How can care partners be most effective when caring for a loved one with lung cancer? Dr. Thomas Marron, a lung cancer specialist, shares key advice for staying organized and prepared, tips for careful monitoring, and when the healthcare team should be contacted.
Dr. Thomas Marron is Director of the Early Phase Trials Unit and Associate Director for Translational Research at the Mount Sinai Tisch Cancer Center. Dr. Marron is also Professor of Medicine and Professor of Immunology and Immunotherapy at the Icahn School of Medicine at Mount Sinai. Learn more about Dr. Marron.
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Transcript
Katherine Banwell:
How can care partners stay organized and prepared while caring for a loved one?
Dr. Thomas Marron:
I think care partners, along with coming to appointments and really knowing what the plan is, I think tracking the plan at home is extremely important. So, understanding when a patient might experience their peak side effects is super key to being a helpful care partner.
I’ll give you an example. In lung cancer, non-small cell lung cancer, we use oftentimes a combination of two different chemotherapies, Carboplatin and a drug called pemetrexed (Alimta). We give it every three weeks. Patients always come, and they’re very nervous the first time they get it because they think they’re going to leave feeling terrible. We give patients a lot of steroids and other medicines that keep them from getting nauseous or having other side effects. So, patients actually leave oftentimes feeling better than when they showed up.
It’s really three or four days later that the fatigue sets in. And if patients do experience nausea, it’s really at that point. And it’s important that caregivers realize the key windows where they need to make themselves available to a patient if they really want to help a patient out. So, it’s not the day after chemo or the day of chemo. It’s really that week later. Don’t check in the day after chemo and hear that everything’s great and then just sort of take off for the week. It’s important that you ask the doctors and the nurses when should we expect side effects and what the side effects we should expect are?
And also, what should we do at that point? Because a lot of the times if a patient’s very fatigued, they’re not going to be wanting to call their doctor, their nurse. It’s important as a caregiver to know the numbers to call with side effects, when to call, and what sort of supportive medications to use, whether those be antinausea medicines, which usually we send patients home with one or two types of antinausea medicines just to keep them in the medicine cabinet. It’s important that the caregivers know what those medicines are, how frequently you can use them, and what dose to use.
Katherine Banwell:
As care partners are monitoring the patient’s side effects and symptoms, what indicates a need to contact the care team?
Dr. Thomas Marron:
Patients and care partners, when they notice a significant change, an immediate change in symptoms, any symptom under the sun, it’s really important to call the care team. Obviously, if it’s an acute change, that is concerning for a heart attack like really bad chest pain or a stroke –
So, if a patient starts being very altered as far as their mental status or slurring their words, that’s a 911 call. So, don’t be calling your doctor’s office. You can call your doctor’s office after you call 911, but 911 should be the first call. But any other change, it’s really up to the patient and the family to notice the small changes from day to day. So, I always tell people it’s really important to every morning wake up and do a head-to-toe assessment and say, “How do I feel?” and is that different from yesterday? Because if you are a 90-year-old golfer who’s coming and seeing me for lung cancer, every time you come in your knee’s going to hurt. But it hurt 10 years before you got chemotherapy also. It’s good to let me know that it’s hurting, and that’s sort of a baseline.
What I’m most interested in are changes from one day to the next or changes from how you felt before therapy to how you feel on a therapy. Because those are the things that will really flag to me what potential side effects are happening and what sort of interventions we can do to help somebody.