Maggie McKay (Host): When you're diagnosed with cancer, there are so many questions to be answered, including how to navigate cancer therapies. So today, we'll chat with your oncology pharmacist, Ian McVinney. Welcome to UAMS Health Talk, a podcast from University of Arkansas for Medical Sciences. I'm your host, Maggie McKay.

Thank you so much for being here today, Ian. Would you please introduce yourself?

Ian McVinney: Of course. Thank you for having me, Maggie. I'm really excited to be here. My name is Ian McVinney. I'm one of the clinical pharmacy specialists at UAMS and I work in the Myeloma Center.

Host: Let's say my oncologist has just prescribed chemo treatment for my cancer. How do I know what insurance will cover and what resources are available for out of pocket treatment costs?

Ian McVinney: Yeah, that's a great question. It's something that a lot of patients wonder about when they start cancer treatment, because we know it can get expensive. Ultimately, there isn't one size fits all answer to this question. It really depends on what insurance you have, of course, what the treatment is, what cancer you have.

There's all sorts of variables, specifically. But at UAMS, we have a great prior authorization and insurance team. We have one in the Myeloma Institute and one for the rest of the oncology center or Cancer Institute. They help ensure that your treatments are covered, that your insurance is paying for it, and they can help you figure out what is going to be out of pocket on your end as well.

If there's oral treatment involved as well, we have our specialty pharmacy as well, which is a great resource. They do prior authorizations, check with insurance to be sure that those medications get covered, and if they can't fill it, they know where to send it so you can receive that as well. And there's also some drug manufacturer and certain cancer care organizations that have grants or can provide free drug. That is more of a last line thing. We like to exhaust all of our other options before we get to that, but those are also out there, if needed.

Host: And how does chemo affect my current home medications?

Ian McVinney: This is another question we get all the time because chemo can affect your home medications and your home medications can affect the effectiveness of your chemo as well. So this is something that we think about, the doctors think about, you know, when you start cancer treatment, all that kind of stuff.

So just for an example, there's a chemo drug that we use pretty commonly. It's called methotrexate. It's in a lot of our chemotherapy regimens. And just a common home med that you can't take while you're on that is ibuprofen, NSAIDs. Those actually prevent the clearance of that chemo from your body.

So it sticks around and can cause some side effects more. So it's just, something that we're always watching, any over the counter medications or chemotherapy and see how it can affect each other. But ultimately there isn't a one size fits all answer for that as well, but just know that we're watching for it.

Host: And what about vitamins and supplements that I'm already taking?

Ian McVinney: Yeah. I have a lot of patients who take vitamins and supplements at home as well. Really it's similar to just the other drugs that I talked about. Vitamins and supplements can affect the chemo and vice versa, just like medications can. One thing that I did actually in my pharmacy training is I actually did a presentation to breast cancer patients on supplements that they should not take while they have breast cancer because it could potentially even make the cancer grow faster and get worse.

That's just another thing to let your doctor know about. Let us know if you're taking any supplements. Whenever you visit the clinics, and they ask you about your medications, be sure you list out all of your vitamins and supplements as well. And we'll be sure that those are safe and effective for you to take.

Host: So you mentioned things not to take. Is there anything I should avoid during my chemo treatment?

Ian McVinney: Not specifically. Just as a general rule, I've touched on a lot of the things that sometimes we want you to avoid; certain medications and supplements that might cause chemotherapy to be less effective or cause more side effects. But this is really dependent on each patient and we'll let you know if there's anything that you need to avoid while you're on your cancer treatment.

Host: Ian, what are some ways to manage the most common chemotherapy side effects and what are they?

Ian McVinney: Great question. Chemotherapy, there's so many different drugs out there and they can have so many different side effects, but some of the ones that we see most commonly are nausea, fatigue, hair loss, neuropathies, tingling in the hands and feet, as well as diarrhea, chemo brain is what I like to call it, and low blood counts as well.

 So I'll talk about each of those a little bit more in depth. Starting with nausea, which I feel like is one of the side effects that, you know, you say the word chemotherapy and people think, Oh yeah, I can get nauseous from this medicine. So I want you to know that if you're getting a treatment regimen here at UAMS, odds are that you're getting pre medicated for nausea to help prevent that. Most if not all of our regimens have that built into the treatment plans.

