What is a Port?

• A port is a device that is usually placed under the skin in the right side of the chest or under the arm. (picture of Single and Dual Ports). A port can have one or two access points.
• The port goes either under the skin of your chest or upper arm.
• It is attached to a thin, flexible tube (also called catheter) that is threaded into a large vein above the right side of the heart ((Picture of septum)
• A surgeon or a radiologist implants a port, usually with local anesthesia or conscious sedation in the operating room. 

How does the port works?

• Your port will look like a small, raised area under your skin. The center of the disk which is raised somewhat is called the septum (Picture of port-a-cath and highlighted text below by the side)
• Fluids are put into or taken out of the port using a special needle that goes into the septum.
• The catheter connects to the septum to take the medicine or inject fluids right into the blood.
• Blood for lab tests can also be taken out through the catheter.
• When the needle is removed from the septum, no fluids or blood can leak out. (remove picture)

What is the purpose of implanting a port?

A port is used 

• to give intravenous fluids, blood transfusions, chemotherapy, and other drugs as well as can be used for taking blood samples.
• for treatments, like continuous infusion therapy, that last longer than 1 day.
• to reduce the number of times a healthcare provider needs to insert a needle in your veins, and
• to reduce the risk of tissue and muscle damage with repeated needle sticks.
• The port can be used on the same day it is put in and may stay in place for weeks or months 

During first 24 to 48 hours after surgery, the incision area will be tender and a little red. Most people don’t need pain medications and the discomfort usually goes away within 48 hours. If your pain persists, please contact your Oncologist.

You should also call your surgical nurse if you develop

• Severe pain 
• Increased pain, swelling, warmth, or redness around the port.
• A fever of 100.5 F or above
• Bleeding from the port
• Swelling or a growing bruise.

Keeping it secure and dry:

• The incision wound will be covered by bandage till the wound heals for about 5-7 days.
• Please keep the bandage and wound areas dry. It may be a good idea to take a sponge bath or 
• Take shower only after making sure the port site is covered and secured with a plastic wrap so water doesn’t not reach it.
• If you notice the bandage is pulling away, reinforce it with medical tape until you see your oncology nurse.
• The nurse will check on your dressing within the next days after surgery.
• Check your bandage daily for bleeding. 
• If there’s bleeding, press firmly with a gauze for 15 minutes. 
• If bleeding didn’t stop call your oncology nurse immediately. If it’s heavy bleeding visit emergency.
• Wearing the seatbelt will put pressure on your wound, try to avoid this by placing small pillow or folded towel between the strap and the wound. 
• No exhausting activities until your wound heals.
• Also please do not to lift objects heavier than 10 pounds (4.5 kg) during this time.

After your wound heals, you can return to your normal daily activities.

You can swim with your implanted port as long as there is no needle in place. 

Avoid playing any contact sports, such as football or rugby.

How a port is used in the hospital: 

• Before you start receiving chemotherapy, Nurses will handle the port with sterile procedures as hand washing, sterile gloves and alcohol scrubbing. You can always ask if you noticed any different handling of your port.
• A dressing will also be placed over the port when it’s in use. 
• During chemotherapy infusion, nurses will check your port for any signs of inflammation.
• If blood tests were needed, hands or arms’ veins will usually be used to get blood. This helps to avoid multiple accessing of the port, which increases risk of infection.
• The port will be flushed by a nurse after each use, and every 4 weeks when it’s not being used, to prevent becoming blocked with blood clots. Saline and heparin (a blood thinning medicine to prevent blood clots) are used.

What are the risks and side effects of the port?

Potential side effects include 

• infections, 
• blockage and 
• clots.

Caring for the port helps to prevent these side effects.

