Oncology Nurses--please help!

  1. My dad was just diagnosed with non-small cell lung cancer. So far we don't know if it is stage IIIb or IV (with mets to bone). My parents have been to two oncologists so far for opinions and have decided to go with one who works at a specific cancer center.

    Today, the wife of my dad's friend got him in for a third opinion with another oncologist at the same cancer center as above mentioned oncologist. Apparently, she says this guy can get my dad into a clinical trial that the other doc can't--not sure why. The thing is, she's not a practicing doctor and works for a pharmaceutical company. She says the oncologist she recommended my dad to "specializes" in lung cancer, though I've found nothing indicating this on the center's website.

    My question is: how in the world do we compare specialists like this to decide who is the best for my dad? I'm a PHN and know nothing about oncology, especially lung cancer. I feel so helpless and like my parents are looking to me for answers.

    Please help!
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  2. 9 Comments

  3. by   alwayslearnin
    Jayla,
    I have no answers for you-oncology is not my specialty. But my heart goes out to you. My father was just diagnosed with non-sm cell ca of the lung with mets to the brain-stage IV. My step father was diagnosed a few weeks ago with stomach and liver CA stage IV. I hope others that can give you answers will reply-but know there is another nurse out there with hope for you and your family-that you find the answers and support you need-keep asking-God Bless
    alwayslearnin
  4. by   nesher
    I recommend that you go the the following site and use the treatment decision tool. It will not only give you treatment options, information regarding clincial trials, but will also specific questions to guide your questions for the doc. I think going to a place that specializes in cancer treatment might be the best idea. At any rate use the tool and see the third doc. It doesn't hurt to have other opinions.
  5. by   caroladybelle
    First of all, my heart goes out to you and my thoughts are with you.

    As a general rule, with most common lung cancers, the best chance of cure is with surgical resection. Unfortunately, it generally requires removal of the tumor as well as removal of sufficient tissue to insure clean margins. And in many patients, this surgery would be so extensive that the patient would not be left with enough tissue to live following the procedure. And chemo and/or radiation, while they will slow the disease down, or help prevent mets, they are rarely curative in and of theirselves, especially when there are mets or when the lung cancer is advanced. They may also be used to shrink the tumor before surgery, or used prophylactically after surgery. It can result in extensive periods of remission.

    That said, what is the patient's goals in life? Is he looking to do anything for a complete cure, or trying to prolong life at all (sometimes painful) costs, or trying to slow the disease, and prevent debilitation from the disease? Is he looking for extensive remission. What are his regular MDs telling him, that his prognosis and stage is?

    Clinical trials are also not the holy grail. They are clinical trials...testing of new possible treatment regimens. There are phases 1-4, testing different issues and there are no guarantees as to any results. And some of those results (percentage of participants with "partial response") can be misleading to patients.

    I do not know how to check MDs except with the local Oncos that you know and trust.
  6. by   Jayla
    Quote from nesher
    I recommend that you go the the following site and use the treatment decision tool. It will not only give you treatment options, information regarding clincial trials, but will also specific questions to guide your questions for the doc. I think going to a place that specializes in cancer treatment might be the best idea. At any rate use the tool and see the third doc. It doesn't hurt to have other opinions.
    Nesher--Could you post the site again please?

    Thanks for your responses.
  7. by   nurseman99
    a dx of cancer is a sad thing.we feel and pray for you and your father.unfortunately, the lady that informed about the trial is partially correct.the md and company that she is affiliated with may run the trial but your dad;s primary oncologist should have access to the same trial if your dad fits the criteria.i would advise you go to the national cancer institutes home page and type in treatment protocols for stage 3b/4 nsclc.my job at work deals mostly w/post chemo side effects than actually giving the chemo but quality of life has improved over the last few yrs with newer tx modalities.he may have to go thru the 3some approach of sx,radiation/chemo but pt;s do much better if they are well informed of each step and it;s side effects.god bless and good luck!
  8. by   nesher
    Jayla,
    Here is the site:
    http://www.seattlecca.org/cancerinfo...cancerInfo.htm
    good luck...
  9. by   Jayla
    Can someone tell me how long it usually takes for the adverse effects of chemo to start? We were told 10-17 days, and I assume that's regarding n/v, diarrhea, etc. But what about mouth sores and hair loss? I would assume that would take a few rounds of chemo treatment and perhaps a few months to develop. Is this assumption correct?

