Cancer Special Services and Support

TERI COLLET: Yeah, it's always a little striking
when I realized how long ago I finished school.
I teach a little bit at Fresno State.
And I taught at Stanislaus state.
And I tell the students so in 1987,
when I got my master's, it's like, oh, that was so long ago.
It's kind of those things how time goes.
And that's part of what I get to talk about today.
So I am not going to separate what I talk about
or how I talk for providers and how
I talk for those who are living with metastatic disease
or those who love and care for someone
with metastatic disease.
What I want to talk about is living.
Granted, living when we have a serious illness
as its own challenge.
Living with advanced age is it's own challenge.
But I am going to say living life is challenging if we
are mindful and we live fully.
And I can tell you, working with people at the end of life
for 20 years and a part of that was grief counseling
for 20 years, I never met anybody who said,
I wish I spent more time at work,
I wished my garden was more perfect,
or I wish I had more dollars my bank account.
We're going to talk about living, realizing
that sometimes it's easy to lose sight
and the challenges that we face in remembering to live fully
are something we can be mindful of and to overcome.
If you're someone that likes notes,
the green hand-outs on the right side of your packet,
the first page is the outline, feel free to glance
at it if you like.
The other though, the last two pages, the last page
is double-sided.
Please set it to the side.
That is actually some tips, and tricks, and ideas
so you can implement when I am talking about today.

So when I talk about living fully
and when I talk about kind of living now,
I want to put it in the context that for most of us,
we spend our lives looking forward at the future.
You look at any lovely poster of the woods.
And there's that path to just kind of goes forever.
And it never ends, because none of us like to that.
And I call it my occupational hazard,
which is I am very mindful that someday my path will
have an end.
And I choose to live intentionally.

It's not just these little posters that
have us living future focused.
I've got a 21-year-old.

He's in college.
And he's constantly hearing, what
are you going to do when you get out?
When are you getting out?
What's your next semester look like?
What your first job going to be?
What's your end goal?
Some one starts work and what do we say, how long are you
going to be here?
When are you retiring?
When you're retired, it's like, so
what are you going to do next?
How many kids?
How many grandkids?
What happens when a couple gets married?
First thing, oh, congratulations.
Cheer's, and when are the grandbabies coming?
Oh, I'm pregnant.
Good for you.
Watch out for that morning sickness, woo,
and those sleepless nights, oh, those terrible twos,
and when they're a teen.
It's always about what's next.
And we forget to live in the now.
And when living in the now is challenging, it's harder.
And I'm going to say when the future feels a little scary,
maybe feels a little uncertain, sometimes
there's not a lot of looking forward.
And when we can't look forward, we tend to look back.
I'm going to assume most of you have had grandparents
at some point in time or the elderly neighbor
or been in a nursing home.
And what did people talk about?
What they talk about is what is natural, is looking back--
back in my day.

So it makes sense that we reflect.
And in living in the moment, it's OK to be looking back,
because hopefully we're reflective.
And when we have positive things we reflect on,
I want encourage you to share those memories.
This is the first summer I get to have my son
home from college, because he goes to school in Southern Cal.
We spent lunch together yesterday.
And I'm like, oh, you know what, do you remember?
And he's like I do.
And didn't we do this?
I didn't think you'd remember.
He was six.
What a thrill that he remembers.
When my husband and I talk about when you were little
and we all laugh, what joy that brings, joy to me
that someone I love has such wonderful memories of something
that was important to me and that I always hoped
was important to him.
And when I get all the kids together--
and they love to harass their dad--
and we get to share in those silly things
and those funky things, to know that my kids will always
remember those things, that's a gift.
There's some amazing positive energy
that comes from hearing our kids remember, from hearing
our grandkids, from hearing our friends.
So I encourage you, one, to share those memories.

And I encourage you to listen as they remember,
because it really is a gift.

Now, I am a social worker.
And we always look at the positive.
And then we get realistic, because I
believe I'm not the only person that when I look back
it's not always positive.
There those things that go, dang, I just wish I had,
or, man, I wish I hadn't.

And most of us have those.
But what we tend to do is we hold them all inside.
Let's just hope you remember, because I don't really
want to have to think about it.
But that carries an enormous emotional burden.

So if when you look back, you begin
to remember those things with some regrets,
I encourage you to kind of voice them, to speak them,
because it's those things we try to hold
inside that end up keeping the most power.
How many of you have ever been in a library or a church
and somebody maybe burps and it becomes funny,
but you can't giggle, because, clearly,
where you are it's just not appropriate
and that makes it even more funny?
And so you are trying so hard, and you can't stop giggling.
If you were in a restaurant and you giggled, poof, it's done.
But the holding it inside is where all that emotional power
comes from.

