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Summary: Chemotherapy

If you already read about radiation, you will see that much of the content in this document is the same.

Since most of us tend to see things we missed during a single reading, it is recommended that you take the time to

reread familiar sections. Mom was right. It is better to be safe instead of sorry. 

Chemotherapy for colorectal cancer takes place over a period of weeks or months depending on the particular drug or drugs used. Because the drugs travel throughout the body and affect both normal and malignant cells, they are given in courses, with some time allowed between doses for normal cells to repair themselves.

The discussion in this article is divided into the following sections:

For information about HIPEC, click here.

At The Start Of Treatment

  • Do not be surprised if starting treatment makes cancer feel real.
  • Do not expect immediate results. 
    • Standard practice is to wait two full cycles before looking for any response to chemotherapy. This can take 2 to 3 months.
    • Response is checked by repeating the same tests that originally diagnosed the cancer.
  • Ask the doctor:
    • What nutrients are absorbed by the chemotherapy drugs. Also ask the doctor what foods will help replenish those nutrients and how much of the food is needed. If food alone will not be enough to replenish the lost nutrients, what supplement does he or she suggest  – and what particular brands if known. The doctor may recommend you speak with a nutritionist/dietitian who specializes in cancer.
    • For a prescription for a drug to control nausea, vomiting and pain “just in case.” You don’t have to fill a prescription. If you do fill it, you do not have to take the drugs. However, being prepared can save waiting time if you need a drug to help. (To learn how to buy, store, and pay for drugs. Even the most experienced drug consumer is likely to learn something new. See Drugs 101) 
    • When to call: For instance, call if any of the following occur. The symptoms may not signify anything important, but then again, they could. Let your doctor decide when a symptom is harmless or whether something should be done right away.
      • Symptoms which indicate there may be an infection. Symptoms of infection include a temperature of 100.5 degrees or higher, chills or sweating, a general sense that you feel poorly, a new cough, burning sensation when urinating, change in bowel habits and an ulcer on the skin.
      • Swelling in the arm or leg that becomes warm, red, and painful. Swelling may be a sign of a blood clot inside a blood vessel that can travel to your heart..
      • Dizziness, headaches, shortness of breath, heart palpitations, pale skin or a feeling of being cold. These symptoms could indicate anemia (a condition in which the blood doesn’t have enough red blood cells or hemoglobin or total volume).  
    • What would be considered an emergency and what you should do if one happens. (Pack an emergency bag "just in case."  The odds are you will not need it, but it can’t hurt). See: Medical Emergency: How To Be Prepared
    • How to get through to the doctor if you have a concern or problem that you do not think can wait until regular office hours. It’s better to call the doctor than end up in the hospital with a serious complication that should have been treated.. Most doctors have 24 hour answering services.
    • How will the drugs be administered? For example, intravenously through a port, a surgically placed line in your chest to minimize using veins? If so, consider wearing a V-neck or button down shirt. Bring a scarf to cover the parts that do not need to be uncovered and may get chilly.
    • Before, during or after treatment:
      • Are there foods to avoid? For example, grapefruit interferes with metabolism by the liver of some drugs.
      • Vitamins, antioxidants or supplements to avoid?
      • Are there other circumstances to avoid? For instance, excessive sunlight or crowds?
    • Can you exercise during treatment? Using your body can make you feel better about yourself, help you get rid of tension or anger, and build your appetite.
      • If you can exercise, to what extent?
      • Is there anything you should avoid doing?
      • Should you follow the rule that some doctors use of not exercising within 24 hours after receiving a treatment ---- or perhaps a guideline of not exercising if your blood cell counts are below a certain level that the doctor will prescribe for you? 
    • Ask whether you should protect a sex partner from drugs that may be in sperm or vaginal secretions. The amount of chemotherapy drug in sperm or vaginal secretions is likely to be very low. However, it may be recommended that  you wear a condom or use a vulva shield during sex. 
