Now is the time for CYRAMZA (ramucirumab)

Transcription

1 Now is the time for CYRAMZA (ramucirumab) Get the information you need at Find out what to expect from your treatment CYRAMZA is used alone or in combination with paclitaxel (a type of chemotherapy) to treat specific kinds of advanced cancer of the stomach or where the stomach and esophagus meet. CYRAMZA is for patients whose cancer has progressed after being treated with certain types of chemotherapy. CYRAMZA is given through an intravenous infusion (IV). FOR PATIENTS WITH ADVANCED STOMACH CANCER WARNING: SEVERE BLEEDING, TEARS IN THE STOMACH OR BOWEL WALL, AND DIFFICULTY IN WOUND HEALING Severe bleeding, including bleeding in the stomach or bowel, has occurred with CYRAMZA. These events are sometimes fatal. Tell your doctor right away if you have bleeding or symptoms of bleeding, including lightheadedness. Your treatment will have to be permanently stopped if severe bleeding occurs. Tears in the stomach or bowel wall may occur with CYRAMZA. These events are sometimes fatal. Tell your doctor if you have severe diarrhea, vomiting, or severe abdominal pain. Your treatment will have to be permanently stopped if this occurs. Wounds may have difficulty healing with drugs like CYRAMZA. Tell your doctor if you have a wound that doesn t heal properly. If you develop a wound that won t heal during treatment, your doctor will stop CYRAMZA until the wound is fully healed. Also tell your doctor if you have planned surgery, as CYRAMZA treatment should be interrupted prior to surgery. Your doctor may restart CYRAMZA after your surgical wound has healed. Please see Important Safety Information, including Boxed Warnings for severe bleeding, tears in the stomach or bowel wall, and difficulty in wound healing, on pages See accompanying full Prescribing Information for additional information about CYRAMZA. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call FDA-1088.

2 Now is the time to figure out a plan to move forward, one day at a time. HOW CAN I USE THIS BROCHURE? This brochure will help you understand how CYRAMZA (ramucirumab) works and what you can expect from treatment when CYRAMZA is used alone or in combination with paclitaxel (a type of chemotherapy). It will also provide you with important resources, such as topics that are important to talk about with your doctor or places you can go for additional support. Being diagnosed with advanced stomach cancer can be overwhelming. With the help of your healthcare team and this brochure, you can find useful information that may help during your treatment. You can also find out more information about CYRAMZA by calling LillyRx ( ). This brochure should not substitute the instructions provided by your healthcare team. If you have any questions about CYRAMZA when used alone or in combination with paclitaxel, talk with your healthcare provider. DEFINITIONS If you see a word that is italicized, that means the word is defined for you in the glossary found on pages of this brochure. CAREGIVER TIP If you are a caregiver, you can find tips throughout this brochure on assisting your loved one. Also see pages for caregiverspecific information. For more information, call LillyRx ( ) 3

3 WHAT S INCLUDED IN THIS BROCHURE? Is CYRAMZA (ramucirumab) Right for Me? 8 What Kinds of Stomach Cancer Does CYRAMZA Treat? 10 What Is Advanced Cancer? 11 What Is CYRAMZA? 12 How Does CYRAMZA Work? 13 How Is CYRAMZA Given? 14 What Should I Tell My Doctor Before Receiving Treatment With CYRAMZA? 16 Now is the time to think about what you hope to get out of each day. What Side Effects Have Patients Experienced? 18 What Can I Do If I Experience a Side Effect? 20 Important Safety Information 22 Your Healthcare Team Is There to Support You 24 Ask Questions 26 Helpful Resources 28 Glossary 30 Guidance for Caregivers 33 For more information, call LillyRx ( ) 5

