education for a better chemotherapy experience€¦ · van dulmen s, driesenaar j, van weert j, van...
TRANSCRIPT
![Page 1: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/1.jpg)
EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE
Ellen Manzullo, MD, FACP
Professor of Medicine Clinical Deputy Division Head, Internal Medicine
UT MD Anderson Cancer Center
![Page 2: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/2.jpg)
Faculty Disclosure
No, nothing to disclose
![Page 3: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/3.jpg)
SessionOutline
1. AspectsofEduca0onpriortotheini0a0onofChemotherapy
2. Thrombosisandeduca0ononit'spreven0onandtreatment
3. Poten0alsideeffectsofChemotherapy
• Ques0onsandAnswers
4. PsychosocialaspectsoftreatmentwithChemotherapy
5. HealthyLifestylePromo0on
• Ques0onsandAnswers
![Page 4: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/4.jpg)
ChallengesofPa2entEduca2onPriortoChemotherapy
• Pa0entsoGenareoverwhelmedwithfacingapoten0allifethreateningillness
• Many0mescancerpa0entsundergoextensivetreatmentoveraprolonged0mecourse
• TheshiGinchemotherapytreatmentfromtheinpa0enttooutpa0entseKnghasdecreasedtheamountof0meforpa0enteduca0on
• Outpa0entchemotherapyhasmadeitimportantforbothpa0entsaswellastheircaregiverstobeknowledgeableaboutsideeffecttreatmentinthehome
![Page 5: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/5.jpg)
ChallengesofPa2entEduca2onPriortoChemotherapy
• Morethan60%ofallcancerpa0entsare65yearsofageandabove
• Many0mescancerpa0entsalsohaveamul0tudeofothercomorbidcondi0ons
• Astudyhasshownthatolderpa0entsonlyac0velyrecalllessthanonefourthoftheeduca0onfocusedonsideeffecttreatmentprecedingchemotherapy
JansenJ,vanWJ,vanderMeulenN,vanDulmenS,HeerenT,BensingJ.(2008).Recallinoldercancerpa0ents:measuringmemoryformedical
informa0on.Gerontologist,48(2);149-157
![Page 6: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/6.jpg)
Pa2entVOICE:AnOnlineCommunica2onToolforOlderPa2entswithCancer
• Online,preparatorytoolwithaudiofocusedonimprovingthepar0cipa0onofolderpa0ents(65yearsorolder)duringeduca0onalnursingencountersbeforechemotherapyandalsoimprovingtheirinforma0onrecall
• Pa0entVOICEwasdevelopedwithinvolvementofbothpa0entsandnurses
• Pa0entVOICEprovidespre-visitinforma0onaboutchemotherapy,thenursingvisit,andtheroleofthepa0entduringtreatment
• Futureresearchisgoingtobeconductedonit'su0lityandusabilityinagroupofolderpa0entswhoreceiveorhavereceivedchemotherapy
vanDulmenS,DriesenaarJ,vanWeertJ,vanOschM,NoordmanJ.(2017).Pa0entVOICE:DevelopmentofaPreparatory,Pre-ChemotherapyOnline
Communica0onToolforOlderPa0entsWithCancer.JMIRResearchProtocols,6(5),1-11
![Page 7: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/7.jpg)
Evalua2onoftheAddi2onofVideo-basedEduca2onforPa2entsReceivingStandardPre-ChemotherapyEduca2on
• Aimofthestudywastoevaluatetheusefulnessofaneduca0onalvideowithregardtopa0ents'abilitytorecallandreportsideeffectsoftreatment
• Pa0entswerethosewithnewlydiagnosedbreastorcolorectalcancer,betweenages18-75,whoweretoreceiveadjuvantchemotherapy
• Pa0entswererandomizedtoreceivestandardpre-chemotherapyeduca0onorstandardeduca0onplusaddi0onofavideo
• Thevideo,"StayingWellDuringChemotherapy",focusedonmostcommonsideeffectsoftreatmentwitheduca0onontheirmanagement
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 8: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/8.jpg)
Evalua2onoftheAddi2onofVideo-basedEduca2onforPa2entsReceivingStandardPre-ChemotherapyEduca2on
HypothesisoftheStudy:• Pa0entswhowatchedthevideo
inaddi0ontoreceivingwriienandverbalinstruc0onsarebeierabletorecallsideeffectsoftreatmentandwouldperformearlyrepor0ngoftreatmentsideeffects
SpecificAimsoftheStudy:• Comparerecallofinforma0on
regardingself-careandsideeffectsinpa0entswhowatchedthevideoaspartoftheirpre-chemotherapyeduca0onwiththosewhoreceivedstandardcare.