    • What to do if there is a disaster so that you cannot get to chemotherapy or the facility is shut down. For information, see: Disaster Planning
    • What cosmetics, jewelry and or nail polish you can wear. Skin and nail bed color are useful ways for the medical staff to assess your well-being and response to drugs. If you feel strongly, ask if you can leave a section of your skin or a fingernail bare for visibility – or whether a thimble-like oxygen sensor that slides over your finger can be used.
    • It is generally recommended that you do not color your hair during treatment.
    • Could lotions or aftershave cause skin irritation? Some drugs interact with lotions or aftershave.
  • Keep in mind tips about how to maximize limited time with a doctor. For instance, learn the meaning of the basic medical words that are likely to come up so conversations can be faster and more precise. For more information, click here.
  • If you need transportation to and from treatment, contact the American Cancer Society at 800.ACS.2345. The Society has volunteers on hand to help. The more notice you give, the more likely that the Society will be able to find a driver.
  • Line up a family member or friend to go with you to the first treatment session. Such a person can provide emotional support and handle issues such as keeping written instructions for diet and after care; remember verbal instructions and assist with the drive home. Depending on the chemotherapy drug or drug used for side effects, you may feel drowsy or unable to concentrate normally when you leave the session.
  • Keep in mind that treatment decisions may change as treatment goes along. A change does not mean that the original treatment was wrong. There is no way to predict how any particular treatment will affect any particular person. Medicine is a combination of science and art. 
  • Stock up on single portions of your favorite comfort foods, including some in your freezer that you can defrost as needed. When you freeze foods for this period, make the portions smaller than usual for those occasions when you don't feel like eating a lot.
  • If you have children, and haven't told them yet about your condition and/or treatment, now is the time to do it in an age sensitive manner. See the document in "To Learn More."
  • Schedule doctor appointments for your convenience.
    • An appointment early in the day or at the beginning of that part of the day when the doctor sees patients generally gets you in and out quickly. Doctors' schedules tend to back up as the day progresses.
    • If you have appointments with different doctors and/or tests coming up, consider scheduling them for the same day or setting doctor appointments for the same day every week.
  • If you are doing any complementary therapy such as acupuncture, make sure your oncologist knows.
  • Decide whether you want to talk with other people in the chemo treatment room more than being superficially friendly. 
    • Not all the people you meet will be positive. Some may have stories that sound somewhat like yours, but have complications that you would rather not think about. It can be difficult to keep in mind that each of us are individual and there is no way to predict what will happen. Stories that touch a fear can replay over and over in your mind as time goes on. It is up to you to decide if meeting people in the chemo room is worth the risk. If not, headphones and a DVD player can be a best friend.
    • As Stacia put it: "Chemo sucks. But it can also be the place where you’ll meet people with invaluable wisdom to share, where you’ll laugh a little, where you’ll learn a lot, and where—if you’re lucky—you’ll find the inspiration you need to focus on kicking your cancer out and letting life in."
  • If you have health insurance:
    • Check with the doctor’s office to be sure that everything is squared away with the insurance company. If not, get involved – at least to extent of following up with the doctor’s office and the insurance company to make sure treatment is being covered.
    • Start thinking about how to pay your share (co-pays, co-insurance and expenses that may not be covered by insurance).
    • When you have time, read: How To Maximize Use Of Your Health Insurance
  • If you do not have health insurance:
    • Start thinking about how to pay for treatment if you haven’t already. We provide information under the general heading of How To Deal With A Financial Crunch.
    • Keep in mind that all medical bills are negotiable. We show you how. Click here. 
  • Consider getting a pet.  A pet does not have to be a dog or a cat to have beneficial emotional and physical effects.

