Making an impact

The Breast Course for Nurses: who we are and what we have done over the last 12 months     

We have run several courses over the last 12 months:

Cape Town, South Africa – 15 nurses trained
Lilongwe, Malawi – 26 nurses trained
Windhoek, Namibia – 30 nurses trained
Ongwediva, Namibia – 30 nurses trained
Harare, Zimbabwe – 257 health care providers trained
Johannesburg, South Africa – 42 nurses trained

An account of each course can be found on the blog: http://www.jennyedge.co.za and Facebook page: www.facebook.com/breastcourse4nurses

blog 2The course is constantly evolving and I want to highlight some of the new changes we have made this year.

The major challenge we have addressed is allowing the course to run independently.

I have learnt a lot about teaching through the whole process.  The course was set up along the principles of the flipped class technique.

blog 2.1Unlike teaching at school, the participants on the courses are very varied and most are experts in their own areas.  We were constantly faced with the challenge of having large numbers of health care workers with vastly differing levels of knowledge about breast cancer and differing needs from the course.  In Zimbabwe, we were asked to extend the training to include doctors.  We met the challenge by dividing the 2 day course into 3 day long modules:
Module 1 was capped at 80 students and aimed at primary health care workers, breast cancer advocates and registered nurses.
Module 2 was capped at 50 participants and was aimed at registered nurses from the clinics, oncology sisters and doctors.
Module 3 was capped at 30 participants and was aimed at oncology sisters and doctors.  It allowed us to teach biopsy techniques.

blog 2.2We were also asked to have a “train the trainers” day. In many ways, the request ran against our aim to equip nurses to be self sufficient in their learning.  (The principle behind PEP is that health care workers should educate themselves with the material provided.)  Nevertheless, we blended the 2 approaches and Prof Woods and I ran a day in which we looked at different teaching modalities and tried to apply them to the course.  We defined “teaching” as the “sharing of understanding”
The result was that Module 1 of the Breast Course for Nurses was entirely taught by the nurses who attended the train the trainer’s day and studied the book (Breast Care).  I was immensely proud!

In Johannesburg, we took a different approach to deal with the challenge.  The course was run at Charlotte Maxeke Hospital by Dr Sarah Nietz and her team.  I wasn’t there at all.  I understand that 45 nurses completed the course.  The faculty were entirely local.

blog 2.3

Many thanks to everyone who has been involved with the Breast Course for Nurses.  If you wish to become involved, run a course or know more, please contact us.

Dr Jenny Edge, Founder and director of Breast Course for Nurses (PBO No.: 930050375)

Facebook: http://www.facebook.com/breastcourse4nurses

Blog: www.jennyedge.co.za

Email: lieskewegelin@gmail.com

 

 

Those dreaded side effects!

sideeffects

The chemotherapy drugs cannot distinguish between cancer cells and normal cells of the body and will attack other rapidly growing cells such as hair,skin, nails, lining of the digestive system and bone marrow (blood cell lines).

Therefore there are various side effects associated with the therapy and  because each drug acts in a slightly different way, the side effects will also differ between different drugs.

Thankfully, like all drugs (including Panado and Aspirin), not every side effect is experienced by every person, and some side effects are experienced to lesser degrees in some people.

Many side effects may be unpleasant, but are not harmful. Some side effects may get worse and some may get better with each cycle of treatment. Others may develop during the course of the treatment.

Some side effects need to be treated and some can be managed by anticipating them and controlling them in advance which lessens their effect.

Some side effects are more serious and it is important to contact your doctor if you are worried.

The good news is that cancer cells divide more rapidly than normal cells and are therefore more likely to be killed by chemotherapy.

More good news is that normal cells are also more able to recover than cancer cells and therefore most side effects are not permanent and will reverse once the treatment is finished.

Blood cell counts are done each time a new cycle of chemotherapy is started. This is usually done the day before the next treatment or very early on the same morning of the treatment. Sometimes a blood test will be done mid-cycle depending on the patient or the combination of drugs used.

The most common side effects and some of the agents that cause them:

Nausea/Vomiting (FEC, AC> CMF, Xeloda)

Drugs that help prevent against nausea are given before the combinations that cause this. Medication is also given to take home for a few days after treatment too. Different drugs work for different people and it may be necessary to try more than one antiemetic before you get relief.  It is important not to give up – if the prescribed antiemetic is not effective, work with your doctor and nurse to find the one that works best for you.

Diarrhoea/ Constipation (all, but especially Xeloda, Vinorelbine)

The irritation of the lining of the bowel may lead to diarrhoea. This can often be managed with dietry changes but may require medication. Drinking lots of fluids is important to help replace losses.

Chemotherapy may cause some people to become constipated.  Others may become constipated because they are less active than before, because of diet changes, or from pain medication they may be taking.

