About Chemotherapy
Carolyn
Hi I'm CAROLYN
Margaret
…and I'm MARGARET.
This is the London Regional Cancer Program's virtual experience for chemotherapy. If you're watching this, it's likely that you or someone you love has been diagnosed with cancer and chemotherapy has become a part of the treatment plan.
Carolyn
You probably have a lot of questions before starting treatment. I did. I wanted to know who'd be involved in my care, how chemotherapy works and what I might feel and experience during treatment.
That's why we wanted to be a part of your journey, to give you answers to these types of questions and to share what we've learned from our experiences at LRCP.
Margaret
You may be feeling overwhelmed by your emotions as you prepare to begin your treatment. It's our hope that this experience can make you more familiar with LRCP and more comfortable with the journey ahead.
I may look familiar. I'm a volunteer at the clinic, and not long ago, myself and a friend of mine Judy, helped by telling you what to expect on your first visit. If you missed it, I highly recommend going back through.
Carolyn
For now, we're going to talk openly about chemotherapy, how to prepare for treatment, and possible side effects. We'll also introduce you and your family to some of the helpful resources you can use during, and after treatment.
If this is your first time through with us, it's important that you watch the whole thing. If you've already viewed this orientation, you can skip ahead.
Margaret
Oh. There's Myra. Excuse me one second.
Carolyn
Myra's a chemo nurse at the clinic.
What Is Chemotherapy
Carolyn
Hey Myra
Myra
Hi Carolyn.
Hi, I'm Myra - a chemotherapy nurse here at LRCP.
Chemotherapy is a drug or combination of drugs that are used to treat cancer, the goal being to destroy cancer cells. It's possible that healthy, normal cells in the area can be damaged too - this is why you may experience some side effects which we'll talk about more in the section called "managing your health".
Sometimes we'll use chemotherapy together with radiation or surgery to achieve the best results possible. You can learn more about radiation therapy in the radiation therapy section of this virtual tour.
How Does It Work?
Carolyn
I have a video here about how chemotherapy works.
Chemotherapy, often referred to as Chemo, is a systemic treatment, which means it travels through your whole body. Chemotherapy tries to slow or stop the growth of cancer cells.
Myra
Chemotherapy can be given a few different ways, including an IV line - which is when a small needle is inserted into the vein. It can also be given orally in pill form or sub-cutaneously which is when an injection is given under the skin. If you already have a PICC line it may be used for your treatment. Another way it's delivered is through a "port-a-cath". Your healthcare team will talk more with you about how your chemotherapy will be delivered.
Carolyn
Thanks Myra
Myra
Your so welcome. It's a pleasure to meet you and I'm sure we'll see each other again.
Your Healthcare Team
Carolyn
Oh I see Dr. Richardson is here, wonderful. I asked her to stop by and say a few more words about your healthcare team.
Dr. Richardson
Hi, I'm doctor Richardson, it's nice to meet you.
So up until now, you've worked closely with your family doctor to monitor your health and he or she will still play a role in your care if you have health concerns that are not related to cancer, such as a heart condition or diabetes. But to ensure that you get the proper care during treatment, your healthcare team will now grow to include specialists in cancer care.
I'm a medical Oncologist, that's a doctor who specializes in caring for people with cancer. Chemotherapy nurses will teach you how to care for yourself, to manage side effects and they administer your chemotherapy. You'll recognize them in their blue uniforms. They have specialized training to give chemotherapy.
You'll also meet a few clinic nurses who you'll see during your clinic appointments once a week. Just like a chemo nurse, they check how you're feeling and suggest ways to cope with side effects.
A pharmacist will provide drugs prescribed by your oncologist and answer any questions or concerns about your medications.
There are booking clerks that look after scheduling your appointments and they'll be the first face you see when you check in at chemotherapy reception.
Students are the future of cancer care, and LRCP is proud to be a teaching hospital. You may have a student involved in your care, learning from LRCP medical professionals.
Carolyn
Here at the cancer centre, volunteers will also help to make you more comfortable during your visit. If you have questions, just ask. Other important members of your healthcare team include social workers, dietitians, and spiritual care specialists.
You'll learn more about their involvement later on in this tour.