Caring for the port at home:

• Always wash your hands with soap and water before and after caring for the port.
• Remind everyone who cares for your port to wash their hands.
• Wear clean medical gloves when you care for your port.
• Avoid touching the port if not needed.
• Clean the skin area surrounding the port every day.
• Check daily for redness, swelling, and oozing at the site of the port. 
• Keep the port covered with bandage whenever the needle is in place.
• You will be able to feel the port under your skin, but it will not be noticeable by people.
• The skin covering the port will not need any special care.
• No bandage will be needed if the port is not in use.

Your oncology nurse will instruct you if it’s needed and they will demonstrate you or a family member how to do it. 

• Never try to use your port without proper training from your caregiver. 
• Do not hesitate to call us for training 
• Have a well-trained nurse to help you at home if possible
• Supplies needed: gloves, alcohol pads, gauze, tubing and needle, saline syringe, heparin syringe

I will review with you the steps of accessing and flushing the port:

• Create a clean working space, 
• Sterilize the surface with alcohol
• Wash your hands properly with soap and water
• Wear a mask during preparing and accessing your port
• First you will need to remove the air in the tubing attached to the needle
• Attach a syringe that contains saline to the tubing
• Open the clamp and slowly push saline through the tubing and needle. Then close the clamp and leave the syringe attached
• Wear clean medical gloves. Clean the port site and the surrounding skin with alcohol pads for 90 seconds then allow it to dry completely
• Feel the edges of the port with one hand, use the same hand to stretch the skin across your port and hold the port in place
• With the other hand insert the needle through your skin, into the center of the port and push it until you hit the back wall of the port.
• Open the tubing clamp, and slowly pull back on the syringe. 
• If blood flows back into the tubing and syringe, the needle is in the proper place. If you do not see blood, you will need to change the position of the needle. 
• Close the clamp on the tubing. 
• For port flushing you will need:
  • 10 ml normal saline syringe
  • 10 ml heparin solution syringe
• Connect the saline syringe by opening the cap, avoid touching the tip of the syringe. Push the saline slowly.
• Clamp the tube after flushing with saline and before you connect the heparin syringe to prevent air bubbles from entering the tube.
• Push the heparin slowly. Then clamp the tubing. After that you can carefully remove the needle.

Nutrition Care 

I want to go over some general nutrition recommendations in three short videos.

I will go over 

• about using nutrition to manage side effects in Video 2 (log in to view)
• about food safety in Video 3 (log in to view)

While this is broad guidance based on quality evidence, we recommend you consult with our Registered Dietitian, to tailor a plan to your specific needs.

How to maintain a healthy weight.

• During many cancer treatments, patients can experience loss of appetite or decreased oral intake due to uncomfortable GI side effects such as nausea, vomiting, diarrhea, or constipation, or as a result of some medications.
• The main focus of our nutrition interventions is to help you to take in sufficient calories to maintain your current weight through the course of treatments, so ensure your body stays healthy and can recuperate from treatments accordingly.
• There may be instances in which weight loss before or after treatment in obese persons is appropriate, but your doctor would let you know if it is needed in your case.
• You can also consider adding oral supplemental shakes to your diet, if you feel you are not eating well. Your Registered Dietitian can guide you about which supplements are right for your body, and how much to take in to meet your needs.
• Weigh yourself regularly. If you notice weight loss that is more rapid than 1 pound per week, contact your Registered Dietitian, so that they can help you manage this appropriately.

Getting essential nutrients.

• Getting essential nutrients means consuming a variety of foods, with balanced portions of protein, carbohydrates, and fats, alongside plenty of fluids. During your treatments, your healthcare team does not recommend any dietary restrictions, unless medically necessary due to your cancer diagnosis or other conditions, which would be discussed with you at your visits.
• Getting the appropriate amount of total calories for maintaining your weight, as well as staying hydrated are most important while fighting cancer. Your Registered Dietitian will provide you with goals for calorie intake and fluids to meet these needs, and help monitor your intake and adjust through your treatment course.
• Depending on your needs, taking a multivitamin or specific vitamins and minerals that you aren’t getting enough of during treatment may be necessary. Nutritional supplements such as Boost or Ensure also can help you meet these needs. Before taking any supplements, please discuss with your healthcare team.

