Chemotherapy and Radiation For Dummies®
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Copyright © 2005 by Wiley Publishing, Inc., Indianapolis, Indiana
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Library of Congress Control Number: 2005921459
ISBN-13: 978-0-7645-7832-8
ISBN-10: 0-7645-7832-4
Manufactured in the United States of America
10 9 8 7 6 5 4 3 2
1B/QY/QU/QV/IN
Alan P. Lyss, MD: Dr. Lyss is the Medical Director of the Missouri Baptist Cancer Center and the Director of the Cancer Research Program of Missouri Baptist Medical Center in St. Louis, Missouri. He is Associate Professor of Clinical Medicine at Washington University School of Medicine and is the honoree of a distinguished Alumni Scholarship Award there. Dr. Lyss also is Associate Clinical Professor at the University of Missouri School of Medicine.
Dr. Lyss is the recipient of several research grants and currently has research funding from the National Cancer Institute. His clinical and research interests are directed toward finding improved treatments for patients with cancer, including improvements in supportive care and psychosocial support. He has been actively engaged in studies directed toward the prevention of common adult cancers and improving the distribution of innovative cancer care to underserved populations, especially to those who reside in rural areas.
Humberto Fagundes, MD: A radiation oncologist, Dr. Fagundes currently holds the position of Medical Director of Radiation Oncology at Missouri Baptist Medical Center in St. Louis, Missouri. He received his training in radiation oncology at Mallinckrodt Institute of Radiology from 1988 through 1992. He was then appointed Chief Resident/Fellow having completed his training in 1993. In the fall of that year he served as Assistant Professor of Radiation Therapy at Loyola University Medical Center in Chicago. Family ties brought him back to the St. Louis area in 1994. In 1999 he arrived at Missouri Baptist Medical Center and was named Medical Director in 2001.
Dr. Fagundes has introduced several innovations at Missouri Baptist, such as 3D Conformal Radiation Therapy, IMRT (Intensity Modulated Radiation Therapy), breast and prostate brachytherapy, as well as intra-operative brachytherapy. His particular interests are in the management of breast and prostate cancers. While in a community hospital, Dr. Fagundes continues to write and publish in the field.
Dr. Fagundes has also worked with the oncology communities in South America and India, where he has assisted in the introduction and implementation of new technologies and cutting-edge treatments in radiation oncology.
Patricia Corrigan: Ms. Corrigan, who holds a B.S. in health education from Lindenwood College, is a reporter for the St. Louis Post-Dispatch, where she writes often on health and fitness. She also is the author of 10 books, including Wild Things: Untold Tales from the First Century at The Saint Louis Zoo (Virginia Publishing Company), Convertible Dreams, a collection of her Post-Dispatch Saturday columns (Virginia Publishing Company), a guide for whale watchers and six nature books for children (NorthWord Press), and a dessert cookbook (Pocketbooks).
Ms. Corrigan has written freelance articles for numerous newspapers across the country and for national magazines such as More, Ms., BBW, Radiance, Lear’s, Family Fun, Cruise Travel, and Northwest Travel and Wildlife. A popular public speaker, she addresses conferences, civic organizations, women’s organizations, and school groups. A breast cancer survivor since 1995, she is especially happy to be associated with this book!
We dedicate this book to everyone who undergoes chemotherapy and radiation.
Safe trip!
We would like to acknowledge the many cheerleaders in our lives, especially our tolerant families.
Also, for their assistance and unflagging enthusiasm, we also want to thank Jeanne Hanson, Mikal Belicove, Joan Friedman, Ros Hofstein, Jean Roark, Carol Riley, Stephen P. Allen, MD, Gerry Puglisi, Susan Cuddihee, and Linda and Bill Gwyn.
We are grateful for the editorial participation of Martin Raber, MD, clinical professor in GI Medical Oncology at M.D. Anderson Cancer Center in Houston.
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.
