Michael Douglas has revealed that his throat cancer is in Stage 4 and that he is undergoing chemotherapy and radiation.
This combination sounds difficult, combining the fatigue of radiation and the effects of treatment on the back of the throat.
Dr. Melissa Dinolfo, who is board-certified in oncology pharmacy, says there are ways to neutralize a patient's reaction to chemotherapy, including different classes of drugs, scheduling of drug intake and physically preparing one's body for changes in drugs and doses. Dinolfo is affiliated with Premiere Oncology, a Santa Monica, Calif.-based cancer treatment center (premiereoncology.com).
Q. The treatment Michael Douglas and other head and neck cancer patients face sounds particularly grueling.
A. Radiation, in combination with chemotherapy, probably causes nausea and diminishes the appetite. It could have a profound impact on taste. Suddenly what was pleasurable becomes painful. It's not unusual for some patients to resort to a feeding tube to maintain their weight. Maintaining body weight during chemotherapy is vitally important. Patients who cannot maintain their weight have a poorer prognosis.
Q. You talk about the "four pillars of cancer care" approach. Can you explain that?
A. Sure. Patients frequently feel incredibly powerless during cancer treatment, especially early after the cancer diagnosis. They feel as if they have no influence or power over their life, basically.
It's important for each patient to maintain these "four pillars" of care:
-Take advantage of what the medical community offers, from the medical oncologist through the radiation oncologist.
-Pay attention to your nutrition.
-Manage your symptoms carefully, particularly pain symptoms.
-Also do not ignore your spiritual and emotional well-being. Who's got your back? It's incredible how we are inculcated to be stoic and not ask for help when we need it most.
Q. How do people handle nutrition problems with head and neck cancers?
A. You can have a feeding tube, as I said. There are supplements and manipulations for your diet. As a pharmacist, looking at all the chemo drugs you are taking, I can make recommendations, but doing them is up to you, the patient. There are drugs for nausea from a patch to long-acting capsules. We can tinker under the hood, so to speak, until we get the response we need, but the patient must be responsible as well.
Q. Can you talk about pain management?
A. I harp on this. People are terrified about medicating for pain and often suffer needlessly, especially with advanced cancers. They come into the experience expecting to suffer and they are frightened. But much of their suffering is not necessary. At least let us work together to minimize the pain.
Q. You say "work together." Can you be more specific?
A. Patients should work with a medical team, and they should expect more than most do. Ask for support. Sing out!
For example, most of my patients don't vomit when they get chemo. If you treat people properly, they won't suffer like that.
Q. You are on a team in Santa Monica. What about patients who live elsewhere?
A. Patients need to first look for a medical care provider who considers them a person, not just a provider focusing on their cancer. The provider should ask about who the patient's caregiver is, about their spiritual guide, about how they are sleeping. There should be a focus on more than the tumor.
Do not underestimate the power of a team: the nurse practitioner and the pharmacist, for example. These people can be incredibly valuable to you. Develop an independent relationship with these people.
And make sure there is a bandwidth for the medical team to manage you and your problems on the Friday afternoon when the doctor has left town. Make sure there is enough support so you are never alone.
Q. And more?
A. More than anything, people need to expect more and to not suffer senselessly. Take notes, be active, don't be afraid to hope.
People have a tendency, with the Internet, to load up on the most terror-inducing information. I encourage people to limit their Internet activity, to only go to blogs and websites that are edited or reference-tied to institutions.
Limit the input from well meaning family friends and the grocery store manager. Don't be somebody's windsock.
The thing I live for is to help patients reframe their lives. Pick up the reins and ride. We give them the tools. Then they must be in charge.
---
(Jane Glenn Haas writes for The Orange County (Calif.) Register. E-mail her at jghaas@cox.net)
---
(c) 2010, The Orange County Register (Santa Ana, Calif.). Distributed by Mclatchy-Tribune News Service.