4 LIVING WITH YOUR CANCER INFORMATION FOR PATIENTS For more information, call LillyRx ( ) 7

5 IS CYRAMZA (ramucirumab) RIGHT FOR ME? If your doctor has talked to you about CYRAMZA, it means that you have advanced stomach or gastroesophageal junction (GEJ) cancer and you have already been treated with chemotherapy. Your healthcare team may have decided it is time to try another treatment. CYRAMZA may be given alone or in combination with paclitaxel. Any change in your cancer or your cancer treatment can be scary. Rest assured that you are not alone. Your healthcare team is there to support you. Ask questions. Talk to your healthcare team about side effects with CYRAMZA when given alone or in combination with paclitaxel. They will help you understand what you can expect from treatment. CYRAMZA (ramucirumab) is used alone or in combination with paclitaxel (a type of chemotherapy) to treat specific kinds of advanced cancer of the stomach or where the stomach and esophagus meet. CYRAMZA is for patients whose cancer has progressed after being treated with certain types of chemotherapy. CYRAMZA is given through an intravenous infusion (IV). SELECT IMPORTANT SAFETY INFORMATION Strokes, mini-strokes, blood clots, and heart attacks have occurred in clinical trials with CYRAMZA. These events are sometimes fatal. Your treatment will have to be permanently stopped if these events occur. CYRAMZA, when used alone or in combination with paclitaxel, has been proven effective in patients with advanced stomach cancer that has progressed after chemotherapy. Keep in mind that the effectiveness of CYRAMZA is different for everyone, and individual results may vary. Your doctor is the best person to talk to about what CYRAMZA alone or as a combination therapy may offer you as a treatment. Now is the time to find out what you can expect from treatment. For more information, call LillyRx ( ) 9

6 WHAT KINDS OF STOMACH CANCER DOES CYRAMZA (ramucirumab) TREAT? WHAT IS ADVANCED CANCER? CYRAMZA, when used alone or in combination with paclitaxel, treats two kinds of advanced stomach cancer. One is in your stomach. The other is where the stomach meets the esophagus. This is called the gastro-esophageal junction, or you may hear members of your healthcare team call it the GE junction. You can ask your doctor to use the adjacent image to help you better understand the kind of stomach cancer you have. ESOPHAGUS GASTRO-ESOPHAGEAL JUNCTION STOMACH When a cancer is referred to as advanced cancer, it means the cancer has spread from where it started to other parts of the body. If the cancer has begun to spread to tissue located near the original tumor, the cancer is considered locally advanced. If the cancer has spread to farther parts of the body (for example, from the stomach to the liver), the cancer is considered to have metastasized. Are cancers that have spread to other parts of the body different? Cancers that have spread to other parts of the body have the same type of cancer cells as the original cancer. For example, stomach cancer that has spread to a bone and forms a metastatic tumor is metastatic gastric cancer, not bone cancer. CAREGIVER TIP By understanding your loved one s cancer at this stage, you will be better prepared to have conversations with members of the healthcare team. CYRAMZA (ramucirumab) is used alone or in combination with paclitaxel (a type of chemotherapy) to treat specific kinds of advanced cancer of the stomach or where the stomach and esophagus meet. CYRAMZA is for patients whose cancer has progressed after being treated with certain types of chemotherapy. CYRAMZA is given through an intravenous infusion (IV). SELECT IMPORTANT SAFETY INFORMATION Severe high blood pressure has occurred with CYRAMZA treatment. Your doctor will monitor your blood pressure every two weeks or more throughout treatment and may adjust, interrupt, or permanently stop treatment depending on the results. Tell your doctor if your blood pressure is high or if you have symptoms of high blood pressure, including severe headache or lightheadedness, or neurologic symptoms such as confusion, changes in your vision, or seizure. KNOW THAT YOU ARE NOT ALONE 74,000 22,000 PEOPLE IN THE US LIVING WITH STOMACH CANCER NEW CASES OF STOMACH CANCER ESTIMATED IN 2014 There are other people like you experiencing this journey. In the United States in 2011, it was estimated that more than 74,000 people were living with stomach cancer. In 2014, it was estimated that about 22,000 people were diagnosed with stomach cancer. There are ways for you to connect with other people going through this journey. See page 28 of this brochure for a list of organizations and websites. For more information, call LillyRx ( ) 11

