Cancer Care Associates

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We give more chemotherapy treatments in our infusion center at Cancer Care Associates than are given at any university cancer center in the Los Angeles area. Our chemotherapy nurses are therefore very skilled and experienced. Many of them also work on the oncology units at our local hospitals. Our infusion center was designed along the lines of a modern intensive care unit. Each infusion station is in close proximity to an oncology nurse work area and patients are easily visible to the nursing staff to facilitate careful observation of each patient undergoing chemotherapy treatment. Our patients appreciate that extra sense of security, and also the opportunity to converse with and receive support from fellow patients. All chemotherapy drugs are obtained directly from the pharmaceutical supplier to insure accuracy, purity, and proper handling to avoid degradation. The medications are stored in a state of the art drug delivery system, Pyxis, for which Cancer Care Associates served as an early developmental site. This system is now widely used in hospitals to store important drugs. All treatments are prepared on site by Cancer Care Associates staff, never by an outside entity. This allows us to be certain that each treatment is prepared to exact specifications as ordered by your oncologist.

It is common and very normal to be nervous before your first chemotherapy session. We advise you to eat a light meal prior to treatment and also to drink fluids to avoid dehydration. Some chemotherapies need extra fluid intake before treatment and patients receiving those kinds of treatment will be advised during the pretreatment teaching session. These are usually regimens containing Cisplatin. Some chemotherapy, like Taxol or Taxotere, require medications to be taken the night before and morning of each treatment to minimize allergic reactions. These instructions will also be given at the teaching session. Learn more >

The chemotherapy will usually be given through a temporary IV placed into a vein on the back of your hand or forearm. Breast cancer patients are generally advised to avoid injections and blood draws in the arm from which lymph nodes have been removed. Patients who have difficult veins for IV access may require a central line that enters the upper arm (PICC line) or upper chest area (Hickman catheter or Portacath) through which chemotherapy is given. These central lines permit delivery of chemotherapy into the blood stream at the entrance of the heart. This is safe and the chemotherapy is rapidly diluted by the blood. Central lines do have occasional problems such as infection and blood clots. We ask our patients to let us know if there is discomfort, redness, or swelling around the entrance site or arm.

Unlike chemotherapy given in previous decades, most patients now receiving chemotherapy will have successful control of nausea with modern anti-nausea medications. Many of the newer chemotherapies cause little nausea while others may require pretreatment infusion with one or more anti-nausea medications such as Anzemet, Kytril or Zofran. These medications can successfully control nausea for 24 hours or more. You might experience a mild headache or constipation from the anti-nausea medication and usually those symptoms are gone after a day. Most chemotherapy related nausea starts 3 to 6 hours after treatment and usually subsides after 1-2 days. Additional anti-nausea medication can be taken at home as needed and will be prescribed to you at your teaching session. Infrequently, nausea will persist through the first week after treatment and require changes in anti-nausea medication. The oncology nurses and your physician will make every effort to minimize treatment related nausea. If vomiting occurs, you still need to drink fluid to avoid dehydration. Often sipping small amounts of liquid will help you to feel better. Please contact our office for severe repetitive vomiting or severe persisting nausea. Learn More >

Many but not all chemotherapy drugs cause hair loss. This seems to be the side effect of chemotherapy that bothers patients the most. Hair loss can occur because the chemotherapy affects hair follicles, the hair root. If you are receiving a chemotherapy that causes hair loss, it usually starts coming out about 2-3 weeks after the first treatment. Regrowth of hair will start generally about 4 weeks after the last treatment. At first your new hair may be somewhat different in color or texture, usually darker and with more curls. After a couple of years it will return to its normal consistency. If you would like to wear a wig after you loose your hair, a prescription can be written as many insurances will reimburse the cost. Losing hair from chemotherapy is very upsetting and you should keep in mind that it is temporary and will grow back when the treatments are completed.

Blood counts are required before each chemotherapy session to make sure that your treatment can be given safely. Not all insurance plans permit the blood count to be performed in our lab and if you have an insurance restriction, arrangements need to be made for the test to be done at a contracted lab. For those patients who are required to use an outside lab, the test should be generally taken 2 days before a scheduled treatment so that we will have the result on your treatment day. A low white blood count is a common reason for treatment postponement. The delay is usually one week.