It is important to remain as active as you can.

• Exercising to maintain your muscle mass as best possible is key to fighting through treatment with energy and rebuilding strength after treatments.
• For example, take a daily walk or incorporate lower impact activities such as tai chi, yoga, meditation and stretching, or swimming into your exercise pattern.
• Once your treatment is complete, ask your healthcare team about our Cancer Exercise Rehab Program available for patients.

While this is broad guidance based on quality evidence, we recommend that you consult with our Registered Dietitian, either personally or using the computer, to tailor a plan to your specific needs.

How to use nutrition to manage treatment side effects?

Cancer treatment often causes side effects, such as nausea, mouth sores, and taste changes which may make it difficult to eat or drink.

Follow these tips to help you manage side effects:

• If water tastes unpleasant to you: 

• take in more liquid through foods and other drinks like soups, popsicles, or 
• fruits like watermelon, flavored water, beverages like Gatorade, Powerade, or 
• try tea, lemonade, or milk.
• If food tastes bland, 

• try seasoning it with flavorful spices such as lemon, garlic, and rosemary. 
• Some prefer to simply eat bland foods, such as breads, oats, pastas, mashed potatoes, dairy products, as this helps to mentally cope the taste alterations.
• If you have a metallic taste in your mouth. 

• Try things such as mints, chewing gum, teeth brushing more frequently 
• Even bites of fresh citrus (yes even sucking on lemon slices), or drinking tomato juices can help
• use plastic or bamboo utensils and cook in nonmetal pots and pans, especially avoiding cast-iron cookware.
• If you experience mouth sores or gum tenderness, 

• choose soft, moist, non-acidic and non-spicy foods. 
• Use a blender or food processor to make vegetables and meats smooth.
•  Smoothies or milkshakes may be a great option that can also help you get additional calories in a texture that is comfortable for you. 
• Tricks such as adding butter, mild sauces, gravy, ricotta, or cream to meals or recipes are great ways to add calories and a soothing texture.
• If you feel FULL with smaller portions
  • try frequent meals are a great way to get those much needed calories
  • try eating 6 small meals a day instead of 3 large meals. 
  • Choose calorie and protein packed items for those small meals.
• If meat becomes unappealing, 

• try getting protein from other foods like fish, eggs, cheese, beans, nuts, nut butters, tofu, or high-protein smoothies or shakes. 
• Also sneaking things like ricotta and silken tofu into mixed dishes can be a great way to add extra protein. 
• If you are experiencing nausea or vomiting, 
  • be sure to take all medications as prescribed. 
  • Unless directed specifically, do not take medications on an empty stomach as this may exacerbate symptoms.
• Some dietary approaches include eating regular meals and snacks, drinking plenty of fluids, and eating bland foods such as crackers, chicken noodle soups, mashed potatoes, toast with peanut butter, etc. Some patients find that drinking ginger teas, or sucking on ginger candies or peppermints help to curb nausea, as well.

While diet can play a role, please reach out to your dietitian if you are experiencing severe constipation or diarrhea.

While this is broad guidance based on quality evidence, we recommend you consult with our Registered Dietitian, either personally or using the computer, to tailor a plan to your specific needs.

Many treatment options weaken the immune system and increase the risk of experiencing food-borne illness.

Patients receiving cancer treatment should follow some basic rules to make sure they are practicing food safety:

• Wash your hands before you handle food, as well as all food prep surfaces.
• Rinse vegetables and fruit thoroughly before eating them.
• Store meat and fish on the bottom shelf of the refrigerator.
• Use separate cutting boards for meat and vegetables.
• Refrigerate food after everyone has been served.
• Eat fully cooked foods and skip raw meats, seafood, or sushi.
• Do not eat unpasteurized foods and pay close attention to cheeses, milk, cider, and juices.
• Follow expiration dates and safe food storage practices.