So be brave.

And I want you to consider clearing the air.
This is a time when maybe we say, I'm sorry,
or I wish I had done it different.
And it could be really little.
When I was 13, I have a list of things.
I went, mom, I am so sorry.
Now, that I am a parent, I really get it.
I am so sorry.
And I am sure she's like, well, now she gets it.

Sometimes they're big.
Some of our regrets, some of our I'm sorries,
and I wish I had done it different can be huge.
If they're huge, others remember it.
It's not like you're reminding them of something
they didn't remember and how healing to say,
I've not forgotten, and I'm sorry.
And I going to say I'm not speaking
to people who are physically well or people who are older.
I am speaking to all of us.
We ought to be saying it now.
Why are we still carrying it?

What about, I forgive you?

I'm going to tell you forgiveness
is one of the harder things that people say and live out.
And a part of it is because, again, we
go back to our society.
We teach people that forgiving means it's OK.
Think of the playground.
Teacher, teacher, Billy stepped on my toes.
Tell her you're sorry.
Sorry.
Tell him, it's OK.
It's OK.
Well, he's not sorry.
And it's not OK.
I'm going to tell you that's not what forgiveness really is.
Forgiveness is I choose to no longer be angry
or to hate you for whatever.
I choose to no longer hold you emotionally ransom.

Perhaps, I choose to show more grace or more mercy
than that to which you're entitled.

Forgiving can actually be selfish.
I don't want to carry this anymore.
And I am going to let it go.
I'm going to accept who you are, who we are now,
and choose to accept it for what it was and no longer live it.
It can also be selfish--
selfless, I'm sorry.
It can be selfless.
I don't want you to think I hate you.
In a perfect world, it's both.
It takes care of my emotional needs.
It takes care of their emotional needs.

But I'm sorry, and I forgive you.
There is a physician named Ira Byock.
And he writes about the four most important things, the four
things that matter most, and then actually changed it
to the five things that matter most.
And this is part of what he talks about.
I am sorry, and I forgive you.
Now, when we say these things, we always
hope for their best response.
I'm going to pick on my son.
Honey, I am so sorry when you were 13
and I said you couldn't play football, because I
didn't want you to get hurt.
And now, I realize I deprived you of this great opportunity.
Hopefully, he's going to that's, OK, mom I get it.
You didn't want me to get injured.
I'm kind of glad I picked up bad mitten instead.

Maybe not, but you know.

Actually, it was rugby.
Let's just not go there.
Hopefully, that's his response.

There is always a risk I am going
to take that he's is going to say,
you know what, I feel like if only
you had let me play football, my life would
have been so much better.

I am taking that risk that that's
the feedback I'm going to get.
It's not ideal, because I love the perfect little hallmark
card ending to this dialogue.
And yet, it opens the communication.
It opens that opportunity to go, just so you know,
I wasn't trying to deprive you, or I'm
sorry that I punished you in these ways.
It was the what I thought was best.
I realized it was probably too harsh,
or I'm sorry, maybe for my infidelity.
I don't think there was excuse, but I am sorry,
or I'm sorry for being the rebellious teenager.
Whatever these things might be, little or not,
we don't get to control their response.
So we hope for the best.
And when it isn't, we say I at least did my part.
At this stage of my life, all I can do is say,
I wish I did it different.
And that's kind of my walking my side
of the street, my kind of cleaning my side of the street.
Now, what they do with it, at least, they know.

In order to minimize some of these regrets,
the I just wish I had done, I just
wish I had said, among those things is
we want to say these things now that are loving,
that are honest, that are important,
rather than not saying them.
So again, the occupational hazard
of working with people who grieve and are
at the end of life is I consistently tell those
that I love that I love them.
And I'm consistently struck by what
the impact that has on others, but also
the impact it has on me.

I was a single mom for a lot of years
and I would always tell him, I just love you.
I'm so glad I get to raise you.
He was like 16, clearly not very interested in mommy mushy stuff
from what I had expected.
And we were talking.
And I said the best thing I ever did was have you.
He went, really?

Why are you so surprised?
And he said, but you never said it that way before.

So that kind of added.
And there's actually been some writing
that says women tend to keep saying things,
because I want to make sure you know.
Oftentimes, gentleman will say, I told you once.
And if it changes, I'll let you know.
Now, if that is how you live your life, regardless
of the gender, I encourage you go ahead and say it again,
because it's amazing what that does for our relationships.
What about thank you?
Thank you for getting my slippers,
or thank you for buying milk today.
What about thank you for your patience with me?
What about thank you for just sitting down and sharing
these memories with me?