Mouth sores and ulcers (all)

The cells lining the mouth may be affected and the mouth may be sensitive or develop small ulcers. Sometimes changes or loss of taste can occur which recovers once treatment is completed.

Lower blood cell counts (FEC,AC, CMF, Gemcitabine,Vinorelbine,)

This occurs because the chemotherapy drugs affect the bone marrow. The bone marrow makes white blood cells, red blood cells and platelets. The levels of these blood cell counts are checked regularly during treatment.

Low white cell counts (FEC, AC, CMF)– white blood cells help fight infection. If you have a severe infection and your white cell count is very low, it could be life threatening and may require hospitilisation. It is important to contact your treating doctor if your temperature goes above 38degC.

Low red cell counts (FEC,AC, CMF,Taxol, Gemcitabine)– red blood cells carry oxygen to the cells. If the count goes down you may become anaemic which will result in you feeling tired and breathless. If severe, you may need a blood transfusion.

Low platelets (Gemcitabine)– platelets help blood to clot. If the count goes down you may bruise easily.

Tiredness/Fatigue (all)

Fatigue is a common side-effect of chemotherapy and can range from mild lethargy to feeling completely wiped out.  It is not always due to a low red cell count (anaemia). It can be a deep tiredness that does not get better from sleep and tends to be worse at the beginning and end of a treatment cycle but may persist for 6 months to a year after treatment.

Hair loss (FEC,AC) Hair thinning (CMF,Taxol, Vinorelbine)

Some chemotherapy combinations (such as AC, FEC, CAF) make all hair fall out both on the head and the rest of the body.

Other combinations cause some hair to fall out so the hair thins out.

This can be upsetting but it is temporary- the hair will begin to grow back a few weeks after treatment has stopped. It may grow back different in colour or texture though.

Skin and nail changes (Taxol, Xeloda, Vinorelbine)

Skin may become dry and sensitive to sunlight and some drugs even cause rashes. Nails may also become brittle or discoloured.

Hand-foot  Syndrome (Xeloda)

The earliest symptoms of Hand-foot Syndrome is a painful sensitivity of the hands and feet. It may progress from sensitivity to redness and swelling on the palms of the hands and soles of the feet.  The redness looks like sunburn and it may blister and in severe cases form sores.  The affected skin can also become dry and peel.  It is important to advise your doctor or nurse about any Hand-foot Syndrome symptoms, even if they are mild, as treating early can help prevent severe cases.

Eye problems (all)

Sore eyes, “gritty” eyes, watery eyes, infection in eyes(conjunctivitis), and blurred vision may occur in some people to varying degrees during their treatment.

Phlebitis (FEC, AC, CMF, Vinorelbine,)

Damage to the lining of the veins used in some chemotherapies can result in discomfort or burning sensation in the veins. This may last for some weeks. If venous access is difficult a port (a cannula inserted under a general anaesthetic)into a large vein in the chest) may be advised. If the vein is burning or painful during chemotherapy, please alert the chemotherapy sister.

Peripheral neuropathy (Taxol, Vinorelbine)

This is experienced as a numbness or tingling sensation in fingers or toes. In more severe cases it may be painful. It is most commonly seen in diabetics and in those who have had multiple courses as it tends to be cumulative. It may persist for a few months after completing treatment.

Allergic reactions (Taxol)

If this occurs, it usually happens with the first dose. If it occurs it will happen in the chemo room and not later at home. It is usually prevented by and easily treated with antihistamines and steroids.

Liver changes (Gemcitabine, Vinorelbine,Xeloda)

In many cases this is only noticed on the blood tests and goes unnoticed by the patient. It will go back to normal after treatment. In the cases of breast cancer that has already spread to the liver, the liver function may be affected by the cancer itself and may actually improve on chemotherapy.

Menstrual irregularity and infertility (all)

When women receive chemotherapy it can damage the ovaries and reduce the amount of hormones they produce, resulting in short-or long-term infertility (inability to fall pregnant).  The effects of ‘chemo’ on your hormones may result in:

♦          Menstrual periods becoming irregular or stopping completely

♦          Menopause-like symptoms, e.g. hot flushes and itching burning, or dryness

of vaginal tissues

♦          Vaginal infections are more likely

Menstrual function can start again up to 2 years after chemotherapy. The onset of menopause may also be brought earlier and fertility may be impaired. If a woman may want a baby after chemotherapy, it is a good idea to discuss this with the doctor before starting chemotherapy.

Remember that, chemotherapy is not a safe method of contraception and a safe contraceptive is very important during chemotherapy as the drugs would be extremely harmful to the foetus.