Members of your healthcare team are experts in cancer care, but you know yourself better than anyone - so be sure to let them know how you're feeling and ask questions along the way.
Be open and honest with your team - it's one of the best ways you can contribute to your care.
Doctor, thank you so much.
Dr. Richardson
It was nice to meet you. I'm sure I'll see you again.
Care Closer To Home
Margaret
Driving to and from London for treatment can be tiring and difficult to plan even with supportive friends and family.
Whenever possible, LRCP works with their regional partners to bring your cancer care closer to home. If you're receiving your chemotherapy at one of the community clinics, your first visit will be at LRCP. An oncologist at LRCP will plan your treatment, and your local healthcare team will take it from there.
Care received in community hospitals is the same care that would be received at LRCP.
Chemotherapy is available in Woodstock, St.Thomas, Wingham, Stratford and Owen Sound.
Clinical Trials
Dr. Richardson
Hi there, I'm going to tell you a little bit about clinical trials.
Clinical research plays a vital role in the fight against cancer.
LRCP is an academic setting and is actively involved in clinical trials. Clinical trials are research studies that involve people. They help to answer questions about what is the best way to treat cancer, how to catch and diagnose cancer early on, and how to manage side effects. Clinical trials are the last step in a very long research process. All common treatments that are used to fight cancer are the result of past successful clinical trials.
If you're a good fit for a clinical trial that is happening at LRCP, you may be approached by a clinical research associate. They'll tell you more about what the clinical trial including the risks and benefits. The benefit of participating in a clinical trial is receiving a treatment that otherwise wouldn't be available. A possible risk of joining a trial is unexpected side effects. Again, these are things that'll be discussed with you, your family, research associate and your doctor.
Don't be afraid to ask questions. The final decision about whether you want to take part in a clinical trial is always up to you.
Margaret
Thanks Dr. Richardson.
Dr. Richardson
You're very welcome.
Margaret
Carolyn's waiting for us over at the library lets head over there.
Preparing For Treatment
Carolyn
Getting ready for your very first treatment can be a worrisome time because the chances are you don't know what to expect. Everyone will need to do different things to prepare, but there are a few tips I can share to help you get started.
You may be experiencing a whole mix of emotions. You may feel scared, worried, or angry- just know that these are common feelings and this is all normal. When I was about to start treatment, I was scared and my mind was overflowing with questions. You are not alone in feeling this way and your healthcare team will be there to support you.
There will be many changes to your day-to-day life which you may have noticed already. Some of these changes can affect your family's routines as well. Listen to your body, and rest when you need to. When it was time for me to rest, I turned off my phones and let my family know not to disturb me.
Don't be afraid to ask for help from those close to you, or accept the help that's offered. I found it helpful to create a list of things that I could use help with, so that way, when people called and asked what they could do - I was ready with an answer. I included things like grocery shopping, preparing meals, driving me to an appointment, or help with chores around the house.
Margaret
Some people will want to know everything about their treatment, whereas others can become overwhelmed with too much information. Let your healthcare team know how much detail to give you.
Your "My Care Binder", which you'll receive at your first visit, is a good place to start. Use this binder to keep yourself organized to keep notes, keep track of your appointments and to hold all of the information you collect along the way.
If you don't have a friend or family member available to drive you to and from treatment, consider contacting the Canadian Cancer Society to arrange for a volunteer driver. With three business days notice, the CCS can provide free transportation to and from your appointment.
If you're a caregiver and watching this guide, don't forget take care of yourself too. Long days spent driving to and from appointments, talking to the healthcare team, keeping track of medications and caring for your loved one can be difficult, so be mindful of your own health along the way.
Oh there's Meredith a clinic nurse, she can tell us how long your treatments will take.
Carolyn
The last tip I can share with you as you prepare to start treatment is to notice the improvements, even if they are small and to focus on things that make you feel good.
How Long Will It Take?
Margaret
This is Meredith, she's a clinic nurse at LRCP. Meredith can you tell us a little more about how long we can expect treatments to take?