Thank you for being a great person.
Thank you for being the person I can talk to
and share my feelings.

We say thank you for refilling my water cup.
Why not thank you for filling up my heart.

A lot of people have these things we always
think about doing some day.
Sometimes they're big, like I'd like
to take a six month cruise.
Maybe we don't do those things today.

But what about, I would love some day to just go to the park
and read a book in the shade.
Why haven't I done that?
I would love to go see my grandson play Little League
or watch my granddaughter at her piano recital.
Do it.
Don't add to the potential of regret.

Go see your neighbor's garden.
Go see your family member's garden.
Go bring them flowers from yours.
Go plant the plant just because it's pretty.
And does it fit with the decor?
Maybe not, but, gosh, I love these flowers.
I'm going to stick a plant in my garden so I can see them.

What are you waiting for?

Sometimes a part of what we want to do
is maybe write a letter to somebody.
Maybe it's a thank you letter, or an I love you letter.
And maybe it's a, sorry, I wish I were different letter.

Personally, I found my first Mother's Day
I wrote to my mother this card.
I was like I find myself remembering this and this.
And the memories just kept going.
So I grabbed another piece of paper.
And this cute little Mother's Day card
had like four pages in it by the time I was like,
and when I was a teenager and when I got married.
It was like all these memories came back.
Let's share them.
Write it now, creating memories for our loved ones.

Back in kindergarten where the kids come
home with like the handprint that's been painted on it,
I'm going to tell you those things are precious.
Have you done with your spouse?
Have you done one with all the generations?
Have you done it in red, white, and blue
so you can put it up for 4th of July?
Why not?
How cool to be able to have that.

Some people take the opportunity now
and start messages, notes, or cards for the young people
kind of just in case.

I have a lady who soon as she had a grandchild--
and she, again, had no health condition.
She was not of a significantly advanced age.
She bought a birthday card for every year
until that grandchild turned 21 and signed it and said,
just in case, I want to guarantee my granddaughter has
a birthday card for me.
Wow.
OK.

Why not?

I know somebody else, who every year on her grandchildren's
birthday writes them kind of a journal about their year,
what they're like, what the child's
like from the grandparents eyes, what the grandparents like,
what they enjoyed doing, these great memories.
And they write these things knowing when the child's 18,
they are going to give them the journal.
What a neat idea.
And she says, I hope they'll look at it eventually.
I'm like, oh, yeah.
Oh. yeah.

What I learned from those at the end
of their life is some of the questions become,
is the world any different because I was here?
Have I made a difference in any way?
Part of what I'm sharing with you, part of how I live my life
is their legacy.
It's learning what matters and living it every day.

Maybe we create these memorable belongings, these handprints
and what not.
Maybe instead of going to Target and buying whatever gift,
maybe we find those gifts that are sentimental that
have family history.
And that's what we give our kids and our grandkids.
Honey, this was grandma's when I was seven.

How cool.
And now they get to hear the story from me.
And I get to see them receive it.
Is that as cool as an Xbox game?
I don't know.
When you're 10 or whatever, maybe not.
But I tell you, that's an investment in their future,
and the family legacy, and those family histories
and how wonderful to get to see it
So as I'm talking about these precious things
and I'm talking about living now, some of you
are thinking, oh, neat ideas.
Some of you are thinking, if you only
knew how exhausting it is just to live in my life right now,
you wouldn't be encouraging me to do all these other things.
And that leads me to the next part and perhaps
the most important part.
And that is conserving your energy
But I want you to think of it in a whole different way.
So when we think of conserving energy, it's like no, no, no,
conserve your energy.
I'll go get the iced tea.
OK, maybe.

But I'm talking about conserving energy in a whole other way.
Because energy is the most valuable commodity
you have, especially as one who is not well.
When we're younger, when we have it an episodic illness--
I have a cold.
I take a little decongestant.
I take some Tylenol.
I plunge through.
And In a few days, I start to feel better.
And boy, isn't that nice.

I hazard a guess for some of you,
there is no trudging through and relief that comes in a few days
and now we're back to normal.

So on some level, we have to accept what is.
And what is means there is not a lot of energy.
And there's not a lot of fighting through.
So I want to encourage you to focus on that
which is most important.

So I'm going to pick on 4th of July,
because it's the nearest holiday that tends
to have traditions for people.
If you think of something else that's
more significant for you, maybe it's Father's Day.
It's coming up closer.
Maybe it's Tuesdays, because you do Taco Tuesday at your house.
Maybe it's not until Thanksgiving or New Year's.
But think for a minute about 4th of July or your day.

