Natalie Warren Bryant Cancer Center

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Natalie Warren Bryant Cancer Center
Saint Francis Health System

6600 South Yale Avenue, Suite 1200
Tulsa, Oklahoma 74136
918-488-6688

Treatment
Cancer is often treated by a team of specialists including an oncologist, a surgeon, a radiation oncologist and other medical staff. Your doctors may decide to use one treatment method or a combination of methods. The choice of treatment will depend on the type and location of cancer, stage of the cancer, your general health and other factors. The following are cancer treatments:

Chemotherapy
Radiation Therapy
Surgery
Hormone Therapy
Biological Therapy
Bone Marrow Transplant

Chemotherapy
Chemotherapy is the use of anticancer drugs to treat cancer. Chemotherapy uses anticancer drugs to destroy cancer cells by stopping them from growing or multiplying at one or more points in their life cycle. Because some drugs work better together than alone, chemotherapy may often consist of more than one drug. This is called combination chemotherapy.

Depending on the type of cancer and its stage of development, chemotherapy can be used:

* To cure cancer
* To keep the cancer from spreading
* To slow the cancer's growth
* To kill cancer cells that may have spread to other parts of the body
* To relieve symptoms that may be caused by cancer

Often, chemotherapy is used in addition to surgery and/or radiation therapy. There are many reasons why chemotherapy may be given in addition to other treatment methods. For instance, chemotherapy may be used to shrink a tumor before surgery or radiation therapy. It also may be used after surgery or radiation therapy to help destroy any cancer cells that may remain.

Your physician will determine the drug or drugs that will work best for you. The decision is based on the kind of cancer you have, the location, extent of its growth, its affect on normal body functions and your general health.

Your doctor also may suggest that you join a clinical trial for chemotherapy, or you may want to bring up this option to your doctor. Clinical trials are carefully designed research studies that often test promising new cancer treatments.

Chemotherapy may be administrated at home, in your doctor's office, in a clinic, in your hospital's outpatient department or a hospital. Where you recieve your chemotherapy treatment depends on which drug or drugs you are recieving, your hospital's policies and your doctor's preferences. When beginning chemotherapy, you may be required to stay at the hospital for a few days so your doctor can observe the treatment' s effect and make adjustments accordingly.

How often and how long you receive chemotherapy depends on your type of cancer, goals of the treatment and how your body responds. Often, chemotherapy is given in pulses (or cycles) that include rest periods so your body has the opportunity to build healthy new cells and regain its strength. Your doctor should be able to estimate how long you will receive chemotherapy. Whatever schedule your doctor prescribes, it is important you stay with it.

Depending on the type of cancer you have and the drug or drugs you recieve, your chemotherapy may be given in one of the following ways:

* Intravenously. The drug or drugs will be administered through a thin needle inserted into a vein, usually on your hand or lower arm.
* Orally. Chemotherapy will be given in a pill, capsule or liquid form.
* Into a muscle (intramuscularly), under the skin (subcutaneously) or directly into a cancerous area in the skin (intralesionally).
* Topically. The medication will be applied directly to the skin.

Chemotherapy by mouth, on the skin, or injected generally feels the same as recieving other medications by these methods. Having an IV started usually feels like having blood drawn for a blood test. If you experience any pain, burning, coolness or discomfort during an IV treatment, inform your physician immediately.

Some medicines may interfere with the effects of chemotherapy. It is important to inform your doctor of all medications you are taking including any over-the-counter medications you may use. Your doctor will inform you if you need to stop taking any of these drugs before you start chemotherapy. After treatment begins, be sure to check with your doctor before taking any new medicines or discontinuing ones you are already taking.

The majority of people are able to continue working while they are being treated with anticancer drugs. If your chemotherapy makes you feel fatigued, you might think about adjusting your work schedule while you undergo treatment.

Your doctor and nurse will use many different methods to determine how well your treatments are working. You will have frequent physical exams, blood tests, scans and X-rays. Do not hesitate to ask your doctor for your test results and status of your progress.

