Are you one of the 168,000 Americans living with metastatic breast cancer? Chemotherapy has been a standard part of treatment for decades. While this is still often a key component, there are several new treatment approaches.

Keep reading to learn about other options that are having a positive impact.

Overview of Metastatic Breast Cancer Treatment Goals

Metastatic breast cancer means that breast cancer cells are now in other body parts. This can include nearby tissue or distant areas such as the liver, bones, lungs, or other sites.

The term “overall survival” describes the length of the person’s life. It also includes whether the cancer grows or returns. The goal of treating metastatic breast cancer is three-fold.

Treatments strive to achieve the longest possible survival. They work to limit the side effects of cancer and the interventions. And to achieve the highest quality of life possible.

Currently, there’s no cure for metastatic cancer. Yet, new approaches are prolonging survival.

New Metastatic Breast Cancer Treatment Options

The Food and Drug Administration (FDA) continues to approve new therapies. These approaches have been proven beneficial in clinical trials before their release. The following gives an overview of these new regimens.

Immunotherapy

In general, cancer overwhelms and defeats the body’s natural immune system defenses. This allows cancer cells to grow and spread. The goal of immunotherapy cancer treatment is to prevent or slow cancer cell growth.

It blocks the interactions of program cell death 1 (PD-1) receptors with program death ligand 1 (PD-L1). This enhances your body’s antitumor immunity.

Depending on your disease pattern, immunotherapy may be the only treatment. In other cases, it’s combined with other forms of cancer therapy.

There are two agents that the FDA has approved for use combined with chemotherapy. They treat triple-negative metastatic breast cancer (TNMBC) that’s PD-L1 positive.

Tecentriq (Atezolizumab) and Abraxane (Nab-Paclitaxel)

The Impassion 130 study compared using immunotherapy and chemotherapy vs. chemotherapy alone. One group received atezolizumab (immunotherapy) plus nab-paclitaxel (chemotherapy). The other TNMBC group received nab-paclitaxel alone.

Patients with PD-L1 positive tumors had longer survival with the combination therapy.

Keytruda (Pembrolizumab) and Chemotherapy

The KEYNOTE-355 study also evaluated treatment for patients with TNMBC. Some participants received pembrolizumab (immunotherapy) and chemotherapy. The other group had chemotherapy alone.

Combining pembrolizumab and chemotherapy showed improved progression-free survival. This benefited those with PD-L1 positive tumors more than only chemotherapy.

Antibody-Drug Conjugates (ADC)

ADCs are new highly potent biological class drugs. They attach small-molecule anticancer drugs or other treatment agents to an antibody. This antibody then targets specified cells that have a specific antigen on them.

Once the ADC binds to the target cell it delivers the anticancer drug into the diseased cell. This optimizes the drug efficacy while reducing systemic exposure. Thus, patients have fewer side effects.

One ADC trial showed the efficacy of Trodelvy (sacituzumab govitecan) in TNMBC patients. These patients had already undergone at least two chemotherapy regimens.

Another ADC, Enhertu (trastuzumab deruxtecan), was also very effective. This study included patients who already received significant treatments.

Poly (ADP-Ribose) Polymerase (PARP) Inhibitors

PARP is an enzyme that repairs damage to DNA in cells. PARP inhibitors treat cancer by stopping this repair in cancer cells, so they die. These drugs specifically target cancer cells while mostly avoiding healthy cells.

It’s used to treat people with TNMBC and hormone receptor-positive disease. Patients that have HER2-negative disease and express a germline BRCA mutation also benefitted.

This treatment for patients involves an oral medication that’s taken at home. It often has fewer side effects than chemotherapy. There are two PARP inhibitors approved for treating breast cancer at this time.

Lynparza (Olaparib) and Talzenna (Talazoparib)

The OlympiAD study reported improved quality of life with olaparib. The patients have already undergone one to two lines of chemotherapy. The median progression-free survival was 2.8 months longer.