Some of the people who helped bring this book to market include the following:
Acquisitions, Editorial, and Media Development
Project Editor: Joan Friedman
Acquisitions Editor: Mikal E. Belicove
Technical Editor: Martin Raber, MD
Editorial Manager: Michelle Hacker
Editorial Supervisor: Carmen Krikorian
Editorial Assistants: Courtney Allen, Nadine Bell
Cover Photos: © Getty Images/Photodisc Collection
Cartoons: Rich Tennant, www.the5thwave.com
Composition
Project Coordinators: Maridee Ennis, Emily Wichlinski
Layout and Graphics: Carl Byers, Andrea Dahl, Joyce Haughey, Stephanie D. Jumper, Barry Offringa
Special Art: Illustrations by Kathryn Born, MA
Proofreaders: Leeann Harney, Jessica Kramer, Carl William Pierce, Dwight Ramsey, TECHBOOKS Production Services
Indexer: TECHBOOKS Production Services
Publishing and Editorial for Consumer Dummies
Diane Graves Steele, Vice President and Publisher, Consumer Dummies
Joyce Pepple, Acquisitions Director, Consumer Dummies
Kristin A. Cocks, Product Development Director, Consumer Dummies
Michael Spring, Vice President and Publisher, Travel
Kelly Regan, Editorial Director, Travel
Publishing for Technology Dummies
Andy Cummings, Vice President and Publisher, Dummies Technology/General User
Composition Services
Gerry Fahey, Vice President of Production Services
Debbie Stailey, Director of Composition Services
Title
Introduction
About This Book
Conventions Used in This Book
What You Don’t Have to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Your Journey Through Cancer Treatments: Preparing for the Trip
Chapter 1: Recognizing the Realities of Chemotherapy and Radiation
Making Peace with Your Diagnosis
Gathering Information
Shopping for Cancer Specialists
Considering Options
Exploring Virtual Chemotherapy
Trying on Radiation Therapy for Size
Sending for Help
Looking Beyond Cancer Treatments
Chapter 2: The Mutants Take Over: A Primer on Cancer
Demystifying the “C” Word
Watching the Immune System in Action
Discovering How Treatments Fight Back
Considering Risk Factors
Looking to the Future: Ongoing Research
Speaking of the “C” Word
Keeping Your Sense of Humor
Chapter 3: You Will Be Tested: What All Those Tests Show
Passing a Battery of Tests
Playing the Waiting Game
Setting the Stage for Treatment
Recognizing Symptoms of Cancer
Appreciating Early Detection
Part II : Your Choices along the Way: Making Good Ones
Chapter 4: Defining Chemotherapy: The Anticancer Drugs
Getting Some Chemotherapy Basics
Investigating Different Delivery Systems
Evaluating Your Oncologist’s Recommendation
Making the Best Choice for You
Chapter 5: Defining Radiation: A Burning Issue
Understanding Radiation Therapy
Evaluating Your Radiation Oncologist’s Recommendation
Making the Best Choice for You
Chapter 6: Setting New Standards: The Role of Clinical Trials
Grasping the Importance of Clinical Trials
Deciding Whether to Participate
Taking Part in a Clinical Trial
Feeling Good About Taking Part
Chapter 7: Getting a Second Chance: Bone Marrow Transplants
Demystifying Bone Marrow Transplants
Exploring the Types of Transplants
Searching for a Donor
Preparing for a Bone Marrow Transplant
Comparing Retrieval Methods
Undergoing the Rescue Process
Keeping an Eye Out for Post-Rescue Problems
Part III : Chemotherapy: What to Expect and How to Deal with Side Effects
Chapter 8: What to Expect During Chemotherapy: A Head-to-Toe Mouthwash
Your First Appointment: Getting the Toughest One Out of the Way
Continuing with Chemo
Asking for the Support You Need
Giving Yourself a Break
Chapter 9: Gimme a Boost: Immune and Bone Marrow Stimulants
Boning Up on Bone Marrow
Boosting the Immune System
Recognizing an Infection
Considering Supplements
Chapter 10: Coping with Serious Side Effects of Chemotherapy
Considering What’s to Come
Keeping an Eye on Kidney and Bladder Function
Combating Nausea
Facing Fatigue
Fighting Pain
Demystifying Depression
Confronting Infertility
Losing Your Hair
Chapter 11: Coping with Less Serious Side Effects of Chemotherapy
Considering What’s to Come
Battling Intestinal Disarray
Retaining Fluids
Experiencing Vision Problems
Fighting Fuzzy Thinking
Losing Interest in Food
Troubleshooting Skin and Nail Problems
Part IV : Radiation: What to Expect and How to Deal with Side Effects
Chapter 12: What to Expect During Radiation: Tattoos and Moisturizer
Your First Appointments: Getting the Toughest Ones Out of the Way
Experiencing the Real Thing
Soothing Your Skin
Making Wardrobe Adjustments
Seeking the Support You Need
Giving Yourself a Break
Chapter 13: Coping with Side Effects of Radiation Therapy
Considering What’s to Come
Fending Off Fatigue
Caring for Your Skin
Soothing Inflamed Mucous Membranes
Experiencing Diarrhea
Saying “No” to Nausea
Living with Lymphedema
Looking Out for Pneumonitis
Running to the Restroom
Watching Your White Blood Count
Dealing with Hair Loss