Side Effects of Chemotherapy
The information about side effects can be overwhelming but remember every person's reaction is different. In fact, some people suffer from few side effects, if any. In addition, the severity of side effects varies greatly from person to person. Be sure to talk to a health care professional about which side effects are most likely to occur with your chemotherapy, how long they will last, how serious they might be and when to seek medical attention.

Since cancer cells grow and divide rapidly, anticancer drugs are made to kill fast growing cells. But certain normal, healthy cells also multiply quickly and chemotherapy can also affect these cells. When this occurs, side effects may result. The normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract, reproductive system and hair follicles. The most common side effects include nausea and vomiting, hair loss and fatigue. Other common side effects include an increased chance of bleeding, getting an infection or developing anemia.

Most normal cells recover quickly when chemotherapy is stopped, so most side effects gradually disappear after treatment ends and healthy cells will grow normally. The time it takes to get over some side effects and regain energy varies from person to person.

Nausea and Vomiting
Chemotherapy can cause nausea and vomiting by affecting the stomach, the area of the brain that controls vomiting or both. This reaction will vary from person to person and drug to drug. Inform your doctor if you are very nauseated and/or have vomited for more than a day or if your nausea is so severe you cannot even keep liquids down.

Nausea and vomiting can almost always be controlled or lessened and severe symptoms are rare with modern management and medicines. Your doctor can prescribe a drug that will help curb this side effect. The following may also help control nausea and vomiting:

* Avoid big meals. Eat small meals throughout the day to avoid feeling too full.
* Drink liquids at least an hour before or after mealtime, instead of with your meals.
* Eat and drink slowly.
* Stay away from sweet, fried or fatty foods.
* Chew your food well for easier digestion.
* Drink cool, clear, unsweetened fruit juices, such as apple or grape or light colored sodas that have lost their fizz.
* Rest sitting up, do not lie flat for at least two hours after you have finished your meal.
* Breathe deeply and slowly when you feel nauseated.
* Avoid eating for at least a few hours before treatment if nausea usually occurs during chemotherapy.

Hair Loss
Hair loss is a common side effect, but it does not always happen. Your doctor can inform you if hair loss is likely to occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or may fall out entirely. Hair will usually grow back after chemotherapy is stopped.

Hair loss does not usually happen right away; more often, it begins after a few treatments. Any hair that is still growing may become dull and dry. The following care tips should be used during chemotherapy:

* Do not dye or perm your hair.
* Have your hair cut short. It will make your hair look thicker and fuller as well as making it more manageable.
* Use sunscreen, sunblock, hat or scarf to protect your scalp from the sun if you lose a lot of hair.

Fatigue/Anemia
Chemotherapy reduces the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues do not receive enough oxygen to perform their functions. This condition is called anemia.

Anemia can make you feel weak and tired. Other symptoms include dizziness, chills or shortness of breath. Be sure to report any other symptoms to your doctor. Severe anemia can be treated by medications or by transfusion.

The following will help you feel better if you develop anemia:

* Get plenty of rest. Sleep longer at night and nap during the day.
* Limit your activities.
* Ask for help.
* Eat a well balanced diet.
* When sitting or lying down, get up slowly. This will help prevent dizziness.

Infection
Chemotherapy can make you more suseptible to infections. This occurs because anticancer drugs affect your body's ability to produce white blood cells, the cells that fight infection.

Your doctor will monitor your blood cell count often during chemotherapy.

If your white blood cell count is lower than normal, consider the following steps to help prevent infections:

* Wash your hands often during the day.
* Avoid people with a cold, flu, measles or chickenpox.
* Avoid children who have recently received immunizations.
* Clean cuts and scrapes right away with warm water, soap and antiseptic.
* Take a warm bath, shower or sponge bath every day. Pat your skin dry. Do not rub.
* Do not get immunization shots without checking with your doctor first.

Radiation Therapy
Radiation is a special kind of energy carried by waves or a stream of particles. When radiation is used at high doses (many times those used for X-ray exams), it can be used to treat cancer and other illnesses. Special equipment aims radiation at tumors or areas of the body where cancer exists. The use of high energy rays or particles to treat disease is called radiation therapy.