WOMEN: NOTE:

  • Consider wearing flats instead of high heels to chemo treatment.
  • Avoid becoming pregnant during chemotherapy treatment. Chemotherapy can be harmful to a fetus. In general, the guideline is 2‐5 years post‐treatment, but talk to your team if you need to get started earlier. As a general matter, pregnancy is not associated with increased risk of colorectal cancer.

During Chemotherapy Treatment

On Treatment Days

Before you go to treatment:

  • Eat at least an hour before treatment if you are experiencing nausea after treatment.
  • Take with you any medications (including stool softeners and anti-diarrheal agents) that you may need later.
  • If prescribed, take your anti-nausea pills before leaving home.
  • Line up someone to drive you to and from treatment if the medication causes drowsiness.
  • Store a bucket in your car “just in case” you become nauseous during the ride home.
  • If your chemotherapy will be administered by an IV drip or syringe rather than by a take home infusion pump:
    • Wear comfortable, layered clothing with easy access to your chemoport
    • Bring something that you find relaxing and enjoy doing, you may be there for several hours.  If you bring music bring earbuds so you do not disturb your neighbors.  Some people find this an ideal nap time.

Keep in mind that often treatment does not start until a doctor, nurse or medical technician does the following:

  • Weigh you
  • Take your blood pressure and temperature
  • Do a brief physical
  • Ask about symptoms and side effects you may have experienced (our Symptoms Diary can help you keep track) 
  • Draw blood to check blood counts to do a standard complete blood count (CBS). If your blood counts are too low, treatment may be delayed a few days or a week. A delay of a few days or a week is not likely to affect the success of your treatment. To avoid a long delay, you may be given drugs to bring your blood counts up to safe levels. These drugs are man-made copies of natural body products that cause bone marrow to produce more new blood cells than it otherwise would.
  • If you had a high level of CEA, part of the blood draw will be used to test for CEA. To learn about CEA, click here.

Try to make friends with the oncology nurses (who are generally friendly as well as knowledgeable) and fellow patients. Both can give you insights about the chemotherapy experience and practical advice – as well as help to pass the time while undergoing treatment. (Who knows? You may even make a new friend. Social support is important to health.)  Due to the federal law known as HIPAA, as a general matter, patients no longer sit in communal circles they usually have private treatment areas which make it difficult to talk with other patients during treatment.

Do not leave the treatment area if you are not feeling well. If you don’t feel well, tell the medical staff.

If you received treatment through an IV line, consider using the bathroom before leaving. IV drugs are often given with a saline drip which can fill  our bladder and surprise you with an urgent need to urinate before you get home.

