Expert patient Jacki Donaldson explains how to prepare for chemotherapy, including obtaining all of the information you need, choosing your drugs, and knowing when to use your instincts.
After my breast cancer diagnosis and lumpectomy, I believed that, unlike other women with my diagnosis, I did not need chemotherapy -- that my cancer was not bad enough, that I would be okay with just surgery and radiation, that I would not lose my hair. Something thick and heavy sank in my stomach the day a nurse walked into my exam room, pathology report in one hand and catalogue for wigs in the other. I saw the catalogue and knew my fate. No words spoken. I knew.
It's a frightening word - chemotherapy. It's mysterious and terrifying and can send shivers through even the toughest of us. Now that my own chemotherapy is complete, I can look back with clarity and perspective. I can make sense of the initial confusion of it all and can share the wisdom I've gathered from an experience I once feared. In this series, I will reveal my insider secrets for coping with chemotherapy. You will learn how to prepare for chemotherapy, how to manage through treatment, and how to survive once treatment concludes. And you'll learn - I hope - that you too can conquer chemo.
Part I: Preparing for Chemotherapy
Statistics and Instincts
When it comes to choosing your treatment regimen, statistics are important. They will help you understand how many people survive breast cancer depending on pathology and specific treatment plans. But numbers and charts and graphs aren't everything. Pay attention to them, but listen to your gut too. If something doesn't feel right, be cautious.
One of the first decisions you and your doctor will make is choosing your chemo drugs. The decision is based on multiple factors obtained from the surgical specimens, on the overall general health of the individual and on the individual's goals of treatment. Factors which help make the determination include the stage, the pathology of the disease, the status of the lymph glands and certain markers found on the cancer cells. Depending on these findings different drugs are offered to different women (I had Adriamycin and Cytoxan). Your doctor's recommendations are important, but you have the final word. For me, the drug Taxol was recommended. But I did not have a spread to my lymph nodes - the reason Taxol is typically prescribed - and I felt this drug was not right for me. When statistics revealed just a 0.7 percent better chance at survival with Taxol, I decided not to receive this drug.
Once you've decided on your treatment, you will sign a form giving your official consent to undergo chemo, and your doctor will likely do tests such as heart scans and x-rays to get baseline readings. You and your doctor will also decide how you will receive chemo, either through a regular IV or a port that is implanted with minor surgery and is ready for use immediately after the procedure. I opted to have a port placed under the skin on my chest near my collarbone. One needle stick accesses this port and all medications flow quickly and effortlessly through a tube directly into large veins and throughout my system. Without a port, you'll receive needle sticks in your arms and hands, which is not always as precise and can harm your veins. Some drugs, such as Adriamycin, are toxic and can severely burn your skin. Be sure to talk to your doctor to investigate which method is best for you.
If you do opt for a port, I recommend wearing shirts that zip or button to chemo treatments. It makes for easy access so your clothing isn't stretched. And consider using a numbing cream, such as Lidosense or Emla, because the needle stick can hurt.
Education is Key
Before you start chemo, you'll meet with a nurse to learn about your drugs and their side effects. The side effects may seem overwhelming, but each person reacts differently to chemotherapy, and you can rest assured that you will not encounter every side effect. Do listen carefully to the side effects that require a call to your doctor. While meeting with the nurse, you should also get a tour of the infusion center, a list of important phone numbers, and a listing of available resources, such as counselors, social workers, and support groups. Another educational component of preparing for chemo is explaining to children what they can expect from the process. Prepare them for the side effects of chemo - like hair loss, fatigue, and possible sickness.