High doses of radiation can kill cells or keep them growing and dividing. Radiation therapy is useful for treating cancer because cancer cells grow and divide more rapidly than normal cells. Doctors carefully limit the intensity of treatments and the area being treated so the cancer will be affected more than normal tissue.

Radiation therapy is a highly effective way to treat many kinds of cancer. Half of the people with cancer are treated with radiation, and the number of cancer patients who have been cured is rising daily. For many, radiation is the only treatment needed.

Doctors use radiation before surgery to shrink a tumor. After surgery, radiation therapy may be used to stop the growth of any remaining cancer cells. Radiation therapy and surgery may be used at the same time.

Even when curing cancer is not possible, radiation therapy can bring relief. Many patients find the quality of their lives improved when they recieve radiation therapy.

There are risks for patients who receive this treatment. Radiation will damage cancer cells but it can also affect normal cells. Your doctor will not advise you to have this treatment if the benefits and control of the disease and relief from symptoms are not greater than the risk.

Radiation therapy is given in two forms: external or internal. Most people who receive radiation therapy receive the external type. The therapy is usually given during outpatient visits to a hospital or treatment center. In external therapy, a machine directs the high energy rays or particles at the cancer. When internal radiation therapy is used, a radioactive substance is sealed in a small container. This implant is then placed directly into a tumor or inserted into a body cavity.

Radiation therapy is administrated by a radiation oncologist, a doctor with special training in the use of radiation. The radiation oncologist will prescribe the type and amount of treatment that will be best for you. The radiation oncologist works closely with other doctors involved in your care. Your radiation therapy team may include:

* A radiation physicist, who makes sure the equipment is working properly and the right doses of radiation are given.
* A dosimetrist, who calculates the number of treatments you should receive.
* A radiation therapy nurse, who provides nursing care and helps to manage side effects.
* A radiation therapist, who sets up your treatments and runs the equipment.

Side Effects of Radiation Therapy
Side effects from radiation therapy vary from patient to patient. The side effects you experience will depend mainly on the treatment dose and the part of the body treated. Before beginning your treatment, talk to your doctor about the side effects you might experience.

There are two main types of side effects: acute and chronic. Acute or short-term side effects occur close to the time of treatment and generally subside within a few weeks of finishing treatment. Chronic or long-term side effects may take months or years to develop and usually are permanent. The most common side effects are fatigue, skin changes and loss of appetite.

Fatigue
Stress, daily trips for treatments and the effects of radiation on normal cells all contribute to your feelings of fatigue. Most people will begin to feel tired after a few weeks of treatment. Feelings of fatigue will usually subside after treatment is finished.

Help yourself through this time by limiting activities that make you tired and use leisure time in a restful way. Try to get more sleep at night and rest during the day to help elevate your feelings of fatigue. Ask family and friends to help with chores, shopping, child care and housework.

Skin Problems
Skin in the treatment area may begin to look reddened, irritated, sunburned or tanned. After a few weeks you may have very dry skin. Ask your doctor for advice on relieving itching or discomfort.

The following tips will help you care for your skin during treatment:

* Do not use soaps, lotions, deodorants, medicines, perfumes, cosmetics, talcum powder or other substances in the treated area without talking to your doctor first.
* Wear loose, cotton clothing over the treated area.
* Do not starch your clothes.
* Do not rub or scrub the treated area.
* Do not apply heat or cold to the treated area.
* Protect the area from the sun.

Eating Problems
Side effects can cause problems with eating and digesting food, but you should always eat enough to keep up your strength. It is very important not to lose weight during radiation therapy.

The following suggestions will help during your treatment:

* Try to eat small meals often, and a variety of food.
* Use soft lighting, music or whatever helps you feel good while eating.
* If you enjoy company while eating, try to have meals with family, friends or turn on the radio or television.
* Keep healthy snacks on hand when you get the urge to snack.
* If others offer to cook for you, let them.

Hair Loss
Radiation therapy can also cause hair loss but only in the area being treated. Hair will typically grow back after your treatment is finished.