In General

  • When you meet other people going through chemotherapy, don’t be surprised if their treatment schedule is different from yours. Chemotherapy schedules are tailored to the individual situation.
  • Understand that treatment decisions may change as treatment goes along. A change does not mean that the original treatment was wrong. Medicine is a combination of science and art.
  • Think about your treatment goals and keep them in mind. Don’t live in the future. Live in the here and now. Setting goals can help. As you move toward your goals you are likely to feel happier and stronger, more energized and effective. You feel more competent and confident in yourself and your abilities. Setting goals recognizes that you can’t make changes overnight, and you can’t heal faster than nature allows. Writing goals down somewhere you are likely to see can be a reminder that helps get through any dark times. 
  • Before taking any supplements or over the counter vitamins or herbs check with your doctor.  
    • Do not take vitamins, minerals, herbs, antioxidants or other dietary supplements without first asking your medical oncologist or other members of your cancer treatment team whether it is okay. Some of these substances such as St. John’s Wort can be harmful when mixed with chemotherapy. Some may reduce the effectiveness of the chemotherapy.
    • All cancer survivors should avoid high-dose vitamin A and C supplements.
    • If medical personnel suggest or allow you to take vitamins, minerals, herbs, antioxidants or other dietary supplements, do not take more than is recommended without first checking with medical personnel.
  • Keep track of your symptoms so you can report them when you see your doctor. We provide a symptoms diary to help you keep track. When you are ready to see a doctor, you can change your diary into an easy to read graph with the push of a button.
  • Do your best to live a lifestyle that helps your body function at its disease-healing best. The same lifestyle may also help prevent a future recurrence. It may make it easier to adopt and continue a healthy lifestyle if you think of it as part of your medical regimen.
    • It is not worth spending even a minute  worrying about your previous habits. Focus on what you can do now to improve your lifestyle.
    • Do not expect to make big changes overnight. Start small, with one step at a time. 
  • Do your best to eat nutritiously. During treatment, you may need extra protein and calories. At times, your diet may need to include extra milk, cheese, and eggs. If you have trouble chewing and swallowing, you may need to add sauces and gravies. Sometimes, you may need to eat low-fiber foods instead of those with high fiber. Ask your oncologist about any diet changes you may need to make. If he or she doesn’t know, ask to be referred to a nutritionist/dietitian who helps people with colorectal cancer. (For information about what a nutritionist/dietitician does, choosing a nutritionist/dietitician, and insurance issues, click here.) 
  • Chemotherapy can wreak havoc with your appetite. Do your best. Be practical, not obsessive.
  • Take it easy. You may not have as much energy as usual, so try to get as much rest as you can. Let the "small stuff" slide, and only do the things that are most important to you.
    • Take a hot bath, with or without bubbles.
    • Get a massage.
    • Go to a movie.
  • Be active and exercise (yes, even during treatment subject to your doctor’s approval - though you may have to take it easier.) NOTE: If your blood counts drop to the point that you are at risk for infection avoid public places including gyms. Your doctor may suggest that you do not exercise at all until your cell counts return to a safe level. (For additional tips about avoiding infection, click here.)
  • Get appropriate rest and sleep. Keep in mind that while actively undergoing treatment, you may need more sleep than the average person.[i] For information about sleep, click here
  • Stay hydrated with safe drinking water. Chemotherapy is toxic. The chemical poisons are flushed out through your kidneys and bladder. If you do not drink enough liquids, your kidneys and bladder will be exposed to higher concentrations of toxic chemicals. This is the reason people are given beverages to drink during treatment and told to keep fluid intake high. Check your drinking water to be sure it is safe for people who are prone to getting infections. (To learn about safe water, click here.
  • Aim for a healthy weight.
    • If nausea and vomiting make it difficult to eat or to maintain weight, click here. 
    • While you may think only about weight loss during chemotherapy, it is not uncommon for people who undergo chemotherapy to experience weight gain. Do not attempt weight loss during treatment. Wait until the post treatment recovery phase.
    • A combination of psychological support, nutritional counseling and exercise can help to maintain or lose weight. 
  • If you are undergoing acupuncture as a complementary treatment:
    • As noted above, be sure your doctor knows.
    • Watch your white blood and platelet counts. If either are low, ask your doctor if it is okay to continue acupuncture. If the doctor says “yes”, be sure to tell the acupuncturist about your low count.
  • Pamper yourself. 
  • Spread the word among your friends that cooking may be difficult for you. Home cooked meals provided by friends have been said to have the taste of love in them.  It may also help if you let them know specifically what you can and cannot eat, friends are more than willing to accommodate you and help with food.
  • Reduce risk of infection in all aspects of your daily life. Infections slow recovery. For instance, avoid public places such  as gyms and spas as much as possible. To learn more, click here.  
  • Practice good oral hygiene.
    • If your dentist advised you to take additional precautions during treatment, take them. For instance, your dentist may recommend a fluoride mouth rinse or a fluoride gel in addition to daily brushing.
    • An infection in your mouth can lower your body's ability to fight your cancer. Keep your mouth clean. Brush at least twice a day. Floss at least once a day. (If you haven't had one lately, schedule a dental check up). 
    • Check your mouth every day. Call your dentist immediately if you notice any changes or problems. Any of the following symptoms may indicate an infection.
      • Bleeding or a sticky, white film in your mouth 
      • Lumps 
      • Soreness 
      • Swelling 
      • Ulcerations.
      • To learn more about oral care, click here.
  • Minimize alcohol consumption. For example, men should limit drinking to two drinks a day. Women should limit alcohol to one drink a day.
  • Minimize stress. To learn how, to avoid unnecessary stress, click here. To learn how to deal with stress, click here.
  • Deal with emotions that surface. To learn how, see: Tips To Help Feel In Control Of Your Emotions 
  • If you smoke, stop. 
    • Smoking may interfere with the effectiveness of cancer therapy. Cancer patients who smoke have a lower survival rate than nonsmokers. By quitting, you can improve the body’s response to treatments, lessen complications and side effects, decrease the risk of recurrence and enhance survival.
    • Quitting during treatment may be very uncomfortable. It may include a variety of symptoms such as difficulty sleeping, depression, anxiety and irritability. On the other hand, it may help keep your mind off of the treatment.
    • For information about quitting, click here.     
  • Keep in mind that your primary doctor is also part of your medical team. Ask your specialists to keep him or her up-to-date. Don't skip your regular appointments. 

For information about chemotherapy, see:

