CONDITION GUIDE

Oral oncology

Introduction and how to use this guide � � � � � � � � � � � � � � � � � � � � � � � � � � � 1

Understanding your diagnosis and symptoms � � � � � � � � � � � � � � � � � � � � 3

What is cancer? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4

Five stages of cancer � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4

Cancer can be treatable � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4

Cancer doesn’t discriminate � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4

Does cancer have symptoms? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

Is cancer contagious? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

What are the risk factors? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

Helping friends and family understand a cancer diagnosis � � � � � � 6

Taking care of your body � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7

Be flexible � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8

Eating healthy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8

Maintaining a healthy weight � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9

Sleeping well � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10

Supporting your emotional health � � � � � � � � � � � � � � � � � � � � � � � � � � 10

Understanding your medicines � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 12

Taking your medicines on time � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13

Medicines and food � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13

Staying on track with your medicines � � � � � � � � � � � � � � � � � � � � � � � 14

Follow your health care provider’s orders � � � � � � � � � � � � � � � � � � � � 15

Together, we’ve got this! � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15

Understanding side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16

Possible side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17

Hand-foot syndrome � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18

Skin rash � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18

Mouth sores � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18

Low blood counts � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 20

Hair loss and nail changes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21

Pregnancy and breastfeeding � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21

When it’s time to call the health care provider � � � � � � � � � � � � � � � � 22

Resources and References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24

Resources � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24

References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25

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How to use this guide

INTRODUCTION AND HOW TO USE THIS GUIDE

We know a cancer diagnosis can be overwhelming. This guide is to help answer concerns, while giving you important information to share with family or friends.

Your health care provider has suggested that you start treatment. This means that your health care provider believes you have a good chance of responding to medicine. We’re here to help, every step of the way. Remember that taking your medicine as prescribed will help you lead a healthy life. Please do not stop taking your medicine without checking with your health care provider.

Health care providers have learned how to individualize treatment so that each patient has the best chance of responding. The treatment you receive may differ from the treatment of other patients with cancer. This is one of the reasons it is so important that you talk about any questions or concerns you may have with your health care provider or with a Prime Therapeutics Specialty Pharmacy™ (Prime Specialty Pharmacy) nurse or pharmacist.

Personal support can help make a challenging journey easier

24/7 ACCESS Visit us online MyPrime.com/SpecialtyA pharmacist is always available to answer questions 877.627.6337 (TTY 711)

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INTRODUCTION AND HOW TO USE THIS GUIDE

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There are four parts to this guide

Understanding your diagnosis and symptoms

We’re here to help you become a better informed member. In this chapter we’ll discuss how to live your best life with a cancer diagnosis.

Taking care of your body

Find ways to reduce stress — both physically and mentally — with proactive approaches to your health.

Understanding oral oncology medicines

Want to learn more about which treatment approaches that your health care provider or Prime Specialty Pharmacy team might suggest? We’ll go over possible treatment plans, including medicine and other ways to help manage cancer in a way that works best for your lifestyle.

Understanding side effects

Learn tips to help reduce side effects, and know when to call your health care provider.

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Understanding your diagnosis and symptoms

In 2017, an estimated 1,688,780 new cases of

cancer will be diagnosed in the United States.

Millions of individuals are living healthy, full lives

beyond a cancer diagnosis. In fact, according

to the National Cancer Institute, the number of

people living beyond a cancer diagnosis reached

nearly 14.5 million in 2014 and is expected to rise

to almost 19 million by 2024.

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UNDERSTANDING YOUR DIAGNOSIS

What is cancer? 1

Cancer occurs when the body’s cells divide and spread to surrounding tissues. As the cells spread, they become more abnormal and new cells form alongside the cancer cells. Some forms of cancer may have masses of tissue, called tumors. Other cancers, such as leukemia do not form solid tumors. As some of these tumors grow, cancer cells travel throughout the body in the blood and lymph nodes to form new tumors.