Food safety is very important. If you have additional questions, talk with our Registered Dietitian at St. Bernard’s.

Eating a balanced diet that incorporates vegetables, beans and legumes, whole grains, and fruits is important during both treatment and recovery. 

While there may be more specific recommendations tailored to you based on your specific cancer and treatment course, a healthy overall diet is important to regaining strength and achieving and maintaining a healthy weight.

These are broad evidence-based guidelines. We always recommend patients to consult our Registered Dietitian either personally or using the telehealth platform to tailor a plan to your specific needs.

Feel free to watch this video as many times as you would like or download scripts to read.

Be sure to watch Video 1 on how to Maintain Healthy Body Weight and ensure you receive Essential Nutrients and Video 2 on how to Nutrition to manage Side Effects from Cancer and Treatments.

If you have any additional questions, you are welcome to reach to your doctor’s office

Thank you and good luck! 

What is Carboplatin, Paclitaxel, Avastin and Tecentriq care plan, and how does it work?

It is a combination of chemotherapy and immunotherapy regimen used for certain types of stage 4 non-small cell lung cancer.

 Carboplatin and Paclitaxel are chemotherapy treatment, Avastin is a targeted therapy treatment and Tecentriq is an immunotherapy treatment

∙       Carboplatin is also called “Platinum-therapy” and kills cancer cells through binding with their DNA, preventing their production and inducing their death.

∙       Paclitaxel is “Taxane” class of chemotherapy medicine which kills cancer cells by damaging the structure or the “skeleton” that supports them, thus preventing their growth and division.

∙       Avastin is also called Bevacizumab. It is a “Monoclonal antibody” that binds and inhibits growth factors important for new blood vessels formation especially in cancer, thus inhibiting cancer cells

∙       Tecentriq also known as “Atezolizumab” is an immunotherapy works by binding to a specific area on immune cells called PD-L1 receptor, helping Immune system to attack and kill cancer cells.

Who gets this regimen:

This regimen is mainly given for non-squamous non-small cell lung cancer that is 

1.      advanced or stage 4, 

2.      cancer cells are free of EGFR and ALK mutations and 

3.      In combination with chemotherapy Tecentriq is given for lung cancers with or without PDL1 expression.

How is this regimen given?

∙       Going back to the main anti-cancer therapy regimen – carboplatin, Paclitaxel and Avastin and Tecentriq, these medications are given by vein on the same day, followed by a rest period of 21 days. 

∙       Each 21 days treatment is considered a cycle. 

∙       Usually 6 cycles are given for a total treatment period of average 18 weeks.

∙       After 4 to 6 cycles of all four drugs, a maintenance treatment consisting of Avastin and Tecentriq every 3 weeks is usually given to prevent disease progression.

What are side effects?

Different agents have specific side effects. It is also important to remember you may not have every side effect related to each medicine of the combination therapy.

You should call your doctor if have: 

•       Shortness of breath which is of new onset.

•       High fever > 100.4 F.

•       Excessive diarrhea of equal to or more than 7 loose stools per day despite taking anti-diarrheal medication prescribed by your doctor. 

•       Diarrhea that is accompanied by significantly reduced urine output, dizziness upon standing up and low blood pressure.  

•       Abdominal pain with nausea and vomiting, fatigue and deep yellow skin and urine. This may indicate liver toxicity.

    –     Swelling of legs associated with pain especially, if one sided. This may indicate blood clots that can be precipitated by Avastin

    –     Stroke like symptoms ( sudden onset of weakness/ numbness on one side of the body, sudden unexplained speech disturbance) may indicate TIA or Stroke. Rarely, this could be precipitated by Avastin. 

The most common side effects are:

•       Allergic reaction during or after chemotherapy infusion. Tecentriq also can cause skin rash and itching which are immune mediated. 