    Thank you.
  10. by   caroladybelle
    Quote from Jayla
    Can someone tell me how long it usually takes for the adverse effects of chemo to start? We were told 10-17 days, and I assume that's regarding n/v, diarrhea, etc. But what about mouth sores and hair loss? I would assume that would take a few rounds of chemo treatment and perhaps a few months to develop. Is this assumption correct?
    It depends on the drugs used.

    Nausea from the chemo itself is not as common as it once was. It generally occurs during infusion or within a day or two. However, with the advent of the 5HT3 premed drugs 8-12 years ago (zofran, kytril, anzemet) and use of decadron, nausea during and directly after the infusion is minimized. Additionally, people are often nervous prior to treatments and that can contribute to nausea and vomiting, and for them we use ativan.

    There can be delayed nausea, generally treated with either old line drugs (phenergan, reglan, compazine) or the 5HT3 drugs. The patient may also have nausea related to the anemia and fatigue, secondary to bone marrow suppression. If one has poor oxygenation due to anemia and/or lung insufficiency (due to the cancer), other systems in the body slow down and don't work as well and that can lead to altered digestion and nausea.

    In later stages of lung cancer, frequently the patient does not eat much and has little appetite related to this poor oxygenation. Easily digested foods are best.

    Anemia and related fatigue generally occur 7-14 days after chemo, but varies per drug and dosage. Sometimes procrit is used to prevent anemia, sometimes transfusions are needed.

    Mouth sores vary as to occurrence. Best prevention methods include: avoiding alcohol based mouthwashes (most commercial mouth washes contain alcohol that dries the mouth), frequent mouth rinsing with NS/saline rinses 6-12 times per day (every 2-4 hours while awake and Q4 if possible at night). If mouth sores occur, saline can be buffered by addition of baking soda. The Md needs to be notified so that magic mouthwash (varies in ingrediants, but usually included zylocaine/decadron/benedryl/carafate/nystatin) can be ordered to help them heal.

    Diarrhea sometimes occurs, sometimes not. Occasionally constipation occurs and can actually be more of a problem. It depends on the drugs.

    Hair loss, also is not predictable. It may or may not occur. The time scale varies quite a bit. It may just thin or change texture/color.

    There may be taste changes related to the chemo and the tumor cell breakdown products in the system.

    With many lung cancer patients, the fatigue and general sick feeling related to the anemia and the byproducts of the tumor cell breakdown is the major discomfort.

    By the same token, the byproducts of the cancer can also cause many of these symptoms in and of itself.

    I hope that this helps. Feel free to PM me.

    Carolina
  11. by   IcouldalwayssellMary
    A good oncology nurse is key. In an outpt setting they get to know their pts well due to the frequency of the pt's visits. Sometimes they're a better resource for education re: chemo side effects and symptom management than the Dr. It's important to remember that the side effects listed are all symptoms that occurred during the drug studies. I usually focus on the more common side effects. I also emphasize that everyone is individual and there is no way of knowing in advance how any one person will react. Some people may tol. a drug well with minimal problems, and that same drug may cause significant problems to another pt. The most important thing is communicating with the chemo nurse/Dr. Often times a balance needs to be found between the effectiveness of the drugs and the toxicities of the drugs. There are different regimens available and the Dr. can make changes in doses, chemo schedule, and/or drugs used. Also, if a pt progresses on 1 regimen, there are other regimens to try.
    If your father was Dx with stage 1V lung Ca he is no longer curable, but people have much longer periods of remission than before because of the increase in Tx options. And side effect management is soooo much better than when I started nursing 25 yrs ago. Many of our pts are working, playing, participating in life during their Txs. And while lung Ca pts are usually "chronic" chemo pts, they do get time off for good behavior if their disease is stable. Stay optimistic.

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