What is it that makes 4th of July feel like 4th of July?
What are the best one or two parts of 4th of July?

Is it watching the parade, getting those little fireworks
from the stands and doing them in the yard,
going to the city's big fireworks,
the barbecue, that best hamburger or dog recipe?

Now, think of everything else you
have to do to make a 4th of July work.
So I have some people over, that means
you got to clean the patio.
You got a clearly clean the house.
My gosh.
You can't have people over with a house like this.
There's dishes in the sink.
And then you got to make the patties, which of course means
you got to go buy the stuff.
And then you got to do all of that,
where maybe what's most important to me is
the parade and the fireworks.
If I spend my energy running the vacuum,
and cleaning the toilets, and doing the dishes,
making sure the laundry is put away,
and that the patio is cleared off,
how much energy do I have to just enjoy the fireworks?
Perhaps, none.

I was a caregiver for five years of my life.
And the person for whom I provided care,
his daughter was going to be baptized.
And that was very important to him
spiritually and in terms of church and family traditions.
So he got up early that morning, normally needed to sleep in,
because he didn't sleep well at night.
But he got up early that morning, showered, shaved,
trimmed all of his facial hair so it was just right.
Did his hair so it's just right, wore a tie, a little hard,
but managed to get it.
Clothes not the most comfortable,
but had to look just right.
Got everything sat, did all of his stuff, went to church,
and fell asleep when she was being baptized.

Great intentions.
He almost maybe forgot that he doesn't
have the energy he used to.
And he wasted his energy on looking perfect
and missed the one big thing it was all about.

So when we think that 4th of July,
the big thing is the parades and the fireworks,
maybe it's OK if my patio isn't perfectly swept.
Maybe this is the time for all those people who've said to me,
let me know if you need anything.
I go, would you mine, just sweeping it
off my patio for me?
Would you mind just running the vacuum in the living room?

Or I go, wait, the people coming to my house
really right here to see my house.
They're here to spend the day with me.
And as much as 4th of July is amazing,
because of my great recipe for potato salad and macaroni
salad and the five ways I marinade
the hamburger meat for hamburgers,
is doing all of that worth not staying awake for fireworks?

If they're that important to me, maybe I make it a potluck.
Maybe I get the little frozen patties.
Maybe we go to Jack in the Box and get a bunch of hamburgers.
Is that the ideal way I like to do 4th of July?
No.
But what's the one or two very most important parts
of the 4th of July?
And let me build everything around that.

I would encourage you to take a moment right now.
Think of the next event or day that's
coming up, whether it's Sunday afternoons, Tuesday nights
with your favorite TV show, Father's Day, 4th of July.
Think for a minute.
What day is that for you?

And what is the one or two most important?

Now, think of everything else she'd have to do,
your vacuuming the living room and sweeping off the patio.
What can you either not do or ask someone else to do?

Because it's easy to go, but I can still do that,
but it's not.

And whether you're trying to live intentionally,
whether your energy is limited because of illness,
we all ought to be considering these kinds of things.
If your health care provider, I want
to encourage you to ask that of the people
that you help take care of.
Don't forget.
What's the most important part?

Part of the other things we can do
is we can plan our activity when our energy is the best.
For some of us, that's the morning.
I wake up.
And I feel pretty good.
And then it's a day goes by, I have less energy.
So if I want to get together with somebody,
why would I plan a late dinner?
Why don't we plan a breakfast or a cup of coffee?

Is after a nap, OK.
There is no rule that says you can't have lunch at 3 o'clock
after your nap.
It doesn't have to be at noon while you're
fighting to try and stay awake.

If you have to clean house, do it a day or two before.

Hire a housekeeper.
Easier said than done for most of us.

I mention the holiday meal at 4th of July.
There's something wonderful about a potluck.
There's something tremendous about letting
other people in the family make the recipe,
because now everyone's going to know how to do it.
And that tradition gives to keep going
when I am not able to do it.
I could sit-in the chair and dictate all day long.
It's great.
And now they get to follow the recipe
or try to make the pecan pie the perfect way.

When we think of these kinds of things
and we think about energy being such a limited commodity
and time being a limited commodity,
we want to consider spending as wisely as some people--
perhaps not everyone-- as wisely as some people
spend their money.
Would you go to Subway, or McDonald's, or spend $100
to get a sandwich or a Big Mac?
Most of us would go, it is so not worth $100.
Is it worth an entire days energy
to argue politics, scrub your toilets,
or watch your grandkids?

