Tips From an Oncology Nurse Practitioner That May Help With Treatment

Cindy Cherry, MSN, AGNP-C, on the right with colleague Paul R. Walker, MD, FACP, on the left. Courtesy of Cindy Cherry, MSN, AGNP-C.

Disclaimer: Please note that all opinions from this article are Cindy Cherry's. Talk with your doctor before considering any of the suggested tips below.

Extensive-stage small cell lung cancer (ES-SCLC) is a type of cancer that is known to be aggressive because it can quickly spread to other parts of the body—that’s what extensive stage means. Once you are diagnosed with ES-SCLC, you may have a lot of questions and feel unsure about where to start. As a nurse who treats people with ES-SCLC, I hope that by sharing my experiences, you may feel more prepared for the treatment journey ahead.

Focus on moving forward by letting go of the past

When beginning treatment, try to focus on the future, not what happened in the past. You may experience feelings of guilt following a diagnosis, but it’s important to know that it’s not your fault. Guilt is not a part of my vocabulary, and it should not be part of yours either. My number one goal is to help make sure my patients understand that no one deserves cancer—it comes from an evil source, and it is something you and your care team will fight together. Concentrate on moving forward.

Start your treatment with an open mind

The unknowns of treatment can be unsettling, and it’s easy to get a set idea in your mind of how the process will go. While it might be difficult, try to listen to your care team with an open mind and then explain any goals that you want to accomplish during treatment. If your goals don’t match what your care team has planned for you, that’s okay too—don’t be afraid to speak up and discuss this with your doctor.

Your care team is full of advice, ask them anything

It’s common to feel a wide range of emotions and be overwhelmed by your new treatment regimens. If you’re unsure of what your care team is explaining, ask them to slow down, repeat things, or explain something in a new way so you can understand it better. I recommend bringing someone with you to your appointments in case you happen to miss any important information your care team is explaining—the more ears the better. I also encourage people to ask their care team if there is literature you can bring home to review on your own terms. Most importantly, I remind everyone to stay hydrated—this helps to protect your kidneys during treatment and helps to keep your energy up, too.

Treatment may cause side effects, but there is medicine to help

While you may experience side effects as a result of the cancer treatment, your care team will try to make you feel as comfortable as they can. There are medicines available for the more common side effects of chemotherapy, like nausea, vomiting, diarrhea, and constipation. We do our best to try to make sure your side effects are as tolerable as possible with all the different medicines that are available. If you do experience any side effects, it is important to let your care team know as soon as possible. Remember that your care team is in this with you and we want to keep you out of the hospital as best as we can.

Myelosuppression is a big word and a serious side effect

One important side effect of chemotherapy that may not be top of mind for you is myelosuppression (my-low-suh-preh-shun). Myelosuppression is one of my biggest worries because it can happen during treatment with chemotherapy—it’s important to understand how serious it is. Myelosuppression means that chemotherapy treatment may be hard on your bone marrow, which could affect your blood cell counts. This results in fewer white and red blood cells, which can cause other side effects like neutropenia and anemia.

Neutropenia is a side effect that occurs when white blood cell counts drop too low and means you could be at risk for infection. Anemia is a side effect that occurs when red blood cell counts drop too low and can make you feel very tired, weak, dizzy, or make breathing more difficult.

There is a treatment available that can help with myelosuppression

To help reduce the occurrence of low blood cell counts caused by myelosuppression, COSELA™ (trilaciclib) is available for people with an ES-SCLC diagnosis receiving certain types of chemotherapy. COSELA is given up to 4 hours before each chemo treatment to help keep chemotherapy from damaging bone marrow while chemotherapy works to destroy the cancer cells. Helping to protect cells in the bone marrow may help keep certain blood cell counts from dropping too low—which is what can cause side effects like neutropenia and anemia. This proactive protection of the bone marrow is what doctors call “myeloprotection” (my-low-proh-TEK-shun) and may help you stay on track with your scheduled treatment plan.

Ask your care team about myeloprotection during the next scheduled treatment. Your doctor will decide if COSELA is right for you.

INDICATION

COSELA is a prescription medicine used to help reduce the occurrence of low blood cell counts caused by damage to bone marrow from chemotherapy. COSELA is used to treat adults taking certain chemotherapies (platinum/etoposide or topotecan) for extensive-stage small cell lung cancer.

COSELA is an injection for intravenous (IV) use given within 4 hours before chemotherapy.

IMPORTANT SAFETY INFORMATION

Do not take COSELA if you have had a serious allergic reaction to COSELA.

What are the possible serious side effects of COSELA?

- Reactions at the site of injection. Pain, irritation, swollen veins, or blood clots may form at or near the injection site. Signs and symptoms may include swelling, pain, redness, tenderness, itchy skin that feels warm to the touch, and the appearance of inflamed veins.

- Serious allergic reactions. Signs and symptoms of an allergic reaction to COSELA can include hives, itching, flushed or pale skin, trouble breathing, swollen face, eyes, tongue or throat, and dizziness or fainting.

- Lung problems (pneumonitis or interstitial lung disease). Signs or symptoms may include trouble breathing at rest or aggravated by exertion, cough, tiredness, unintended weight loss, loss of appetite, and chest pain. Report any new or worsening problems with breathing to your doctor right away.

- COSELA can harm your unborn baby. Females should use effective birth control during treatment with COSELA. COSELA may cause fertility problems in females, which may affect your ability to have children. Talk to your doctor if you have concerns about fertility.

Call your doctor or get medical care right away if you develop any of these symptoms or conditions.

Before taking COSELA, tell your doctor about all of your health conditions, including if you:

- are taking medication for diabetes, heart disease, or multiple sclerosis

- have liver disease

- are pregnant or plan to become pregnant. COSELA can harm your unborn baby. Tell your doctor right away if you become pregnant or think you may be pregnant during treatment with COSELA. Females who are able to become pregnant:

-- your doctor should give you a pregnancy test before you start treatment with COSELA

-- you should use an effective method of birth control during your treatment for at least 3 weeks after the last dose of COSELA

- are breastfeeding or plan to breastfeed. It is not known if COSELA passes into your breast milk. Do not breastfeed during treatment and for at least 3 weeks after the last dose of COSELA.

Tell your doctor about all the medications you are currently taking, including prescription and over-the-counter medicines, vitamins, supplements, and herbal supplements. COSELA and other medicines may affect each other. Keep a list of the medicines you take to show to your healthcare provider or pharmacist when you get a new medicine.

The most common side effects of COSELA include:

- fatigue

- low levels of calcium, potassium, or phosphate in your blood

- high levels of a liver enzyme called aspartate aminotransferase

- headache

- infection in the lungs (pneumonia)

- rash

- reactions related to the infusion

- swelling in the legs or arms

- stomach pain

- blood clots

- a high blood sugar level (hyperglycemia)

These are not all of the possible side effects of COSELA. Call your healthcare provider for medical advice about any side effects you may be experiencing. You are encouraged to report any negative side effects to G1 Therapeutics at 1-800-790-G1TX, or to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see the full Prescribing Information.

Reference

1. COSELA (trilaciclib). Prescribing Information. G1 Therapeutics, Inc; 02/2021.