Cancer can be treatable2, 3

Treatment for cancer has come a long way — especially in the past few years. Doctors have learned more about how cancer affects the body, and have been able to use more specific treatments, including targeted therapies and immunotherapy. These medicines target specific cell abnormalities that cause cancer cells to grow, progress, or spread, or use your body’s own immune system to help fight cancer.

Cancer doesn’t discriminateCancer can happen anywhere in the body and to any individual. Certain cancer types are more common in women and vice versa. Breast cancer is the most common cancer in women. Prostate cancer is the most common for men. But lung, colorectal and other cancers affect both men and women.

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Does cancer have symptoms? 5

Different types of cancer have many different symptoms. But many forms of cancer have no symptoms at all. The American Cancer society states that some symptoms of cancers that have progressed include, fever, extreme tiredness (fatigue), skin changes like brightening or darkening and weight loss. In many cases, cancer is found by a scan or blood test.

Is cancer contagious? Cancer is not contagious and cannot be spread through close contact with another individual.

What are the risk factors? 6

Some cancers are caused by genetic or environmental factors. And some people get cancer even though they don’t seem to have any risk factors at all. Research teams are still investigating why some individuals are prone to cancer while others are not. In fact, the majority of cancers occur in people who don’t have any known risk factors.

Factors known to cause cancer include7:→ Cigarette smoking and tobacco use

→ Infections

→ Radiation

→ Immunosuppressive medicines

Factors that may affect the risk of cancer include:→ Diet

→ Alcohol

→ Physical activity

→ Obesity

→ Diabetes

→ Environmental risk factors

You can reduce your risk of getting cancer by practicing healthy lifestyle choices8:→ Don’t smoke

→ Use sunscreen

→ Limit the amount of alcohol you drink

→ Keep a healthy weight

What is oral oncology? Oral oncology drugs are prescribed for the treatment of cancer and are taken by mouth. Chemo you swallow is as strong as other forms of chemo and works just as well. You take oral chemo at home. One of the best ways you can help fight the cancer is by taking your oral chemo just like your health care provider tells you to.4

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Helping your family and friends understand a cancer diagnosisIt’s up to you to decide when and how to tell your friends and family about a cancer diagnosis. The people who care about you may have many questions, and may be worried. If these questions seem overwhelming, or you are having trouble responding, consider saying, “I’ll share more information when I learn more from my doctor.” Some people with cancer have found it helpful to use a website like CaringBridge.org where they can post updates about their diagnosis and treatment in one place.

Remember that people often struggle for the right words when they find out that someone they care about has cancer. Your family and friends will want to find the best ways to support your emotional and physical needs. It’s okay to ask for help and receive help.

You’re not aloneA cancer diagnosis can leave you feeling very much alone. Find a support group within your community, and friends and family who can be there for you at any time. A positive outlook can greatly enhance your treatment.

UNDERSTANDING YOUR DIAGNOSIS

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Taking care of your body

Fortunately, there are ways you can reduce your physical

and mental health stress by being proactive in a few areas.

This includes lifestyle habits to cope with the symptoms of

cancer, and maintaining a healthy diet, regular exercise, a

smart sleep schedule and a great emotional support network.

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TAKING CARE OF YOUR BODY

ASK YOUR HEALTH CARE PROVIDER

Be flexible One strategy that seems to work well with cancer treatment is allowing yourself to be flexible. Being flexible means placing greater emphasis on listening to your body and its needs — whether eating, sleeping or being active. When you’re in tune with your body, you’ll find that you’ll be better able to manage fatigue, eat a balanced diet and have better communication with your health care team.

Eating healthy 9

There is no diet that is universally best for people with cancer. Eating a healthy diet gives your body the fuel it needs to perform at its best. Invest the time to learn how to improve your diet. Your health care provider can also direct you to a diet that works for you.

Good nutrition can help:

→ Improve immune function

→ Reduce inflammation

→ Increase muscle strength

→ Increase energy

→ Stabilize mood

→ Manage fatigue

A balanced diet includes plenty of fruits, vegetables and whole grains. It also limits salt, sugar, saturated fat and alcohol. It may include taking daily vitamins and minerals. Foods rich in omega-3 fatty acids, such as fish, may be helpful in reducing inflammation.