Maybe and maybe not.
Only you get to decide what it's worth.
So the perspective really is what price am I
paying for what am I getting.
Am I paying $100 to get one chicken strip,
or am I paying $100 for the pot of gold?
And again, everyone's pot of gold is different.
You give me a day with my granddaughter,
I'm completely worn out.
I can't answer one more question, one more
why question, but it's the best day.
It's worth all my energy to have her for a day.

Depending, perhaps when she's older, it may not be enough.

But I want you to consider that.
Consider investing in your relationships.
There are those people in our lives
that we're with because we love them, because we enjoy them,
because we bring quality to their lives,
and they bring quality to ours.

And then there's those others.

How much time and energy are you spending with those others?

Is that worth the price you're paying?

You're all here today on a Saturday.
I imagine there's other things you could have done,
but you know, you believed this would be valuable.
So instead of mowing your lawn this morning or jogging
with a friend if you're so inclined, you're here.
I hope you did that as intentionally as I did.
I knew this was valuable.
I knew this was a rich opportunity.
And therefore, I paid the price to be here.
Think of those people in your lives.
You don't have to say anything out loud.
It may not be proper.

If you had one four hour stretch, just one from now
for six months, who would you want
to spend those four hours with?

When was the last time you spent four hours with them?

And what are you waiting for, and where else are you
spending that time and energy?
And what are you getting for it, or what
are you able to give for it if you're
thinking of spending my time in ways that serve others?
Is this is valuable?

When we think of the energy for conversations,
when we think of the time and energy we spend--

excuse me-- we think of the time or energy we spend,
we also want to be able to spend it getting the most out
of our medical appointments, exactly to Karen's point.
I can walk in passively and sit and wait while my doctor tells
me something, walk out and say to the person
in the car with me, did you know what he was saying?
I'm not quite sure what he meant.
It takes a lot of energy to get to the doctors,
to have that appointment, and to get back home.

One, I don't need to get dressed up
and put my hair together and my make-up on to go to the doctor.
I can save my energy for something more positive.
But we don't tend to think that we are purchasing a service
with health care providers.
Now, granted my insurance pays for it and my copay,
but financially, our time, our energy.
We are a equal partner in what we're doing.
We're an equal partner in our health care.
And I hazard a guess, as the one who's
got a health care need, if there's a battle between me
and somebody else, me and the doctor, me
and his aid, medical assistant, me and the nurse,
I kind of win.
I'm the patient.

So I want to take a moment before my appointment
and prepare the scripting, as Karen mentioned.
What do I want to make sure he knows?
What do I want to be sure to ask her?

I encourage you to use a little of this time and energy
to jot it down, because you know how
you walk in the office with these four things.
You asked the first one.
They give you the answer.
You're like, oh, OK.
Anything else?
I know there were three others, or was there anything else?
Jot it down.
If you're comfortable, take someone else in there
so two of you were hearing it, going they said this, right?
That's what they meant.
OK.
OK.
That's what I thought.
Just want to sure I heard it right.
Because your time and energy is valuable.

I did counseling for a lot of my life.
And I tell people, I know social work.
I know grief.
But you know you.
And it's where the two come together
in this magical intersection is where the relationship happens
is where the healing occurs.
It's whether it's healing physically, whether it's
healing emotionally.
It takes the two.
It takes the communication.
It takes the connection.
So I encourage you to make the most of your doctor's
appointments, both before and during.
Have you've ever taken your car into the shop?
And I don't know cars.
All I know is it's making a funny sound.
And the guy says, oh, it's your struts.
Oh, OK.

And then I leave, going, I guess, it's my struts.
Don't know what I do.
He doesn't realize I don't understand.
He probably doesn't realize he's using jargon that I
have no idea what it means.
I told my husband, it's like we just
need to simmer it on low for about 10 minutes.
I'll be right back.
He went, is this a low simmer?
I meant you turn the burner to a low flame and let it sit.
I knew what I meant.
We all fall victim to that.
So ask, clarify, because if you're
spending-- how long do you spend at the doctor's,
leaving your house, doing your thing, coming back, two hours?
If you have to wait a long time, maybe more.
That's a lot of energy and a lot of time.
Make sure you're spending it the way you want to need.

So talking about this, talking about living in the present
is foreign, as I mentioned.
We're all future focused.

If you want to make your present valuable,
if you want to make your future valuable,
I encourage you to truly make the most of every moment,
make the most of every day, and live with the awareness
that our time and our energy really are limited resources.
And they're gifts we give to people when
we spend our time with them.
They're gifts we can give ourselves
when we take care of ourselves if we
get the massage or the manicure, or sit-in the garden,
or watch a favorite TV show.
I encourage you please to live fully and make
the most of every day.
Thank you.

