VENTURACOUNTYHEMATOLOGYONCOLOGYSPECIALISTS

(VCHOS)

PATIENTGUIDEFORCANCERTHERAPY

1700NROSEAVENUE 2900LOMAVISTAROAD 500PASEOCAMARILLOSUITE320OXNARD,CA93030

SUITE200VENTURA,CA93003

SUITE106CAMARILLO,CA93010

P(805)485-8709F(805)485-5521

P(805)643-4283F(805)643-0604

P(805)383-1567F(805)383-1569

www.venturaoncology.com

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TableofContents

HowtoReachUsWhenYouHaveQuestionsorConcerns...............................................................3

WhatYouShouldKnowBeforeYourTreatment.................................................................................5

TreatmentScheduling....................................................................................................................................6

OralDispensingInformation........................................................................................................................6

PriorAuthorizationsandMedicationCoverage...................................................................................6

ExpensiveCopays,Appeals,FinancialAssistance...............................................................................7

SafeStorageandDisposalofCancerMedications...............................................................................8

ManagingTreatmentSideEffects................................................................................................................9

NauseaandVomiting.........................................................................................................................9

Diarrhea...................................................................................................................................................9

Constipation…....................................................................................................................................10

MouthandThroatChanges..........................................................................................................11

LowBloodCellCounts...................................................................................................................12

Anemia....................................................................................................................................12

Neutropenia..........................................................................................................................12

Thrombocytopenia...........................................................................................................13

HairLoss......................................................................................................................................................14

SkinandNailChanges...................................................................................................................14

NerveChanges..................................................................................................................................15

Fatigue..................................................................................................................................................15

Infection...............................................................................................................................................16

SideeffectsofImmunotherapy..................................................................................................17

SexualandFertilityChanges........................................................................................................19

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ManagingyourCancerCareDuringanEmergency..........................................................................20

AdvanceDirectives.........................................................................................................................................21

Resources............................................................................................................................................................22

FrequentlyAskedQuestions........................................................................................................................24

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HowtoReachUsWhenYouHaveQuestionsorConcerns

Ifyouhaveamedicalemergencythatrequiresimmediateassistance,pleasecall911.ForQuestionsDuringOfficeHours:8:00am–5:00pm,Monday–Friday

Ifyouneedtospeakwithanurseorphysicianduringofficehours,pleasecall(805)485-8709.

Thenurses’stationextensionforIVinfusions/injectionsis136.

Thenurses’stationextensionfororaltreatmentsis123.

Ifyoureachthenursesvoicemail,thenursesareassistinganotherclient.Pleaseleaveabriefmessagewithyournameandphonenumber,andthenursingstaffwillreturnyourcall.Thevoicemailischeckedeveryhourduringtheday.

Fornon-urgentquestions,youmayemailthenursingstaffatnurse@venturaoncology.com.Thisemailaddressisalsocheckedeveryhourduringbusinesshours.

ForUrgentMedicalIssuesAfterOfficeHoursoronweekends:

Youmaycontacttheon-callphysicianbydialing(805)485-8709andenteringoption1.

ForPrescriptionRefills:

Ifyouneedaprescriptionrefill,pleasecheckwithyourpharmacy.Refillsmayalreadybeavailable.Ifnot,yourpharmacywillcontactyourphysicianonyourbehalf.Pleaseallow48hoursforprescriptionrefills.

Torefillmedicationsfilledatourin-housedispensary,pleasecallLisaDayatext126

Painmedicationrefillsrequireaspecialprescriptionandcannotbecalledintoapharmacyorfilledafterhoursoronaweekend.Pleaseallowadequatetimeforrefills.

pg. 4

ForQuestionsRegardingAppointmentScheduling:

Pleasecontactyourphysiciancoordinatoratthefollowingextensions:

Physician

PatientCareCoordinator

Extension

Dr.Kong

GracieA

220

Dr.Chang

KeriR

252

Dr.Dalsania

LisaG

273

Dr.Yates

Vanessa

253

Dr.Mortazavi

JC

283

PA/NPcoordinator

222

ChemotherapyCamarillo

Erica

128

ChemotherapyOxnard

Ashley

113

Chemotherapy

Ventura

Marisol

215

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WhatYouShouldKnowBeforeYourTreatment

Therearemanydifferenttypesoftreatmentsthatcanbeusedtotreatcancer.Inadditiontochemotherapy,immunotherapy,targetedtherapy,andhormonetherapymayalsoberecommended.Cancertreatmentcomesinmanyformsandcanbegivenintheseways:

• AnIV(intravenously)inyourarmorthroughacentralline,suchasaport-a-cath• Ashotintoyourmuscleorotherpartofyourbody• Apillorliquidthatyouswallow• Acreamthatisrubbedonyourskin

Chemotherapyisacancertreatmentthatusesdrugstodestroycancercells.Itisalsocalled“chemo.”Chemotherapycanbeusedtodestroycancercells,stopcancercellsfromspreading,orslowthegrowthofcancercells.Immunotherapyisatypeofcancertreatmentthathelpsyourimmunesystemfightcancer.Someimmunotherapytreatmentshelptheimmunesystemstoporslowthegrowthofcancercells.Othershelptheimmunesystemdestroycancercellsorstopthecancerfromspreadingtootherpartsofthebody.Immunotherapytreatmentscanbeusedaloneorcombinedwithothercancertreatments.