Ask your health care provider if there are vitamins or minerals that could help to manage your symptoms and keep you healthy� Also, note how your diet affects your symptoms� Try to avoid any foods that seem to increase symptoms�

Talk to your health care provider before taking any nutritional supplements to make sure they can be safely used along with your cancer treatment�

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Maintaining a healthy weight 10

Along with taking any medicines your health care provider prescribes, there are many things you can do to help your body stay strong. Good, balanced nutrition and proper hydration are very important:

Eat a balanced diet, and be sure to include protein to protect lean body mass. Beef, pork, poultry, tofu and soy nuts are excellent sources of protein. So are dairy products — try some Greek yogurt, which is higher in protein than regular yogurt.

Increase the number of calories you eat. Choose nutritious foods that you enjoy. If appetite is a problem, try eating smaller, more frequent meals; make milkshakes, smoothies, and purees, which may be easier to digest; and add milk or protein powder to your foods.

Drink plenty of liquids throughout the day. Water is best, but you can also get fluids from soups, popsicles and sports drinks.

Keep a journal. Keeping details of the side effects that you experience will help your health care team. Having a health care journal or notebook will allow you to keep all of your health information in one place. If you are experiencing constipation, it may be helpful to keep a journal detailing:→ Physical activities you do and how they affect your mood and

energy level→ Your diet→ Fluid intake and type of fluid→ Medications you’re currently taking

Physical exercise also plays a key role in building new muscle and decreasing fatigue. It has also been shown to improve one’s mood, outlook, and self-image.

Start off slowly. If you are very weak or tired, start with 3 or 4 minutes of walking at a time and build up from there. You can also try some upper body exercises while sitting in a chair — moving your arms up and down and front to back can help maintain flexibility. Making a fist and lifting your arms up and down in front of you can increase strength.

Pay attention to your breathing. Rounded shoulders restrict chest movement, but good posture helps your breathing and reduces fatigue. Focus on maximizing your breath during activities: for example, when climbing stairs, breathe out with each step so you won’t be as tired when you reach the top.

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Sleeping wellYour body needs rest to heal and recharge, especially during treatment for cancer. One of the best things you can do for your body is to make sure you are getting eight or more hours of sleep each night. If your body is telling you that you’re tired and you are having trouble falling asleep, make sure to mention it to your health care provider.

Supporting your emotional health Maintaining your emotional health can help to support your physical health. Some people become overwhelmed with their diagnosis and the life adjustments they need to make. This is normal. Managing your stress and seeking help from friends, family or professionals are important aspects of staying healthy. Many people also benefit from in-person or online support groups.

Stress

A cancer diagnosis can be very stressful. Stress may make the challenges of life difficult to handle — especially when it comes to your body. Here are three great ways you can manage your stress:

Write it down: Record your thoughts in a journal and read through it often. Celebrate daily successes. You are more than this disease.

Take a break: When you’re in the midst of a particularly difficult moment, step back and take a deep breath. Even taking a short nap or watching something you enjoy on TV may help brighten your mood.

Find a support group: Everyone needs a healthy balance of people that are able to help in stressful situations. Keep the phone numbers of family or friends you trust handy, and reach out to them as often as needed.

TAKING CARE OF YOUR BODY

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Depression

Depression is not a character flaw or weakness. It’s a health problem that starts from a chemical imbalance in the brain. If you have thoughts of suicide or of harming yourself or others, call 911 or go to the emergency room.

A note on depressionEveryone feels sad now and then. Sometimes a deep sadness or loss of interest in activities you usually enjoy can actually be a medical illness called depression. Depression can cause deeply sad feelings or high anxiety around everyday activities, and may make it hard to live your life the way you want.

If you think you may be depressed, talk with your health care provider. Your health care provider may prescribe an antidepressant medicine to help with your symptoms. Please note that it may take several weeks for you to feel the full benefit of antidepressants. Your health care provider may also recommend counseling for you with a mental health professional. It may be helpful to speak to someone about the impact cancer has had on your life.