7 WHAT IS CYRAMZA (ramucirumab)? HOW DOES CYRAMZA WORK? CYRAMZA is not a traditional chemotherapy. It is a type of therapy called an anti-angiogenic. This means CYRAMZA is thought to block the development of new blood vessels, a process called angiogenesis. Why is angiogenesis important? There are many reasons why angiogenesis is a normal, healthy process for the body. For example, new blood vessels can help the body heal. However, in cancer, tumors use the blood supply from new blood vessels to help them grow. Without new blood vessels, a tumor may not have the nutrition it needs to keep growing. CYRAMZA helps stop or slow the growth of new blood vessels, including tumor-feeding blood vessels. CYRAMZA was shown to interfere with angiogenesis to slow tumor growth* WITHOUT TREATMENT Tumor sends out signals asking receptors to build new blood vessels. Receptors receive the signals. SIGNAL BLOOD VESSEL SURFACE RECEPTOR WITH CYRAMZA SIGNAL BLOOD VESSEL SURFACE CYRAMZA RECEPTOR Tumor sends out signals asking a receptor to build new blood vessels. CYRAMZA attaches to a receptor and blocks the signals. CAREGIVER TIP Ask a member of the healthcare team to help your loved one understand how CYRAMZA is thought to work in their body. Development of new, tumorfeeding blood vessels begins. Development of tumorfeeding blood vessels is limited. * The process of how CYRAMZA is thought to work was shown in laboratory studies. For more information, call LillyRx ( ) 13

8 HOW IS CYRAMZA (ramucirumab) GIVEN? CYRAMZA is given alone or in combination with paclitaxel. Both CYRAMZA and paclitaxel are given by intravenous infusion, commonly referred to as an IV. The medicine will be delivered into your vein. A doctor or nurse will administer treatment at the doctor s office, a hospital, or an infusion center. Before you receive treatment with CYRAMZA, your doctor will administer different medicines to help prevent an allergic reaction that may occur during infusion. Treatment with CYRAMZA alone 60 MINUTES The time it will take to receive the treatment infusion is about 60 minutes. CYRAMZA will be given to you once every 2 weeks, or as recommended by your doctor. Your doctor will determine the number of treatments you receive. Treatment with CYRAMZA in combination with paclitaxel When you receive CYRAMZA in combination with paclitaxel, treatment will be given over a 28-day cycle. Your doctor will determine the number of treatments you receive. CYRAMZA will be given once every 2 weeks over the 28-day period. The treatment infusion will take about 60 minutes. Paclitaxel will be given once a week for 3 weeks and the infusion will also take about 60 minutes. On the days you receive both medications, CYRAMZA will be given first, followed by paclitaxel. No treatment will be given for the final week of the 28-day cycle. You can refer to the following page for an example of a treatment schedule. Example CYRAMZA combination treatment schedule DAY CYCLE CYRAMZA is given first, followed by paclitaxel Paclitaxel is given alone No treatment given SELECT IMPORTANT SAFETY INFORMATION Infusion reactions related to injecting CYRAMZA have occurred. Most of these reactions happened during or after the first or second CYRAMZA infusion. Signs and symptoms of infusion reactions include shaking or stiffness of the body, back pain or spasms, chest pain or tightness, chills, flushing, difficulty breathing, wheezing, becoming blue due to lack of oxygen, and tingling or numbness of the skin. In severe cases, rapid heartbeat, low blood pressure, and severe trouble breathing may occur. Your healthcare team will monitor you for these side effects. In the case of a severe infusion reaction, your CYRAMZA treatment will have to be immediately and permanently stopped. CAREGIVER TIP Help make this experience for your loved one as positive as possible. Surround them with the things they love, whether that is family, music, or a favorite book or blanket. For more information, call LillyRx ( ) 15

9 WHAT SHOULD I TELL MY DOCTOR BEFORE RECEIVING TREATMENT WITH CYRAMZA (ramucirumab)? Before you receive CYRAMZA, tell your doctor if you: Have had or are at high risk for strokes or heart attack Have high blood pressure or have blood pressure problems Are planning to have surgery of any kind Have or have had liver problems, including liver cirrhosis or other diseases of the liver Are pregnant or may be pregnant: CYRAMZA can harm your unborn baby. You should avoid getting pregnant, and use adequate contraception, while receiving CYRAMZA and for at least 3 months after stopping CYRAMZA Are breastfeeding: your doctor will tell you to stop breastfeeding during treatment Tell your doctor about all the medications you are taking, including prescription and over-the-counter medications. Keep the conversation going Once you start taking CYRAMZA, either alone or in combination with paclitaxel, it is important to stay in communication with your doctor and other members of your healthcare team. Share with them how your treatment is going and alert them of any changes, whether in your health or even in your lifestyle. The more your healthcare team knows, the better they can help you manage treatment. CAREGIVER TIP It s CAREGIVER important to TIP make the healthcare team aware It s important of upcoming to make events the that healthcare are important team aware to of you upcoming and your events loved that one, are such important as birthdays to you and or your other loved important one, such milestones. as weddings It will or other help important them milestones. make decisions It will help to work them toward make decisions to treatment goals, together. work toward treatment goals, together. For more information, call LillyRx ( ) 17