Please share additional tips you learn by e mail to: Survivorship A to Z

On Treatment Days

  •  If you haven’t been to the chemotherapy facility before, consider taking a family member or friend with you to the first treatment. If you’d like, continue to take someone with you as often as necessary.
  • Dress in layers so you can add or remove clothes depending on whether or not you feel cold during treatment. Wear comfortable, layered clothing with easy access to your chemo port .  A loose top with buttons at the neck so that the port can be easily accessed.  If you prefer you can find tops with chemo port access at http://chemotherapyclothing.com/index.html offsite link
  • Take an activity to keep yourself busy during treatment. For instance, a good book, or a pad or lap top with games or work.  Bring something that you find relaxing and enjoy doing, you may be there for several hours.  If you bring music bring earbuds so you do not disturb your neighbors.  Some people find this an ideal nap time also.
  • Before each treatment:
    • Take some time to relax. Consider meditating or doing deep relaxation breathing. Both meditation and deep breathing can be done anywhere at any time. You don’t need any special training to do either technique. For information about meditation, click here. For deep breathing, click here.
    • Eat before each treatment, if you can. It is often difficult to eat after a chemotherapy treatment. (Take a snack with you to treatment in case you have to wait).
  • Drink plenty of safe water.
  • During a treatment: Some oncologists recommend doing the following while chemotherapy is being administered to act as an anesthetic and to also provide hydration:
    • Suck on a sugar-free popsicle 
    • Eat ice cubes or ice chips. 
  • If you find you get queasy after treatment let your medical oncologist know. He or she can prescribe anti-nausea medication.

Keep in mind that you may not experience any side effects at first, but they may appear and then become get worse as treatment continues. Some side effects may linger after treatment ends.

Side effects are a price for regaining health or at least minimizing the effects of cancerSome people would say the price is small compared to the potential reward.

If side effects do start to appear, the articles in “To Learn More”  provide practical information about minimizing the effect.

Toward The End Of Treatment

Do not be surprised if you look and feel worse than when you started. Your body has been through a lot. The end of treatment is in sight.

While there is likely to be a feeling of joy that treatment is ending, there may also be negative feelings such as the feeling that you are about to lose the (cancer) family that helped you through the medical aspects of treatment.  You may also feel  numbness, fear of relapse, anger at having cancer, alienation and loneliness and even depression. If you haven’t before, this is a good time to consider finding a cancer buddy who has gone through a similar situation and/or the support of other people going through a similar situation. For other tips about dealing with emotions during treatment, click here.  If these feelings become overwhelming, speak with your doctor or seek professional help. See “To Learn More.”

Ask your oncologist for a Cancer Follow Up Plan. Among other subjects, a Cancer Follow Up Plan provides information about what to look for after treatment, as well as a schedule of tests and visits to have afterward. For more information, see: Colorectal Cancer Follow-Up Plan

Emotionally, you are likely to experience depression from the withdrawal of the treatment family. Learn the symptoms and what to do if they appear. Seeing your doctor again can help provide reassurance. 

If you have a chemo port and your stage and type of colorectal cancer has an increased risk of recurrence, consider keeping the port, at least for a while – especially if surgery with general anesthesia will be required to remove it and reinstall it if necessary. Of course, if you keep it, you will have to continue to keep it clean because of the risk of infection.

Plan a treat for yourself when treatment is over. It doesn’t have to be expensive.  A treat will help you deal with the changes  treatment  made  in your routine and your life. (This subject is covered in more detail in Day To Day Living).

If there are clothes you wore during treatment, consider marking the end of treatment by giving the clothes to charity. It is a visual reminder that you are finished treatment and that you are healing.

Consider thanking the professionals who helped you through treatment.

NOTE:

  • If you are treated in a hospital other than your local hospital,  get a copy of your medical records for the local hospital where you will do the follow up. You are legally entitled to a copy. There may be a charge. For additional information, click here.
  • For information about medical care after treatment, see: Colorectal Cancer: Post Treatment 0 – 6 Months, Medical Care

If Treatment Is Not Working

There are likely other treatments to consider. Discuss alternatives with your doctor.

If your situation is unusual, consider researching other treatments yourself or ask a family member or friend to do it for. For information about medical research and how to do it, click here. Alternatively, you can hire a medical research service.  (For information, click here.)

  • Watch for quack treatments. To learn how to spot a phony treatment, click here.
  • Discuss what you find with your doctor. 
  • If you feel as if you need one, get a second opinion from a qualified, experienced specialist who is not connected with your doctor – preferably from a doctor who is with a NCI designated Comprehensive Cancer Center offsite link. A second and even a third opinion will likely be covered by your health insurance. If you do not have insurance, second opinions do not have to be expensive. TO learn how to get a second opinion, click here. 
  • A consultation with a doctor who specializes in treating pain (a palliative-care specialist) can help. Such professionals are trained to consider the patient’s entire medical and personal situation and to focus on symptom management and pain relief along with curative treatments.