Recognizing Depression
Part V : Your Success Strategies: Assembling Your Support Team
Chapter 14: Your Health Professionals: Your Friends and Guides
Communicating with Your Doctors
Seeking Help from a Psychologist
Meeting Other Health Professionals
Chapter 15: Good Nutrition: Eating Right No Matter How You Feel
Welcoming New Members to the Team
Knowing When You Need Help
Catching Up on the Food Fights
Boning Up on the Benefits
Acknowledging the “A” List
Plumbing the Pitfalls of Poor Eating
Considering Problems that May Develop
Chapter 16: Meeting Spiritual Needs: Turning to Prayer and Meditation
Defining Distress
Tallying Up the Benefits of Faith
Talking about Spirituality with Your Doctors
Examining Prayer Practices
Accepting Prayers from Others
Assessing the Healing Power of Prayer
Listening to a Doctor on Spirituality
Squaring Faith with Cancer
Chapter 17: Finding a Support Group: Realizing You Are Not Alone
Determining Your Level of Interest
Defining “Group”
Locating a Group
Asking the Right Questions
Seeking One-on-One Support
Looking at the Benefits
Assessing the Risks
Helping Newcomers
Part VI : Your Future after Cancer Treatments: Looking Ahead
Chapter 18: Finishing Therapy: An End and a Beginning
Monitoring Your Health after Cancer
Coping with Long-Term Side Effects
Reducing Your Hormone Level
Working Out a Wellness Plan
Chapter 19: Dealing with Recurrence: Here We Go Again
Defining Recurrence
Redefining Survivor
Riding the Emotional Roller Coaster
Establishing a Treatment Plan
Considering Unconventional Treatments
Facing the Future, Whatever Comes
Chapter 20: Defining Yourself after Cancer: The New Normal
Looking at Life Through New Eyes
Making Semantic Decisions
Allowing for Negativity
Finding Inspiration in Amazing Recoveries
Looking at Time Differently
Protecting Yourself Emotionally
Defining Your Boundaries at Home and Work
Lightening Up
Part VII : The Part of Tens
Chapter 21: Ten Myths about Cancer
Myth #1: When You Get Cancer, You Die
Myth #2: If the Cancer Doesn’t Kill You, the Treatments Will
Myth #3: Cancer Treatments Are One-Size-Fits-All
Myth #4: You Can’t Work while You’re Having Cancer Treatments
Myth #5: It Takes Forever to Get Over Cancer Treatments
Myth #6: It’s Your Fault You Got Cancer
Myth #7: The Medical Community Suppresses Alternative Healing Methods
Myth #8: Now Your Family Will All Get Cancer
Myth #9: Cancer Always Comes Back
Myth #10: Nothing Is Ever the Same after Cancer
Chapter 22: Ten Ways for Family and Friends to Help You
Acknowledging That You Have Cancer
Giving You Time to Accept the Diagnosis
Holding You While You Cry
Making You Laugh
Seeking Help Coping from Someone Else
Asking for Specific Ways to Help You
Carrying Out Your Requests
Offering What You Are Reluctant to Ask For
Helping to Protect You
Celebrating with You
Chapter 23: Ten Things Beyond Your Control
Turning Back the Clock
Keeping the Diagnosis a Secret
Encountering an Alien Culture
Making New Friends
Experiencing Mood Swings
Facing Your Own Mortality
Suffering Power Outages
Missing Some Good Times
Choosing the Texture of Your New Hair
Receiving Help from Many Sources
Chapter 24: Ten Ways Life Will Be Better after Cancer
Cancer Goes Away
Treatments End
Fear Recedes
A Sense of Adventure Grows
Inner Strength Builds
People Matter More
Forgiveness Gains in Importance
Support Comes Naturally
The Tongue Loosens
Time Flies
Chapter 25: Ten Sources for More Information
Searching the Web
Coping with Cancer Magazine
Glossary
You hold in your hands a cancer treatment book with bedside manner.
You can find here facts on chemotherapy and radiation — topics generally perceived as scary, and rightly so — presented in a straightforward manner and a conversational tone. We don’t overload you with medical jargon, but we do give you the information you need to have a fruitful conversation with your doctors.
Who are “we”? Fair question. “We” are a medical oncologist, a radiation oncologist, and a professional writer who just happens to be a cancer survivor. Among the three of us, we’ve accumulated quite a thorough understanding of cancer and its treatments. One of our goals is to provide you with plenty of inside information as you contemplate, begin, traverse, and end your cancer treatments.
Another of our goals is to remind you that even though you spend part of your life as a cancer patient, that part does not define who you are or restrict you as much as you may think.
Chemotherapy and radiation are not simple topics, but this is not a dense, academic book. Instead, this is a book written in lay terms with all the material organized in an easy-to-read fashion. We cover one topic at a time in a logical sequence. You may want to start with Chapter 1 and proceed straight through the book in an orderly fashion, or you may want to skip around, reading whatever takes your fancy in any order that you choose.