Talzenna (talazoparib) studies also showed improved progression-free survival. This rate was better than patients treated with chemotherapy.

Combined Targeted and Hormonal Therapy

Kisqali (ribociclib) and Ibrance (palbociclib) provide benefits when given with hormone therapy. They belong to the class of drugs called selective cyclin-dependent kinase inhibitors.

These drugs inhibit the cyclin-dependent proteins kinase 4 and 6 (CDK4/6). When these proteins become overactive, they help cancer cells rapidly divide and grow.

Thus, they precisely target CDK4/6. The goal is to stop the uncontrollable growth and division of cancer cells.

This drug works best when given with hormone therapies. This stops the estrogen’s stimulation of cancer cell growth.

Hormone receptor-positive (HR-positive) breast cancers grow faster when stimulated by hormones. This includes estrogen and/or progesterone. Hormone therapies work to reduce the levels of these hormones.

Hormone therapies include Femara (letrozole), an aromatase inhibitor, and Faslodex (fulvestrant). Ribociclib, palbociclib, and letrozole are pills that you take by mouth. Fulvestrant comes in a pre-filled syringe that’s injected into the muscle.

This combination regimen offers better survival for women with breast cancer. This specifically included those with metastatic, HER2-negative, or HR-positive types.

Endocrine Therapy

Endocrine Therapy (ET) alone or combined with targeted agents reduces the tumor burden. Patients also experience fewer side effects and toxicities compared to chemotherapy. This regimen is useful with receptor-positive metastatic breast cancer.

ETs work by targeting the estrogen receptors to deplete estrogen levels. The goal is to improve quality of life and prolong survival time.

Are You or a Family Member Dealing With Cancer?

This article discussed the latest options for metastatic breast cancer treatment. OncoPower offers on demand care for patients in active cancer treatment and cancer survivors. You can ask a board-certified oncologist using our Ask-A-Doc tool, or order for a second opinion. You’ll have FREE access to oncologists with Ask-a-Doc tool 24/7. You can ask any number of questions without a credit card number.

You can also get second opinions and receive rewards when you invite someone to OncoPower. The second opinion feature is like a marketplace nothing between you and your physicians.

In addition, OncoPower offers patients with FREE treatment specific patient education videos, a secure medical storage tool, pill reminder features. You’ll also find advocacy groups in your community.

Remote Patient Monitoring

If you’re a healthcare provider, this can enhance your care. To improve clinical care, OncoPower enables oncologists to remotely monitor cancer patient’s vitals like temperature, blood pressure, weight and pulse to improve quality of life for patients.  Sign up today Free!

The COVID-19 pandemic put a strain on many cancer patient’s treatments and support. Telehealth offers a virtual way for patients and providers to interact. Advances in technology have also facilitated symptom monitoring and physical assessment.

Home-based automated systems helped providers track vital signs and symptoms. These systems send alerts to the healthcare provider if there’s a change in the patient’s conditions.

This reduces the patient’s risk of exposure to COVID and other diseases. It also facilitated emotional support for patients and families coping with cancer.

Onboard your practice or institution today to give patients a complete digital experience.

If you or someone you love is suffering from cancer, then you may have heard of immunotherapy.

If you’re wondering ‘what is immunotherapy?’, it’s a form of cancer treatment that helps your immune system battle cancer. Your immune system is there so your body can battle diseases and infections. Your immune system is made up of white blood cells and organs and tissues of the lymph system.

This form of cancer treatment is a type of biological therapy. Biological therapy is a form of treatment using substances from living organisms to treat cancer.

To learn more about immunotherapy, keep reading.

How Does the Immune System Fight Cancer?

Your immune system comprises a complex process your body uses to fight illnesses like cancer. This procedure involves your cells, organs, and proteins.

Cancer can typically beat many of the immune system’s natural defenses, enabling cancer cells to continue to grow. Different forms of immunotherapy work in various ways. Some immunotherapy cancer treatments help the immune system prevent or slow the growth of cancer cells.