Meredith
Yes. Hello. It's nice to meet you. I can't tell you how long you'll spend at the hospital on each treatment day because it's different for everyone. The length of your treatment will depend on many things, including the type of cancer you have, the type of chemotherapy being given and how you are responding to treatment. What this means is that everyone's situation is unique and only your doctor can tell you how long it will take. What I do recommend is to keep your treatment days free of other obligations.
Margaret
That's great, thanks Meredith.
What To Bring
Carolyn
Great you brought your bag. Let's open it up and take a look and make sure you have everything you need.
Margaret
For all of your appointments, make sure you have your health card with you. Also bring all of your medications in their bottles or containers so that your healthcare team knows exactly what you're taking. This includes vitamins, minerals, and herbal supplements as well.
On treatment days you could be at LRCP for several hours so if you need any medication for non-cancer related issues, bring these with you. It's also a good idea to bring your 'My Care Binder' there's room in here to write down questions, track of your appointments, and keep all of your contact information. You may also want to read through some of the sections while you're waiting.
If you have private insurance, don't forget your drug plan information including your group or policy number.
Bring cash or a debit or credit card for expenses including medications, parking, food. You are allowed to bring food in from home to the chemotherapy suite at LRCP, but please make sure the food is not too spicy or greasy, and that it doesn't have a strong smell as this can make many patients feel nauseous.
If you need reading glasses or mobility aid, please bring this with you to. There are wheelchairs available at the front entrance to LRCP if needed.
The treatment room is quite cold, so we welcome you to bring in a blanket from home to keep you warm. It's also a good idea to dress in layers, so you can be comfortable while you receive chemotherapy treatment.
That's great, it looks like you have everything you need.
Who To Bring
Carolyn
Now that you know what to bring, let's talk about who to bring. James over here is a volunteer and he's going to help us out with that.
James
Hi, it's a good idea to bring a friend or family member with you to treatment. This person can provide company as well as support. They can help ask questions and keep track of important information.
You can have one visitor in the chemotherapy suite with you at a time, but they can feel free to swap in and out. This person must be over 16 years old, since the chemotherapy suite is not a safe place for children.
Together you can listen to music, read a book or a magazine, play a game or watch a movie on an ipad or laptop.
You'll need someone to drive you to and from your treatments. If a family member or friend is not available to do so, then contact the Canadian Cancer Society about arranging for a volunteer driver.
Margaret
Thanks James.
James
You're very welcome.
Treatment Day
Carolyn
On treatment day, you'll use the level two entrance. When you're going through chemotherapy, your immune system is really weak so it's important to wash your hands a lot especially when you enter the cancer centre. It's one of the best ways to protect yourself from getting sick.
Follow me, and I'll show you where you check in.
Checking In
Carolyn
And we have arrive at reception. This is where you check in.
Receptionist
Hi there, your healthcard please.
Now that we have you checked in, please fill in this assessment form and here are some blood work slips.
Take this pager with you, it will buzz when we are ready for you.
You're welcome to take a seat.
Carolyn
Using a pager helps protect your privacy it also lets you walk around the centre while you're waiting. Let's sit down.
Understanding Your Bloodwork
Carolyn
Before you get your chemotherapy a nurse will do some blood work to measure your blood counts. They'll do this every time you come in for treatment. I'll wait for you here.
Merideth
Hello, come in, have a seat.
These blood counts measure your white blood cells, which help fight off infection, your red blood cells, which help carry oxygen around your body, and platelets, which helps your blood clot and heal wounds.
Chemotherapy gets into the bone marrow and may lower these blood counts which puts you at a higher risk for infection.
We take measurements to make sure you are well enough for treatment. If not, your treatment may be delayed to give your body more time to heal.
The greatest risk for infection is 7 to 14 days after each treatment - that is when your white blood cell count is the lowest.
This is the lab at LRCP. If you'd like to have blood work done at an outside lab please talk to you healthcare team.
I will look at your lab results to make sure you're ready for treatment.
The Treatment Room
Carolyn
…and they're ready for you. I'll take your pager and let's go meet your nurse.
Chemo Nurse
Hi there, may I have your name and date of birth please.
Carolyn
They're going to ask you that every time you come for treatment so that they can be one hundred percent sure they're giving the right chemotherapy drugs to the right person.
