SELF-CARE FOR THE CANCER PATIENT

Transcription

1 SELF-CARE FOR THE CANCER PATIENT Maryann R. Cooper, PharmD, BCOP Associate Professor of Pharmacy Practice MCPHS University School of Pharmacy Worcester/Manchester

2 OBJECTIVES Identify side effects in oncology patients that are appropriate to manage with self-care strategies Describe when it is appropriate to refer a patient to their provider vs. recommend self-care strategies Discuss appropriate self-care approaches for certain treatment related side effects

3 ROAD MAP Nausea/ Vomiting Diarrhea Pain Constipation Xerostomia PPE

4 NAUSEA AND VOMITING

5 POTENTIAL CAUSES Chemotherapy Radiation therapy Post-surgery Constipation Obstruction Gastroparesis Pain Metastatic disease Liver Brain Vestibular dysfunction Electrolyte abnormalities Anxiety Other medications Corticosteroids Opiates Antibiotics NSAIDs Alcohol Iron

6 WHEN TO REFER Nausea or vomiting not controlled with prescribed antiemetics Nausea or vomiting that is preventing eating or drinking Nausea or vomiting that occurs > 1 week after receiving chemotherapy Abdominal pain Hematochezia or dark colored emesis Weight loss in excess of 2 lbs/week Signs or symptoms of dehydration

7 SELF-CARE STRATEGIES Eat small, frequent, light meals throughout the day BRAT diet: bananas, rice, applesauce, toast, or other bland foods Avoid spicy, greasy or fried foods or foods that are irritating to the stomach Eat foods that are appealing Slowly advance the diet as symptoms resolve Avoid unpleasant odors, sights or sounds Lying down may alleviate some symptoms Avoid right after meals Drink ounce glasses of water, sports drinks, or juice per day

8 ADDITIONAL STRATEGIES Ginger Acupressure Aromatherapy Acupuncture Yoga

9 OVER-THE-COUNTER PRODUCTS PRODUCTS THAT MAY HELP Proton pump inhibitors (PPI) Histamine H 2 receptor antagonist (H2RA) Antacids PRODUCTS UNLIKELY TO HELP Emetrol Nauzene Bismuth subsalicylate Antihistamines (histamine H 1 antagonists) Oral replacement solutions

10 CONSTIPATION

11 POTENTIAL CAUSES Medications Serotonin 5HT 3 receptor antagonists Phenothiazines Iron Opiates Cancer treatments Inactivity Immobility Cancer growth or spread Bowel obstruction Dehydration Poor diet Depression Anxiety Stress

12 WHEN TO REFER Severe abdominal pain Fever Nausea/vomiting Colostomy Daily laxative use Dark or tarry stool Pencil thin stool Symptoms lasting > 2 weeks

13 SELF-CARE STRATEGIES Balanced diet Women: 25 g fiber/day Men: 38 g fiber/day Avoid constipating foods Increased fluid intake Exercise

14 OVER-THE-COUNTER PRODUCTS USEFUL PRODUCTS Bulk forming laxatives MiraLAX (PEG 3350) Docusate sodium or calcium Senna Bisacodyl PRODUCTS TO AVOID Mineral oil Saline laxatives Caster oil

15 DIARRHEA

16 POTENTIAL CAUSES Chemotherapy Immunotherapy Hormonal therapy Targeted therapy Radiation therapy Surgery Infection Other medications (e.g. antibiotics) Cancer CTCAE* Grade Criteria 1 Increase of < 4 stools per day over baseline; mild increase in ostomy output compared to baseline 2 Increase of 4-6 stools per day over baseline; moderate increase in ostomy output compared to baseline; limiting instrumental ADL 3 Increase of 7 stools per day over baseline; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self care ADL 4 Life-threatening consequences; urgent intervention indicated 5 Death *Common Terminology Criteria for Adverse Events version 5.0

17 WHEN TO REFER 6 loose stools/day for > 2 days Blood in stool or rectal area Weight loss Fever Incontinence Abdominal cramps lasting > 1 day Dizziness Diarrhea or abdominal cramps that interfere with activities

18 SELF-CARE STRATEGIES Clear liquids Low fiber foods Avoid irritating foods, alcohol, caffeine, nicotine Eat small, frequent meals Maintain hydration Clean with mild soap or baby wipes Apply water-repellant ointment

19 OVER-THE-COUNTER PRODUCTS Loperamide Bismuth subsalicylate Probiotics Oral replacement solutions

20 LOPERAMIDE DOSING OTC dosing Rx dosing Irinotecan Neratinib Recommended Dose 4 mg PO initially, followed by 2 mg PO after each loose stool (DNE 8 mg/day) 4 mg PO initially, followed by 2 mg PO after each loose stool (DNE16 mg/day) 4 mg PO initially, followed by 2 mg PO q2h (4 mg PO q4h at night) until diarrhea has stopped for at least 12 hr (DNE 48 hrs) Weeks 1-2: 4 mg PO TID Weeks 3-8: 4 mg PO BID Weeks 9: 4 mg PO prn titrated to maintain 1-2 BM/day (DNE 16 mg/day) BM = bowel movement; DNE = do not exceed; OTC = over-the-counter; Rx = prescription