Other immunotherapy treatments help the immune system kill cancer cells or prevent cancer from spreading to other areas of the body.

Immunotherapy can be used alone or combined with other different types of cancer treatments.

There are plenty of forms of immunotherapy. They include:

• Monoclonal antibodies and tumor-agnostic treatments, like checkpoint inhibitors
• Oncolytic virus therapy
• T-cell therapy
• Cancer vaccines

The type of immunotherapy drug, dose, and treatment schedule depends on various factors.

These factors include:

• Type of cancer
• Size
• Location
• Where cancer has spread

Your age, overall health, body weight, and how well you can deal with side effects are also essential to consider. Please speak with your professional health care team regarding why they suggest a specific immunotherapy plan.

Which Cancers Are Treated with Immunotherapy?

Immunotherapy cancer treatment drugs have been approved for use with many types of cancer. But, the treatment isn’t yet as widely used as chemotherapy, surgery, and radiation therapy.

Speak with your health care team to see if immunotherapy can be used to treat your cancer.

What Are Some Common Side Effects?

Some forms of immunotherapy attack cancer or slow its spread to other areas of the body. Other types make it is easier for the immune system to kill cancer cells. Immunotherapy may lead to the immune system attacking healthy cells, which can lead to side effects.

Some common side effects of immunotherapy treatment include skin reactions. Skin redness, blistering, and dryness are typical reactions to immunotherapy. The skin on the fingertips sometimes cracks.

The skin may also become more sensitive to sunlight. If your skin is scratched, it may break, making it more susceptible to infections. Inflammation surrounding the nails can make grooming, dressing, and other activities challenging or painful.

Other common side effects of immunotherapy include flu-like symptoms. These include fatigue, fever, weakness, vomiting, dizziness, body aches, and chills. These symptoms are especially common in non-specific immunotherapy and oncolytic virus therapy.

If you experience any of these symptoms, it is essential to stay hydrated. If you have difficulties keeping any liquids down, speak with your doctor on how to manage these side effects. Many side effects and symptoms will fade alone, but others can be severe and require immediate attention.

Individuals may experience other side effects, including:

• Muscle aches
• Difficulties breathing or shortness of the breath
• Edema (swelling of the legs)
• Sinus congestion
• Headaches
• Weight gain
• Diarrhea
• Coughing
• Hormone issues, including hypothyroidism

Hypothyroidism is when the thyroid does not produce enough thyroid hormones. It can cause tiredness and weight gain.

How Often Do You Receive Treatment?

How often and how long you undergo treatment depends on:

• Type of cancer
• How advanced the cancer is
• Type of immunotherapy you receive
• How your body reacts to treatment

You may receive treatment every day, week, or month. Some forms of treatment are provided in cycles. A cycle is a set period of treatment followed by some rest time.

The rest period allows your body the chance to recover, respond to immunotherapy treatment, and create new healthy cells.

How Can You Tell if Treatment Is Working?

Following immunotherapy treatment, you’ll see your doctor often. He or she will provide you physical exams and ask you how you feel.

You will take medical tests, including blood tests and various types of scans. These tests will assess the size of your tumor and scan for shifts in your blood work.

How Is Immunotherapy Provided?

Different types of immunotherapy may be administered in different ways.

These include intravenous (IV.) This is when the immunotherapy treatment goes directly into a vein. Immunotherapy treatment can also be provided orally, available in pills or capsules to swallow.

Topically is another option. Immunotherapy is also available in a cream that you can rub into your skin. The form of immunotherapy can be used for very early skin cancer.

Finally, it can be administered using an intravesical method. This immunotherapy goes directly into the bladder.

Follow up Care

Receiving care for side effects following immunotherapy treatment is essential. While many side effects will fade when treatment ends, some effects can persist beyond the treatment period.

Other side effects may appear months or even years later after treatment. Your health care team can help you manage persistent, long-term side effects.

If you require seamless and remote cancer care, we’re here to help. Learn more about our services and how they can help you comfortably here.