If your doctor has recommended chemotherapy or radiation therapy, you may want to start with the overview of either, or go straight to a description of what each treatment may mean for you. You decide. Later, if you are curious about some other aspect of these cancer treatments, if you missed something, or if your treatment plan changes, everything you need to know will be waiting for you when you next pick up the book.
Here’s another advantage to this book: You can use it to complement the information that your doctors provide. If the details about a specific test, the description of a type of treatment, or a suggestion on how to manage a given side effect eludes you late one night or over the weekend, chances are this book can fill in the blanks until your doctor is back in the office.
Not all cancer treatment guides are created equal. On purpose, this one was developed and written to lead the pack — and to give you exactly the help you need.
Some of the material in this book is a little technical and involves some medical terminology. Whenever a new word or phrase is introduced that needs to be defined, the word or phrase appears in italics and the definition is close at hand. You may think you don’t need to know these words and phrases, but your conversations with your doctors will go more smoothly if you are familiar with the terminology.
Also, all Web addresses in the text appear in a special font, called monofont , to set them apart from the rest of the text.
Text sitting next to the “Technical Stuff” icon is exactly that. You are welcome to move on if you think you already have plenty of information.
Here’s another tip: When you run across any material printed in a gray box, this is material that you may find interesting, but it’s not crucial, especially if you are a reader who prefers just the facts about chemotherapy and radiation. Skipping the sidebars will not cause you any trouble in terms of following the rest of the text.
We have boldly assumed that you are not a medical student, a physician, or a person considering seeking advanced training in oncology or radiation oncology. We also figure you’re probably not a contestant preparing for a TV quiz show.
No — we think you have been diagnosed with cancer and are preparing to begin either chemotherapy or radiation, or maybe both. Having cancer ushers you into a whole new world with a whole new language, so we have done our best to explain the culture and define the terms that you are likely to encounter.
On the other hand, you may be shopping for a good reference book to give to a family member or close friend facing cancer treatments. When you hand that person this book, be sure to say we think he or she is lucky to have the support of such a thoughtful person.
This book is divided into seven parts to help you make your way through cancer treatments.
This is a suggested packing list, as it were, to ease your experience as you head off to cancer treatments. Here, you find suggestions to help you choose your doctors, a brief refresher course in simple cell biology from your days in science class, and information on some of the tests you may need to schedule to help determine which treatment would be best for you.
When you have been diagnosed with cancer, you make a lot of important decisions in a short time after you talk with your doctor about which treatments are most likely to stop the cancer. In this part, you get an overview of chemotherapy and radiation therapy — the gold standards today in cancer treatment. Also in this part are many of the answers to questions you may have about clinical trials. And this is where you find detailed information about bone marrow and stem cell transplants.
We can’t literally accompany you to your first chemotherapy appointment, but we have been where you are going, and we can tell you what to expect on that day and in the days to come. You’ve probably heard about the side effects of anticancer drugs. Here, you find them described in detail, one at a time, along with practical suggestions to help you manage those that affect you.
Preparing to begin radiation therapy? In this part, we take you step by step through your setup appointment, your first dose of radiation, and the remainder of your treatment. This is also the place to look for strategies to help you manage side effects throughout treatments.
We are big fans of the idea of building a support team to call on as you go through cancer treatments. In this part, you find suggestions on how to build good relationships with medical practitioners involved in your care, as well as others you may want to add to the team, including yoga instructors, massage therapists, tai chi practitioners, fitness experts, nutritionists, and spiritual leaders. Here, too, you can decide whether a support group is right for you — and, if so, discover how to find one.
Is there life after cancer? Of course, but don’t expect everything to be the same as it was before. In this part, you find an assessment of some of the long-term physical changes that may affect you, a frank discussion on recurrence, and discussions of emotional “potholes” that may exist on the road to your future. You also discover some ideas on how to make the most of every day.
You’ve probably heard a lot about cancer, and some of what you heard may even be true! In this part, you discover the real story behind some of the myths of cancer. We also suggest ten specific things people can do to help you as you go through treatment; identify ten matters completely beyond your control; and present what we consider ten gifts from cancer, each of which will make your life after cancer more rewarding. Last of all, look for ten sources for more information about cancer.
Cancer comes with its own vocabulary, so look here for a list of words you’re likely to hear as you go through cancer treatments.
Icons used throughout this book call your attention to material that may be of particular use to you.
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Our foremost hope is that you go on to live a long and happy life after cancer.
This is your book — take what you need, and may it serve you well.
In this part . . .
Starting with a look at the new world you are entering, we provide tips on what to expect and offer suggestions on how to choose the medical professionals who will accompany you on your journey through cancer treatments. This part also brings you up to speed on what cancer is, how it attacks the body, and what tests are available to help determine the best treatment for you.