Surgery
Surgery is an operation in which all or part of a cancerous tumor is removed. Occasionally, healthy tissue surrounding the tumor will also be removed. This is done to ensure that the cancer will not spread to other areas of the body. Your particular surgery will depend on where your tumor is located. Often times, surgery will be performed in conjunction with chemotherapy or radiation therapy.

If you have surgery, it is likely that you will have to stay in the hospital for some period of time. When you are strong enough, you will be sent home. The length of time it takes to recover from surgery varies for each patient.

Hormone Therapy
The natural defense system of the body is referred to the immune system. Some cancers such as breast and prostate depend on hormones to grow. In these cases, your doctor may recommend therapy that prevents cancer cells from getting or using the hormones they need. Hormone therapy may be used to stop hormone production or change the way hormones work. Hormone therapy is a systemic treatment that affects cells throughout the body.

This type of therapy can cause a wide array of side effects including nausea, vomiting, swelling, weight gain and in some cases hot flashes. When undergoing hormone therapy, women may also experience interrupted menstrual periods and sometimes, loss of fertility. Men may experience impotence, loss of sexual desire or loss of fertility. The side effects may be temporary, long lasting or permanent. You should discuss the type of hormone therapy you will receive and its side effects with your doctor.

Biological Therapy
The immune system is the body's natural defense system. Biological therapy uses substances to try to improve the ability of your immune cells to fight infection and disease. Monoclonal antibodies, interferon, interleukin-2 and several types of colony-stimulating factors are forms of biological therapy.

The type of biological treatment you receive will determine the side effects you are likely to experience. Biological treatments are often likely to cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting and diarrhea. Some patients may bleed or bruise easily or possibly get a rash. Interleukin therapy can also cause swelling.

Depending on the severity of the side effects, you may or may not need to be hospitalized during your treatment. Side effects from biological therapy are usually short-term and will gradually go away after treatment stops. Discuss this type of treatment and its potential side effects with your doctor.

Bone Marrow Transplant
Bone marrow transplants are used to treat patients diagnosed with leukemia, lymphomas such as Hodgkin's disease, multiple myeloma and some solid tumors such as breast and ovarian cancer.

Bone marrow is the spongy tissue found in the bones which produces the body's blood cells. These blood cells include white cells, which fight infection; red blood cells, which carry oxygen and remove waste products from the body; and platelets, which allow the blood to clot.

In patients with leukemia, the cells in the bone marrow produce excessive amounts of defective or immature blood cells. These cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues.

Large doses of chemotherapy and/or radiation are often used to destroy abnormal stem cells and blood cells. These therapies not only kill the abnormal cells but can also destroy normal cells found in bone marrow. Aggressive chemotherapy used to treat some lymphomas and other cancers can destroy healthy bone marrow. A bone marrow transplant enables a person to undergo intense chemotherapy and/or radiation by restoring diseased or damaged bone marrow after the treatment.

A bone marrow transplant requires that a patient's bone marrow be destroyed and healthy marrow is infused into the patient's blood stream. If the transplant is successful, the new bone marrow will begin to produce normal blood cells.

The patient must have the strength to undergo this procedure. Age, general physical condition, the diagnosis and the stage of the cancer must all be taken into account when determining if a person should undergo a transplant.

For some types of cancer, bone marrow transplants can increase the likelihood of a cure or a longer period of disease-free survival.

Cancer Center Services
Clinical Services

Radiation Oncology
The Radiation Oncology department is staffed with three board-certified radiation oncologists, 11 registered radiation therapists, two board certified radiological physicists, two board certified dosimetrists, a board certified oncology nurse, an equipment engineer and other support staff. The radiation therapy program includes the contemporary use of high energy x-rays and electrons, computerized three-dimensional conformal treatment planning and brachytherapy (implanting radioactive material directly into the cancer).