Headache is a very common problem. It is also a symptom many cancer patients experience, whether alone or with other symptoms.

There are two types of headache depending on the cause; 

• Primary headache; this is the type of headache mostly caused or aggravated by stress, like tension headache, migraine headache, and cluster headache.
• Secondary headache; is the headache that happens as a result of other problems affecting the brain like brain tumors, infections, or medications.

Both types of headache can affect cancer patients, thus the headaches you might experience can vary in site, type and severity according to the cause. 

The most common causes of headache in cancer patients include:

1- If the cancer is originally in the brain, spinal cord or pituitary gland tumors, or tumors in other places that had spread to the brain.

2- As a side-effect of chemotherapy, brain radiation therapy or other cancer treatments.

3- As a side-effect of other medications, such as high blood pressure treatments, antibiotics or antiemetics.

4- Cancer related conditions as anemia or dehydration.

6- Stress, anxiety, fatigue, poor appetite and sleep.

5- Infections as sinusitis or meningitis.

How to manage headaches:

If you started having new headaches, you must tell your healthcare team about them.

• Describe how frequent and severe they are, the exact site, if they occur at certain times of the day, describe if they were sharp, throbbing, dull or pressure like, and whether you are having any other symptoms as well. 
• Symptoms your doctor would want to know if you have are:

• Dizziness
• Blurring of vision
• Nausea 
• Vomiting
• Fever
• Pain and stiffness in your neck that is worse by moving
• Limb weakness, change in your sensations, or inability to talk.
• Poor appetite and decreased fluid intake.
• Fatigue, looking pale, decreased activity, or shortness of breath.
• Talk to your doctor if you have low mood or feeling anxious.

•  Your team can order some tests to rule out some of the causes as:

• Blood tests can tell whether or not you are having anemia.
• Brain imaging like CT or MRI scans, in case of suspected new brain mass or change in size of an old mass.

• Talk to your healthcare team about you medication list and their possible side-effects.
• If possible, your doctors will treat the conditions causing you headache like giving antibiotics for infections, or iron supplement for anemia.
• Your doctors might also prescribe medications for headache, depending on its type and cause. These medications might include; paracetamol, non steroidal anti-inflammatory as ibuprofen, triptans, antidepressants, steroids in case of brain cancer or cancer spread, 

Tips to help you cope with headaches:

1. Eat an adequate healthy diet and drink enough fluids to prevent fatigue and anemia.
2. Sleep well and give your body the rest it needs.
3. Avoid noisy or crowded places when you are experiencing the headache.
4. Avoid stress and tell your doctors if you’re having low mood.
5. If you are also experiencing dizziness, make sure your house is safe and organized to avoid the risk of falling.
6. Certain techniques can help you cope with headaches including relaxation, yoga, massage, ask your doctors about their availability and if they will be helpful in your case.
7. Tell your doctor if headache is becoming more frequent or severe, if it changes in character or doesn’t go away.

Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.

Hair loss

• Hair loss is a very stressful symptom in cancer patients.
• It usually occurs as a treatment side effect.
• Not necessarily all patients receiving cancer treatments develop hair loss. Also some drugs have higher risk than others
• The amount of hair loss also differs among patients. It depends on the drug you take, its dose and even the way you receive it, whether as a pill or through veins.

Causes in cancer patients are:

• Some chemotherapy medications
• Hormonal therapy
• Radiation therapy
• Some targeted therapy medications
• Anemia, poor nutrition, thyroid problems, stress and anxiety can also cause hair loss in cancer patients.

• Chemotherapy drugs usually cause hair loss throughout the body, this includes scalp hair, eyelashes, eyebrows, arms, legs, underarms and pubic area.
• Targeted therapy doesn’t cause complete hair loss, but hair may become thinner or drier.
• Radiotherapy only causes localized hair loss at the site of exposure. With higher radiation doses, the regrown hair might be thinner or with different texture than the original hair.
• Hormonal therapy can affect hair after several years of therapy. However it does not cause complete hair loss.
• Hair loss as a side-effect of cancer treatments doesn’t start right away with starting treatment but takes weeks to start. 
• Hair loss is usually temporary. Patients start regrowing hair back usually 1-3 months after ending treatment.
• It usually takes 6-12 months for new hair to completely grow back. New hair may be thinner or thicker, may have different color than the normal hair but usually returns to its normal in the following years.

