From time to time, I’ll share some of the most frequently asked questions I receive because I’ve found that so many of us share the same concerns. I hope you’ll add to this dialogue.
When chemotherapy is the recommended course of cancer treatment, the most pressing question many patients and caregivers share is, “What will chemo be like?” For most of us, the first treatment is the most daunting: we cannot imagine what chemo feels like, how we will respond and how our loved ones will react. If we take our cues from TV or movies, we might imagine that the first chemo is dramatic – one suddenly goes bald and is confined to bed, with a team of worried doctors and nurses hovering nearby.
The reality of most chemotherapy is far less dramatic and far more manageable than these hospital dramas would have us believe. Many patients remain independent and active throughout the course of chemotherapy; a great many patients continue working during chemo. Treatment schedules generally become predictable and after-effects can be anticipated.
Although no two treatment plans are precisely the same and no two individuals experience precisely the same side-effects, most patients find their introduction to chemotherapy manageable if they have a good understanding of what to expect – and if they prepare for it. An individual’s experience throughout chemo will be affected by several things, including his general level of health before beginning treatment, and especially how well he protects his health during treatment. In all cases, the chemo will progress more smoothly if patients and their caregivers ask the physician and nurse what to expect.
Some patients receive chemotherapy treatments by regular appointment in clinical settings, such as their oncologist’s office, an out-patient clinic, or a cancer treatment center. These settings are more often like your living room than a hospital room, with patients situated in comfortable recliners. Patients read, nap, do needlework, watch movies or TV, and chat with friends and fellow patients while undergoing treatment. Family caregivers may be able to stay with your loved one throughout each treatment. Some patients receive chemo through port or catheter implants;the port is round and disc-like that allows easy access via a single needle stick, the catheter is a soft, thin tube that that allows health care professionals to draw blood and deliver chemotherapy drugs into a vein without having to insert an IV needle each time. Some patients receive chemo by injection; others receive it by an oral dosage. With some cancers, topical or implantable chemo is required. Caregivers, especially, should ask medical staff specific questions about how to manage each form of chemo; healthcare professionals can give you detailed instructions, for example, about how to clean chemo infusion areas and to recognize any signs of infection.
Chemotherapy battles cancer cells progressively, which means their side-effects are progressive as well. But some symptoms may be experienced – and controlled – right from the start. Physicians may administer chemotherapy resistance testing before chemo begins to determine the right mix of drugs for the individual’s particular form of cancer. Medications can be prescribed pre-chemotherapy to control symptoms that may occur during infusion.
One of the most noticeable first side-effects is fatigue. Caregivers should expect their loved one’s energy level to drop. Your doctor should be able to help you gauge when the fatigue level will be highest, although most patients learn very quickly when their energy will ebb and when it will revive, and they plan their lives accordingly. Plan to provide rides to and from chemo treatments. Encourage your loved one to get as much rest as possible before the first treatment, and as much rest as needed throughout treatments.
Nausea is one of the most dreaded symptoms of chemo. Enormous strides have been made in curbing chemo-related nausea. Some patients will experience nausea right from the start; some patients will never experience it. Anti-nausea medications are widely prescribed, and you should discuss these options with the physician before treatment begins. Patients can help themselves by limiting meal sizes and by avoiding foods (even old favorites) that now upset their stomachs. Many patients find that the taste of their favorite foods changes during chemo; that certain smells (food, cologne, coffee) have a strongly negative effect on them during chemo; and that their appetites change too. Small, well-balanced, frequent meals are usually the best course.
Pain in the bones is another common occurrence, and some patients will feel it from the start. Physicians can take some active measures to control your pain and manage these side-effects. Your loved one may need to limit certain kinds of exercise as a result, but exercise during chemotherapy is possible and important. Ask your physician before your loved one undergoes any sort of deep-tissue massage.
Hair loss – perhaps the most visible manifestation of chemo – occurs for some patients, but certainly not all. Most hair loss occurs within two weeks of the first treatment. Your physician or staff can help you predict whether hair loss is likely and recommend salons that might help your loved one manage the effects of partial hair loss, or direct you to companies that provide comfortable wigs. (Be prepared that these wigs are not cheap, so check in advance if your insurer will help you with costs.) When hair loss is expected, many patients find it simpler just to have their heads shaved before treatment begins. Some patients are emotionally prepared to lose the hair on their head, but have not contemplated losing hair elsewhere, such as their eyelashes. Knowing what to expect will help you and your loved one adapt.
It is very important to note that the absence or presence of a side-effect has no bearing on how well the chemo is working.
You should expect to make some adjustments in your routine from the start of your chemotherapy. While most chemo patients are not confined to their homes or hospitals, they will be encouraged to avoid crowds and crowded places (especially during the height of flu season). Their immunity will be lowered, and doctors will want them to stay healthy so that treatments are not interrupted by flu or colds. Caregivers and their loved ones should get in the habit of carrying hand sanitizers (which is a good measure for all of us). Some normal grooming habits may need to be adjusted or temporarily suspended (such as manicures, pedicures). There may also be restrictions on eating fresh fruit and vegetables or contact with flowers and plants during the course of chemotherapy.
While plenty of what-to-expect online resources exist, the best method of preparation is to compile a list of your specific questions and ask your physician.
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