Several high energy machines are available at the Cancer Center including a Varian 2100-C, a Varian 1800 and two Varian 6/100s. X-ray energies of 18, 10, and six million volts are available. High energy x-rays such as the 18 and 10 million volt beams are used to treat structures deep within the body. The six million volt x-ray beam is used for treatments to the breast, head and neck and other tissues lying close to the skin's surface. In addition to x-ray beams, the Cancer Center has a large spectrum of elctron energies available. These include electrons with energies from six to 20 million electron volts. The electron volt treatment is used for cancers that are close to the skin's surface or only inches below. Low energy X-rays are also available for skin cancer. The Cancer Center has a RT-50 X-ray machine which is used to treat some very early rectal cancers.

Three dimensional conformal radiation therapy is available to patients at the Natalie Warren Bryant Cancer Center. The therapy uses a three dimensional computer-generated image of the tumor or treatment site to plan the delivery of treatment beams from a variety of different angles. This type of therapy allows for a maximum dose of radiation to reach the cancer site, while restricting the dose to the surrounding tissue area.

Brachytherapy delivers a high dose of radiation directly to the tumor. This type of therapy involves the placement of radioactive seeds in tumors or near tumors. Radiation is emitted from the seeds in short distances to enhance the radiation that reaches the tumor and decrease the amount of radiation that reaches normal tissue area. Brachytherapy can sometimes be used in place of surgery to preserve organs. The combination of brachytherapy and external beam radiation can often improve the results in a variety of malignancies. Sites that may be treated with radioactive material implanted directly into tumors include cancer of the prostate, esophagus, bronchus, cervix, vagina, head and neck.

The implant program for prostate cancer patients at the Natalie Warren Bryant Cancer Center utilizes lodine 125 or Palladium 103 seeds. The seeds are implanted with ultrasound assisted guidance.

Treatments with radioactive materials injected into the blood stream or given orally are also available. These include intravenous injection of Strontium 89 for relief of pain caused by bone metastases and oral I-131 for treatment of thyroid cancer.

A support group for patients receiving radiation and their families meets weekly at Saint Francis Hospital. The group is facilitated by Saint Francis Hospital social workers and a radiation oncology nurse manager. Topics for the support group include managing the stress of cancer, managing the side effects of cancer, question and answer sessions with radiation oncologists and activities during treatments. For additional information about the support group, please call (918) 494-1585.

Pediatric Oncology
The Pediatric Oncology Clinic is a private outpatient clinic that offers consultation, treatment and follow-up for pediatric patients with cancer and blood disorders. The clinic manages inpatient as well as outpatient chemotherapy, transfusion therapy, infusion therapy, diagnostic procedures, such as bone marrow and spinal procedures and long term follow-up to its patients. Please visit the pediatric cancer pages for additional information.

Saint Francis Breast Health Services
Saint Francis Breast Health Services offers mammography screening plus a full range of diagnostic procedures including galactography, fine-needle aspiration, digital stereotactic core biopsy, ultrasound guided core biopsy and aspirations. Other services include risk counseling and prosthetic fitters. For additional information, please visit Saint Francis Breast Health Services.

Bone Marrow Transplant Program
The Bone Marrow Transplant Program began at the hospital in 1987 and was designated as an Eastern Cooperative Oncology Group Bone Marrow Transplant Center in 1989. The program provides state-of-the-art technology and medical care for patients requiring transplant therapy for blood diseases and selected solid tumors.

The transplant program includes allograft (donor) transplants and peripheral stem cell harvest/infusions. Peripheral blood stem cell transplants collect healthy stem cells, before they are affected by chemotherapy which are later intravenously reinfused. This transplant provides cancer patients with a non-surgical procedure that may aid their recovery. The procedure is usually done on an outpatient basis and does not require surgery.

Saint Francis is also a designated center for the National Bone Marrow Registry for donor harvest and shares data with the International Bone Marrow Transplant Registry.

Inpatient Adult Medical Oncology Unit
The Medical Oncology Unit is for adult inpatient care. The staff of specially trained and certified registered nurses and nurse technicians is devoted to caring for the medical and emotional needs of the cancer patient. Nurses are certified in the administration of chemotherapy, blood products and medications. They are also trained to access intravenous administration devices and observe drug side effects. The nursing staff coordinates patient activities with other hospital staff to offer compassionate, effective and individualized care for each patient.