10 WHAT SIDE EFFECTS HAVE PATIENTS EXPERIENCED? CYRAMZA (ramucirumab), either alone or in combination with paclitaxel, may cause side effects. Remember, your doctor has prescribed CYRAMZA for you because he or she believes that this is the right treatment option for you. However, if you experience new symptoms on treatment, it is essential that you speak with your healthcare provider for evaluation. You may experience different types of side effects with CYRAMZA alone or in combination with paclitaxel than you did with treatments you ve had in the past. Talking to your doctor or nurse about side effects can help you understand what to expect with treatment that may be new or different. Serious side effects of CYRAMZA observed in clinical trials included: Severe bleeding Stroke, mini-stroke, blood clot, or heart attack Severe high blood pressure Allergic reactions related to infusion Tears in the stomach or bowel wall Difficulty healing wounds May worsen certain types of liver disease Reversible posterior leukoencephalopathy syndrome (a very rare but serious brain disorder) Too much protein in urine Thyroid gland problems CYRAMZA ALONE The most common side effects were: High blood pressure Diarrhea Headache Low sodium The most common serious adverse events were: Anemia (a decrease in red blood cells) Blockage of the intestine CYRAMZA IN COMBINATION WITH PACLITAXEL The most common side effects were: Tiredness Low white blood cell count Diarrhea Nosebleed The most common serious adverse events were: Low white blood cell count Low white blood cell count with fever You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call FDA Risk to unborn babies CAREGIVER TIP You can help keep track of how your loved one is feeling by keeping detailed notes. It may be hard to tell the difference between discomfort caused by the cancer and side effects associated with treatment. So it is important that you communicate all concerns to the healthcare team. For more information, call LillyRx ( ) 19

11 WHAT CAN I DO IF I EXPERIENCE A SIDE EFFECT? The best thing to do is let your doctor or nurse know if you are experiencing side effects while being treated with CYRAMZA (ramucirumab) alone or in combination with paclitaxel. Your healthcare team will closely monitor certain things, such as your blood pressure, but always be sure to speak up whenever there is a change in how you are feeling. They may be able to make recommendations, such as over-the-counter medicines or changes to your diet, to help you feel more comfortable. If your side effects are serious enough, your doctor may have to alter or stop your treatment. Together, you can decide what the best decision is for you. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit medwatch or call FDA For more information, call LillyRx ( ) 21