Hormonetherapiesareusedtotreatcancersthatusehormonestogrow.Targetedtherapyisatypeoftreatmentthattargetsthechangesincancercellsthathelpthemgrow,divide,andspread.Targetedtherapymaybegivenalongwithchemotherapyandothertreatments.PersonalizedCancerMedicine.Youmayhaveheardtheterms"personalizedmedicine."Thismeansyourmedicaltreatmentisbasedonyourgenesandyourspecificdisease.Manycancersaffectorinvolvespecificgenes.Personalizedcancermedicineoftenhasfewersideeffectsthanothertypesoftreatmentbecauseitisdesignedtobemorespecifictoyourcancer.

ClinicalTrial.Aclinicaltrialisaresearchstudythatinvolvesvolunteers.Manycancerclinicaltrialsarelookingforabetterwaytotreatcancerbyfindingasafer,moreeffectivewayofdestroyingcancercellsandkeepingthemfromcomingback. Radiationtherapyistheuseofhigh-energyx-raysorotherparticlestodestroycancercells.Ifradiationisrecommendedinyourtreatmentplan,youwillbereferredtoaRadiationOncologistinanotheroffice.

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TreatmentScheduling

Youmaygetchemotreatmenteveryday,everyweek,oreverymonth.Yourtreatmentscheduleandyourinfusiontimemayvarydependingonwhatchemotherapydrugsyourphysicianorders.Thenursingstaffwillreviewyourchemotherapyregimenandsideeffectsatyourfirstappointment.

WhattoExpectDuringYourInfusionTreatment

TherearethreeDignityHealthinfusioncenterswhicharemanagedbythephysiciansatVCHOSandarelocatedinCamarillo,OxnardandVentura.Alloftheinfusioncentersareequippedwithrecliningchairs.Youarewelcometobringreadingmaterialsand/orsmallelectronicportabledevicessuchasiPodsorportableDVDplayers.Asacourtesytoothers,weaskthatyouuseheadphoneswithelectronicdevicesandlimitcellphoneusetonecessaryphonecallsonly.Foryourconvenience,weofferjuicesandcrackers.However,youarewelcometobringfoodandsnackswithyou.Oral(Pill)DispensingInformation

Foryourconvenience,weofferoraldispensingservicesformanyofthemedicationsourphysiciansprescribe.Weacceptavarietyofprescriptionplansandwillbillyourinsurancepharmacybenefit.Theco-paywechargewillbethesameasiftheprescription(s)werefilledatanylocalpharmacy.Foryourconvenience,wewillsynchronizerefillswithyourofficevisitswheneverpossible.Forourpatientswithoutprescriptionbenefits,weoffercost-savingpricingonmanyofourprescriptions.

PriorAuthorizations&MedicationCoverage

Somemedicationsourphysiciansprescribemayrequirepriorauthorizationfromyourinsurancecompany.Nomatterwhichpharmacyyouchoosetoutilize,wewillneedtocalltheinsurancecompanyforauthorization(permission)beforeyourinsurancewillpayforthatmedication.

Occasionally,yourlocalpharmacymaygetamessagefromyourinsurancecompanystatingthedrugisnotcovered.Inmanyoftheseinstances,asimplepriorauthorizationisallthatisrequired.Sometimes,yourdoctorwillneedtochangethemedicationtoanothermedicationthatiscoveredbyyourinsurance.

Ifyourprescriptionneedsapriorauthorization,yourpharmacyshouldcallustoletusknow.Obtainingapriorauthorizationmaytakeseveraldays.Insomeinstances,approvalfromtheinsurancecompanyisgivenoverthephoneimmediately.Ineithercase,whena

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priorauthorizationisgranted,wewillcallyourpharmacytoletthemknowtheinsurancewillpayandwewillcallyoutotellyouthemedicationhasbeenapproved.Youwillmorethanlikelyreceivepaperworkinthemailfromtheinsurancecompanyinformingyouofthedecision.

Appeals

Theremaybetimeswhenyourinsurancecompanywillnotapproveamedicationanddenythepriorauthorizationrequest.Atthispoint,ifthedoctordeemsitnecessary,wewillinitiateanappealforthedenial.Thistimeframetendstobeabitlengthier.Sometimesanappealcantakeamonthorlongertoberesolved.

Insteadofoptingforanappeal,yourphysicianmaychoosetochangethemedicationprescribedtoamedicationthatiscoveredbyyourinsurancecompany.ExpensiveCo-Pays

Ifyourco-payistoohighandissimplyoutofyourbudget,orifyourinsurancewillnotapprovecoveragefortheprescription,therearemanyavenuesthroughwhichthemedicationcanbeobtained.Yourdoctormaychoosetochangethemedicationtosomethingthatiscomparablewithalowerco-pay.Anotheroptionistoobtainfinancialassistance.Wearehappytohelpyouifthissituationarises.

Nomatterwhattheinstanceis,pleasedonotjustpaythehighout-of-pocketcost.Callusfirstsowecanworkwithyourpharmacyandinsurancecompanytohelpyougetthemedicationyouneedatapriceyoucanafford.FinancialAssistanceTheremaybefinancialassistanceavailableforyourIVororaltreatment.Forassistance,pleasecontact:LisaDay 805-485-8709x126 regardingyouroralmedication.AnnetteA 805-988-2500x3983 regardingyourIVmedication.