• Surveypa0entsandevaluatetheusefulnessofthevideoinassis0ngthemmanagesideeffectsofchemotherapyinthehome.
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 9: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/9.jpg)
Pa2entSelec2on
• Pa0entswithcolorectalcancerandwerescheduledtoreceiveadjuvantchemotherapywithweekly5FluorouracilandFolinicAcid
• Pa0entswithbreastcancerandwerereceiving5Fluorouracil,EpirubicinandCyclophosphamideorAdriamycin/EpirubicinandCyclophosphamideChemotherapy
• Pa0entshadEnglishastheirprimarylanguage
• ECOGscore0-2
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 10: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/10.jpg)
ExclusionCriteria
• Iftheyoranyimmediatefamilymemberhadpriorchemotherapy
• Comorbidcondi0onthatwouldprohibitcomprehensionandgivinginformedconsent
• Visuallyorhearingimpaired
• Unabletocompletetheques0onnaire
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 11: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/11.jpg)
WithdrawalCriteria
• Pa0entswerewithdrawniftheyhadtoxici0esthatrequiredstoppingtreatment
• Iftreatmenthadtobedeferredduetoseriousillnesslas0ngmorethan3weeks
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 12: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/12.jpg)
"StayingWellDuringChemotherapy"includedthefollowing:
• Selfhelpformul0plesymptoms– Nausea/vomi0ng– Infec0on– Anemia– Thrombocytopenia– Mouthcare– Dietary&fluidintake– Diarrhea– Cons0pa0on
• Pa0entswerealsoinstructedwhentoseekmedicalcare
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-based
educa0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.EuropeanJournalofCancerCare,17(4),328-339
![Page 13: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/13.jpg)
"StayingWellDuringChemotherapy"includedthefollowing:
• Pa0entscompletedabaselineques0onnaireevalua0ngknowledgeandanotherques0onnairepriortothesecondchemotherapycycleevalua0ngrecallofinforma0on
• Pa0entswhowatchedthevideowereaskedtoassessthevideoaGer6cyclesofchemotherapy
• Telephonecallstothedepartmentrepor0ngsymptomswereevaluatedforbothgroups
Kinnane,N.,&Thompson,L.(2008).Evalua0onoftheaddi0onofvideo-basededuca0onforpa0entsreceivingstandardpre-chemotherapyeduca0on.
EuropeanJournalofCancerCare,17(4),328-339
![Page 14: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/14.jpg)
Results
• Thevideogroupshowedatrendtowardshigherrecallininforma0onpertainingto:
– Fever– Mouthproblems– Anemia– Preven0onofcons0pa0on
• Thevideogroupmorecommonlytelephonedrepor0ngmedicalproblemsof:
– Nausea– Vomi0ng– Signsofinfec0oncomparewiththestandardgroup
![Page 15: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/15.jpg)
InternetResourcesforPa2entsonChemotherapy:SideEffects
• ASCO:hips://www.cancer.net/naviga0ng-cancer-care/side-effects
• NCI:hips://www.cancer.gov/about-cancer/treatment/side-effects
• ACS:hips://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects.html
![Page 16: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/16.jpg)
Pa2ent-orientedAPPS
iOS(iPhone/iPad):
CaringBridgeHelpConnectcaregivers&Pa0entswithsupportsystem.Link:hips://itunes.apple.com/us/app/caringbridge/id365726944?mt=8
Cancer.netGuidesto120cancers,interac0vetooltokeeptrackofques0onstoaskprovidersandrecordvoiceanswers,symptomtrackerforsideeffects.Link:hips://itunes.apple.com/us/app/cancer-net-mobile/id433501257?mt=8
NCCNGuidelinesforPa2ents
VirtualPa0entversionofNCCNGuidelines.Havetobecomeuser(free).Link:hips://itunes.apple.com/us/app/nccn-pa0ent-guides-for-cancer/id1168594706?mt=8
CancerSurvivorshipConnec2onByGeorgiaCoreLinkstoSurvivorsVideos,Blogs,AppsandCancerhospitalsinGeorgiaLink:hips://itunes.apple.com/us/app/cancer-survivorship-connec0on/id1189987382?mt=8
![Page 17: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/17.jpg)
Pa2ent-orientedAPPS
ANDROID:
SymptomManagementGuidelinesByCancerCareOntarioSimplifiedguides(includesFa0gue)Link:hips://play.google.com/store/apps/details?id=com.cancercare.symptommanagement
Cancer.netGuidesto120cancers,interac0vetooltokeeptrackofques0onstoaskprovidersandrecordvoiceanswers,symptomtrackerforsideeffects.Link:hips://play.google.com/store/apps/details?id=com.fueled.cancernet
NCCNGuidelinesforPa2entsVirtualPa0entversionofNCCNGuidelines.Havetobecomeuser(free).Link:hips://play.google.com/store/apps/details?id=com.mediaparts.nccn
![Page 18: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/18.jpg)
ThrombosisandCancer
• Riskofvenousthromboembolism(DVTorPE)isincreasedinpa0entsreceivingcancerchemotherapy.