Cardiac failure (FEC, AC, CAF, Xeloda)

In very rare instances some chemotherapy can lead to heart failure. If your doctor thinks you are at risk a cardiac function test will be done before starting chemotherapy.

There are many other possible side effects of chemotherapy, many of which are extremely rare or mild and therefore not covered here but can be discussed individually with your doctor if you have concerns.

Frequently asked Questions:

“So just how bad am I going to feel?”

This is impossible to predict.  Everybody is different.  Many people can continue working during chemo, but may find they need to take a day or 2 off after chemo before going back to work.  Remember your experience will be different from the lady sitting next to you in the chemo room, so don’t panic if you find you are having a harder time than she (or an easier time!).  Tell your doctor.  Often something can be done to make the next time better.  Some things  you may have to grin and bear.

“What about other medicines, drugs and supplements during chemotherapy?”

It is important to discuss this with your specialist any other drugs your are taking or additional drugs you would like to take.  This includes vitamins or dietary supplements, vaccines or immunizations, immune boosters and herbal medicines.  They may interfere with the effectivity of your chemotherapy treatment.  Whatever boosts you may boost your cancer cells too!!

Blog written by Ronelle Lovric http://www.capebreastcare.org

 

 

Tailor made treatment

Miko Kapidzic works at University of California San Francisco

Did you know that when you get chaemotherapy, you will get a treatment plan that is tailor-made just for you?

The type of treatment you’ll get will depend on the type of cancer, where exactly it is and the stage of development of the cancer. The oncologist will also take into account whether the cancer has spread, your general health and the purpose of the treatment –  to cure or to relieve symptoms.

Research into cancer treatments goes on all the time, and new treatment regimes are always being developed. What that means is that your experience of chaemo may be different to any one else’s.

So, what happens when you get chaemo? It may be administered directly into a vein, it may be given to you in the form of a pill, you may get an injection or it may be applied directly to your skin.

The most common form of administration is through a vein. A thin needle is inserted into a vein on the hand or lower arm. This needle is removed once the chemotherapy has been completed. Chemotherapy can also be given intravenously by means of catheters, ports and pumps. A port is a round plastic or metal chamber that is placed under the skin. It is connected via a thin tube to one of the major vessels in the chest cavity. This method is more permanent and can be used for as long as necessary.

Most patients receive chemotherapy as out-patients in the oncology unit and do not need to be admitted to hospital.

Chemo Q & A

http://www.thewhyfoundation.org/cancer-answers/cancer-treatments/what-does-chemotherapy-look-like/
Original colour photograph by Mary Elizabeth Gentle from the article by writer, Allison W. Gryphon, Stage 3a Breast Cancer Survivor: “What Does Chemo Look Like?”

 

How often is the chemotherapy given and how long does it take?

This is decided by:

  • the type of cancer.
  • the goal of the treatment — i.e. either curative or to relieve symptoms.
  • the different chemotherapy drugs.
  • how your body copes with the chemotherapy.

It can be given daily, weekly or monthly and given in cycles where treatment is alternated with rest periods. Just make sure that you stick to the schedule so that you can get the best results.

Can I take other medication?

It depends what you are taking. Make sure that you give your oncologist a list of any prescription drugs or over-the-counter medication you are taking so you can get the best advice for your specific situation. e.g. vitamins, allergy pills, indigestion aids, pills for colds and flu, aspirin, pain killers and any minerals or herbal supplements.

ADVOCATES FOR BREAST CANCER_what is chemo_what does chemo look like_south africaBlack and white photograph of a chemotherapy drip/cancer treatment - via The Why Foundation: "What Does Chemo Look Like?"

 

 

 

 

 

 

 

 

 

~ original colour photographs by Mary Elizabeth Gentle from “What Does Chemo Look Like?” by Allison W. Gryphon ~

How will I know if the chemotherapy is working?

When necessary, you will be sent for examinations and tests which will help your oncologist determine how effective the treatment has been. Please ask your oncologist to explain these tests to you.

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Important questions to ask before you start:

When you are having treatment, it is sometimes difficult to know what to ask about — so here are some ideas to get you started:

  • Why should I receive chemotherapy?
  • What are the benefits of chemotherapy?
  • What are the associated risks of chemotherapy?
  • Are there any other methods of treatment available for my specific cancer?
  • What is the standard of treatment for my type of cancer?
  • Are there any ongoing clinical trials for my type of cancer?


Ask these questions about your TREATMENT SCHEDULE:

  • How many chemotherapy treatments must I get?
  • Which chemotherapy drugs/agents will I receive?
  • How will the chemotherapy be administered?
  • Where will the chemotherapy be given?
  • How long will each chemotherapy treatment take?

