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Establishing a Plan for Treatment



Adam M. Brufsky, MD, PhD: We’ve talked about all of these various subtypes of cancer, but when patients first come in, what kind of questions do they usually have for you? They’ve seen me, but a lot of times, they don’t want to ask me certain things.

Lynn Acierno, BSN, RN, OCN, RN-BC: Patients do open up to nurses (maybe a little bit more).

Adam M. Brufsky, MD, PhD: I know they do.

Lynn Acierno, BSN, RN, OCN, RN-BC: We see a spectrum of emotions. We see those who are very stoic, [who say,] “I’m going to fight this.” Then, we also have patients who have tremendous concerns about their future. We just try to comfort them and let them know that once we know what type of breast cancer we’re fighting, we have the means to treat it and we’re going to be with them every step of the way.

Adam M. Brufsky, MD, PhD: That’s good. Are there any common questions that people tend to have?

Lynn Acierno, BSN, RN, OCN, RN-BC: I would say some of the most common questions, of course, are in regard to side effects. Everybody seems to know somebody who’s been treated for cancer. And whether it’s the same type of cancer or other cancers, they want to know, “Am I going to get sick?” “Am I going to lose my hair?” Probably the most common questions the nurses receive are, “What type of side effects am I going to have?” And, “How do we deal with them?”

Adam M. Brufsky, MD, PhD: And, “Which ones, in particular?” I know people always will worry about nausea. They saw this movie. I forgot the name of the movie. I forgot what it was. Someone had CML [chronic myeloid leukemia]. The patient got really sick and lost all of his hair. He was throwing up all the time. I just remember people always asking, “Am I going to be nauseous? Am I going to throw up?” Is that really a big one anymore or no?

Lynn Acierno, BSN, RN, OCN, RN-BC: It’s a very big question because most people have, maybe, people in their family who were treated 20 years ago for cancer. I always tell them, “We’ve come a long way with the anti-nausea therapy.” And, as a matter of fact, our most common complaint from patients is probably fatigue (as opposed to nausea).

Adam M. Brufsky, MD, PhD: Yes, fatigue is a big one. What do we do about that when people get it?

Lynn Acierno, BSN, RN, OCN, RN-BC: With fatigue?

Adam M. Brufsky, MD, PhD: Yes.

Lynn Acierno, BSN, RN, OCN, RN-BC: We advise patients to rest when they need to. And if they feel energetic, we advise them to take advantage and get out and do things that they enjoy. But for the most part, we tell them to just kind of listen to their body.

Adam M. Brufsky, MD, PhD: The other one that I get, especially with women, is hair loss. A lot of women will go, “Look, I’m going to lose my hair. OK, it’s better. I want to live.” But some people are really dead set against losing their hair. I see part of it, but again, I’m a guy. I’m a doctor. You’re a nurse. You’re a woman. You probably hear more about it from people, as a nurse?

Lynn Acierno, BSN, RN, OCN, RN-BC: We do hear a lot of concerns about that. And again, that sometimes guides your treatment options, as to what they’re going to get.

We try to offer emotional support. We give them resources. The American Cancer Society is a resource. We direct them to places where they can purchase head coverings and wigs. But we listen to their concerns and we try to help them.

Adam M. Brufsky, MD, PhD: Do they ever ask about cold caps?

Lynn Acierno, BSN, RN, OCN, RN-BC: We don’t have many conversations about cold caps, but we try to give them as much information as we have. Unfortunately, we don’t see that a lot.

Adam M. Brufsky, MD, PhD: Yes. We went through a period where we almost bought the machine. There was a machine out there that circulated (kind of like a refrigerator) over your head. It was for people who don’t want to lose their hair. But it was, at the time, still very expensive. We weren’t sure if it was covered by insurance. We decided not to do it, but a lot of my colleagues around the country, especially at the UCSF [University of California, San Francisco] and other places, really wanted to use it. It is very successful. I’m surprised people haven’t talked as much to you guys about it.

Lynn Acierno, BSN, RN, OCN, RN-BC: We do let them know the pros and cons of that, but it is a big commitment on their part.

Adam M. Brufsky, MD, PhD: It is. It’s a huge commitment. You tell them that it’s about an hour, or 2, in the chair before and after. It’s a big deal.

Lynn Acierno, BSN, RN, OCN, RN-BC: We do provide them with the necessary resources to look into cold caps if they do want to follow through on that.

Adam M. Brufsky, MD, PhD: Good. Why is it important to have a treatment plan for people? Why is it important to have a plan for them up front?

Lynn Acierno, BSN, RN, OCN, RN-BC: It’s absolutely important, for everybody involved, to know what the plan is so that we’re all on the same page. Again, it’s based on their specific pathology.

Adam M. Brufsky, MD, PhD: Right. What we do with people, in our practice, as you know, is that I’ll go in and see patients and I’ll talk about everything, in general—especially if they need chemotherapy as part of their plan. Then, I’ll have you guys come in and do what we call a “teaching session,” to everybody. Can you explain what that is? What do you guys do during that session?

Lynn Acierno, BSN, RN, OCN, RN-BC: When you determine what the treatment plan is going to be, we gather the materials and we go in with the patient and review the different drugs that you’ve chosen. We’ll go through the most common side effects, talk about the lesser common side effects, discuss how to treat those side effects at home and when to call us. We also talk about when they absolutely must call us right away. If there’s a fever that they develop and any life-threatening situation, we would want them to, of course, seek emergency assistance. We also provide them with resources, not only for their medical side effects, but perhaps for connecting with social work or dieticians. We talk about all of the resources that are available.

Adam M. Brufsky, MD, PhD: How many people do you think look for a dietician?

Lynn Acierno, BSN, RN, OCN, RN-BC: There are many patients who want to be proactive. Nutrition therapy is something that they can do, on their own. There are actually many patients who are very pleasantly surprised that we have a nutritionist on staff. Many people want to know about nutrition. They’ve heard, “If I don’t eat sugar, is that going to help?” “Should I avoid red meats.”

Adam M. Brufsky, MD, PhD: Or even chicken.

Lynn Acierno, BSN, RN, OCN, RN-BC: Yes. Again, that’s something they can do, on their own, and they’re very interested in knowing more about it.

Transcript Edited for Clarity

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