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SafeStorageandDisposalofCancerMedications

Duringandaftercancertreatment,peoplemayhaveoneormoremedicationstotakeathome.Thesemedicationscanbeveryharmfulifsomeoneotherthanthepersonwithcancertakesthem.Therefore,youandyourcaregiversneedtoknowthesafestwaystostoreanddisposeofspecificmedications.

• Storeyourmedicationsseparatelyfromthoseofyourotherfamilymembers.

• Storeyourmedicationsinthecontaineritcamein.Thishelpsyouknowwhichoneiswhichandkeepstheinformationabouthowoftentotakeitrightatyourfingertips.Alwayskeepthelidtightlyclosed.Ifyouuseapillboxorothertypeofmedicationorganizer,useoneforchemotherapyandoneforanyothermedication(s).Clearlylabelbothboxes.

• Storeallchemotherapyinitsoriginalcontainer,inasafeplace,andawayfromallothermedications.Alwayskeepmedicationsoutofthereachofchildrenand/orpets.

• Mostoralchemotherapyshouldbestoredatroomtemperature,awayfromheat,moisture,anddirectsunlight.Sometypesofchemotherapyrequirespecialstorageorhandling,suchasrefrigeration.Thiswillbenotedonthelabeland/orpackageinsert

• Keepthelocalpoisoncontrolcenter’stelephonenumberhandyincaseapet,child,orothermemberofyourhouseholdaccidentallyswallowsthemedication.Thenationalnumber,whichwillrouteyoutothelocalcenterbasedonyourareacode,is800-222-1222.

• Youshouldneverthrowoutorflushleftoverchemotherapy.Normally,youwillnothaveextraoralchemotherapybecausedoctorstypicallyprescribeitintheexactdosageandamountnecessary.Butifyoudohaveunusedoralchemotherapypills,returnittoyourdoctorornursefordisposal.

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ManagingTreatmentSideEffects

NAUSEAANDVOMITINGNauseaiswhenyoufeelsicktoyourstomach,likeyouaregoingtothrowup.Vomitingiswhenyouthrowup.

HelpfulHints• Takeyouranti–nauseamedicineasprescribedandtalkwithyourdoctoror

nurseifthemedicineisnotcontrollingyournausea.• Eatlessgreasy,fried,salty,sweet,orspicyfoods• Eat5or6smallmealsduringtheday,insteadof3largemeals.• Drinkplentyofwater,6to8glassesaday.Ifyoufindithardtodrinkafullglassat

onetime,takesmallsipsofwaterthroughouttheday.• Thesefoodsanddrinksmaybeeasyonyourstomach:

• Clearbroth,suchaschicken,beef,andvegetable• Clearsodasuchasgingerale,water,tea,cranberryorgrapejuice.• Oralrehydrationsolutiondrinks,suchasPedialyteorGatorade• Oatmeal,CreamofWheatorCreamofRiceCereal• Crackers,Pretzels,toast,whiterice,pasta,noodles,orplainboiled

potatoesBroiledorbakedchickenwithouttheskin• Bananasorcannedfruitsuchasapplesauce,peachesorpears• Jello,Yogurt,PopsiclesorSherbet

WhentoCallYourDoctor

• Youranti–nauseamedicinesarenoteffective• Youarevomitingandareunabletotoleratefluidsfor24hours

DIARRHEADiarrheaiswhenyouhavesoft,loose,orwaterybowelmovements.Callyourdoctorornurseif:

• Youhavediarrheaandcrampsformorethan1day• Youhaveafeverof100.5degreesForhigher• Youfeeldizzy• Yourrectalareaissoreorbleeds• Thediarrheadoesnotrespondtooverthecounterorprescribedmedication.

Dothesethingstofeelbetter:

• Eat5or6smallmealseachday,insteadof3largemeals• Eatfoodsthatareeasytodigestsuchasbananas,applesauce,whiterice,and

whitetoast• Drinkmoreliquidseachday,atleast8to12cupsofclearliquids.Thiswillnot

stopthediarrhea,butitwillhelpreplacefluidsyouarelosingwithdiarrhea.

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• Cleanyourrectalareawithwarmwaterandababywipe.Keeptheareadry.Askaboutcreamsthatcanhelp.

• Takeoverthecounterdiarrheamedication,suchasImodium.

FoodstoAvoid:• Dairyproducts,suchasmilk,cheese,icecream,sourcream• Spicy,greasy,orfriedfoods• Foodsthatcausegas,suchasbeans,broccoli,orcabbage• Foodshighinfiber,suchaswholewheatbreads,granola,orbrancereals• Don’thavebeer,wine,oranyotherdrinkswithalcoholinthem• Don’thavecaffeinedrinkssuchascoffee,blacktea,orcolas

CONSTIPATIONConstipationishavingbowelmovementsthatcomelessoftenthannormalforyou,arepainfulorarehardtopass.