12 IMPORTANT SAFETY INFORMATION FOR CYRAMZA (ramucirumab) What is the most important information I should know about CYRAMZA? WARNING: SEVERE BLEEDING, TEARS IN THE STOMACH OR BOWEL WALL, AND DIFFICULTY IN WOUND HEALING Severe bleeding, including bleeding in the stomach or bowel, has occurred with CYRAMZA. These events are sometimes fatal. Tell your doctor right away if you have bleeding or symptoms of bleeding, including lightheadedness. Your treatment will have to be permanently stopped if severe bleeding occurs. Tears in the stomach or bowel wall may occur with CYRAMZA. These events are sometimes fatal. Tell your doctor if you have severe diarrhea, vomiting, or severe abdominal pain. Your treatment will have to be permanently stopped if this occurs. Wounds may have difficulty healing with drugs like CYRAMZA. Tell your doctor if you have a wound that doesn t heal properly. If you develop a wound that won t heal during treatment, your doctor will stop CYRAMZA until the wound is fully healed. Also tell your doctor if you have planned surgery, as CYRAMZA treatment should be interrupted prior to surgery. Your doctor may restart CYRAMZA after your surgical wound has healed. Strokes, mini-strokes, blood clots, and heart attacks have occurred in clinical trials with CYRAMZA. These events are sometimes fatal. Your treatment will have to be permanently stopped if these events occur. Severe high blood pressure has occurred with CYRAMZA treatment. Your doctor will monitor your blood pressure every two weeks or more throughout treatment and may adjust, interrupt, or permanently stop treatment depending on the results. Tell your doctor if your blood pressure is high or if you have symptoms of high blood pressure, including severe headache or lightheadedness, or neurologic symptoms such as confusion, changes in your vision, or seizure. Infusion reactions related to injecting CYRAMZA have occurred. Most of these reactions happened during or after the first or second CYRAMZA infusion. Signs and symptoms of infusion reactions include shaking or stiffness of the body, back pain or spasms, chest pain or tightness, chills, flushing, difficulty breathing, wheezing, becoming blue due to lack of oxygen, and tingling or numbness of the skin. In severe cases, rapid heartbeat, low blood pressure, and severe trouble breathing may occur. Your healthcare team will monitor you for these side effects. In the case of a severe infusion reaction, your CYRAMZA treatment will be immediately and permanently stopped. CYRAMZA may worsen certain types of liver disease. Tell your doctor if you have or have had liver disease or other liver problems. RPLS (reversible posterior leukoencephalopathy syndrome), a very rare but serious brain disorder, has been reported in clinical trials with CYRAMZA. Signs and symptoms of RPLS may include headache, seizures, visual changes, and changes in mental function. These symptoms usually stop or improve within days, but some patients can experience continuing changes in mental function or death. Too much protein in the urine (proteinuria) has been reported in clinical trials with CYRAMZA. This may be a sign of kidney damage. Your doctor will monitor your urine protein levels during treatment. If you develop protein in your urine, your doctor may interrupt your treatment and decrease your dose of CYRAMZA. In severe cases your treatment will have to be permanently stopped. Thyroid gland problems have been reported in clinical trials with CYRAMZA. Your doctor will do blood tests to monitor your thyroid gland function during treatment. CYRAMZA can harm your unborn baby. You should avoid getting pregnant, and use adequate contraception while receiving CYRAMZA and for at least 3 months after stopping CYRAMZA. What are the most common side effects of CYRAMZA? The most common side effects reported in patients treated with CYRAMZA when given alone were high blood pressure, diarrhea, headache, and low sodium. The most common serious adverse events were anemia (a decrease in red blood cells) and blockage of the intestine. Red blood cell transfusions were given to 11% of CYRAMZA-treated patients and 8.7% of patients who received placebo. The most common side effects reported in patients treated with CYRAMZA when given in combination with paclitaxel were tiredness; low white blood cell count; diarrhea; nosebleeds; high blood pressure; swelling in the arms, legs, hands, or feet; mouth sores; too much protein in the urine; low platelet count; low albumin (a protein in the blood); and bleeding in the gastrointestinal tract. The most common serious adverse events were low white blood cell count and low white blood cell count with fever; 19% of patients treated with CYRAMZA plus paclitaxel were given treatment to increase white blood cell count called granulocyte colonystimulating factors. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit medwatch or call FDA What should I tell my doctor before receiving treatment with CYRAMZA? Before you receive CYRAMZA, tell your doctor if you: Have had or are at high risk for strokes or heart attack. Have high blood pressure or have blood pressure problems. Are planning to have surgery of any kind. Have or have had liver problems, including liver cirrhosis or other diseases of the liver. Are pregnant or may be pregnant: CYRAMZA may harm your unborn baby. You should avoid getting pregnant, and use adequate contraception while receiving CYRAMZA and for at least 3 months after stopping CYRAMZA. Are breastfeeding: your doctor will tell you to stop breastfeeding during treatment. Tell your doctor about all the medications you are taking, including prescription and over-the-counter medications. How is CYRAMZA given? CYRAMZA is slowly infused (injected) into your vein. The infusion will last about 60 minutes. You will usually receive CYRAMZA once every 2 weeks. Your doctor will also give additional medication(s) prior to your CYRAMZA infusion to address potential side effects. CYRAMZA is available by prescription only. Please see accompanying full Prescribing Information for additional information about CYRAMZA, including Boxed Warnings for severe bleeding, tears in the stomach or bowel wall, and difficulty in wound healing. RB-G CON ISI 18DEC2017 For more information, call LillyRx ( ) 23