Chemo Nurse
Now, before we head inside, I'll ask you to clean your hands at this hand-sanitizing station. I'd also like to remind you that this is a scent-free area. Strong scents can make some of us feel quite ill, so we'll ask you to wash off anything with a heavy scent.
Ok so common with me, we'll get you all seated, have a little chat. Have a seat right over here, and I'll sit right here beside you.
Before we get started with your first treatment, there are a few things I'd like to talk to you about. Everyone will have a different treatment plan, depending on the type of cancer you have and the goals of your treatment.
Today is considered day one of your first cycle. Now, after today, you'll have 21 days to rest before your next cycle begins. What this does is it gives your body a chance to heal and recover in between treatments.
You may have been given some medicine before today's treatment to help prevent nausea and I want to remind you that if you are thinking about trying an alternative treatment, such as taking vitamins, or minerals or herbal supplements, you need to talk to your team first - some of these things can interfere with your treatment.
Now, before I begin your treatment, a pharmacist Kelly has a few questions for you. Comon in Kelly.
Kelly
Hi there. My name is Kelly.
At each of your visits, an LRCP pharmacist, like myself, will check your chemotherapy orders to ensure you're receiving the correct dose based on your height and weight. Our team of Pharmacy Technicians will prepare chemotherapy drugs that were specifically ordered for you.
I'll need to know what drug allergies you may have, your drug plan information, and what pharmacy you normally go to.
When you've finished your treatment, come see me at the LRCP pharmacy down the hallway to pick up your take-home medications.
I'll tell you more about those medications after your treatment. I'll see you soon.
Myra
Thanks, Kelly. Hi nice to see you again.
I can't stress enough that you're only job today is to check in with your body, and let us know if you start to feel any differently. What I mean by that, lets say for example, you start to feel back pain, chest pain, or a headache, tell us immediately for you might be having a reaction to the chemotherapy.
If you're receiving treatment through an IV, you going to feel the prick of the needle, but the area where the needle is inserted shouldn't give you any grief at all - and what I mean by that, is that it shouldn't burn or sting. If you feel any irritation around that site, please let any of us know.
You can see that the chemotherapy nurses work as a team, so feel to talk to any of us. I'd like to just start your IV and then we'll talk some more. Great.
While you're here with us today, you're going to hear lots of beeps around you – don't worry about this, we're always close by making sure everything is working properly.
I see that you dressed in layers, which is great – you probably noticed when you walked in this room that the chemotherapy suite is a lot cooler. There a few different reasons for this, one of them being that it can help prevent nausea.
You look comfortable and your chemotherapy has started, so I'll come back and check on you in a little bit.
Patient #1
It sounds like this is your first treatment. Just like your nurse said, don't be afraid to ask questions or let them know if you feel any differently. They may look busy, but they'll always want to make sure you are well taken care of.
I also found the volunteers help you to feel more comfortable by bringing you a warm blanket or even a drink.
Myra
Great, your chemotherapy is all done now. I'm just going to disconnect that IV.
It's very important for you to monitor your temperature from now on. So if you have a fever that's greater than 38 degrees celsius or higher, that's your body's way of telling you that you have an infection going on and that shouldn't be taken lightly. We'll talk more about what to do if you have a fever a little later on.
Make sure you drink plenty of fluids and listen to your body – rest when you need to.
Take care and let me show you the way out.
Picking Up Your Medication
Carolyn
Ok let's head over to the pharmacy and pick up your medication.
The LRCP pharmacy is open from Monday to Friday, from 9am to 5pm. Most of the medicines given in the chemotherapy suite are covered by OHIP, but not always. Your doctor will let you know if this is the case.
Since this will be your first visit to the pharmacy, a pharmacist will want to review all of your medications with you.
I think she's ready for us.
Kelly
Hi, common in.
Your prescriptions are ready to go, but before you leave, I'd like to take some time to go over the medications your oncologist has prescribed for you.
After you receive your chemotherapy, there are some other medications that you're responsible for taking at home. These medications are usually to help with side effects. Everyone will have to take different medicines with different instructions - it all depends on the type of cancer you have, your overall health, and other factors. Many people will receive prescriptions for anti-nauseants. Anti-nauseants are a type of drug that help reduce or prevent nausea and vomiting.