KERRI: My name is Kerri, and I am an oncology nurse at Sutter.
We have created this short video to help introduce you
to your oncology journey.
We will be introducing you to people on the Sutter Health
team who may be helping you throughout your journey.
Before we begin, we want to say that the content is not
intended to be a substitute for professional medical advice,
diagnosis, or treatment.
Always seek the advice of your physician
or other qualified health provider
with any questions you may have regarding a medical condition.
Different treatment for different people.
It is important to remember that everyone experiences cancer
differently.
Even though you may have the same type of cancer
as someone else, your treatment plan may be different.
You will work with your doctor to find the treatment plan that
is best for you.
Keeping your appointments is one of the most important things
you can do during your cancer treatment.
When you and your doctor decide on your specific treatment,
you will be given a schedule.
For instance, your doctor calculates the specific amount
of chemotherapy or radiation you need over a set amount of time
based on guidelines that are followed throughout our country
and the world.
It is very important that you keep your appointments,
and if you are not able to, contact your care team
as soon as possible so we can keep you on schedule to make
your treatment a success.
So now we will tell you about some
of the people who may be helping you along the way.
We have placed pictures of some of our clinicians
providing cancer care throughout our health system
so you can get a sense of the team who
is here to support you.
All of your individual providers work together with you
as a team to ensure communication
throughout your journey.
Nurse Navigators.
Finding out you have a serious health problems such as cancer
can be a shock.
It can bring in a lot of different feelings, which
can make it hard to take in all that your doctors are telling
you about your diagnosis and your treatment.
A Nurse Navigator can help you better
understand the care you receive and what to expect.
You can talk to this person about any fears or concerns
you have about your cancer and your cancer treatment.
Nurse Navigators have expertise in cancer care.
Like doctors, they specialize in different types of cancer
and different types of treatments.
Depending on the Navigator, he or she
can also provide support for your family
and other caregivers.
They may be able to help you with things like coordinating
referrals to other cancer specialists,
identifying your goals of care and what is important to you
to maintain quality of life during your treatment
and after, helping you find the right care and resources.
This may include counseling or support.
Helping you with advanced care planning.
And as I mentioned earlier, your Nurse Navigator
can also provide support for your family
and other caregivers.
Infusion nurses.
Should you need IV chemotherapy, immunotherapy,
or blood products, the infusion nurses
will be another team of people with resources and knowledge
supporting you throughout cancer treatment.
Sutter's infusion nurses have advanced
training in the safe preparation and administration
of chemotherapy and immunotherapy.
This amazing team of nurses will help
ensure that the IV treatment you receive
is administered safely through the right IV device
and will monitor your response to therapy.
Infusion nurses work closely with your physician
and our pharmacist to be sure you were tolerating
your infusion and that you are comfortable during
your procedure and treatment.
These nurses are an important part of your team
and typically have years of oncology experience
to help make your journey one that is well informed and safe.
You may have a different infusion
nurse with each treatment.
Radiation oncology nurses.
Should you need radiation therapy
as part of your treatment plan, the radiation oncology clinic
nurses will be important caregivers.
In partnership with your provider and radiation
therapists, they will follow you closely during your treatment
course, helping with communication between you
and your provider, assisting with any referrals
you may need, like to a dietician, a social worker,
or other support services.
They can answer questions and help
you understand parts of your treatment
and what side effects to expect, offering ideas about how
to keep feeling good throughout treatment.
Radiation therapists.
The radiation therapist as part of the care team that
treat patients with cancer through the use of radiation
treatments, working closely with their doctors and nurses.
Radiation therapists operate the machines
such as linear accelerators to deliver concentrated radiation
therapy to the area of a patient's tumor.
If you get radiation as a part of your cancer treatment,
your radiation therapist will be someone you usually
see every day, and you will find that they
are in incredible support during treatment.
Dosimetrists.
Dosimetrists are people who work behind the scenes that
are a vital part of your radiation oncology team.
They work with the radiation oncologists, radiation
therapists, physicists, and others
to create treatment plans as prescribed by physicians.
The dosimetrists work with computer software,
the laws of physics, math, and their knowledge
of human anatomy to help create a safe radiation treatment
plan for you.
While you most likely will not meet them,
they provide the utmost care and concern for you
during treatment.
Physicists.
Radiation oncology physicists are also
people who work behind the scenes that
are a vital part of your radiation oncology team.
They are responsible for ensuring patients receive
the safest possible treatment delivered
with advanced radiation oncology treatment.
They work alongside the physician, radiation therapist,
and dosimetrist to help ensure accurate delivery
of all aspects of the treatment prescription,
including quality assurance.
Radiation oncology physicists are certified in their field
and are scientists trained in medical and radiobiological
sciences.
Schedulers.
You will meet schedulers at each location,
and there are different schedulers for your doctor's
office and the infusion center.
They are there to assist you in turning your visit