• Inthegeneralpopula0on,VTEoccursatarateof1per1000persons/yearor0.1%(2/3DVT,1/3PE)andpa0entswithcancerhaveanincidenceofreportedthrombo0ceventsthatrangesfrom4%to20%
• VTEispresentatautopsyinapproximately50%ofpa0entswithcancer• Cancerpa0entshavearecurrencerateofthrombo0cevents30mesthatof
generalpopula0on• Riskofvenousthromboembolismalsorisesprogressivelyoverthecourseof
treatment• Retrospec0vestudieshavesuggestedanassocia0onbetweencancer-
associatedvenousthromboembolismandpa0entsurvival
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
![Page 19: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/19.jpg)
ThrombosisandCancer
• Venousthromboembolismisthesecondleadingcauseofdeathfollowingcancerprogression
• Mayresultindelayordiscon0nua0onofchemotherapy• Thrombosisincancerpa0entshasanincreasedriskofrecurrent
eventsaswellasmajorbleedingincomparisontothrombosisinnon-cancerpa0ents
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
![Page 20: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/20.jpg)
ClinicalRiskScore
Factor RiskScoreSiteofcancer
Veryhighrisk(stomach,pancreas)Highrisk(lung,lymphoma,gynecologic,bladder,tes0cular)
21
Prechemotherapyplateletcount≥350,000/mm3 1
Prechemotherapyleukocytecount>11,000/mm31
Hemoglobinlevel<10g/dLoruseofredcellgrowthfactors1
Bodymassindex≥35kg/m21
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
Cumula0vescore:highrisk,≥3;intermediaterisk,1-2;lowrisk,0.
![Page 21: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/21.jpg)
ThrombosisandCancer
• Alarge,na0onwide,prospec0vecohortstudyofadultswithsolidtumorsorlymphomaini0a0ngchemotherapyfrom2002to2006at115USprac0cesiteswasperformed.
• Purposeofthestudywastoinves0gateiftheVTEClinicalRiskScorealsopredictedearlymortalityandcancerprogression
• Duringthefirst4monthsoftherapyof4,405pa0ents,134(30%)diedand330(7.5%)experienceddiseaseprogression
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
![Page 22: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/22.jpg)
Results
• HighRiskPa0ents(n=540,12.3%)bytheClinicalRiskScorehada120daymortalityrateof12.7%
• IntermediateRiskPa0ents(n=2,665,60.5%)hadamortalityrateof5.9%
• LowRiskPa0ents(n=1,200,27.2%)hadamortalityrateof1.4%
120dayFollow-upResults:Cancerprogressionoccurredin27.2%ofhighriskpa0ents,16.4%ofintermediateriskpa0ents,and8.5%oflowriskpa0ents.
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
![Page 23: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/23.jpg)
Conclusion
• VTEClinicalRiskScorewasalsopredic0veofearlymortalityandcancerprogressionduringthefirstfourcyclesofoutpa0entchemotherapy.Thiswasalsoindependentofothermajorprognos0cfactorsincludingVTE.
KudererN,CulakovaE,LymanG,FrancisC,FalangaA,KhoranaA.(2016).AValidatedRiskScoreforVenousThromboembolismIsPredic0veof
CancerProgressionandMortality.TheOncologist,21;861-867
![Page 24: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/24.jpg)
Pa2entEduca2ononThrombosis
• AmericanCollegeofPhysiciansPa0entEduca0onBookleton:WhatYouShouldKnowAboutBloodClots
“ADVTisabloodclotthatformsinthedeepveinsofyourbody,usuallyinthelegorarm.Iftheclotbreaksfreeandmovestothelungs,itcanblockbloodsupplyandmakeithardforoxygentogettotherestofyourbody.