Diagnostic Radiology
Radiology offers a broad range of diagnostic services that include computerized tomography such as CT directed biopsy procedures, magnetic resonance imaging, nuclear medicine, ultrasound, special vascular procedures and portable radiology. The staff includes more than 20 board certified radiologists.

Re/Flex Center
The Re/Flex Center established the comprehensive lymphedema management services to help patients who suffer from lymphedema. The Re/Flex Center places a strong emphasis on education. The center provides written information about its treatment process and techniques. Each month there is a free monthly orientation program which introduces you to information that will help determine how to pursue treatment and manage your health.

Patients require daily treatment sessions for two weeks, followed by a gradual tapering of visits over two to four weeks, depending on the severity of the edema and condition of the skin. Follow-up visits are usually required since this is a chronic condition.

Support Services

Social Services
Social services are provided to patients and their families to help deal with practical, emotional and financial concerns. The social services consultation and guidance with discharge planning serves as a link between the patient and family and the appropriate community resources and support systems.

A support group for patients receiving radiation and their families meets weekly at Saint Francis Hospital. The group is facilitated by Saint Francis Hospital social workers and a radiation oncology nurse manager. Topics for the support group include managing the stress of cancer, managing the side effects of cancer, question and answer sessions with oncologists and activities during treatment. Guidance regarding ways the cancer patient can participate in his/her own care through complementary medicine is also available. For additional information about the support group, please call (918) 494-1585.

Nutrition Support Services
A proper diet is beneficial to a person undergoing cancer treatment. Assessment of the patient's nutritional status and needs allows the dietitian to suggest appropriate interventions for a balanced diet. The nutritional plan can be monitored to minimize possible adverse side effects or weight loss that may be experienced during cancer treatment. A registered dietitian conducts regular classes on nutrition and its effect on cancer, as well as provides individual consultation for outpatients upon request. Seminars in food preparation for cancer patients are also provided.

Home Health
A variety of services are available to meet the needs of the patient in the home environment. Home Health Care and Continued Care are two resources available through Saint Francis. Both services provide skilled nursing care including physical examinations, medication monitoring and education, services for personal hygiene and environmental maintenance. Home health serves mainly Medicare-eligible clients while Continued Care serves all age groups and provides a variety of services including private-duty nursing care.

Rehabilitative Services
The ability to function independently is a vital component of the recovery phase. Speech therapy helps restore communication. Physical therapy helps in increasing or restoring mobility and coordination. Occupational therapy assists with improving performance of everyday tasks such as eating, bathing and dressing as well as vocational and recreational skills. All rehabilitative services are available on an inpatient and outpatient basis.

Hospice
Hospice care provides physical, psychological, social and spiritual support to terminally ill patients and their families. The Hospice staff works with the physician and family to promote quality medical care with emphasis on pain and symptom control.

Pharmacy
A team of experienced registered pharmacists and qualified pharmacy technicians provide a broad spectrum of services to the cancer patient, hospital staff and physician. These services include providing a wide range of pharmaceuticals, preparation of chemotherapy medications and the storage and distribution of investigational drugs. The pharmacy staff also monitors the patient's overall medication regimen for effectiveness and works to minimize adverse events.

Education
Educating the patient, family and community plays an important role in the fight against cancer. The Education Department provides learning opportunities from various community support groups as well as in the hospital setting. Resources from the American Cancer Society also contribute to these classes.

Pastoral Care
Serious illness affects the emotional and spiritual aspect of the patient's life. Representatives from pastoral care offer the patient and their family compassionate concern and an opportunity to talk and pray about issues they are facing.

Diagnostic Services

Laboratory
The Saint Francis Laboratory is staffed with nine board-certified pathologists, a cytotechnologist, eight histologists and 75 board-certified medical technologists.

Laboratory services include an image analyzer which allows quantitative analysis of DNA, yielding further ability to interpret cancer specimens. This service is useful in the diagnosis of malignancy and determination of prognosis. The flow cytometry laboratory assists with the diagnosis of lymphomas and leukemias. It also assists the Bone Marrow Transplant program by providing the estimation of the best time to harvest stem cells.

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