•       Tiredness and weakness

•       Reduced blood cells: resulting in fatigue, increased possibility of infections and bleeding.

•       Nausea

•       Constipation or diarrhea. Both chemotherapy and immunotherapy may cause diarrhea. 

•       Loss of appetite

   – Tingling, numbness or pain in hands/ feet/ legs which may indicate NEUROPATHY that can be cased by Paclitaxel. 

  – Increased Blood Pressure is a common side effect of Avastin. If you are monitoring your BP at home and  if it is unusually elevated compared to baseline, please call your doctor. Your doctor may use  blood pressure medications to control it. Controlling your blood pressure and maintaining it in a healthy range is crucial while on Avastin. 

– Increased Protein in the urine ( proteinuria) is a side effect of Avastin. Your doctor will monitor your urine samples for protein before you get Avastin. For this reason, you will be asked to give a urine sample prior to every treatment with Avastin. 

•       Hair loss

•       Cough

•       Infections 

•       Fever

Please note that Tecentriq is an immunotherapy that activates your immune system and may attack any of the organs. 

•       Other than these common side effects, Tecentriq may cause skin rashes, liver, kidney, lung and thyroid problems. 

•       Your doctor will monitor thyroid and liver tests while you are on treatment. It is important to follow your directions for lab tests.

Please call your doctor if you feel you are not well and if side effects don’t reduce or go away after medications prescribed your doctor.  

Please view the video “How to self-manage common symptoms before calling your doctor”:

Please tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the-counter medicines, to make sure they won’t interfere with your treatment.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. For managing a specific side effect.

What is Oral CMF:

This is a chemotherapy treatment with combination of three drugs used

to treat breast cancer.

C; Cyclophosphamide

M; Methotrexate

F; Fluorouracil

Cyclophosphamide is given as oral tablets, and both methotrexate and fluorouracil will be given through infusion in the veins.

How oral CMF Works:

o Cyclophosphamide is a type of chemotherapy medicine called an alkylating agent and also called Cytoxan. It stops cancer cells from reproducing.

o Both Methotrexate and Fluorouracil are related to another type of chemotherapy medicine called antimetabolites. They stop DNA synthesis in cancer cells thus preventing cancer cells growth and division.

Who Gets oral CMF:

• CMF is one of the chemotherapy regimens commonly used to treat early invasive breast cancer that has not spread to other body organs.
• It can be given before surgical removal of the cancer to shrink the tumor, this is called  Neoadjuvant treatment. It can also be given after surgical removal of the cancer to kill any remaining cancer cells and prevent the return of cancer, in this case it is called Adjuvant treatment.
• It can also be used in people who have had a recurrence or spread of cancer depending on the medicines you received before.

How is oral CMF Given:

• Please tell your doctor about any medicines you are taking, including vitamins, herbal

supplements and over-the-counter medicines, to make sure they won’t interfere with your CMF treatment.

• This regimen is given in a chemotherapy clinic outpatient, which means you can go home after you receive your medications.

• Cyclophosphamide is taken as a tablet once daily starting from day 1 of the treatment cycle and for 14 days continuously.
• To take a cyclophosphamide tablet safely, make sure you swallow it as a whole, don’t cut or crush it before swallowing. 
• It is very important with cyclophosphamide to drink plenty of fluids, at least 2-3 liters of water each day, and to not take cyclophosphamide tablets before bedtime.
• Both methotrexate and fluorouracil are given by vein in the same day, at day 1 and day 8 of each treatment cycle.
• This cycle is repeated every 28 days. You should receive 6 cycles of CMF for a total duration of treatment of 6 months.

What are the side effects from Oral CMF treatment:

 It is important to remember that different medicines have different side effects for different people.

You may not have every side effect related to each medicine of the combination therapy.

Common side-effects of CMF include: 

1. Low blood counts: CMF chemotherapy affects rapidly dividing cancer cells but also some of the normal cells as blood cells.