13 YOUR HEALTHCARE TEAM IS THERE TO SUPPORT YOU Your healthcare team consists of a supportive group of medical professionals who are there to help you. Each member will play a unique role during your treatment journey. Your primary healthcare team may include an oncologist, primary care physician, nurse, and nutritionist (see right). Other members of your healthcare team may include a radiologist, gastroenterologist, care coordinator, and reimbursement specialist. Remember to keep in constant contact with your healthcare team. The more you talk with them, the better they will understand what you are going through, and the better prepared they will be to help you. It is important to have the contact information for your primary healthcare team easily available and all in one place. Write down their contact information on page 39 of this brochure, and keep it in an easy-to-find place. Your healthcare team may consist of the following professionals: ONCOLOGIST A doctor who specializes in the treatment of cancer YOU PRIMARY CARE PHYSICIAN A family doctor who provides general medical care NURSE NUTRITIONIST Now is the time to know who can help, and when to ask for it. A person trained to treat and care for patients, which may include providing essential medical services A person who understands what food the body needs, and for you that means he or she can help you choose the right foods to eat For more information, call LillyRx ( ) 25

14 ASK QUESTIONS It is important that you ask your healthcare team every question that comes to mind. Sometimes it can be hard to keep track of your questions or know what to ask. Below is a list of questions that might help you learn: About CYRAMZA (ramucirumab) How is CYRAMZA different from my past treatments? What should I do to prepare for treatment? How soon might I start to experience side effects? How can I tell the difference between side effects of the treatment and symptoms of the cancer? What can I do to reduce the side effects? What can CYRAMZA alone or in combination with paclitaxel offer me as a treatment? About eating right and keeping up your strength How can I keep myself as healthy as possible during treatment? What kind of foods should I eat and what should I avoid? Will I need any extra food supplements? Are there activities I can do to keep up my strength? About support services What support services are available to me and my family? Are there other patients I can talk to? CAREGIVER TIP Play an active role. Talk to any member of the healthcare team if you have any questions or concerns. For more information, call LillyRx ( ) 27

15 HELPFUL RESOURCES These pages list places where you can find support and information. They include resources for stomach cancer, as well as general cancer resources you may find useful. These resources are independent of Lilly; Lilly does not control the content. FOR SUPPORT Debbie s Dream Foundation CancerCare HOPE ( ) Cancer Support Community Patient Advocate Foundation FOR EDUCATION Debbie s Dream Foundation American Cancer Society ACS-2345 ( ) National Cancer Institute CANCER ( ) ClinicalTrials.gov FOR HELP WITH DIET AND NUTRITION Debbie s Dream Foundation PearlPoint SM Cancer Support LIVESTRONG Foundation CAREGIVER TIP There are also some resources located on page 36 you may find helpful in your role as a caregiver. For more information, call LillyRx ( ) 29

16 GLOSSARY Advanced cancer Cancer that has spread from the place where it started to other parts of the body Allergic reaction The body s excessive reaction or sensitivity to a substance Angiogenesis The process for making new blood vessels Anti-angiogenic A type of treatment used to prevent the growth of tumor-feeding blood vessels Blood vessels A pipeline that carries blood through our body Care coordinator A person who works to ensure that a patient s needs are fulfilled Chemotherapy A drug treatment that kills cancer cells Esophagus A tube at the back of the throat that is used to pass food to the stomach Gastric Relating to the stomach Gastroenterologist A doctor who specializes in the diseases of the stomach, intestines, and other associated organs Gastroesophageal junction (GEJ) The place where the stomach meets the esophagus Infusion center A place where patients can go to receive intravenous infusions Intravenous infusion A method for delivering fluid, such as medicine, into the bloodstream through a vein. Often referred to as an IV Locally advanced Cancer that has spread to tissue located near the original tumor Metastasized Cancer that has spread from one part of the body to farther parts of the body (for example, from the stomach to the lungs) Paclitaxel A type of traditional chemotherapy that is sometimes given with CYRAMZA (ramucirumab) to treat advanced stomach cancer Radiologist A doctor trained to examine images taken of the human body (for example, an x-ray) to diagnose disease Receptors Structures located on a cell that when activated will cause a specific effect in the cell Reimbursement specialist A person who helps patients with insurance reimbursements Stomach A hollow organ that breaks down food Tissue A group or layer of cells that work together to perform a certain function Vein A type of blood vessel that carries blood For more information, call LillyRx ( ) 31