White blood cells are important because they keep the blood free of infection. Infections due to a low white blood count from chemotherapy are now a less common but still potentially serious complication. This problem arises because of the potential of having a very low white blood count (WBC) in-between treatments. The lowest WBC will usually occur during the 2nd week after a treatment. If the WBC is very low, bacteria from the skin or from the intestines can infect the blood. You are advised to take your temperature whenever you don’t feel well, and if you have a fever higher than 100.5, a preventative antibiotic (usually Cipro) should be taken. If this occurs, you should take the antibiotic to completion of the prescription and you should also call our office in the morning so that your blood count can be checked. Recently, there have been reports of infrequent but serious ankle tendon problems from Cipro and patients who get ankle pain while on Cipro should stop treatment and contact us to prevent ankle tendon injury. If you feel very ill with a fever, it's probably safer to get checked in an emergency room to see if you need an intravenous antibiotic. Intravenous antibiotics usually work faster than antibiotic pills. For most patients, fever can be treated at home with Cipro because the WBC recovery occurs in a couple of days but sometimes hospitalization for intravenous antibiotics is needed. It should be noted that these types of infections are not viruses such as colds or flu so you aren't catching something from someone else. We don't restrict activity and avoidance of other people is generally not helpful or recommended. Some treatments require regular use of preventative antibiotics and antivirals such as patients with lymphoma or leukemia receiving Campath and Fludara and those patients are advised accordingly. To minimize chemotherapy related infections, we check blood counts before each chemotherapy and for treatments that may cause very low WBC we'll add Neulasta to stimulate white blood cell formation.

Platelets are important because they keep you from bleeding when cut or injured. Chemotherapy can sometimes reduce platelet counts. The lower limit of normal is 150 (thousand). Bleeding during major surgery usually doesn’t occur until platelet counts are below 70-80. Patients with low platelet counts are cautioned to not take aspirin or non-steriodal anti-inflammatories (NSAIDs) such as Motrin, Advil, Aleve, etc. Tylenol and Celebrex are okay because they don't affect platelet function. Sometimes platelet transfusions are given when counts are below 10-15 or if significant bleeding should occur. However a platelet transfusion will raise platelet counts for only one day because platelets have a short life span.

Many chemotherapy regimens can permanently affect fertility by stopping ovarian function in women and sperm production in men. Although men may elect to sperm bank, at the present time there is no clear proven alternative for women although a fertility specialist can be consulted. Egg harvesting prior to chemotherapy can sometimes be successful and lead to pregnancy later but the success rate is not as high as freezing fertilized eggs (embryos). The effect on fertility may take a number of months to occur and therefore all women of childbearing age are required to use birth control to avoid pregnancy during all cancer treatment. Women undergoing treatment for breast cancer need to use non-hormonal methods of birth control.

You are advised to maintain a normal diet for most chemotherapy regimens. At present, there are no proven specific diets of particular merit. The National Institutes of Health recommends a eating 5 or more servings of fruits and/or vegetables daily and this is reasonable guide for most patients. Alcohol is generally permitted but should be limited to no more than 2 drinks daily. Daily fluid intake does not need modification. However certain chemotherapies will require additional fluid intake either before (for Cisplatin) or after (for Cytoxan) treatment, but this applies only to the day of treatment and those patients will be advised during the pretreatment teaching session. Learn more >

Some chemotherapy can sometimes cause diarrhea. This refers to watery stools, not to stools that are just loose. Patients with diarrhea should take Imodium and avoid ingesting lactose, which is contained in milk, cheese, cream, and ice cream. The chemotherapies which are more often associated with diarrhea include Camptosar (CPT-11 or irinotecan) and Flourouracil (5FU). It is important for patients having active diarrhea on treatment day to notify the oncology nurse so that treatment adjustments and sometimes postponements can be considered. Patients at home with more than 3 episodes of diarrhea daily need to contact the office. It is very important to drink fluids and you will feel better if you do. Gatorade-type drinks are recommended to prevent dehydration and replace electrolytes. Patients with both diarrhea and vomiting may need intravenous fluids and we will advise patients with both diarrhea and vomiting to go the emergency room to prevent severe dehydration.

You should NOT take vitamins and supplements routinely during chemotherapy and radiation therapy. Any attempt at so-called anti-oxidant therapy with very large doses of vitamins or supplements is never permitted during the entire course of chemotherapy and/or radiation, because there is a potential to protect the cancer from the effects of the treatments. There is some data suggesting that even standard vitamin doses may blunt some of the effectiveness of chemotherapy. Both chemotherapy and radiation ultimately damage cancer cells by the process of oxidation. We recommend against taking any supplement, herbal remedy, and daily multi-vitamins during chemotherapy or radiation.

You are encouraged to maintain a near normal level of activity whenever possible. There is some fatigue related to treatment, usually lasting 2-4 days. Chemotherapy can also cause anemia, a low red blood count, which can also make you tired. Anemia can be treated with medication (Procrit and Aranesp) or transfusion of red blood cells. There is some recent controversy regarding the use of Procrit and Aranesp and you should discuss the pros and cons of these red blood cell growth factors with your oncologist before starting them. If you exercise regularly, you are permitted to continue, perhaps somewhat less vigorously if you're fatigued. All patients are encouraged to take walks and remain active. If you feel well enough to work and want to work, we encourage this as well. Overwork, however, is not recommended and of course you should use common sense when very tired. Learn more >