21 XEROSTOMIA

22 POTENTIAL CAUSES Radiation therapy Chemotherapy Graft-versus-host disease Other medications Antidepressants Antiemetics Diuretics Opiates Infection Dehydration

23 WHEN TO REFER Unable to take medications Unable to eat or drink Dry, cracked lips Mouth sores Trouble breathing Tooth decay Candidiasis, gingivitis, periodontitis Inability to wear dentures Fever

24 SELF-CARE STRATEGIES Check mouth daily Preventive dentistry Brush teeth twice daily with soft toothbrush with mildly flavored, low-abrasive fluoride toothpaste Floss 1-2 times/day Fluoride rinses Clean dentures

25 SELF-CARE STRATEGIES Rinse mouth with salt and soda solution q2h Sip liquids with meals Sip water in between meals Add liquids to solid foods Use ice chips, sugarless hard candies Use petroleum jelly or mild lip balm Maintain hydration Avoid alcohol and tobacco Avoid hot, spicy foods Avoid sugary foods Avoid chewy candies, tough meats, hard fruit or vegetables

26 Acupuncture ADDITIONAL STRATEGIES

27 OVER-THE-COUNTER PRODUCTS Trade Name ACT Total Care Dry Mouth Lozenges Biotene Oral Balance Gel/Liquid Biotene Moisturizing Mouth Spray Entertainer s Secret Spray Biotene Dry Mouth Gum Primary Ingredients Isomalt, Xylitol, Glycerin Glucose oxidase 10,000 units; lactoferrin 16 mg; Lactoperoxidase 15,000 units; lysozyme 16 mg; sodium monofluorophosphate 0.14% (w/v fluoride ion) Sodium carboxymethylcellulose; dibasic sodium phosphate; potassium chloride; parabens; aloe vera gel; glycerin Sorbitol; gum base; xylitol; maltitol syrup Biotene Dry Mouth Toothpaste Sodium monofluorophosphate 0.14% Source: Chapter 32. Handbook for Nonprescription Drugs: An Interactive Approach to Self-Care, 19 th Ed. November 2017.

28 PAIN

29 POTENTIAL CAUSES Tumor pressing on bone, organ, or nerve Chemotherapy Radiation therapy Surgery Other treatments

30 WHEN TO REFER More than mild to moderate pain Pain lasting > 10 days Change in chronic pain or new acute pain Limb weakness Loss of bowel/bladder control Signs of infection Neuropathic pain Bone pain Concurrent chemotherapy Drug or disease interaction with NSAIDs or acetaminophen OTC medications not controlling pain

31 SELF-CARE STRATEGIES Rest Ice/heat Elevation Distraction/imagery Relaxation

32 ADDITIONAL STRATEGIES Biofeedback Counseling Hypnosis Massage Transcutaneous electric nerve stimulation (TENS)

33 OVER-THE-COUNTER PRODUCTS TOPICAL Menthol Camphor Capsaicin Lidocaine Trolamine salicylate Combination Methyl salicylate/menthol ± camphor Camphor/menthol Lidocaine/menthol Acetaminophen NSAIDS Aspirin Ibuprofen Naproxen SYSTEMIC

34 INTERACTIONS & PRECAUTIONS ACETAMINOPHEN Imatinib Limit acetaminophen to 1300 mg/day Sunitinib Dasatinib Mask fever NSAIDS All chemotherapy Methotrexate Pemetrexed Cisplatin Sorafenib Corticosteroids Multiple myeloma

35 PALMER-PLANTER ERYTHRODYSESTHESIA (PPE)

36 POTENTIAL CAUSES CHEMOTHERAPY Capecitabine 5-flurouracil Continuous infusion doxorubicin Liposomal doxorubicin Ixabepilone TARGETED THERAPIES Lapatinib Vemurafenib Axitinib Cabozantinib Regorafenib Sorafenib Sunitinib Pacopanib

37 WHEN TO REFER Self-care strategies aren t working Limiting ADLs Peeling Blisters Bleeding Edema Fever

38 SELF-CARE STRATEGIES Avoid exposure to hot water Don't rub skin with a towel Avoid pressure on the soles of the feet or the palms of the hands Avoid using tools or other utensils that require strong pressure Avoid exposure to the sun Avoid contact with harsh chemicals Elevate hands and feet Gently apply moisturizing creams Wear loose fitting, comfortable clothing and shoes Cool hands and feet with an ice pack or cool pack

39 OVER-THE-COUNTER PRODUCTS Prevention: Urea 10% cream TID plus after handwashing Treatment: Acetaminophen Topical corticosteroids Avoid topical diphenhydramine and topical anesthetics, topical rubefacients

40 QUESTIONS