If the prognosis is particularly worrisome or the cancer does not respond to aggressive measures, consider modifying treatment to preserve your quality of life. For information, click here. (Link to the new article about factors to consider when deciding whether to change to palliative care)

If it looks as if you have a shortened life expectancy of six months or less, consider hospice care. Hospice care can be given at home – and can be free if necessary. To learn about hospice care, click here

How Chemotherapy For Colorectal Cancer Is Administered

Chemotherapy is administered in several different  forms.

Intravenous Therapy

Intravenous therapy includes the use of a  temporary or semi-permanent IV line into the forearm or by any one of a number of venous access devices(VADs). 

  • The most common VAD’s are a chemoport which is surgically implanted in your chest under general anesthesia, or a PICC line which is usually in your arm. 
  • These devices allow chemotherapy and fluids to be delivered without harming your veins with the sometimes caustic chemotherapy.  
  • Ports also decrease the number of needle sticks needed and eliminate the need for temporary IV lines.  

While the drug is administered, you may feel a warm rush or begin sweating. If you do, check with the medical staff to be sure this is appropriate for your particular drug regimen.

Notify the medical staff if you feel burning, pain, redness or swelling near the injection site.

Portable Ambulatory Pumps 

A portable wearable pump delivers a continuous flow of chemotherapy  into the body.

With a portable pump, a drug or combination of drugs is administered through the day or at preset times. Settings can be for hours, days or weeks.

The pump is a small battery powered pump about the size of a small paperback book. It is connected via a tube to a needle which is either inserted in your Chemoport or PICC line..

The pump can be carried in a satchel that you wear around your waist or carry over your shoulder.

There are a variety of treatment schedules and pump types. Do not be concerned if you hear about people with other types of pumps  and schedules.

Advantages of the pump include continuous delivery of the chemotherapy and when the pump needs to be changed a nurse comes to you and changes it for you. Disadvantages include the inconvenience of having to carry and adjust to being  attached to a pump all day and night.

Intraperitoneal chemotherapy

For some types of colorectal cancer that spread along the lining of the abdomen, there may be an injection of chemotherapy directly into the abdominal cavity (the peritoneal cavity).

To get to the peritoneum, doctors either:

  • Insert a catheter each time the treatment is given, or
  • Implant several tubes and drains during the surgery to remove the tumor or during a later surgery.

As a general matter, this chemotherapy is given in cycles of five days a month for several months. The drugs are infused, left in lace for almost 24 hours, then drained.

Imaging studies such as CT scans may be administered during or after infusion to be sure that all areas of the peritoneum receive adequate amounts of medication.

Hepatic artery infusion (HAI)

Hepatic artery infusion is the delivery of chemotherapy directly into the liver.

HAI can be during surgery in the doctor’s office or at home through a portable infusion pump.

Administration in the doctor’s office is similar to delivery during Intravenous Therapy (see above).

Administration at home is by portable infusion pump. See above. 

Oral Therapy

Oral therapy is taking a drug by mouth.

Chemotherapy may include an oral medication together with or instead of intravenous injections.

You may also be given oral medications to prevent or treat side effects, such as nausea.

If you have difficulty taking pills, we have tips available by clicking here. It may also help to look at our information about tips to help keep you compliant (taking drugs over time when you are supposed to.)  For information, click here 

Subcutaneous injections 

An injection under the skin. (The traditional needle stick you get at the doctor's office).

