Giving 5Fu in the home…

1. Giving 5Fu in the home… Safe handling practices for the patients and nurses

2. What is 5FU? 5FU or 5-Fluorouracil is a chemotherapy drug that is cell cycle specific. Cell cycle specific means that the 5FU attacks cancer cells at a specific phase in cell division. Cell cycle non specific means that the chemo will work no matter where the cell is in it’s cell division process. Most of our patients are getting a combination treatment most commonly called FOLFOX.

3. What is 5FU? • FOLFOX is a combination of: • Oxaliplatin (non cell cycle specific), • Leucovorin-(cell cycle specific) • 5FU (cell cycle specific) • Oxaliplatin is non cell cycle specific which means will kill cancer cells any time in a cells growth. • Patients will receive Oxaliplatin, Leucovorin infusions with a 5FU push in clinic and then a connection to a 46 hour infusion of 5FU.

4. How do we give 5FU? We administer 5Fu either by an Intermate device or by Curlin pumps. Most infusions go at a slow rate 2 to 10 mls. per hour over 46 hours on FOLOX regimen. Some patients receive a combination therapy that includes radiation Monday through Friday and continuous 5FU administered Monday through Friday for a 6 week course. The radiation patients would then have a once a week bag change and line care (either PORT or PICC care) in the treatment room with their bag change.

5. What do 5Fu patients get from DHCH to manage 5Fu in home? • Chemo spill kit • Chemo Container • Instructions for chemo in the home • These items help us teach the patient/caregiver how to dispose of chemo, how to flush line for emergent reasons, how to clean a spill and who to call if this happens.

6. 5Fu or 5-Flurouracil A course of 5Fu treatment is given to patients for the treatment of GI cancers, such as colon/rectal, anal, esophageal, pancreatic, gastric and alsosome breast cancers. At DHCH, we see mostly GI cancers on 5FU. The typical course consists of IV therapy every 2 weeks for a total of 12 cycles. Some patients may have chemotherapy pre-surgery for tumor reduction, then surgery for removal of tumor, then another course of chemotherapy post surgery to treat any remaining cancer. Some patients may not need surgery at all and still others may need radiation to shrink tumors. It’s all dependent on size, stage and type of cancer. 5FU treatment for GI cancer is what we typically see in the home.

7. 5Fu or 5-Flurouracil The typical day of a 5FU patient starts with a PORT access, some patients may have a PICC line for chemo which they will keep for the duration of treatment. Then they go for a lab draw, current weight and calculation of the BSA. They may or may not see the doctor. Then, based on labs, they may then get an infusion in clinic that could take up to 3-4hr to complete, then subsequent hook up by one of our infusion nurses to the 5FU, and then home. The patient will be hooked up to a continuous infusion of 5FU for the next 46 hours. Then after 46 hours the patient will need to be disconnected, flushed and de-accessed in the home (otherwise know as a “takedown”). That’s our part.

8. Priming a tubing with 5Fu • In order to prime a tubing with IV fluid which contains 5Fu: • Put on blue gloves • Obtain a piece of gauze • Hold the tubing over a chemo container • Prime the tubing into the small piece of gauze • Dispose of gauze into the container

9. What are the side effects of 5FU? • Things to remember about 5FU…. • Side effects are often predictable in onset and duration • Side effects are often reversible and will go away after treatment is complete • Side effects depend on variety of factors including Dosage • Metabolism • Other drugs given as part of combination therapy • Schedule and duration of treatment

10. What are the side effects of 5FU? • Side effects that are most common in 5FU patients (occurring greater than 30% of patients) • Diarrhea • Fatigue • Nausea and occasional vomiting • Metallic taste in mouth • Mouth Sores • Poor appetite

11. What are the side effects of 5FU? • Low blood counts including red, white and platelets which causes increased risk for infection, anemia and bleeding. • This occurs at the “nadir”, and is the mid-point between chemo cycles where blood counts are the lowest • Onset 7 to 10 days • Nadir 9 to 14 days • Recovery 21 to 28 days

12. What are the side effects of 5FU? • Side effects that are less common in 5FU patients (occurring in 10 to 29 %) • Skin changes dry cracked peeling skin darkening of skin • Hair thinning • Hand-Foot syndrome reddened skin peeling skin pain palms of hands soles of feet usually after 5 to 6 weeks of treatment will decrease dose as needed Hand Foot Syndrome

13. What are the side effects of 5FU? Fever If patient is febrile greater 100.5* chills, sweats CALL MD ASAP!!

14. How to help patient’s manage side effects? • Salt water rinses to PREVENT mucositis • Drink plenty of fluids • Anti diarrheal meds • Eat a bland diet, with low fiber foods, including bananas, rice, and noodles. And encourage low fat foods and small portions spread out over the day • Avoid crowds and people with colds • Wash hands often • Use anti-nausea meds as prescribed • Get plenty of rest • Wear sunscreen SPF 15 • For mouth sores rinse mouth with 1 to ½ tsp of salt in 8 oz of water 3 to four times per day

15. What are things we should document? • Medication given • Dose • Route • Rate • Side effects • Type of device • What did you educate your patient/caregiver about? • Patient response to medication and teaching • What cycle of Chemotherapy • Medication given • Dose • Route • Rate • Side effects • Type of device • What did you educate your patient/caregiver about? • Patient response to medication and teaching • What cycle of Chemotherapy

16. What do we teach our patients and caregivers? • How to flush line if needed • Use of special “blue”, nitril gloves • How to dispose of chemotherapy supplies including all tubing and medication bag into a large yellow chemo container • We review the chemo spill kit and demonstrate its use • If spill on skin, wash area well with soap and water assess for rash • If spill on bed linens or clothes, wash in washer x2, use spill kit

17. How do you transport, store and dispose of chemotherapy? • Store in leak proof container, large yellow • containers • When priming chemo line, prime into chemo container • Wear protective equipment gloves gown and goggles/mask if potential spray or splash • Have an extra chemo container in car and spill kit • If patient has a full chemo container call office to come pick up or use dirty box in car and drop in dirty utility room

18. If your Yellow container is full… Carry an extra container in your car in the event the yellow container is full. Switch out the full one for an empty one Take the full container back to office and put it in the soiled utility room. If you don’t have an extra container, call the office and schedule to have the full container picked up. NEVER OVERFILL A CHEMO CONTAINER

22. References: www.chemocare.comCleveland Clinic Foundation www.clinicalpharmacology-ip.com http://www.halls.md/body-surface-area/bsa.htm For body surface area

23. GO TO QUIZ