine. An appeal is a request for the company to change their mind. Appeals may take three to five days.

Patient Assistance Program Patient assistance programs give free or discounted medicines to patients who cannot afford them. These programs are sponsored by drug companies. Patients who do not have any insurance, reached their insurance maximums, or were denied coverage for medicines may qualify for help. Each drug company makes its own guidelines. Eligibility rules may differ. For example, companies may have different medical or income requirements.   The patient assistance program starts when you are denied a prescription by your insurance. You will be referred to a pharmacy resource specialist for help. The resource specialist helps you complete an application(s), get doctor signatures and collect paperwork. He or she will also help you submit the application. The decision process may take up to 7-10 days. Someone will call you once a decision has been made. A drug company may stop its patient assistance program for a specific drug at any time.

Expensive Medicines There are often new medicines so this list is not complete. These are examples of expensive drugs. Oral chemotherapy drugs: Abiraterone (Zytiga™) Apixaban (Eliquis™) Axitinib (Inlyta™) Capecitabine (Xeloda™) Crizotinib (Xalkori™) Dasatinib (Sprycel™) Enzalutamide (Xtandi™) Erlotinib (Tarceva™) Etoposide (Toposar™) Everolimus (Afinitor™) Imatinib (Gleevec™) Interferon (Intron A™) Lapatinib (Tykerb™)

Pharmacy Patient Resources The University of Texas MD Anderson Cancer Center ©2013 Revised 01/2014, Patient Education 3787

Lenalidomide (Revlimid™) Nilotinib (Tasigna™) Pazopanib (Votrient™) Pomalidomide (Pomalyst™) Regorafenib (Stivarga™) Sorafenib (Nexavar™) Sunitinib (Sutent™) Temozolamide (Temodar™) Thalidomide (Thalomid™) Topotecan (Hycamtin™) Vemurafenib (Zelboraf™) Vorinostat (Zolinza™)

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Growth factor drugs: Darbapoietin (Aranesp™) Eltrombopag (Promacta™) Epoetin (Procrit™) Filgrastim (Neupogen™) Pegfilgrastim (Neulasta™) Blood thinner drugs: Dalteparin (Fragmin™) Enoxaparin (Lovenox™) Fondaparinux (Arixtra™) Rivaroxaban (Xarelto™) Tinzaparin (Innohep™) Antibiotic/Antifungal/Antiviral drugs: Linezolid (Zyvox™) Oral Vancomycin (Vancocin™) Posaconazole (Noxafil™) Voriconazole (Vfend™) Other drugs: Demeclocycline (Declomycin™) Hydromorphone (Exalgo™) Sirolimus (Rapamune™) Tolvaptan (Samsca™)

Additional Resources For more information:  Call the Pharmacy Patient Resources helpline at 713-563-4965.  Pick up a “Pharmacy Patient Resources” brochure at an MD Anderson pharmacy.  Go to www.needymeds.org  

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Outside Organizational Resources American Cancer Society 800-227-2345 http://www.cancer.org Not-for-profit organization that supports cancer research. Offers patients and their families educational programs, support groups and free booklets. CanCare of Houston, Inc. 713-461-0028 or 888-461-0028 http://www.cancare.org Cancer support network made up of cancer survivors and family members of cancer survivors. CancerCare 800-813-4673 http://www.cancercare.org This non-profit agency provides free emotional support, information and practical help. This agency also offers online teleconferences, referrals to support services and other services. Caregiver.Com http://www.caregiver.com info@caregiver.com Online newsletters and discussions for caregivers. Produces “Today's Caregiver” magazine. Centers for Disease Control http://www.cdc.gov/cancer/ National agency that works with other groups supporting efforts to prevent and control cancer. Crisis Hot Line 713-228-1505 (English) or 713-526-8088 (Spanish) A 24-hour confidential telephone counseling service for emotional or stress-related problems. Staffed by trained volunteers. Hospice Foundation of America 800-854-3402 http://www.hospicefoundation.org Provides information on terminal illness, death and the process of grief and bereavement.

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LIVESTRONG Foundation 866-965-7502 http://www.livestrong.org Non-profit organization provides reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility. Website also covers survivorship topics on the physical, emotional and practical issues of cancer.

National Cancer Institute 800-422-6237 http://www.cancer.gov/ Part of the National Institutes for Health, NCI provides information for all cancer types. National Coalition for Cancer Survivorship 888-650-9127 http://www.canceradvocacy.org/ Answers questions and directs callers to local groups and individuals. Offers information on legal issues and discrimination. Patient Advocate Foundation 800-532-5274 http://www.patientadvocate.org Serves as a liaison between patients and their insurer, employer and/or creditors. Helps resolve insurance, job retention and/or debt crisis matters. United Ostomy Associations of America 800-826-0826 http://www.uoaa.org Dedicated to complete rehabilitation of all "ostomates." United Way Help Line Houston Dial 2-1-1 Volunteers provide 24-hour telephone referral to appropriate agencies/services. Visiting Nurse Association of America 800-426-2547 http://www.vnaa.org Provides information on all aspects of home health care.

Specific Cancer Types Most cancer types have a specific organization with resources. The Learning Center at MD Anderson creates pathfinders for specific cancer types and subjects. Pathfinders contain references to print, video and online resources. To find a pathfinder for your type of cancer, visit The Learning Center at www.mdanderson.org/TLC.

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Chemotherapy Guide The University of Texas MD Anderson Cancer Center Š2015 Revised 11/2015, Patient Education


Chemotherapy Guide