Your doctor will be monitoring your blood counts weekly in the first two weeks of each cycle.

• Low red cell counts. referred to as Anemia. If you get too anemic, you may experience a lot of fatigue, palpitations/ increased heartbeat and shortness of breath with exertion. If you have symptoms and significant anemia, your doctor may choose to give you blood transfusions.
• Low white blood cell counts can result in reduced immunity and increased susceptibility to Infections. 
• Low platelet counts can result in increased bleeding tendency, as heavy bleeding from small wounds, nose bleeding, bruising, coffee ground vomiting or blood in urine or stool.

• If you develop very low white blood cell or platelet count, the next cycle of treatment might be deferred until these counts rise to normal again. 
• Your doctor might also decide to reduce the dose of medications or omit one or two if the counts remain very low.
• Watch for signs of anemia and bleeding tendency and call your doctor if any of these symptoms are bothering you.

2. Infections: they can follow a low white blood count. 

• Watch for signs of infection as; high fever, cough, sore throat, skin changes, burning urine, or diarrhea. Call your doctor whenever one of these symptoms are bothering you. Also call your doctor in case of fever > 100 degree F.

3. Nausea and vomiting: you may experience nausea alone or with vomiting, as a result of CMF chemotherapy. Your doctors give you one or more anti-nausea medications before each cycle to prevent early nausea and vomiting which can happen in the first hours. You will also be given an oral medication to take for a few more days at home, and as needed after that.

It is very important to follow your doctor’s instructions regarding taking the antinausea medications, to avoid this side-effect and its complications.

4. Bladder irritation: this is a side-effect of cyclophosphamide that happens in case of decreased fluid intake. It’s very important to drink plenty of fluids and at least 2-3 liters of water each day throughout your treatment duration.

5. Diarrhea or constipation.
6. Mouth sores and changes in taste.
7. Fatigue.
8. Loss of concentration.
9. Hair loss or thinning.
10. Eye soreness.
11. Effects on fertility and symptoms of menopause: as hot flashes and mood changes. Your doctor will discuss with you the available options for preserving your fertility.

Less common but more serious side effects include: 

1. Heart changes: 

This can sometimes occur with fluorouracil. Call your doctor right away in case you had chest pain, tightness at the center of your chest, palpitations or bounding chest.

2. Allergic reactions: your doctor prescribes medications to prevent allergic reaction before chemotherapy infusion. If you have an allergic reaction, you may show symptoms such as chills, difficulty breathing or shortness of breath, flushing, rash, itching, face and tongue swelling. If you have any of these symptoms at any time call your healthcare team right away.
3. Skin changes: ulceration, pigmentation or light sensitivity are less common symptoms. But to avoid more serious forms of skin problems, avoid excess sun exposure and make sure you wear sunscreen.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you

manage them. For managing a specific side effect, please watch our symptom specific video.

During your consultation, your doctor likely discussed about Lynparza and Avastin care plan used for treating your cancer.

What is Lynparza and Avastin maintenance therapy, and how does it work?

Avastin, also called Bevacizumab, is a targeted therapy treatment. It is a “Monoclonal antibody” that binds or attaches and inhibits or blocks growth factors that are important for new blood vessels to form which can be one of the ways the cancer grows. Therefore, this can stop cancer cells’ growth.

Lynparza, also called Olapraib, is a PARP inhibitor. It inhibits PARP – an enzyme which is involved in DNA repair and thus growth of cells. Lyparza works by blocking Cancer cells from repairing their damaged DNA.

Who gets this regimen:

Please note that this is Maintenance therapy. Maintenance therapy is used for those patients who have already had a response to initial therapy. 

This regimen is mainly given as a “maintenance therapy” to patients with ovarian, fallopian tube, or primary peritoneal cancer with 

1. Advanced or stage 4, 
2. who achieved complete or partial response to first-line platinum-based (Carboplatin) chemotherapy, and 
3. whose cancer is associated with homologous recombination deficiency positive status defined by either a deleterious BRCA mutation, and/or genomic instability. (This test is done on the tumor specimen.)