How To Live With Medications and Supplements

  • Before agreeing to take any drug, learn about the risks as well as the benefits.
    • Survivorship A to Z provides questions to ask before agreeing to take any drug. 
  • Do what you can to avoid medical errors
    • Start by obtaining a readable doctor’s prescription. If you can't read it, neither can the pharmacist.
    • Check the drug you receive against the prescription and make sure it looks like you expect. 
  • Avoid overmedication
    • Overmedication is all too common. Ask your doctor if a lower dose will do the same job - particularly for drugs you continue to take over time.
    • See: Drugs: How To Choose Which To Take
  • Carry a list of your drugs all the time. Emergencies happen. You may need to tell emergency personnel all the drugs you are taking. A list of medications becomes even more important if you become unconscious. Plus the list will be helpful each time you see a doctor or fill a prescription. Survivorship A to Z provides a form: List Of Medications that can be saved and printed as needed.
  • Ask that each newly prescribed drug be checked for negative interaction with other drugs you are taking. Do not assume that this will happen automatically. .  Try to use the same pharmacy to avoid any problems.
  • Treat over-the-counter medications, supplements and vitamins as if they are drugs. Just because they are sold without a prescription does not mean that there is no risk.
  • Take care if you use herbs, vitamins or other supplements.
    • Herbs, vitamins and supplements are not subject to FDA approval so there is no guarantee about their safety or effectiveness. There is not even a guarantee that the same mix of ingredients will be in each bottle – even for bottles from the same manufacturer.
    • Look for products with the mark: “USP Verified.” USP Verified means that the supplement meets standards of quality, purity and potency which are set by the not-for-profit U.S. Pharmacopeia. For information, see www.uspverified.org offsite link
    • Also see: Health Supplements
  • Consider the price of drugs, even if insurance will pay for them.  It may feel like insurance company money is other people’s money, but expenses show up in your increased premiums. See: Drugs: How To Save Money When Buying Or Using
  • Do not let price be the sole factor in determining what you want or where to obtain a medication. 
    • Consider, for example, what happens if you need a refill in an emergency? 
    • A pharmacist can be a very important part of your health care team. Consider whether you have access to a pharmacist where you buy your drugs. 
    • If necessary, you may be able to obtain drugs for free or very low cost.
  • If the current drugs on the market don’t satisfy your needs, there may be newer drugs to consider that are still being tested for safety. Access to these drugs is through a process known as a clinical trial – a controlled test in which use of the drug is medically monitored. It is essential that you be fully informed before entering a clinical trial.
  • Live with drugs wisely.
    • Comply with prescribed orders. Non-compliance can be harmful. Time tested tips help if you have difficulty complying.
    • Do not share drugs.
    • Store drugs correctly (not in a medicine cabinet in the bathroom).
    • Travel well with your drugs. Carry a copy of your prescription. Carry an extra supply in case you get delayed.
  • Stay open. Decisions regarding medical care and treatment may change over time.

To Learn More

More Information

Herbs

How To Consider "Complementary" or "Alternative" Treatments

So called "alternative" or "complementary" treatments should only be considered in addition to medical treatments - not instead of them. There is no scientific evidence that any such treatments work on their own.

An excellent source of reliable information about each therapy and what medical evidence indicates with respect to cancer, is American Cancer Society Complete Guide To Complementary & Alternative Cancer Therapies offsite link $24.95 including shipping. (Available from www.cancer.org/docroot/PUB/PUB_0.asp  offsite linkor call 800.ACS.2345)

Discuss any complementary treatments you are considering with your doctor before starting them. 

To learn whether to use a particular complementary treatment, and, if so, how to choose the best practitioner, click here.

How To Prepare In Case Of An Emergency Or Natural Disaster

While emergencies can happen to anyone, you may be more vulnerable to emergencies because of your treatment.

Consider the following:

  • The types of emergency care available to you and when to go to which resource. This includes deciding which emergency room to go to if needed. This exercise should be considered for your home, where you work, and any other place in which you spend substantial amounts of time. (Survivorship A to Z includes information about how to maximize your time in an Emergency Room)  (link to article 497)
  • Think about what to communicate to emergency first responders. For instance, be ready to tell responders your disease, current treatment, recent treatments and drugs you are taking. (Carrying a List of Medications helps).
  • In case you become unable to communicate, wear a medical alert, carry a computer flash drive or a card with a summary describing your condition and treatment(s) to let emergency first responders know about your medical condition, treatment and/or medications. 
  • How to continue treatment if a disaster occurs. Speak with the doctor overseeing the treatment or his/her staff.

 “Just in case:”

  • Keep an emergency bag packed. 
  • Think about the following subjects:
    • The financial and legal steps to take now so you are prepared in the event of a medical emergency.
    • If you travel, how to prepare for medical emergencies that may come up during travel.  See: Medical Emergency: How To Be Prepared
    • What to do if you have underage children and cannot care for them because of a medical emergency.
    • Each of these subjects are discussed in the documents in "To Learn More."

If it would be helpful, use the Survivorship A to Z prioritizer (link to prioritizer.php) to list the steps you want to take. You can then number them in order of priority. A push of a button will change the order of the list to your priority. 

NOTE: While considering emergencies: Be sure to protect your property and pocketbook in the event of a loss with Homeowners Insurance and Automobile Insurance. Information about what to look for, how to minimize cost, and how to file claims as a person with a serious health condition is contained in the linked articles.