I am going to give you a personalized chemotherapy calendar so you remember when to take your pills. Beside each day on the calendar there are pictures showing which pill to take. I will write down the exact dates on your calendar. It's important to follow your calendar because the medications work best when taken correctly. I am also going to give you drug information sheets for each of the pills you've been prescribed. These sheets will explain what the drugs are for as well as listing some of the common side effects you may experience.
If there's something you're still not sure about, please ask someone at the pharmacy, or a member on the healthcare team. Keep the information I gave to you today, such as the chemo calendars and drug information sheets handy. Your care binder is a good place to store them.
If you run out of your medicine and you have a refill on your prescription, you can re-order more by calling the LRCP Pharmacy. If you ran out of re-fills, you will need to call the Triage Nursing Line to order more. Both of these phone numbers are listed on the contact page in your Care Binder.
The last thing I should mention is that if you have any questions about paying for your medication, we will have a Drug Access Facilitator who can help you understand your drug coverage options. If you open up your binder to the section called 'Finances', you'll find more information about drug coverage and the Drug Access Facilitator.
Let's go back to the pharmacy desk so I can get you your medications.
Managing Your Health
Carolyn
Now I'm going to show you the kiosk.
Emma
Hi, I'm Emma.
Before each clinic appointment, which is when you will meet with a nurse or your oncologist, you'll be asked to use this touch screen kiosk. This kiosk will ask you some questions about how you're feeling on that day. Your healthcare team reviews your answers each time. They may make suggestions on how to cope with a certain side effect, make changes to your medications, recommend other supports, or introduce other healthcare professionals to your team.
If you're unsure how to use the kiosk, a volunteer like myself will be here to help.
Carolyn
Thanks Emma.
Now it's really important to learn how to manage your side effects. In a moment we will meet with a clinic nurse who can tell us more about that. Follow me.
You can have a seat right here and we'll wait for her.
Common Side Effects
Meredith
Hello, come with me. Right in here. Have a seat.
Chemotherapy targets cancer cells but sometimes healthy cells are also damaged. This is why you may experience side effects.
Based on the type and amount of treatment you're receiving and your overall health, your health-care team will explain which side effects you are most likely to experience and suggest ways to manage them.
Some common side effects include fatigue, nausea, vomiting, hair loss and changes to your appetite. Another side effect you may experience is memory changes, which some people often call "chemo brain" or "brain fog." Side effects can start at any time during your chemotherapy. Fatigue, or feeling more tired than usual, is a common side effect and is usually present throughout treatment. It can leave you feeling like you don't have enough energy to do the things you want, such as socializing with your friends or going to work. Track your energy levels, and plan your day around when you have the most energy. Try not to overload your day, and prioritize what needs to be done. When you are tired, the last thing you want to do is exercise, but the odd thing about fatigue is that the more you rest, the more tired you will feel. Incorporating some light exercise into your day can increase your energy level and help you sleep better at night. My last tip for managing your fatigue is to ask for help when you need it.
There are certain side effects that you may experience while receiving chemotherapy that require more urgent attention. For instance, signs of infection, such as a fever or a temperature over 38 degrees, need to be reported to a healthcare professional right away. If it's between 8:30 and 4pm on a weekday, call the Telephone Triage Nursing Line and an LRCP nurse will let you know what to do. If it is after hours or on a weekend or holiday, call your family doctor if he or she is available at that time, or visit your nearest emergency department. Tell the staff that you're being treated for cancer and show them your fever card.
Read over the list of times when you should call for help which is right at the front of your 'My Care Binder. Your nurse will go over this with you as well. We don't want to scare you, but it's important to get the right help when you need it.
Telephone Triage Nursing Line
If you aren't sure if what you're feeling is considered normal, or if you've noticed a change in your condition, call the triage nursing line and follow the instructions to speak to a nurse. The line is open weekdays 8:30 to 4pm.
I'll show you back to the waiting room.
Margaret
There's another service at the centre that I think you'll find very useful. Come with me, I'd like to show you supportive care.
Carolyn
And this is where I leave you. It was lovely to meet you and I wish you well.
Margaret
Follow me.