FOR SUPPORT

Gilda’s Club Cancer Support Community 888�793�9355

American Cancer Society Resource Search cancer�org/treatment/supportprogramsservices

Association of Cancer Online Resources acor�org

National Suicide Prevention Hotline 800�273�8255 TTY 800�799�4889

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Understanding oral oncology medicines

Taking an active role in your care includes paying careful

attention to both symptoms and treatment. It also means

talking openly with your health care provider. This part of

the guide can help you:

Learn the best way to take your medicines

Understand more about how to get the most from your medicine therapy

Write down questions or concerns to discuss with your health care provider

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Taking your medicines on time The timing of your medicine dosing is based on how long each drug will work in your body after you take a dose. The goal is to take the next dose before the effects of the first one have completely worn off. After four or five doses, the levels of medicine in your blood reach what is called a “steady state.” Levels will stay that way as long as you continue taking doses as directed.

Try the following steps to help stay on time with your medicine schedule:

→ Consider using a medicine reminder system or app to help track your medicines, their dosages and the time you should be taking them

→ Make your medicine part of your daily routine

→ To help you remember your medicine, take your pills at the same time as another routine task, like when brushing your teeth

→ Set an alarm on a watch or a cell phone, or set a timer to remind you to take your medicine

Medicines and foodSome medicines are absorbed best with food in the stomach. Others need to be taken on an empty stomach. Ask your health care provider or pharmacist at Prime Specialty Pharmacy if you’re not sure.

ASK YOUR HEALTH CARE PROVIDER

Taking your medicine the right way is important, too� Your oral oncology medicines must be taken whole to be effective� Drinking a full glass of water with your medicines will help make sure you’ve swallowed them completely�

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UNDERSTANDING YOUR MEDICINES

Staying on track with your medicines Here is what you can do to help get good results from your cancer medicine therapy:

DO

→ Call your health care provider or pharmacist with any questions you may have about your cancer medicines.

→ Educate yourself about your cancer medicines, especially risks and warnings.

→ Keep a list of the names and prescribed amounts for each medicine you are taking.

→ Stick to the medicine schedule your health care provider has prescribed.

→ Add taking your medicines into your normal routine.

→ Check with your health care provider before starting any new medicines, including vitamins, supplements, herbal remedies, prescription medicines and over-the-counter products.

→ Drink plenty of fluids. The best choices are water, clear fruit juices and other caffeine-free drinks.

DON’T

→ Skip or change doses. By taking your medicine as prescribed, you will improve your chances for a positive treatment outcome.

ASK YOUR HEALTH CARE PROVIDER

Remember to talk with your health care provider about your lab test results� Make sure you understand what they mean and don’t be afraid to ask questions if you need more information�

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Follow your health care provider’s orders 11 One of the best ways you can help fight cancer is by taking your medicine exactly as your health care provider prescribes. Oral chemotherapy treatments may have special instructions and precautions.

When starting oral oncology medicines, keep these things in mind:12

→ Pay close attention to the instructions on how and when to take your medicines. Follow these instructions carefully. Don’t change anything unless instructed by your health care provider.

→ Many oral oncology drugs require special storage in order to keep the drug effective and safe. Oral oncology medicines should be considered hazardous, so don’t combine them with regular medicines in a pill organizer. Keep a separate organizer for your oral oncology pills.

→ Oral oncology pills should NOT be crushed, broken or chewed.

Working togetherWe’re committed to partnering with you in your cancer care. Until recently, most cancer therapy was only given intravenously (into a vein, through an IV) at a hospital or a clinic, but now oral medicines — those taken by mouth — are available. While many cancer treatments are still given by IV, some newer treatments come in tablets or capsules.

Oral medicines are sometimes started after IV therapy has finished. They are often used long-term. The goal of extended use is to slow the rate of cancer growth, or to help keep tumors from returning. Oral drugs may cause different side effects than IV drugs. The dosing schedule for oral medicines can be complicated and you may feel confused at first. We want to help you get the most benefit from your cancer treatment.