So you'll be receiving pre medication for nausea. If you're curious about that, you can ask anyone in the clinic. We can tell you more about those medications and you'll also likely be sent home with medications to take as needed if you do feel nauseous. But beyond that, avoiding strong smells like perfumes or strong smelling foods and spices, that can trigger some feelings of nausea for patients. Eating more frequent and smaller meals is also can help prevent some nausea and also eating easy to digest foods like crackers, yogurt, rice, broth, things like that. Also having a glass of, you know, ginger or peppermint tea before your treatment can actually ease some nerves and also help with the nausea potentially.

Don't go start taking ginger pills, or anything like that. We want to be sure that that won't interact with your chemo. But a cup of tea beforehand, could really help you and make you feel better about things. And eat what you feel like eating, but avoid your favorite foods. This is something I like to tell people because if you have nausea while on your favorite foods, it can ruin it for you. So we don't want that to happen, but if you have any issues with nausea, just let us know. We have a lot of drugs that we can use to treat nausea.

The second side effect I mentioned was fatigue. This is another very common one. It can happen at any time during treatment. It can happen well into it or right at the beginning. It just depends. There's varying levels of tiredness. And there's also many different causes of tiredness. Could be the cancer itself. Side effects of your treatment and, you know, just emotional exhaustion because cancer therapy and going through treatment can be a really tiring immersive immersive process, you could say.

So all of those things can contribute to tiredness. Things that could potentially help with fatigue; be sure you're getting enough sleep, or planning times to rest, exercise, I know it sounds counterintuitive, but exercise can really help you have some more energy on a day to day basis. Avoiding alcohol, staying hydrated, moderating your caffeine intake. It can help you stay awake during the day, but it can prevent you from getting that good sleep at night. And then we're also managing your underlying causes. If like, if your blood counts are low, we're keeping an eye on that. And if persistent, you can always ask your doctor. There are medication options, but we like to do everything possible before prescribing a medication for fatigue.

Third side effect, hair loss, and this is one that can be really tough psychologically on patients. Losing all of your hair can make you not feel like yourself anymore. So I will say, not every treatment causes hair loss, some cause thinning, some cause full loss, and some cause none. So it really depends on your treatment, and we'll let you know in advance if it is one that could cause some hair loss.

At UAMS, we have a great resource in the Cancer Institute. We have our Patient Pavilion. And there's actually a program that can get you one wig and a few hats. It's a free resource. And it's open for anyone who's receiving treatment at the Cancer Institute. So it's a great resource down in our Patient Pavilion on the first floor of the Cancer Institute.

You can pick out a wig that fits you well and you have people to help you do it. So, take advantage of that if you're interested in it. But besides that, scarves, bandanas, any of that can be used if hair is lost. And certain treatments can, there's actually some evidence for a cooling cap that you can wear on your head. It's not the most comfortable. It can be a little painful and it's not for every cancer treatment, but that's something you can ask your physician about as well. And some people just like to shave their hair before they even start treatment, rip the bandaid off per se, and just take ownership of that potential side effect. So, ultimately with certain treatments, you can't really prevent hair loss, but there are things we can do to make it a little bit better on you.

Next side effect is neuropathy. This is that numbness and tingling in the hands and feet that I mentioned. It's somewhat common depending on the drugs, but this is one that's really difficult to prevent. If you're having these symptoms, definitely let your doctor know right away. We may dose reduce your treatment or consider different treatments if it's bad enough. Avoid sharp objects, wear gloves if you're using sharp objects like knives, chopping vegetables, for example and wear shoes everywhere, even in the house, because if you have some of that neuropathy on your feet, you can get infections and cuts that you don't even know about because you don't feel it.

 So that's something to keep in mind there. And if you have diabetes, this is another thing you have to monitor closely as well because both diabetes and the treatments, can potentially worsen the neuropathy. So that's just another thing to watch for with certain cancer treatments and let us know if it's becoming a problem.

