About drugs, support groups

I recently had surgery to remove a cancerous tumor from my breast and will soon be starting chemotherapy. I was surprised by the amount of medication I was told to take before I begin chemo, including anti-nausea and allergy medications. I’m wondering if this is common. How are patients typically prepared for chemo treatment?

Anti-nausea and anti-allergy medications are routinely given to breast cancer patients preparing for chemotherapy, says Dr. Christy A. Russell, co-director of the breast center at USC Norris Cancer Hospital and past president of the California division of the American Cancer Society.

Unrelenting nausea and vomiting are closely associated in people’s minds with chemotherapy treatment. But, according to Russell, those side effects have been eliminated for most breast cancer patients thanks to the development of new and improved drugs that stop nausea before it starts.

“Prior to the current era of preventive medications for chemotherapy, we would give chemotherapy and then give drugs afterward to deal with side effects once they already occurred,” Russell says. The goal today is to prevent as many side effects as possible -- and administering anti-nausea drugs in advance is very effective at doing just that, she says. “To have people not have nausea is just so wonderful.”

Russell adds that many clinical trials have shown that if the side effects of chemotherapy can be prevented, getting through treatment is much easier for patients.

Patients also are less likely to experience nausea if they take a mild anti-anxiety drug to combat the fear commonly felt before treatment begins. “When you’re scared, you get sick easier,” says Dr. John Glaspy, an oncologist at UCLA’s Jonsson Comprehensive Cancer Center.

Anti-allergy medications are also always given prior to treatment when a patient receives a commonly used class of chemotherapy drugs called taxanes.

“Taxanes have been very important drugs in treating breast cancer and mark one of the big advances of the last 20 years,” Glaspy says. But the solvents used to get the drug into liquid form for intravenous administration commonly cause allergic reactions, such as hives, swollen lips and difficulty breathing.

In order to block a possible allergic reaction, patients are instructed to take steroids by mouth, typically the night before or morning of chemotherapy and are also given over-the-counter anti-allergy medications, such as Benadryl or Claritin, immediately before the treatment begins.

Of course, it’s a hassle to take all these pills, but their side effects are minimal and the safety and comfort rewards make them well worth the inconvenience, doctors say.

“One of the success stories of modern oncology is that it’s a lot less dangerous and uncomfortable in the 21st century than in the 1980s, when I started,” Glaspy says.

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I have Stage 2 breast cancer and have been undergoing treatment for months. I’ve tried to keep my spirits up, but I feel so drained some days that it’s hard not to feel depressed. I’m not someone who is very open about my feelings, so I’m hesitant about joining a support group. Still, I could use talking with someone who understands what I’m going through. What are some of my options in looking for emotional support while going through treatment?

Depression is common among cancer patients, and it can be exacerbated by the side effects of medications that are prescribed during treatment. For that reason, it’s important to talk with your oncologist about what’s going on with you physically and emotionally to rule out physical reasons for your emotional state.

According to Susan Brown, director of health education at the Dallas-based breast cancer foundation Susan G. Komen for the Cure, it’s common for people to feel reticent about joining a support group. “They feel they may not want to participate and are unsure if they will be pressured to share and if it will take them out of their comfort zone,” Brown says.

For women who feel that way, there are online groups or message boards that don’t require face-to-face participation and allow you to control how quickly you’re exposed to information and begin to share your feelings. According to Brown, some people feel that interacting with others online helps them to realize they are not alone and takes off the pressure to talk.

“Online, you’re in control. And it’s there when you want it, as opposed to having to be at a group at 7:30 on Tuesday,” says Brian Loew, founder and chief executive of the health and wellness social networking website Inspire.com. But he adds that many people find both useful: “People use them in a complementary way and at different times for different reasons.”

One of the most important considerations in choosing a support group -- whether online or in person -- is to find one with members whose situations closely match your own. Nothing is more likely to send a woman with early-stage breast cancer reeling than sitting in on a group with women who don’t expect to survive their illness.

The good news is that a variety of groups are available from which to choose. “There are some groups designed for women with certain characteristics, like metastatic disease, or younger women who feel they don’t fit with the general population of women with breast cancer, which is generally an older demographic,” Brown says.

There are groups for the newly diagnosed, designed primarily for disseminating information about cancer and helping women understand what to expect. These tend to be short-term in nature.

Others are there to provide ongoing emotional support. Many are run by mental health professionals, such as clinical social workers or nurses who understand breast cancer and are trained to facilitate groups and expertly help members address their emotions.

If you decide to seek support online, Loew suggests looking for communities that place a premium on members’ ability to control their privacy settings. But he advises against ones that allow total anonymity. Though you shouldn’t have to use your real name, members should be required to have a persistent identity. That tends to keep people on their best behavior and also allows members to connect individually with others using the site.

Online moderators -- individuals trained to make sure things run smoothly and that all members are supported and nobody is abusive -- are another important feature.

There are many resources available to help breast cancer patients connect with support of one kind or another.

* The American Cancer Society offers a wide range of support services, including its Reach to Recovery program, which provides one-on-one support by trained volunteers. You can find a program in your area by contacting the organization through its website (cancer.org) or by phone: (800) 227-2345.

* Susan B. Komen for the Cure helps people locate support groups in their community as well. Call (877) GO-KOMEN or go online ( ww5 .komen.org/).

* The Cancer Support Community, formerly known as Gilda’s Club, offers online and in-person support for cancer patients ( gildas club.org).

* Cancer Care offers free professional support ( can cercare.org), and the Wellness Community ( twcvv.org) as well as Simms/Mann UCLA Center for Integrative Oncology ( www.simms manncenter.ucla.edu) also offer a range of support services to breast cancer patients.

* Online social networking sites are plentiful too. Check out Inspire.com, Pa tientslikeme.com and Cure Together.com.

* Finally, most cancer foundations have a Facebook page and are on Twitter.

You may need to try several groups before finding the right one -- but don’t give up.

“We know from the literature that there are real quality-of-life benefits from social support,” Brown says. “Be proactive and continue to try until you find that good place.”

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