17 SUPPORTING YOUR LOVED ONE GUIDANCE FOR CAREGIVERS For more information, call LillyRx ( ) 33

18 THE IMPORTANT ROLE YOU PLAY BE INVOLVED WITH THE HEALTHCARE TEAM A caregiver who takes care of a loved one with advanced stomach cancer often takes on many roles. You help with many daily tasks, such as managing your loved one s medical care, providing transportation, running personal errands, cooking, cleaning, and completing many other household chores. A caregiver is often the emotional backbone for their loved one. Remember, each person handles their cancer experience differently. By simply listening and acknowledging their feelings, you can provide a great deal of support. A caregiver also plays a key role in providing a loved one with information to help with decision making about treatment. This may include using the Internet and asking advice from family and friends. Remember, information from outside sources may be wrong or different from that provided by your loved one s doctor, so be sure to talk to their healthcare provider about any information you learned. And as a caregiver, you may often serve as your loved one s communicator to their healthcare team. Don t be afraid to make yourself heard. Your efforts will help support your loved one and the medical care provided. You can be an integral partner and meaningful resource for the healthcare team. Through long-term care, you see the changes in your loved one s medical condition, which allows you to provide important first-hand information. You can also identify any side effects or changes they may be experiencing with treatment. You can help coordinate care, keep track of appointments and prescriptions, and be the core person who makes sure the healthcare team knows what is going on with your loved one s condition. When you speak with a member of the healthcare team, bring your notes and don t be afraid to ask questions. Your help and contribution is valuable to the healthcare team and the medical care provided to your loved one. CAREGIVER TIP During discussions with the doctor, be sure that you and your loved one review treatment goals and expectations of treatment. For more information, call LillyRx ( ) 35

19 DON T FORGET TO TAKE CARE OF YOURSELF Part of taking care of a loved one with advanced stomach cancer is taking care of yourself, too. There are many stresses and obligations that a caregiver takes on when caring for a loved one with cancer. Often, a strong focus is placed on the loved one. Don t ignore your needs; they are just as important. Make and keep doctor appointments for yourself, eat healthy foods, get rest, exercise, and spend time with family and friends. Caregivers also need help and emotional support. Share your feelings with family and friends. Ask the healthcare team for help. Reach out to support groups. If you cannot visit a group in person, online communities offer opportunities for you to talk with other caregivers, as well as obtain advice and information. Below is a list of support communities that you may find helpful. These resources are independent of Lilly; Lilly does not control the content. RESOURCES Debbie s Dream Foundation CancerCare HOPE ( ) Cancer Support Community CAREGIVER TIP Remember, it takes a great deal of strength to be a caregiver. By taking care of yourself, you will be better able to take care of your loved one. For more information, call LillyRx ( ) 37

20 IMPORTANT CONTACTS You can use this sheet to keep track of important contact information for members of your loved one s healthcare team. ONCOLOGIST Name: Phone: Address: NURSE Name: Phone: Address: PRIMARY CARE PHYSICIAN Name: Phone: Address: NUTRITIONIST Name: Phone: Address: GASTROENTEROLOGIST Name: Phone: Address: OTHER Name: Phone: Address: For more information, call LillyRx ( ) 39

21 Now is the time to find out about CYRAMZA (ramucirumab) Get the information you need at Learn more about CYRAMZA, how it works, and what you can expect from treatment when used alone or in combination with paclitaxel Identify resources that will provide you with more information and support If you are a caregiver, get tips on how to assist your loved one FOR PATIENTS WITH ADVANCED STOMACH CANCER For more information about CYRAMZA therapy, call LillyRx ( ). Please see Important Safety Information, including Boxed Warnings for severe bleeding, tears in the stomach or bowel wall, and difficulty in wound healing, on pages See accompanying full Prescribing Information for additional information about CYRAMZA. PP-RB-US /2018 Lilly USA, LLC All rights reserved. CYRAMZA is a registered trademark owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates. Other product/company names mentioned herein are the trademarks of their respective owners.