 Diarrhea is another side effect. We actually have different kinds of diarrhea, believe it or not. They'll be the same on your end, but depending on what treatment that you're getting, there are different kinds. So we can have chemotherapy induced, there's infectious diarrhea, or immunotherapy induced, which presents a little bit later into your treatment course.

 Overall, if you're having diarrhea, let us know about it, because it's managed differently, depending on what the cause is. But just some big things that you can do overall is be sure you're hydrated. Drink a sports drink. You know, you can use liquid IV, Gatorade, Pedialyte, all of those things will really help you feel better if your diarrhea is bad.

Also eating the BRAT diet, kind of starchy foods like bananas, rice, applesauce, and toast is a great method for deciding what to eat, as well as avoiding spicy and acidic foods, as well as caffeine and alcohol, because all of that can dehydrate you or make your diarrhea worse. And depending on the cause, ask us about drug options, because there are options to help lessen the burden of that diarrhea if you get it.

There's also chemo brain, which I like to explain as just not feeling quite like yourself, mentally, while you're on cancer treatment, or becoming a little bit more forgetful. A lot of people will say that's because of chemo brain. So certain chemotherapy can cause specific toxicities, but this is just more of a general thing that many people experience while they're undergoing treatment. These can last throughout treatment or be very short and just go away on their own. So really just use a planner or calendar with reminders that can help if you're feeling like you're becoming a little bit more forgetful while you're on treatment.

 Also exercise your brain, do puzzles, paint, hobbies, what have you, that makes you happy and keeps your brain active. And some things that I mentioned earlier, get enough sleep, exercise if you're feeling up for it, and let your doctor know if you're having issues with this and we can do a medication review, see if there may be any drug causes. And the last thing I'd recommend is keep a diary of your memory problems and just keep us posted with how that looks. We may make some changes or discuss it with you at your next visit to your doctor.

And lastly, we have low blood counts. There are many different blood counts, but certain chemotherapy can really cause side effects associated with low blood counts. Anemia or low red blood cells is one of the biggest causes of fatigue that we see. Your low white blood cells, that can increase your risk for infection. So stay away from sick people, wash your hands. If you're out in public, in a crowded place, I'd recommend wearing a mask if you have one, and call your doctor right away if you have sick symptoms like a fever, chills, any of that while you're on treatment. And then if you have low platelets, the last big blood cell count; that can actually increase your risk for bleeding. So just watch for blood where it shouldn't be is what I like to say. If there's blood, when you're going to the bathroom, if you bleed easy when you brush your teeth, you're bruising really easily, or it's unexplained bruising, all of those things, are stuff that you should let us know about and let your doctor know about.

And we can be sure that your counts are in order. And I will say we monitor your blood counts throughout treatment. So we're always keeping an eye on it. So hopefully we'd be able to get in front of any of those side effects that you may have with low blood counts. So that was not an all inclusive list, but those are some of the most common side effects that I see with chemotherapy.

Host: And finally, how do I contact my oncology pharmacist?

Ian McVinney: Yeah. We're always happy to help and answer any questions that you have. As of right now, what I would say is just message your doctor, however you usually would message the clinic that you're being seen in. And, everyone who's reading those messages knows a pharmacist who works with that team. So they can forward the message to us, and either we can give you a call, or we'll tell them what to respond, and be sure that you get the pharmacist expertise that you're looking for. Hopefully in the future, you know, we don't have any pharmacists in clinics right now, but hopefully in the future, we're going to have one in the Hem Onc Clinic here at UAMS.

So you can have a pharmacist come see you at your next visit, if that's something that you would like. So that's something we hope to offer in the future as well, but yeah, just message your clinic as you usually would. And we'd be happy to help.

Host: That would be amazing that you seem to make everything as easy as possible because when you're going through that, I can imagine everything is a challenge. So it sounds like UAMS really has it all covered. Thank you so much for sharing all this useful information, Ian. We really appreciate it.

Ian McVinney: Yeah, absolutely. Happy to share it. And once again, thank you for having me today.

Host: Of course. Again, that's Ian McVinney. For more information, head over to cancer.uams.edu. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you, I'm Maggie McKay. Thanks for listening to UAMS Health Talk from University of Arkansas for Medical Sciences.