How to cope with hair loss:

• Hair loss can cause social and emotional distress for many patients. It’s important to deal with it as a major problem that affects quality of life.
• It is also important for patients to understand the time needed for their body to heal, and use the coping mechanisms until that happens.

1. Talk to your healthcare team to understand the amount of risk of hair falling with your cancer treatment.
2. Use gentle shampoo to wash your hair, do not wash it everyday or scrub it vigorously.
3. Use wide-toothed comb and pat your hair dry to avoid any damage.
4. A shorter haircut can help you care for your hair, and help your hair taking less time to grow back.
5. Avoid blow-drying your hair with heat, hair straightener or curler, and chemical hair products and dyes.
6. Cover your head to protect it from the sun, and use sunscreen over areas with hair loss.
7. Talk to your doctors about vitamin supplements that can help your hair become stronger and grow back.
8. Talk to your doctors about scalp cryotherapy or cold cap therapy. This type of therapy helps preventing hair loss from chemotherapy drugs given into veins. It works through narrowing the scalp blood vessels at time of chemotherapy infusion thus reducing the amount reaching the scalp.
9. You can use Natural looking wigs and hairpieces pieces. You can style them the way you want until your hair grows back to normal. Insurance companies may cover for them as well. Or you can use other options include fashionable scarfs.
10. Care for the regrowing hair the same way. You can also ask your doctor about hair growing medications as minoxidil, as well as vitamins, creams and lotions.
11. Follow your doctors’ instructions on caring for associated problems as treating anemia and nutritional deficiencies. 
12. Support groups can help you express your emotions and let out your feelings. Use all the support you can get and give your body time to heal.

Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.

Causes of cancer related fatigue include: 

1. Cancer Itself.
2. Aggressive cancer treatments as surgery, chemotherapy or radiotherapy, or as a side-effect of other non-cancer drugs.
3. Drugs that make you drowsy.
4. Lack of sleep.
5. Pain.
6. Anxiety or mental stress.
7. Depression.
8. Anemia.
9. Other side-effects of drugs as vomiting or diarrhea resulting in dehydration, or loss of appetite. This can cause loss of nutrients and fatigue.  

Fatigue due to cancer or as side-effect of cancer treatment is different from any other. You may feel that it is always accompanying you and nothing is making it go away completely, even rest and sleep.

How can you cope with fatigue?

1. Have better quality sleep time:

-Making your priority to have good night sleep. 

-Lie in bed for sleep only, and avoid noise caused by electronic devices and television. 

-Take frequent naps as much as your body needs. 

-Avoid caffeine and alcohol before bed time.

2. Exercising can boost your energy and make you feel better.  -Plan ahead a daily schedule for simple exercises. 

-Choose the exercise that suits you and don’t strain yourself. -Simple exercises as walking each day even if inside your house, swimming, cycling or yoga are very beneficial. 

3. Maintain a routine during the day for activity and rest, and distract yourself with simple activities. 
4. Eat a healthy diet rich in protein, calories, vitamins and iron, and drink a lot of fluids. Talk to your doctor if you need dietary consultation.
5. Talk to your doctor if you are feeling sad or depressed, some medications can help you feel better, also keep your support system of family or friends close.
6. Talk to your doctor about any other uncontrolled symptom that can be contributing to your fatigue. As pain, vomiting, diarrhea, fainting or loss of appetite. 
7. Support groups and talk therapy have been proved to control cancer-associated fatigue. Talking about your feelings of fatigue, depression or any fears can help you get through it. 

Dizziness is a symptom many cancer patients experience.