TreatmentandPreventionofConstipation:• Eathighfiberfoodssuchaswholegrainbreadsandcereals,fruitsandvegetables,

nuts,seeds,andpopcorn• Drinklotsofliquids,atleast8cupsofliquideveryday.Waterisagoodchoice,

andsoarefruitandvegetablejuices,suchasprunejuice• Warmliquidssuchascoffeeorteamayhelp• Trytobeactiveeveryday.Walkorrideanexercisebikefor15to30minutesa

day• Medicationforconstipation,suchascolace,miralaxorsenokot,isavailableover

thecounter.• Ifyouarestillhavingconstipation,discussothermedicationswithyourdoctoror

nurse.Thesefoodsmayhelpifyouareconstipated:

• Breadsandgrains–Branmuffins,branorwholegraincereals,brownorwildrice,cookeddriedpeasandbeans(suchaspinto,black,red,orkidney),wholewheatbread,wholewheatpastaandtortillas

• Fruits–Driedfruitsuchasapricots,dates,prunes,andraisins,freshfruitsuchasapples,blueberries,andgrapes

• Vegetables–Raworcookedvegetables,suchasbroccoli,corn,greenbeans,peas,andspinach

• Snacks–Granola,nuts,popcorn,seeds,suchassunflower

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MOUTHANDTHROATCHANGESChemotherapycancausechangesintasteorsmell,drymouth,smallsoresonyourgumsortongue,and/orpainwhenyoueathotorcoldfoods.

Ifyouhavemouthsores,takethesestepstofeelbetter:• Brushyourteethandtongueaftereachmealandbeforeyougotobed.Useasoft

toothbrush• Usetoothpasteorgelthathasfluorideandbakingsodainit• Rinseyourmouthwithabakingsoda,salt,andwatermixtureevery3hours

duringtheday.Mixtogether:1cupwarmwater,¼teaspoonbakingsoda,and1/8teaspoonsalt

• Keepyourmouthandlipsmoist.Usealipbalm,sipwateroricechips,andtrydrinkingthroughastraw

• Eatsoftblandfoods,suchascookedcereals,mashedpotatoes,orscrambledeggs.Trysofteningfoodswithgravy,sauce,orotherliquids

• LethotfoodcooldownCallyourdoctorornurseifyouhave:

• Troubleeatingorswallowing• Whitespotsinyourmouthoronyourtongue• Soresonyourlipsorinyourmouth• Paininyourmouthorthroat

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LOWBLOODCELLCOUNTSChemotherapymayleadtolowbloodcounts,causingthepossibilityofavarietyofsymptomswhichdependonwhichbloodcellnumberislow.Yourdoctorornursewillorderbloodtests.Acompletebloodcount(CBC)isabloodtestusedtocheckyourbloodcounts.

ANEMIAAnemiaiswhenyourbodydoesn’thaveenoughredbloodcells.Thiscanalsobecalledlowhemoglobinorlowhematocrit.Havinganemiacanmakeyoufeelverytiredorweak,orcauseyoutoexperienceheadaches,dizziness,orshortnessofbreath.

Trythesetipswhenyoufeeltiredorweak:• Saveyourenergy.Choosethemostimportantthingstodoeachday• Askforhelp.Whenfamilyorfriendsoffertohelp,letthem.They

cantakeyoutothedoctor,buygroceries,ormakemeals,• Balancerestwithactivity.Takeshortnapsduringtheday.Short

napsoflessthan1hourarebest.Toomuchbedrestcanmakeyoufeelweak

• Sleepatleast8hourseverynight• Eatanddrinkwell.Youmayneedtoeathighproteinfoods.Meat,peanut

butter,andeggsaregoodchoices.Youmayalsoneedtoeatfoodswithiron.Redmeat,leafygreens(suchascollardgreensandspinach),andcookeddriedbeansaregoodchoices.Drinkatleast8cupsofliquideveryday.

Callyourdoctorornurseifyoufeel:• Dizzyorfaint• Shortofbreath• Veryweakortired• Yourheartisbeatingveryfast,oryouhavechestpain

Ifyouhaveanemia,youmayneedmedicine,vitaminsorabloodtransfusiontohelpyoufeelbetter.

NEUTROPENIANeutropeniaisadecreaseinthenumberofneutrophils,atypeofwhitebloodcell.Whitebloodcellsfightinfections.Alowwhitebloodcellcountcanmakeyouvulnerabletoinfections.

Onceyoustarttreatment,itisimportanttobeawareofmeasuresyoucantaketopreventinfections:• Washyourhandswellwithsoapandwater.Alwayswashyourhandsbefore

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youcookoreat,afteryouusetherestroom,andafterbeing inpublicplaces.Havepeoplearoundyouwashtheirhandsaswell

• Brushyourteethaftermeals,andbeforeyougotobed.Useasofttoothbrush• Trytostayawayfromgerms.Stayawayfrompeoplewhoaresickorhavea

cold.Trytostayawayfrombigcrowds• Washrawfruitsandvegetablesandwashyourhandswellafterhandlingraw

meat• Havesomeoneelsecleanupafteryourpetorweargloves• Cleanyourselfwellandgentlyaftergoingtothebathroom.Letyour

nurseknowifyourrectalareaissoreorbleeds• Don’tsqueezepimples• Donotuserectalsuppositoriesortakeyourtemperaturerectally

Callyourdoctorornurserightawayifyouhave:

• Feverthatis100.5oForhigher.Haveathermometerathometocheckyourtemperature

• Shakingchills–checkyourtemperature• Coughorsorethroat• Headacheorastifforsoreneck• Neworunexplainedpain• Bloodyorcloudyurine,orpainorburningwhenyouurinate• Soresorwhitecoatinginyourmouthoronyourtongue• Swellingorrednessanywhere.Watchforswellingorsorenessifyouhavea

catheterTHROMBOCYTOPENIA(Lowplateletcount)Plateletshelpbloodtoclottopreventbleeding.Whenlowbloodplateletcountoccurs,tinydropsofbloodcanleakthroughthebloodvessels,causingredorpurpledotsontheskincalledpetechiae(pa-TEE-kee-eye).Iflowplateletcountispresent,thereisanincreasedriskofbruisingandbleeding.