ThisiscalledaPE.”
![Page 25: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/25.jpg)
Pa2entEduca2ononThrombosis
• RiskFactorsYouCannotChange– Havingafamilyhistoryofbloodclots(bloodrela0vewhohashad
bloodclotsinthepastorabloodcloKngdisorder)– Beingover60yearsofage– Apersonalhistoryofbloodclots
• RiskFactorsYouCanWorktoChange– Smoking– Beingoverweightorhavingobesity
• Mul0pleRiskFactorsthatYouMayHaveDuringYourLife0me– Cancerdiagnosis
WhatYouShouldKnowAboutBloodClots:RiskFactors,Preven0on,andTreatment.(2016).AmericanCollegeofPhysicians,1-24
![Page 26: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/26.jpg)
Pa2entEduca2ononThrombosis
• SymptomsofDVTandPE
• Ac0onstotakeifhavingsymptomsofaDVTorPE
• Waystopreventbloodclotsfromforming– Importanceofregularexercise– Smokingcessa0on– Compressionstockings(Howtoapplyandtakeoff)
![Page 27: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/27.jpg)
WarfinandOtherBloodThinners
WhatYouShouldKnowAboutBloodClots:RiskFactors,Preven0on,andTreatment.(2016).AmericanCollegeofPhysicians,1-24
Warfarin(Coumadin®) OtherBloodThinnersApixaban(Eliquis®),Dabigatran(Pradaxa®),Edoxaban(Savaysa®),Rivaroxaban(Xarelto®)
FoodInterac0ons
VitaminK—foundinleafygreenvegetables.Importanttoeatthesameamountandtypeeachweek.
Noknowninterac0onswithfood.
DrugInterac0ons
Over-thecounter:Herbalanddietarysupplements(ginger,ginsengandgarlic);an0-inflammatory(ibuprofenandnaproxen;coldmedicines).Prescrip2on:An0neoplas0c(cancer),heart,an0fungal,steroids,an0bio0cs,andan0depressantmedicines.
Talktoyourhealthcareprofessionalaboutpossibleinterac0onswithcurrentmedicines.Otherbloodthinnerscanhaveseveresideeffectsifnotmonitoredcorrectly.
BloodTests RequiresregularbloodtestscalledINRstomakesureyouareontherightdoseandthatyourbloodisnottoothickorthin.
Occasionalbloodteststomakesureyourblood,liver,andkidneysareworkingnormally.
Costs Lowercost(dependingonyourinsurancebenefits).
Highercost(dependingonyourinsurancebenefits).
PossibleSideEffects
Bleedingandbruising(talktoyourhealthcareprofessionalaboutyourriskforbleeding).
Bleedingandbruising(talktoyourhealthcareprofessionalaboutyourriskforbleeding).Possiblestomachdiscomfort.
Storage Canbestoredinapillorganizer. Dabigatranneedstobekeptinitsboile.Allotherscanbestoredinapillorganizer.
![Page 28: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/28.jpg)
Prescrip2onMedica2ons
WhatYouShouldKnowAboutBloodClots:RiskFactors,Preven0on,andTreatment.(2016).AmericanCollegeofPhysicians,1-24
NameofMedicine Dosage Size,Shape
&ColorHowMuch
WhentoTake/HowtoUse
WhatIUseItFor
Start/StopDate Notes
Example:Warfarin 5mg small,oval,
peachcolor 1pill Takebymouth,everymorning BloodThinner 4/1/13-
Don'tskipdoses,beconsistentwithgreenveggies
![Page 29: EDUCATION FOR A BETTER CHEMOTHERAPY EXPERIENCE€¦ · van Dulmen S, Driesenaar J, van Weert J, van Osch M, Noordman J. (2017). PaentVOICE: Development of a Preparatory, Pre-Chemotherapy](https://reader034.vdocuments.mx/reader034/viewer/2022042208/5eaad828dfc890100e68bbd8/html5/thumbnails/29.jpg)
Conclusion
• Acancerdiagnosisisateachablemoment
• Pa0enteduca0onpriortochemotherapyisessen0alandshouldfocusonpreven0onandtreatmentofsideeffectsaswellasinstruc0ononwhentoseekmedicalcare
• Pa0entsshouldbeeducatedonthepossibilityofvenousthromboembolism(DVTorPE)andwaystopossiblypreventthisfromoccurringandthatitisamedicalemergency
• Educa0onhelpspa0entsandtheircaregiversbebeieradvocatesfortheirwellbeing