It’s about more than a cure

The word “cure” is a hot topic in cancer research studies. While health care providers prefer not to use the word “cure” when talking about cancer, new treatments and clinical trials are being developed every day to combat cancer. With new and valuable studies continuing to help health care providers make progress with cancer, there is hope for the future. You never know when the next study will offer an incredible discovery. Remember, your body functions best with the right lifestyle choices, good communication with your health care provider and by taking medicine as prescribed.

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Understanding side effects

You may have concerns about possible side effects of your

cancer medicine. That concern can sometimes make it hard

to stay on track. It helps to set realistic expectations about

how your treatment may affect you. Remember that the

medicines you take now may be different from ones you

had before. Your current medicines may have fewer, less

severe, or completely different side effects. Talk with your

health care provider about any side effect that doesn’t go

away after a little while.

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Possible side effects

1 If you’re having trouble sleeping, consider avoiding large meals or caffeine too close to bedtime. You may also consider developing a peaceful bedtime routine that can help your body and mind better relax in the evening. Many people have found that relaxation techniques such as yoga, meditation or deep breathing can help with alleviating sleep problems.

2 If you are experiencing regular headaches, consider drinking more fluids — especially water. Some people have also found that dark rooms or warm baths can help reduce some headache symptoms. Make sure to speak to your health care provider or a pharmacist at Prime Specialty Pharmacy before you use an over-the-counter pain reliever.

3 If you are experiencing a fever, make sure you are drinking plenty of fluids. Remember that a high fever or a fever lasting more than 48 hours needs to be addressed with your health care provider immediately.

4 If you’re lacking an appetite, consider eating smaller and more frequent meals. Taking a walk before and after meals also may help stimulate the appetite and aid digestion. Practice good self-care and indulge in a few of your favorite meals. Try taking supplements or drinking meal replacement shakes to help provide the nutrition your body needs.

5 If you are experiencing a dry mouth, it’s recommended to start each day with a glass of water. Make sure to get regular dental check-ups and let your dentist know about any medicines you are taking.

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Hand-foot syndrome Oral drugs for cancer can cause a unique skin rash known as hand-foot syndrome (HFS). This can affect the palms of the hands and the soles of the feet. HFS can also cause skin to become dry, peel, form calluses, swell or produce sunburn-like redness. In severe cases, blisters can develop and become open sores. If you are taking medicines that your health care provider thinks may cause HFS, consider the following tips to help prevent or ease the symptoms:

→ Avoid putting prolonged pressure on your feet.

→ Wear gel socks and consider using inserts in shoes to protect your feet.

→ Use special creams that contain urea (like Kerasal or Udderly Smooth Extra Care) twice per day.

Skin rashOral drugs for cancer can cause dry, itchy skin. Constant scratching can lead to infection. Here are tips to keeping your skin in optimal shape:

→ Use an oatmeal bath product to protect your skin and prevent itching

→ Wash with an unscented moisturizing soap

→ Use lukewarm water instead of hot

→ Drink plenty of fluids to keep your skin hydrated

Mouth sores 13

Some oral cancer medicines can cause mouth sores. These may range from an inconvenience to something more severe. Notify your health care provider if you have mouth sores. There are medicines for treatment. Things you can do to combat mouth sores:

→ Get a dental check-up. Visit your dentist before you begin cancer treatment to take care of any unresolved dental issues.

→ Practice good oral hygiene by taking extra care to brush and floss regularly.

→ Use cold therapy. If you experience pain with mouth sores, try swishing with ice chips or cold water. This can cause a numbing effect and reduce some of the pain.

UNDERSTANDING SIDE EFFECTS

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A note on nausea, vomiting and diarrheaSome medicines may cause digestive issues including nausea and diarrhea. When either occur, it’s important you keep your body hydrated and well-rested.