PossibleSymptomsofThrombocytopenia:• Increasedbruising• Petechiae(redorpurpledotsonyourskinasdescribedabove)• Bleeding,especiallyfromnose,gums,rectum

Thingsyoumaydotodecreaseyourriskofbleedingifyouhavelowplateletcount:• Donottakeanymedicationsthatinterferewiththeplateletsbeingableto

formaclotsuchasAspirin,Ibuprofen(Advil,Motrin),orNaproxen(Aleve)• Donotuserectalsuppositories,enemasortakeyourtemperaturerectally• Useaverysoftbristletoothbrush&usecautionoravoidflossingyourteeth.If

yourgumsbleed,rinsewithcoldwater.Ifbleedingdoesnotstop,callyourdoctor• Avoidactivitiessuchascontactsports,strenuousexercise,oramusementpark

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rides• Avoidorlimittheuseofsharpobjectssuchasknivesorrazors(electric

razorsareok)• Holdpressureonanycutorscrapeforatleast5minutes

Ifyourplateletcountislow,CallYourDoctorif:• Youhavebleedingthatwillnotstopafter5minutes• Bleedingthatoccursspontaneouslywithoutinjury(Ex:nosebleed)• Youhaveafallorexperiencetraumaorinjury• Youfeeldizzyorlightheaded,orhavedifficultyseeingorhavedoublevision• Youhaveneworunexplainedpain

HAIRLOSS(Alopecia)Chemotherapycanharmthecellsthatmakehair.Thismeansthathaironyourheadandanywhereonyourbodymayfallout.Hairlossisalsocalled“alopecia.”Yourhairmaystarttofallout2to3weeksafterchemotherapybegins.

Beforeyourhairfallsout:

• Treatyourhairgently.Washitwithamildshampoo.Patitdrywithasofttowel.Avoidheatedappliancessuchasblowdryersorcurlingirons

• Somepeoplechoosetocuttheirhairshort,orshavetheirhead.Ifyoushaveyourhead,useanelectricshaversoyouwon’tcutyourscalp

• Getawig.Ifyouplantobuyawigorhairpiece,getonewhileyoustillhavehair.Thisway,youcanmatchittothecolorofyourhair

• Manyinsurancecompanieswillcoverthecostofawig–askyourdoctorAfteryourhairfallsout:• Protectyourheadfromthesun.Usesunscreenorwearahatwhenyouareoutside• Protectyourheadfromthecold.Wearahatorscarf• Trywearingasoftscarfwhenyousleep• Mostlikely,yourhairwillstarttogrowback1monthafteryouhavecompleted

chemotherapy,butitwilltakeseveralmonthstobelongenoughtogowithoutawig.Sometimesyournewhaircanbecurlierorstraighter–orevenadifferentcolor.Intime,itmaygobacktohowitwasbeforetreatment

SKINANDNAILCHANGESCertaindrugscancausechangestoyourskin.Yourskinmaybecomedry.Itisbesttousemildsoapsthataregentleonyourskin,andtouselotionsandcreamstokeepyourskinmoist.Itisalsoimportanttoprotectyourskinfromthesun.Whenyouareoutside,alwayswear

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sunscreenandlipbalm.Wearprotectiveclothingsuchaslongsleeveshirts,pants,andahatwithawidebrim.Donotusetanningbeds.

Keepyournailscleanandcutshort.Checkwithyournurseordoctorbeforegettingamanicure.CallYourDoctororNurseif:

• Youdevelopsuddenorsevereitching• Yourskinhasarashorhives

NERVECHANGESSometreatmentscancausenerveproblems.Youmayhavenumbness,tinglingorburningfeelingindifferentpartsofyourbody.Itoftenbeginsinyourhandsorfeet.Thisiscalled“peripheralneuropathy.”

NotifyYourDoctororNurseif:• Youdeveloppain,tingling,burning,orweakfeelinginyourhandsorfeet,orhave

painwhenyouwalk• Youhavemovementproblemssuchaslosingyourbalance,orfall.Youhaveshaking,

trembling,ornumbnessinyourhandsandfeet.Youhavetroubleholdingorpickingthingsup

• YouhavetroublehearingFATIGUETreatmentcanmakeyoutired.Socanotherthingslikeanemia,beingdepressedorinpain,takingcertainmedicines,orhavingtroublesleeping.