If you feel dizzy, you might feel that the room is spinning around you or that you have lost your balance.

Dizziness can be related to cancer and its medications or other problems you might also be having.

Cancer-related causes include:

1- Chemotherapy. Many chemotherapy drugs include dizziness as one of their side-effects.

2- Anemia. Cancer and many treatments can cause anemia. When you have anemia you brain doesn’t get enough oxygen and nutrients which causes your feeling of dizziness.

3- Inadequate eating or drinking, also nausea and vomiting can cause your feeling of dizziness.

4- If the tumor in the brain or have reaches the brain, this might be the cause of dizziness.

Other causes for dizziness include:

1- Changes in your blood pressure.

2- Changes in your blood sugar.

3- Dehydration.

4- infections.

5- Ear problems.

6- Other medications.

• If you experienced dizziness, call your healthcare team, your team will need to find out possible causes and rule out anything serious as dehydration, stroke, low blood sugar or even tumor spread to the brain.
• Tell your healthcare team about any other symptoms you are experiencing, particularly if you have nausea, vomiting, blurring of vision, hearing problems, headache, diarrhea, feeling cold, sweaty or chills.
• Make sure your healthcare team knows about all the drugs you are taking.
• Once your doctor find the cause of dizziness, they will be able to reach the plan for managing it.
• Call your doctor if any symptoms are bothering you or don’t go away.

Here are Some tips to help you cope with dizziness:

1- Keep yourself hydrated by drinking a lot of fluids, try to drink up to 10 glasses each day.

2- Avoid drinks with too much caffeine.

3- Have adequate nutrition.

4- Avoid standing or changing positions too fast.

5- Be careful on walking, make sure you hold on the railing while walking downstairs.

6- Avoid driving if you feel dizzy more often.

Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.

Diarrhea is a common side-effect of cancer treatment.

It is either caused by chemotherapy or immunotherapy drugs.

Other causes in cancer patients can be; radiation therapy to the abdomen or pelvis, or infections.

Diarrhea can be complicated if not managed properly, Complications include:

1. Dehydration and loss of minerals.
2. Fluid and mineral loss if severe, may cause heart or kidney failure.
3. Malnutrition and weight loss.
4. Persistent diarrhea may affect treatment course by dose reduction, delaying or discontinuing of treatment.

Management of diarrhea:

1. Report diarrhea to your health care provider. It is necessary to exclude serious causes for diarrhea as infections.

Some symptoms should also be reported as they are considered warning signs if existed with diarrhea, they indicate infection or dehydration. 

Which are:

• Fever
• Severe abdominal pain
• Blood in stool
• Dizziness on standing
• Feeling of thirst 
• Vomiting
• Decreased amount of urine
• Stool incontinence

2. If your diarrhea is less than 6 times a day, with no warning symptoms:

-Your doctor will prescribe a drug called Imodium (or Loperamide) capsules, Start with 2 capsules (4 mg), then take 1 capsule (2mg) every 4 hours or after each loose stools, up to 8 capsules (16 mg) in a day.

-Loperamide should be continued for 12 hours after resolution of diarrhea.

3. If diarrhea persisted for more than 24 hours or became worse, call your doctor o exclude any complication, the dose of loperamide can be increased starting with 2 capsules (4 mg) then 1 capsule (2 mg) every 2 hours. If you develop any of the symptoms above, tell your doctor immediately.
4. To cope with diarrhea and prevent its complications:

• Remember to drink no less than 10 glasses of water each to replace the fluids   lost.
• If you were taking any stool softeners, don’t forget to stop taking them.

–     Avoid food and drinks that worsens diarrhea as fatty, spicy food, milk products, coffee and alcohol. 

–     Do not avoid eating. Instead you can increase the intake of food that improves diarrhea, as the BRAT diet, which is a diet consisting of Bananas, Rice, Apple sauce, and Toast, is thought to help in controlling diarrhea. Increase intake of clear fluids as water, broth, and clear juices.

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.

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.