Side effects make therapy education tougher
Difference between side effects and infection
Health care now has a new treatment in the fight against cancer that many may not be aware of. Biological therapy, or immunotherapy, is used to stimulate or restore the ability of the immune system to fight infection and disease. According to the National Cancer Institute based in Bethesda, MD, "Biological therapies use the body’s immune system, either directly or indirectly, to fight cancer or to lessen the side effects that may be caused by some cancer treatments."
Patients can experience difficulty with this form of therapy because of the side effects experienced, says Marilyn Rhodes, RN, BSN, OCN, oncology resource nurse at City of Hope National Medical Center in Duarte, CA.
Several of the biological response modifiers may cause flulike symptoms including fever, chills, and muscle aches and pains. "We teach them what to expect and how to take care of the symptoms at home," says Rhodes.
Tylenol usually is recommended for the low-grade fevers, chills, and muscle aches. Also, patients are told to inject themselves with the drug at night so they sleep through the initial phase of side effects, she says. If the side effects are extremely bad, the dosage sometimes can be adjusted.
Although the symptoms never completely subside, they do get better once the body becomes use to the drug, says Rhodes. Yet because the side effects could be masking an infection in patients with compromised immune systems, they are instructed to call a member of their health care team any time day or night if needed.
"We try to teach our patients that this is a team, and they are the most important part of the team. We don’t care if they call six times a day. We don’t call it complaining; we call it reporting," Rhodes says.
Tracking symptoms
To help the health care team make wise evaluations, patients are instructed to keep records of fevers and other symptoms experienced following an injection. The logs help physicians make modifications on the dosage when patients come for their checkup.
The logs also help members of the health care team determine whether patients need to be seen by a physician when they call. They need to provide specific information when they call, explaining their symptoms and knowing their temperature. "They can’t just call and say they have a fever," says Rhodes.
Anyone undergoing biotherapy who develops a fever above 101° F must be seen by his or her physician, she says.
Patients encouraged to try
Biological therapy can greatly impact the lifestyle of cancer patients. Active people who enjoy such sports as skiing or running usually must stop during treatment, says Rhodes. Though the reality of side effects can’t be minimized during education about biotherapy, patients usually agree to try the therapy knowing that if it gets really bad they can stop.
Most patients have a caregiver to help monitor their symptoms during treatment and contact the medical team if the patient is too ill to call. "The difficult patients are the ones who live alone, but usually we refer them to social services and have them try to identify someone that could be called in case of an emergency," Rhodes explains.
A buddy system often is worked out where someone calls daily. It might even be the pastor of the patient’s church. While an out-of-town relative is OK, there needs to be a person who can drive to the patient’s house and check on him or her if something is wrong.
Because the drugs used in biological therapy usually are injected, a good part of the education is teaching the patient and caregiver how to inject the drug. Similar to the instruction for diabetes patients who must inject insulin, those on biotherapy sit around a table with vials and syringes and practice drawing the medication and injecting oranges until they are comfortable with the technique.
Once comfortable, patients try to give their own injection with the nurse watching, says Rhodes. Depending on the drug used, injections could be daily or every two weeks. Those who don’t have to be injected frequently do have the option of going to a clinic for the injection.
Amgen, a drug company based in Thousand Oaks, CA, has a diagrammatic instruction sheet and a training video on self-injection that is in both English and Spanish. The video covers everything a patient needs to know about self-injection, including choosing the site for the injection and preparing the skin.
"Education on biotherapy takes time," says Rhodes.
Source
For more information about biological therapy, contact:
- Marilyn Rhodes, RN, BSN, OCN, Oncology Resource Nurse, Patient and Family Community Education, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-0269. E-mail: [email protected].
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