Trythesetipstofeelbetter:• Doactivitiesthataremostimportantfirst• Askothersforhelp• Taketimeofffromyourjob,orworkfewerhours• Eatanddrinkwell• Beasactiveasyoucan• Taketimetorest• Makeabedtimeroutinetohelpyourelax

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INFECTION

Canceranditstreatmentsmaymakeitmorelikelythatyouwilldevelopaninfection.Aninfectionoccurswhenbacteria,viruses,orlessoften,fungi(suchasyeast)invadethebody,buttheimmunesystemcannotstopthemfastenough.Cancertreatmentsmayweakentheimmunesystem,increasingthechanceofaninfection.Infectionduringcancertreatmentcanbelifethreatening.Yourhealthcareteamwillhelpyoudetermineiftheinfectionisseriousandhowbesttomanageyoursymptoms.Youmayalsobeprescribedmedicationstopreventinfection.Symptomsofinfectionrequiringimmediatecare:

Peopleexperiencingthesesymptomsmayneedemergencycare.Callyourhealthcareteamrightawayifyouhave1ormoreofthesignslistedbelow.Ifyoursymptomscannotbeassessedrightaway,youmayneedtogototheemergencyroom.• Feverthatis100.5°F(38°C)orhigher• Shakingchills• Chestpainorshortnessofbreath• Confusion• Severeheadachewithastiffneck• Bloodyorcloudyurine

Symptomsofinfectionrequiringpromptcare:

Thesesymptomsmaybesafelymanagedbyvisitingyourdoctor’soffice:• Cough• Swellingorrednessanywhere,includingaroundacut,wound,orcatheter• Soresorwhitecoatinginyourmouthoronyourtongue• Toothorgumpain• Sorethroat• Earpain• Headacheorbadsinusorfacialpain• Stifforsoreneck• Abdominalpain• Skinsoresorrash• Diarrheaorsoresneartheanus• Bloodyorcloudyurine,Painorburningwhenurinating• Vaginaldischargeoritching• Anychangeorsomethingthatdoesnotfeelnormalforyou,includingageneral

senseoffeelingunwell

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Preventinginfections

Thefollowingtipscanhelppreventinfections:

• Washyourhandswellandoftenoruseantibacterialhandsanitizers.Alwayscleanyourhandsbeforeeatingandafterusingtherestroom.

• Avoidcontactwithpeoplewhoaresickorrecentlyill.

• Avoidbigcrowdswhenpossible

• Avoidsharingfood,drinks,utensils,andpersonalitems• Showerorbathedailyandapplylotiontopreventdrycrackedskin

• Cleanteethandgumswithasofttoothbrush• Avoidcutsanduseanelectricrazorifpossible

• Avoidcatlitterandhandlinganimalwaste

• Keeptheareaaroundanycatheter(s)cleananddry• Followfoodsafetyguidelines,includingnoraworundercookedmeats,fish,

shellfish,orpoultryandwashingallfreshfruitsandvegetables

• Eatavarietyofnutritiousfoods• Getatleast7to8hoursofsleep

• Getenoughphysicalactivity• Checkwithyourhealthcareteambeforegettinganyshotorvaccineyourself

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SIDEEFFECTSOFIMMUNOTHERAPYTreatmentwithimmunotherapymaycausedifferentsideeffectsthatchemotherapytreatment.Immune-relatedsideeffectscanaffectanyorganortissue,butmostcommonlyaffecttheskin,colon,lungs,liver,andendocrineorgans(suchasthepituitaryglandandthyroidgland).Themostcommonsideeffectsofimmunotherapyinclude:

• Skinredness,itchinganddrynessarecommonreactionstoimmunotherapy.• Flu-likesymptoms:Fatigue(feelingtired),fever,chills,weakness,nausea(feelingsicktoyourstomach),vomiting(throwingup),dizziness,bodyaches,andhighorlowbloodpressureareallpossiblesideeffectsofimmunotherapy.

Otherpossiblesideeffectsthatyoumayexperienceinclude:

• Muscleaches• Shortnessofbreath(troublebreathing)• Swellingoflegs(edema)• Sinuscongestion• Headaches• Weightgainfromretainingfluid• Diarrhea• Hormonechanges,includinghypothyroidism,whichiswhenthethyroidglanddoesnotmakeenoughthyroidhormonesandcancausefatigueandweightgain• Cough

Itisveryimportanttostayhydratedwhenexperiencingthesesymptoms.Seekmedicalattentionifyouareunabletokeepanyliquidsdown,andtalkwithyourdoctorabouthowtomanagethesesideeffects.Manysideeffectswillgoawayontheirown,butotherscanbeveryseriousandrequireattentionrightaway.Itisimportanttonotethattherecanbeothersideeffectsthatarenotlistedhere.Talkwithyourhealthcareteamaboutwhatsideeffectsyoucanexpect,whotocontact,andwhattodoifyouhaveunexpectedsideeffects.

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SEXUALANDFERTILITYCHANGESTalkwithyourdoctorbeforetreatmentstartstolearnaboutwhatsexualchangesorchangestoyourfertilityyoumayhave.Thesechangesyoumayhavedependonthekindofchemotherapyyou’llbegettingandthetypeofcanceryouhave.Yourageandotherhealthissuesarealsoimportant.

PotentialSexualProblemsinMen:

• Alwayswearacondomwhenyouhavesexbecausesomechemotherapymaybeinyoursemen

• Youmayfeeltootiredorstressedtohavesex• Youmaynotbeabletohaveanorgasm• Itmaybedifficulttokeepanerection.Thisiscalled“impotence”

PotentialSexualProblemsinWomen:

• Drynessoritchyfeelinginthevagina• HotFlashes• Infectionsofthevaginaorbladder• Periodsthatarenotregularornoperiods• Stress,fatigue,orlittleinterestinsex• Ifyouhavenotgonethroughmenopause,itisimportanttousebirthcontrol.