to the doctor's office, infusion center, and other treatment
locations.
Most insurance plans require authorization
for any treatment, and our scheduler
will keep you up to date on the authorization
while scheduling your appointments.
Upon completion of each appointment,
you will have a plan for your next visit.
Please check in with your scheduler at each visit
so that you stay updated.
Financial coordinators.
The financial impact of cancer treatment
can vary with each patient and family.
Our financial coordinator is here to assist you from
before your treatment begins to treatment completion.
They work behind the scenes to validate your insurance
coverage and authorizations and can
help locate copay assistance and other resources.
You can call them if you need help
understanding your insurance.
The Patient Access Center is also
available to assist you with additional coverage questions.
You can see the phone number here on the screen,
1-855-398-1637.
Dieticians.
A dietician can provide you a nutrition assessment
and counseling where you can get support and learn
how to eat well from a registered dietician
or nutritionist who works in cancer care.
He or she can help you plan meals and find food and drink
that you like and can eat and will work closely
with your doctor and nurses to help ensure
that whenever possible, you are able to maintain
a safe, healthy weight.
For some cancer patients, treatment
may cause too much weight loss, and the dietician
may recommend additional support for you.
Our dieticians are available to you with recommendations
for helping you feel your best before, during,
and after cancer treatment, and they
will help you to learn healthy eating habits.
Social services.
Cancer care can be complex, and the role
of our oncology social worker is to help patients, families,
and caregivers to deal with the challenging
experience of facing cancer.
Sometimes called licensed clinical social workers
or social workers, they're educated
and skilled to assist with the psychological, social,
spiritual, and emotional concerns that arise when
one has a cancer diagnosis.
They can provide important guidance
in learning to cope with your cancer.
Social workers are available throughout all phases
of cancer care.
They are also able to provide counseling, advocacy, referrals
to community resources, and support groups.
They can also help you figure out advanced care planning
and what health care you would like in case
you are unable to make your own decisions.
Advanced care planning should be considered
throughout your life, and it is always a good idea
to review it when you have a change in your health
condition, like being diagnosed with cancer.
Pharmacists.
Sutter oncology pharmacies provide evidence based,
patient centered medication therapy management
and direct patient care for individuals
with cancer, including treatment assessment and monitoring
for potential adverse drug reactions and interactions.
Basically, they help manage the preparation of your medicine.
They have experience in infusion therapy and symptom management
and are an essential part of our team.
They help in educating staff and patients
and work closely with your physician
to help ensure the treatment you are receiving
is the most appropriate therapy considering your health status,
preexisting medical conditions, and the type of cancer
you have.
While you may not meet your oncology pharmacist,
know that they are one of your biggest champions
and are working diligently to ensure
the best possible outcome with the treatment
you are receiving.
They are key partners with physicians and nurses
to ensure your safe infusion.
Rehab services.
Some people will need rehabilitation services
as a part of their cancer care.
If you do, our physical, occupational,
and speech rehabilitation therapists
will be here to help you.
You may need their support before,
during, or even after your treatment.
A physical therapist or a PT program
will assist with therapeutic exercises that
aim to reduce fatigue and improve physical function
by maximizing strength, balance, and mobility before,
during, and after treatment.
An occupational therapist, or OT,
focuses on activities of daily living,
such as dressing and bathing.
OTs assist with quality of life by working with patients
on maintaining and improving activities, function,
and independence.
Speech therapy works with patients whose treatment
may cause problems with talking, voice changes, dry mouth,
swallowing difficulties, and memory and concentration.
Sometimes we call this chemo brain.
Cancer genetic surfaces.
About 10% of cancers occur because of genetics or things
that you may have inherited from your family.
Whether you have specific genes may affect the best way
to treat your cancer.
If your doctor thinks it is appropriate,
he or she may order a genetic test
to understand more about your cancer.
Often your doctor will first refer you
to a genetic counselor.
A genetic counselor is trained to understand your family
history, specific cancers that could
be of concern, and what genetic tests are available to you.
Sometimes genetic counselors meet with people
and determine that genetic testing is not needed.
If you are referred to a genetic counselor,
he or she will work with you to determine if genetic testing is
appropriate for your case and answer any questions you have.
If it is appropriate for you, you
should then get to decide whether or not
you want to have testing, which is usually done with a blood
or saliva sample.
Once the results are received, the genetic counselor
goes over them with you and ensures your oncologist also
has them.
You and your medical team would then
be able to factor those results into your treatment plan that
is best for you.
Additional services.
Sutter Health has several cancer centers
throughout northern California that are here to help you.
Depending on your location, there
are a variety of services available to you
and your family to help you along your journey.
Your health care team will partner
with you to match the services you need to help you
feel your best during treatment and beyond.
Some of the other services that may be available
are clinical trials research, integrative medicine,
laboratory services, and survivorship support.