How is this regimen given?

·       Bevacizumab or Avastin is given through an IV or infusion port. It is administered every three weeks. Each three weeks constitutes a cycle. Each session lasts for about 30-60 minutes. This is usually continued for 1-2 years of maintenance as long as it is tolerated well and there is no progression or regrowth of cancer.  

. Olaparib or Lynparza tablets are taken twice a day by mouth. This is continued for up to 2 years or until disease worsens or a patient experiences unacceptable side effects. The tablets can be taken with or without food and should be taken at around the same time every day. 

Please tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the-counter medicines, to make sure they won’t interfere with your treatment.

Feel free to watch this video as many times as you would like or email for the transcript to read. 

In Video 2, we will go over some of the common side effects from this treatment and how to manage them at home or by calling your doctor if there are serious side effects. 

If you have any additional questions, please call your doctor’s office.

Thank You and Good Luck.

Advanced ovarian, fallopian tube, or primary peritoneal cancer

Lynparza plus Avastin Combination

Hi… I am Laura.  I’m a patient navigator.   

During your consultation, your doctor (Show picture Oncologist) discussed about Lynparza and Avastin for treating your cancer.

What are side effects?

All medications have side effects – unwanted effects of the medication. It is also important to remember you may not have every side effect related to each medicine of the combination therapy.

You should call your doctor if you have:

• Shortness of breath or persistent cough which is of new onset. This may indicate “pneumonitis”, a rare side effect of Olaparib/ Lynparza.  
• Temperature over 100.4 degree Fahrenheit.
• Excessive diarrhea that is defined by equal to or more than 4 loose stools per day despite taking anti-diarrheal medication prescribed by your doctor. 
• Diarrhea that is accompanied by significantly reduced urine output, dizziness upon standing up and low blood pressure.  
• Abdominal pain, excessive nausea and vomiting, fatigue and deep yellow skin and urine. This may indicate liver toxicity or bowel issues associated with either medication.
• Swelling of legs associated with pain especially, if one sided. This may indicate blood clots that can be precipitated by Avastin. 

Studies show that patients receiving Lynparza and Avastin combination have a higher risk of having blood clots compared to those receiving Avastin alone. 

• Stroke like symptoms (e.g. sudden onset of weakness/ numbness on one side of the body, sudden unexplained speech disturbance) may indicate a transient ischemic attack (TIA) or Stroke. Rarely, this could be precipitated by Avastin. 
• Increased Blood Pressure is a common side effect of Avastin. If you are monitoring your BP at home and if it is unusually elevated compared to baseline, please call your doctor. Your doctor may use blood pressure medications to control it. Controlling your blood pressure and maintaining it in a healthy range is crucial while on Avastin. 

The most common side effects are:

• Fatigue 
• Nausea / vomiting
• Anemia, low white blood cell and lymphocyte count
• Urinary tract infections
• Headache. 
• Increased Protein in the urine (proteinuria) is a side effect of Avastin. Your doctor will monitor your urine samples for protein before you get Avastin. For this reason, you will be asked to give a urine sample prior to every treatment with Avastin. 
• Based on animal studies, LYNPARZA can cause fetal harm. Therefore, a pregnancy test is recommended for women of childbearing age prior to initiating treatment. Women of reproductive age should use effective contraception during treatment and for 6 months following the last dose.

Please call your doctor if you don’t feel well and if side effects don’t reduce or go away after medications prescribed your doctor.  

Please tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the-counter medicines, to make sure they won’t interfere with your treatment.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. For managing a specific side effect, please watch our symptom specific video.

Feel free to watch this video as many times as you would like or email us for the transcript to read.

If you have any additional questions, please call your doctor’s office

Thank You and Good Luck.