Donotgetpregnantduringtreatmentbecauseitcanharmthefetus

FERTILITYPRESERVATIONSomecancertreatmentscancauseinfertility(inabilitytohaveachild)ordecreaseyourfertility.Yourriskdependsonseveralfactorsincludingage,previousfertilityproblems,thetypeofcanceryouhave,andthetypeoftreatmentsyouwillreceive.

• Fertilitypreservationmaybeanoptionifdoneinatimelymanner• Preservationtechniquesdonotworsenyourcancerprognosis.• Fertilitypreservationcanbedonequicklyandavoidsignificantdelayoftreatment• Talktoyoudoctoraboutyourchoicesanddiscussthepossibleneedfor

afertilityspecialistreferralbeforestartingchemotherapy.

FERTILITYRESOURCES

SouthernCaliforniaReproductiveCenter:www.scrcivf.com;805-658-9112

FertileHOPE:www.fertilehope.org;855-220-7777

“MovingForward”VideoSeriesforYoungAdultsWithCancer:Fertility:www.cancer.net/movingforwardTheSpermBankofCalifornia:www.thespermbankofca.org

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ManagingYourCancerCareDuringanEmergency

Anemergencysuchasaflood,fire,earthquake,orhurricaneischallengingforeveryone.Havingcancerputsyouatanevengreaterriskbecauseitmightbedifficulttogettreatmentorcareforyourselfandyourlovedones.1.Planahead.Makeafamilyemergencyplan.Talktoneighborsandexchangephonenumberswiththem.

2.Createanemergencykit.Youneednutritiousfood,enoughwater,andawaytocontactemergencyservicesifneeded.Afirst-aidkitwithhandsanitizer,disinfectant,andantibioticcreamisimportant.Packyouremergencysuppliesinawaterproofcontainer,suchasasealedplasticbagorpouch.Youcanpacksomeofyourfoodandwaterina“gobag”totakeifyouleaveyourhome.Putacanopenerinyourkittoopencansoffood.Thisbagshouldalsoincludemedicalsuppliesandyourmedicalinformation.

3.Bereadytomakeacallorleavehome.Keepyourphonechargedandready.Keepfueloranelectricchargeinyourcarsoyoucaneasilygettosafetyifneeded.Youshouldalsokeepaflashlight,emergencyradio,andcontactinformationforneighborsandfamilymembersonhand.

4.Takesheltersafely.Youcanstayhomeinsomeemergencies,butyoumightnothavewater,electricity,heat,orairconditioning.Thinkaboutshoesandclothingyoumightneed,includingbootsorshoesandblanketsorcoats.Youneedfoodandcleanwaterforatleast3days.Enoughfor1to2weeksisevenbetter.Alsostorefood,water,andmedicinesforanypets.

5.Carryyourmedicalinformation.Keepthefollowinginformationinasafeplaceinyourpocket,purse,orbriefcaseatalltimes:Yourdoctor’snameandphonenumber,informationonyourtypeandstageofcancer,andthetypeofcancertreatmentyouarehaving.

6.Getreliableinformation.CheckyourlocalnewsonTV,theradio,oronlinetofindaccurateweatherreportsandemergencyinformation.Youcanalsocheckthesocialmediapagesforyourlocalpolice,fireorsheriff’sdepartment.

7.Findemergencycancercare.Callyourdoctor’sofficeassoonaspossibletolearnwhattodo.ASCOandtheNationalCancerInstitute(NCI)haveawebsitewithemergencyresourcesforpeoplewithcancerinEnglishandSpanish.

8.BepreparedduringtheCOVID-19pandemic.BesuretohaveonhandthesuppliesyoumayneedtoprotectyourselffromCOVID-19infection.Thesafestwaytoobtainyoursuppliesistohavethemdelivered.Ifyoumustshopinperson,avoidbusytimesoftheday,alwayswearaclothfacecovering,andkeepadistanceofatleast6feetfromotherpeople.Besuretowashyourhandsaftershoppinginpublicorusehandsanitizerifyoudon’thaveaccesstosoapandwater.

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AdvanceDirectives

Advancedirectivesarewritteninstructionsregardingyourmedicalcarepreferences.Becauseunexpectedsituationscanhappenatanyage,all adultsneedadvancedirectives.Theydescribeyourpreferencesregardingtreatmentifyou'refacedwithaseriousaccidentorillness.Yourfamilyanddoctorswillconsultyouradvancedirectivesifyou'reunabletomakeyourownhealthcaredecisions.Havingwritteninstructionscanhelpreduceconfusionor disagreement.Choosingapersontoactasyourhealthcareagentispossiblythemostimportantpartofyourplanning.Youneedtotrustthatthispersonhasyourinterestsatheart,understandsyourwishesandwillactaccordingly.Advancedirectivesinclude:

o Livingwill.Thiswritten,legaldocumentspellsoutthetypesofmedicaltreatmentsandlife-sustainingmeasuresyouwantanddon'twant,suchasmechanicalbreathing(ventilation),tubefeedingorresuscitation.Alivingwillcan'tcovereverypossiblesituation.Therefore,youmightalsowantamedicalPOAtodesignatesomeonetobeyourhealthcareagent.Livingwillsmayalsobecalledhealthcaredeclarationsorhealthcaredirectives.