Thank you so much for taking the time to learn about some
of the people who will be with you along your cancer journey.
If you have any questions about your cancer treatment,
please talk with your team.
Across our Sutter Health system, we
are here to support you and wish you the very
best throughout your treatment.

LIZZIE: Hi.
My name is Lizzie, and I'm a clinical coordinator here
at Sutter.
We put together this short presentation
to give you some tips that may help you understand
your medical care better.
The content is not intended to be
a substitute for professional medical advice, diagnosis,
or treatment.
Always seek the advice of your physician
or other qualified health provider
with any questions you may have regarding a medical condition.

Being diagnosed with cancer feels pretty
overwhelming for most people.
There is so much to understand and so much to do.
It can be a very scary time in your life,
either as a patient, family member, or other caregiver.
Because of that, many people have a hard time
taking in all of the information that their doctors, nurses,
and other staff try to give them.
I know I personally had a very serious health
issue a few years ago, and even as a medical professional,
I had a hard time understanding and remembering
everything I needed to do.
I couldn't understand all the information I was getting,
so I couldn't always figure out what questions to ask.

We want to make sure that you understand as much as possible,
because when we understand better
about what is happening to us or to a loved one
and what we should do next, we generally
tend to be able to cope better and rest easier.
We use this resource.
It's not a Sutter creation.
It's from the Institute for Healthcare Improvement.
It's called Ask Me Three, and it gives you three questions
that you can ask your health care provider anytime
you have an encounter with them, either in person
or on the phone.
We are going to go over this document with you
now so you have a sense of what questions
you can ask to understand your cancer diagnosis
and treatment better.
This also applies to caregivers and loved ones.
It's just as important for caregivers
to understand how to care for their friends and family.
The first question is, what is my main problem?
The second question is, what do I need to do?
And the third question is, why is it important
for me to do this?
So when should you ask questions?
You can ask questions when you see a doctor, nurse,
pharmacist, or other health care provider,
when you prepare for a medical test or procedure,
or when you get your medication.
And what happens if you ask and you still don't understand?
This is completely normal and expected.
Please let your health care provider know if you still
don't understand what you need.
You might say something like, this is new to me.
Will you please explain that one more time?
Don't feel rushed or embarrassed if you
don't understand something.
Ask your health care provider again.
OK, so who needs to Ask Three?
Everyone wants help with health information.
You are not alone if you find information about your health
or care confusing at times.
Asking questions can help.
The Institute for Healthcare Improvement
reminds us that we can write down our provider's answers
to those three questions.
They have a brochure that you can see here,
but all you need is a piece of paper.
So as a patient or as a caregiver,
you can bring that piece of paper into your appointments
and write down the answers to the three questions.
And remember, the questions are, what is my main problem?
What do I need to do?
And why is it important for me to do this?
Asking these questions can help you take care of your health,
prepare for medical tests, and take your medications
in the right way.
You don't need to feel rushed or embarrassed if you
don't understand something.
You can ask your health care provider again.
When you Ask Three, you are prepared.
You know what to do for your health.
If you are nervous to ask your provider questions, don't be.
You may be surprised to learn that your medical team wants
you and your caregiver to let them
know that you need help or more information.
They want you to know all that you
can about your health or condition or that of your loved
one.
They want you to know why their instructions are
important for your health.
And they want you to know steps that you
can take to keep you healthy and keep
any conditions under control.
The Institute for Healthcare Improvement
also recommends that you bring your medications with you
the next time you visit a health care provider.
You can also write the names of the medications
down and bring that list with you.
Again, we are showing their brochure here,
but all you need to do is write your medications
on a piece of paper and bring it to your appointments.
Like many people, you may see more than one health care
provider, and it is important that they all know about all
of the medications you're taking.

Thank you for taking the time to review
the Institute for Healthcare Improvement brochure with us.
We want you to understand as much as possible
about your care and the care of your loved one.
Don't forget to Ask Three anytime you need to,
and always call your doctor's office
if you have any questions.