For nausea, consider taking small bites of a cracker, or try eating foods at room temperature. For vomiting, sip drinks throughout the day, rather than drinking a large volume at one time. For diarrhea, consider limiting foods that contain caffeine and taking dairy out of your diet. Also avoid foods that cause cramping such as, cabbage, beans, onions, green peppers and carbonated drinks.

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Low blood counts 14,15

Low blood cell counts can be a serious complication during your treatment. Some oral oncology medicines temporarily stop cells from dividing and growing. Your health care provider monitors your blood counts to make sure your body can continue to undergo treatment. To manage low blood counts:

→ Take time to rest between activities and plan ahead to save energy

→ Eat a healthy diet and exercise when your energy level can support it

→ Drink plenty of water and try to avoid caffeinated beverages

→ Practice good hand washing

→ Avoid contact with individuals who are ill

TYPE OF CELLS WHAT THEY DO POTENTIAL COMPLICATIONS FROM LOWER COUNT

Red blood cells Carry oxygen and nutrients throughout the body

Fatigue

Shortness of breath

Increase in heart rate

Dizziness or lightheadedness when changing positions

White blood cells Fight infection Low white blood counts sometimes present no symptoms. Call your health care provider right away if you have:

A temperature greater than or equal to 100.5° F. (Check with your health care provider. He or she may want you to call for a temperature greater than or equal to 100° F)

Chills, shaking or exaggerated shivering

Sudden onset of new or unexplained pain

Platelets Help blood to clot Increased bruising

Petechiae (red dots on your skin caused by tiny amounts of blood leaking from blood vessels)

Bleeding from nose, gums, rectum

UNDERSTANDING SIDE EFFECTS

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Hair loss and nail changesSome common medicines used to treat cancer may cause hair loss. After you finish your treatment, your hair will grow back slowly. When combing, use a wide-toothed comb to prevent hair breakage. Take a break from perming, braiding or tightly pulling hair back. Blow-dry your hair on low heat. Keep in mind it may take from three to six months after therapy is completed for hair to grow back. It may even have a slightly different color, texture or curl.

Pregnancy and breastfeedingLet your health care provider know right away if you are pregnant, planning to become pregnant or are breastfeeding. Most oral oncology medicines should not be used during these times, and some may affect fertility. Talk with your health care provider about which medicines are most appropriate for you.

It is important for male patients to be aware that some oral anticancer drugs are present in semen. This could lead to birth defects. Check with your health care provider or pharmacist before engaging in unprotected sex, in case pregnancy should be avoided.

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UNDERSTANDING SIDE EFFECTS

When it’s time to call the health care providerChest pain

This includes discomfort in your chest, esophagus (throat) or lungs. This may feel like a burning or aching chest pain. Seek emergency treatment immediately if you develop chest pain while taking cancer medicines, especially if the pain is:

→ Very severe

→ Different from pain you have had before

→ Occurs when you are doing a strenuous activity, such as climbing stairs

Shortness of breath

If you feel short of breath, call your health care provider. Your health care provider will determine if it is related to your cancer medicines or another medical problem that requires prompt treatment.

Vision changes

Although it is uncommon, some people have sudden changes in vision while taking cancer medicine. Call your health care provider right away if you develop:

→ Blurry vision

→ Double vision

→ Light sensitivity

23

ASK YOUR HEALTH CARE PROVIDER

Also call your health care provider right away if you experience: → Swelling in your legs, feet or ankles

→ Severe diarrhea lasting for more than 48 hours

→ Blood in your stool

→ Skin rash or unusual skin reaction in the area of an injection

→ Fever higher than 100.5° F at any time, or you have a fever lasting longer than 48 hours

→ Extreme fatigue

→ Allergic-type reactions such as trouble breathing, hives, etc.

If you are experiencing a symptom or side effect that is worrying you, it is always best to call your health care provider� Your health care provider will determine if you need immediate attention and the next steps�

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ResourcesORGANIZATION DESCRIPTION

American Cancer Society www.cancer.org 800.227.2345

The American Cancer Society is a nonprofit dedicated to resource, education and prevention of cancer.