o Medicalorhealthcarepowerofattorney(POA).ThemedicalPOAisalegaldocumentthatdesignatesanindividual—referredtoasyourhealthcareagentorproxy—tomakemedicaldecisionsforyouintheeventthatyou'reunabletodoso.Thispersonwillbeguidedbyyourlivingwillbuthastheauthoritytointerpretyourwishesinsituationsthataren'tdescribedinyourlivingwill.AMedicalPOAisdifferentfromapowerofattorneyauthorizingsomeonetomakefinancialtransactionsforyou.

o Donotresuscitate(DNR)order.Thisisarequesttonothavecardiopulmonaryresuscitation(CPR)ifyourheartstopsorifyoustopbreathing.AdvancedirectivesdonothavetoincludeaDNRorder,andyoudon'thavetohaveanadvancedirective tohaveaDNRorder.YourdoctorcanputaDNRorderinyourmedicalchart.

o PhysiciansOrdersforLife-SustainingTreatment(POLST)isaformthatgivesseriously-illpatientsmorecontrolovertheirend-of-lifecare,includingmedicaltreatment,extraordinarymeasures(suchasaventilatororfeedingtube)andCPR.Printedonbrightpinkpaper,andsignedbybothadoctorandpatient,POLSTcanpreventunwantedorineffectivetreatments,reducepatientandfamilysuffering,andensurethatapatient'swishesarehonored.ThePOLSTcomplementsanAdvanceDirectiveandisnotintendedtoreplacethedocument.http://capolst.org/

o FiveWishesProgram–Letsyourfamilyanddoctorsknow:whoyouwanttomakehealthcaredecisionsforyouwhenyoucan'tmakethem,thekindofmedicaltreatmentyouwantordon'twant,howcomfortableyouwanttobe,howyouwantpeopletotreatyou,whatyouwantyourlovedonestoknow.http://www.agingwithdignity.org/

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RESOURCESNATIONAL:• NationalCancerInstitute:www.cancer.gov• CancerCare:www.cancercare.org• PeopleLivingWithCancer:www.peoplelivingwithcancer.org• AmericanCancerSociety:www.cancer.org• TheNationalCancerComprehensiveNetwork:www.nccn.org• TheWellnessCommunity:www.thewellnesscommunity.org• ChemoCare:www.chemocare.com• SusanG.KomenfortheCure:www.komen.org• OncologyNursingSociety:http://ons.org/patientEd• Leukemia&LymphomaSociety:www.leukemia-lymphoma.org

LOCALRESOURCES&SUPPORTGROUPS:

• AmericanCancerSociety–GreaterVenturaCountyUnit2186KnollDrive,SuiteAVentura,CA 93003(805)644-4248• CommunityMemorialHospital–CancerResourceCenter

2900LomaVistaRoad,Suite101Ventura,CA 93003(805)652-5459

• Leukemia&LymphomaSociety–TheGreaterLosAngelesChapter6033WestCenturyBlvd.Suite300LosAngeles,CA90045(310)342-5800

• St.John’sCancerCenterofVenturaCounty1700NorthRoseAveOxnard,CA.93030(805)988-2641

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• SusanG.Komen–LosAngelesCountyAffiliate 1000EastWalnutAve,Suite123 Pasadena,CA.91106

(626)577-2700. komenlacounty.org

• CancerSupportNetwork 530HampshireRd.WestlakeVillage,CA91361(805)379-4777

LocalWigShops• ArtisticHairpiecesandWigs1840VenturaBlvdCamarillo,CA(805)482-4848

• Debra’sAlternative737N.AStreetOxnard,CA(805)983-1590

• KimberlyHairpieces&Wigs

1425StateSt.SantaBarbara,CA(805)899-8200

BreastProsthesisandCustomBras• AltheasCorsetShop2320E.MainVentura,CA93003(805)643-3537

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FrequentlyAskedQuestions

1. CanIeatpriortotreatment?Yes,youmayhavealightmealpriortoyourappointment.Werecommendyouavoidgreasy/friedfoods.

2. WillIfeelsickduringmyinfusion?Priortoreceivinganynauseacausingtreatment,youwillbe“pre-medicated”withanti-nauseamedicationthroughanIV.Thesedrugsworkquicklysoitisunlikelyyouwillhavenauseaduringyourinfusion.

3. WhencanIexpecttofeelsick?Dependingonwhatdrugsyoureceiveyoumayexperiencemildtomoderatenausea.Nauseausuallystartsone-twodaysaftertreatmentandmaylastforseveraldays.Thisisreferredtoas“delayednausea”.Youwillbegivenmedicationbasedonwhatdrugsyoureceivetohelpyoumanagedelayednausea.

4. WillIlosemyhair?Theamountofhairlossyouexperiencewilldependonwhatdrugsyoureceive.Manychemotherapydrugscauselittleornohairloss,whilesomewillalmostalwayscausetotalhairlossandusuallystartsabouttwoweeksafteryourfirstinfusion.Yournursewilltellyourhowmuchifanyhairlossyoucanexpect.

5. CanItakemyusualmedications?Beforeyoubegintreatment,yourdoctorwillreviewallthemedicationsyouaretakingandtellyouifthereareanydrugsthatyoushouldnottakewhileontreatment.Unlessotherwiseinstructed,youshouldcontinuetotakeyourregularmedications.Itisimportanttokeepyouroncologistinformedofanymedicationsthatyoustartorstopwhileontreatment