Ask these questions about the SIDE EFFECTS of chemotherapy:

  • What are the possible side effects of my chemotherapy?
  • When will the side effects start?
  • What side effects usually occur with my type of cancer?
  • Are there any side effects that need to be reported immediately?
  • What can I do to minimise the side effects?

To ask any more questions – or answer other users’ questions – join us on Twitter here or Facebook here!

TAKEAWAY:

A must-read by THE WHY FOUNDATION:

What Does Chemo Look Like? 

 

 

What is chaemotherapy?

 

goodman
In 1942, Alfred Gilman (above) and his colleague Louis S Goodman, were assistant professors at Yale University in the US. They performed the first clinical trials on a patient using mustard gas as the first chaemotherapy drug.

The ‘chaemo’ in chemotherapy refers to the chemicals that are used to kill the cancer cells.

The use of chemicals to kill cancer cells was first discovered in a different kind of war. During World War 2, doctors discovered that people who had been exposed to nitrogen mustard gas had much lower white blood cell counts. They began to wonder if the chemicals could be used to kill rapidly dividing cancer cells.

The initial study was performed in 1943 and the results were published in 1946, and mustard gas began to be used to treat all sorts of cancers. The research didn’t stop there. Doctors began to experiment with folic acid, plant alkaloids and various combinations of different chemicals.

In combination therapy, two or more drugs are given. This forms the basis of most of chemotherapy today. The different drugs enhance each other and  are chosen so that they do not have the same side effects on tissue, in order for the side effects to be minimised.

The treatment is highly effective, but unfortunately, normal healthy cells are also affected and this causes the well-known side effects of chemotherapy. Fortunately, the normal healthy cells have repair mechanisms in place, so they are able to recover after the treatment.

Chemotherapy  is also commonly used in combination with surgery, radiotherapy and biological treatment in order to:

  • shrink a tumour before radiotherapy or surgery. This is called neo-adjuvant therapy;
  • destroy any remaining cancer cells after surgery or radiotherapy. This is called adjuvant therapy;
  • enhance the effect of radiotherapy and biological therapy; and
  • destroy recurring cancer or destroy cancer that has spread to other parts of the body.

What about radiotherapy?

 

When a patient is diagnosed with cancer, it is usually a turning point in their life. Few forget the initial shock and disbelief after the diagnosis, as well as the fear and the feeling of helplessness that is experienced. In between all these emotions there are usually further tests that must be done and an urgency to start treatment – and to start experiencing the haven of care and empathy that is the oncology unit.

robin

Treatment of cancer can be labelled curative (when the treatment is aimed at  the remission of the cancer and the healing of the patient is possible ) or palliative (when the treatment is aimed at ensuring symptom control and focuses on improving quality of life of the patient ) cure is not possible patients can live long and well before they pass on.

The oncology team will decide on the best possible treatment for you, depending on the type of cancer and the stage it is in. We talked about this coordination of care in this post and about the teams who will take care of you in this one.

One of the ways in which your cancer may be treated is though radiotherapy. This is the use of high-energy x-ray beams that can penetrate tissue, causing cell damage and cell death and reducing the cancer growth.

Normal cells are also influenced by radiation, but most of them recover from the effect of radiation. Normal tissue still needs to be protected from radiation as far as possible so the total amount of radiation is limited to the dosage normal tissue can tolerate.

Every patient’s treatment is planned individually with the use of highly sophisticated 3-D computer technology. Normal tissue is protected from radiation beams when possible and the newer radiation machines have built-in  shielding that is very sensitive and effectively protects the patients sensitive organs.

The aim of radiotherapy is to kill cancer cells with as little risk as possible to normal cells.  Radiotherapy can be used in the treatment of different kinds of cancer in nearly any part of the body.

Radiation, like surgery, is a local treatment. It influences only the tissue in the specific area of the body that is being radiated.

Radiation is often used in combination with surgery to treat cancer. Radiation can be given before surgery to shrink a cancer mass, this may enable them to remove all cancer tissue by using less extensive surgical methods. Radiotherapy can also be given after surgery to reduce the chances of regrowth of any remaining cancer cells.

In some cases radiation is used in combination with chemotherapy. The radiation can be given before, during or after chemotherapy. Combination therapy is tailored carefully to suit each individual patient’s needs according to the type of cancer, the location and the disease stage.

Where a cure isn’t a realistic option anymore, radiation is often used to shrink cancer masses and in doing so to relieve pressure, pain and other symptoms associated with uncontrolled cancer growth. This treatment is known as palliation (symptom relief). Most cancer patients find that they can lead a better quality of life after radiation for problematic symptoms.

 

Next week we will explain what to expect when you go for your radiotherapy treatment.

 

Onwards and upwards!

Well, here we are in 2016, ready to jump in to all that this year will bring.

We hope you will join us as we carry on advocating for an equitable breast health policy in South Africa!

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