Mayo Clinic www.mayoclinic.com

The Mayo Clinic is a nonprofit medical practice and research group based in Minnesota.

Medline Plus® www.nlm.nih.gov/medlineplus/cancer.html

Medline Plus’ cancer page is an initiative of the U.S. National Library of Medicine to help with information around diagnoses, medicines and side effects related to cancer.

National Cancer Institute www.cancer.gov 800.422.6237

The National Cancer Institute is a U.S. government initiative to educate and prevent all types of cancer.

National Comprehensive Cancer Network www.nccn.com

The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education.

Patient Advocate Foundation www.patientadvocate.org

Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides professional case management services to Americans with chronic, life threatening and debilitating illnesses.

RESOURCES

25

References1. “What Is Cancer?” National Cancer Institute. Accessed 9/28/2015. www.cancer.gov/about cancer/

what-is-cancer.

2. National Cancer Institute. Accessed 1/26/2017. www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet.

3. National Cancer Institute. Accessed 1/26/2017. www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy.html.

4. “Oral Chemotherapy: What You Need to Know.” American Cancer Society. Accessed 1/27/2017. www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/oral-chemotherapy.html.

5. “Signs and Symptoms of Cancer.” American Cancer Society. Accessed 9/28/2015. www.cancer.org/cancer/cancerbasics/signs-and-symptoms-of-cancer.

6. “Cancer Risk Factors.” Mayo Clinic. Accessed 9/28/2015. www.mayoclinic.org/diseases-conditions/cancer/basics/risk-factors/con-20032378.

7. National Cancer Institute. “Cancer Prevention Overview (PDQ®) — Patient Version — What is Prevention?” Accessed 1/27/2017. www.cancer.gov/about-cancer/causes-prevention/patient-prevention-overview-pdq#section/_199).

8. “Centers for Disease Control and Prevention.” Accessed 1/26/2017. https://www.cdc.gov/cancer/dcpc/prevention/other.htm.

9. “Diet and Cancer.” U.S. National Library of Medicine. Accessed 9/28/2015. www.nlm.nih.gov/medlineplus/ency/article/002096.htm.

10. “Coping with Cancer-Related Weight Changes and Muscle Loss.” Accessed 1/26/2017 http://www.cancercare.org/publications/140-coping_with_cancer-related_weight_changes_and_muscle_loss.

11. “Importance of Taking Your Medicine Correctly.” Cancer.net. Accessed 9/27/2015. www.cancer.net/ navigating-cancer-care/managing-your-care/importance-taking-your-medication-correctly.

12. “Oral chemotherapy — not just any ordinary pill.” Mayo Clinic. Accessed 9/28/2015. www.mayoclinic.org/diseases-conditions/cancer/expert-blog/oral-chemotherapy/bgp-20056402.

13. “Mouth sores caused by cancer treatment: How to cope.” Mayo Clinic. Accessed 9/30/2015. www.mayoclinic.org/diseases-conditions/cancer/in-depth/mouth-sores/art-20045486.

14. “Low blood cell counts: Side effect of cancer treatment.” Mayo Clinic. Accessed 9/30/2015. www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20046192.

15. “Low Blood Counts” ChemoCare.com. Accessed 9/30/2015. chemocare.com/chemotherapy/side-effects/low-blood-counts.aspx.

REFERENCES

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NOTES

27

NOTES

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NOTES

Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC (Prime). Prime Specialty Pharmacy works with your health plan to provide the specialty medicines you need. Prime Specialty Pharmacy wants to help you get the most from your medicine therapy by:

→ Helping you get the medicines you need, when you need them

→ Providing ongoing, personalized support from disease-specific experts

→ Helping you manage the details so your condition does not manage you

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→ This guide provides an overview of oral oncology� It is not meant to replace medical advice from your health care provider, pharmacist or other health care provider� Please contact them for more information� This guide is intended to be accurate� However, Prime Therapeutics and Prime Specialty Pharmacy are not responsible for loss or damage due to reliance on this guide�

ABOUT PRIME THERAPEUTICS SPECIALTY PHARMACY

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