Chemotherapy: An Infusion Nurse’s Experience
This interview, “Chemotherapy: An Infusion Nurse’s Experience,” is provided by Grand Rounds in Urology’s content partner, Prostatepedia.
Catherine Guider is an infusion nurse with Kaiser Permanente in Sacramento, CA.
She offers Prostatepedia her perspective on chemotherapy for prostate cancer.
Why did you become an oncology nurse?
Ms. Catherine Guider: I was interested in oncology even back in nursing school. I had a grandfather who had cancer and was given a very short timeline of survival, and he was one of those that beat the odds and made it to 93. I got to see a side to cancer that some people don’t get to see.
In nursing school, I did some time on an oncology inpatient floor and found it challenging and rewarding when it came to the personal relationships that I got to build with patients and their families.
When I came to Kaiser, I didn’t start in that department, but after a couple of years, I took an opportunity to move to the floor that does inpatient chemotherapy. A short time later, I was certified with chemotherapy and biotherapy, and I stayed there for many years. Now, I’m in the outpatient infusion oncology clinic.
Have you had any patients over the years who changed how you see your own role or how you see nursing in general?
Ms. Guider: Because I was in the inpatient side where sometimes people stayed for longer than a day or two, I saw the impact that we can have on their lives. I would spend my lunchbreak with some of our oncology patients, sharing lunches and time together, and I noticed that sitting with them would help them eat more and make them feel lighter. It’s gone both ways; they have enriched my life also.
There are definitely some who have impacted me. Being on the infusion oncology team, I’m part of a patient’s cheer group and their support group. When they cry, sometimes I cry, and sometimes that’s difficult. It’s definitely made nursing more personal for me.
What’s the process like for getting chemo for men with prostate cancer?
Ms. Guider: We have a good process here when it comes to onboarding new chemotherapy patients. Our doctors work with our nurse navigators, who then work with our triage on our medical assistance to get the patient scheduled for their chemo class and their first chemo treatment. All these people make sure that labs, pre-med home medications, and post-treatment meds are ordered with support. Overall, there are a lot of people involved to make sure that the patient and their family are well-informed. When they come in, they already have an idea of what that day and treatments are going to be like.
When they arrive, we make sure that a patient is up to chemotherapy. We make sure that they are physically and mentally well, and then we notify our pharmacy to make the medication. We have our own pharmacy within our department. If there is anything questionable, we get in contact with the patient’s oncologist, and they’re directly across the hall from us, so it’s very easy to do. All of that is addressed right then and there.
What is the infusion like? Is it painful?
Ms. Guider: No. You have to start an IV or access a port, which could be painful. But the majority of people don’t feel the chemotherapy. There’s always a potential reaction to certain medications, but we are good about how we handle those. We already have medications ordered that we can administer if someone has a side effect on the premises, and we can get that side effect reversed.
How long does the actual infusion last?
Ms. Guider: It all depends on the regimen. With prostate cancer, that’s normally Taxotere (docetaxel), and that is an hour infusion.
I have only given Jevtana (cabazitaxel) once or twice before, but I believe that’s an hour also. Taxotere (docetaxel) is still the first choice IV treatment.
What kinds of side effects have you seen patients deal with after chemo?
Ms. Guider: The normal: nausea. We send patients home with a list of medications to use for the nausea, and we recommend smaller meals throughout the day to stay ahead of it. There’s the hair loss, nailbed changes. You can have peripheral neuropathy with the chemotherapy. There’s fatigue, of course, and the impact on white blood cells, red blood cells, and platelets that we’re watching for as well.
Do you have any tips or advice for men to make the whole process of getting chemo easier?
Ms. Guider: Somebody’s mindset has a lot to do with how they come into it and how they handle it.
Somebody who’s active, eating a well-balanced meal, and good on their hydration normally does better than someone who isn’t. Some people don’t like to take additional medication, and so there is not that adherence there.
We give patients a list of antiemetics to use if they become nauseated. Sometimes, they take them that first or second day, just as a safety measure to keep the nausea away. Some people don’t like to do that. But it’s always better to stay ahead of the nausea than let the nausea set in because it’s hard to play catch-up and get it to go away once it’s there. Nausea doesn’t only make patients feel unwell, but they’re not going to drink the amount of fluids that they need or eat the meals that they need if they’re nauseated. Coming in with all of that already in place, makes somebody tend to do better.
What role do you see the caregivers playing in the whole chemo process?
Ms. Guider: We invite caregivers to the chemo class. It’s always up to the patient if they want their caregiver to come to join them. Sometimes people and their family members come for the first appointment, and then after a while, the patients come by themselves. We have other people whose family members come every time. It all depends on the role that they already have in the relationship.
Sometimes caregivers are more of the voice for the patient. Sometimes they speak up and say that the patient is having a difficult time getting their food in, or they’re having this nausea afterwards, but the patient is not telling us.
Other times, caregivers are the cheerleaders who will bring a sandwich, and when the patient eats half, they’re the cheerleader saying “why don’t you take just one more bite? Don’t quit yet.” They all have different roles.
We also have caregivers who take an unproductive role, and that’s probably been in the relationship. Encouraging people to do better or take that next bite is very different than a person saying: “you need to eat that.”
Presentation can be huge, and if that avenue isn’t already developed between them, then sometimes we’ll see people bicker over how much they drank the day before.
I guess any conflicts that are already in the relationship will be highlighted by a situation like this, right?
Ms. Guider: Yes, along with the stressors of all of it.
Any other tips you have for men who are about to get chemo or maybe have already had chemo and are struggling with side effects?
Ms. Guider: When it comes to the side effects, you don’t have to struggle through them. Your team is there for you if you speak up. We can change pre-medications around. We can change medications at home. We can try completely different meds. We also have a social worker. We have nutrition. We have mental health. We have various support groups. Be open to reaching out.
Be open to asking questions, getting things clarified, and gathering more information, especially if it’s researched-based. There’s a lot of misinformation on Google that can backfire. You need to make sure that your information is based on research.
We all come in with a different knowledge base, so when it comes to what’s on the internet, sometimes it’s written for a certain group only, and at times there’s not even anything factual.
It’s great to talk to other people who have gone through cancer and treatment, but always keep in mind that every body is different. You could have the same people going through the same exact treatment, and for whatever reason, their side effects will be different, and how they handle them will be different. It’s not a cookie cutter.
Just like everybody comes in with a different level of fitness and a different mindset, right?
Ms. Guider: Yes, and it’s the history of how they took care of their bodies. The other comorbidities that they might have will factor in how they’re going to physically handle the chemotherapy. There’s the whole emotional side of handling the cancer itself. Just the word brings so much with it.
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