Day by Day - ChemoReady.ca

Incorporating
Side by Side
From the team support approach
of Side by Side, to Day by Day’s
in-depth look at the physical and emotional side
effects experienced by cancer
patients as they face
chemotherapy, Monica
Wright-Roberts continues to
advocate for the needs of the
patient and their family.
SIDE BY SIDE IN 1991
MONICA, JODY AND RYAN IN 2001
“Monica speaks from the perspective of someone who has made the
journey. Her understanding that cancer is truly a ‘family affair’
is what inspired her to write her first book, Side by Side.
Day by Day complements that book as she looks at the physical and
emotional challenges posed by chemotherapy.”
DR. S. VERMA
“Chemotherapy is probably as stressful as being diagnosed with
cancer and it places heavy physical and emotional stress on the
patient. This book, which includes the perspective of patients and
their experience as well as health care providers, will be one of the
most important sources of information for future patients. I hope
it will help to relieve some of the hardships and help to reintegrate
them back into a normal and healthy life.”
DR. S. GLÜCK
N1129E
PHOTO: ASHLEY RANSON
DAY BY DAY
Incorporating
Side by Side
Facing the
challenge of cancer:
a practical resource
and support guide
BY MONICA WRIGHT-ROBERTS AND DR. ROY M. CLARK

This book has been extremely inspirational to
many cancer patients and families over the years.
Amgen Canada is proud to reprint this book in
honour of Monica Wright-Roberts.
This book meets the Canadian Association
of Nurses in Oncology guidelines for
educational content, and will support
nurses in the area of patient care.

Incorporating
Side by Side
MONICA WRIGHT-ROBERTS
DR. ROY M. CLARK
MONICA WRIGHT-ROBERTS, 1953-2002
To describe Monica Wright-Roberts as a breast cancer ‘survivor’
would be to do her an injustice. For the over 13 years that she
battled this disease, she also recognized that each day was a gift to
be enjoyed to the fullest.
There is no doubt that her diagnosis of cancer was a catalyst that
led her to raise awareness of the disease. She was an advocate and
pioneer. Monica was one of the first individuals to cross the
country speaking to patients, families and healthcare professionals
at a time when few people were discussing the disease.
Monica did so much in her shortened lifetime, even with the
limitations that cancer imposed on it. She inspired and challenged
friends and colleagues with her passion for life, her enthusiasm and
her optimism.

MONICA WRIGHT-ROBERTS
Monica’s life took a dramatic turn when in 1988, at the height of
her professional career, she was diagnosed with progressive breast
cancer. This experience, including her battle with chemotherapy,
radiation and surgery and coping as an independent mother,
shaped her role as business owner, philanthropist and outspoken
advocate inspiring groups of television and in-person audiences
across the country. Volunteer President and founder of the
National Breast Cancer Fund, a grassroots organization dedicated
to raising and distributing funds to cancer centres in communities
across Canada, Monica was also a spokesperson for the Terry Fox
Foundation; board member of Ronald McDonald House, Toronto
Children’s Care Inc., and national co-chair of Princess Margaret
Hospital Foundation Breast Centre Women’s Committee. In
addition to her previous book, Side by Side, which has received
critical acclaim by both health care professionals and cancer
patients, Monica produced documentaries for prime-time television
and educational videos aimed at cancer patients and health care
professionals.
DR. ROY M. CLARK
During 35 years in the practice of radiation oncology, Dr. Clark’s
principal interest has been the diagnosis and treatment of breast
cancer. He has written over 80 papers which have been presented
by invitation in European and North American centres. His work in
breast conservation at the Princess Margaret Hospital is well known
and has significantly influenced the management of breast cancer
both nationally and internationally. At the time of his retirement in
1995 he was Radiation Oncologist at the Princess Margaret
Hospital, Toronto and also at Toronto General Hospital;
Consultant Radiation Oncologist at The Wellesley Hospital,
Toronto and Professor, Faculty of Medicine, University of Toronto,
Department of Radiation Oncology. Dr. Clark was cited in The
Best Doctors in America in 1992-1993 and 1994-1995, and is also
listed in the Canadian Who’s Who. His work has appeared in
numerous publications and he has been a frequent presentor at
seminars and symposiums across North America and Europe.

Incorporating
Side by Side
Made possible by the generous support of
AMGEN Canada Inc.
and the
National Breast Cancer Fund
BOOK DESIGN AND PRODUCTION: ROGER MURRAY AND ASSOCIATES INCORPORATED

6 DAY BY DAY
Sponsors
AMGEN CANADA INC.
AMGEN Canada Inc., along with its parent company,
AMGEN Inc., based in California, is the world’s
leading research-based biotechnology company, in
the business of advancing human healthcare by
providing important and meaningful products to
patients. Our goal is to improve the lives of patients
at a time when they need the most help and support.
Over the years, AMGEN Canada Inc. has made a
major commitment to patient education. By working
with oncologists, other healthcare professionals and
cancer survivors, we have created patient education
materials to help people become informed
participants in their own therapy. To that end, we are
proud and honoured to be a sponsor of this new
publication.
NATIONAL BREAST CANCER FUND
The National Breast Cancer Fund (NBCF) was
established in 1995 to provide direct financial
support for breast cancer research and all aspects of
the management of this disease, targeting programs
across Canada. The NBCF has committed to funding
research and treatment centres in every Canadian
province and territory.

This book could not have been produced without the valuable input of the
following individuals:
DR. YASMIN ALAM, FRCP(C)
Medical Oncologist, Windsor Regional Cancer Centre
DR. STEFAN GLÜCK, MD, PH.D
Medical Oncologist and Associate Professor
Tom Baker Cancer Centre, University of Calgary
BARBARA JOUDREY R.N., CON(C)
Nurse Coordinator, In-Patient Unit, Moncton Hospital
DR. KATHLEEN PRITCHARD, MD, FRCPC
Head, Division of Clinical Trials and Epidemiology
Toronto-Sunnybrook Regional Cancer Centre
JEAN REMMER
Social Worker, Hope & Cope, Montreal
DR. GARY RODIN
Head of the Psychosocial Oncology Program
Princess Margaret Hospital, Toronto
BRIAN C. STILLER
President, Tyndale College & Seminary, Toronto
KATHY THOMSON, R.N., M.N.
Director, Breast Cancer Centre of Hope, Winnipeg
DR. SHAILENDRA VERMA, MD, FRCPC
Medical Oncologist, Ottawa Regional Cancer Centre
Assistant Professor, Department of Medicine, University of Ottawa
We also thank all of those patients who shared their experiences with us.
PRINTED IN CANADA.
ISBN 0-9687856-1-1
Copyright ©2007 Roger Murray and Associates Incorporated, all rights reserved.
No part of this publication may be reproduced, stored in or introduced into a retrieval
system, or transmitted, in any form, or by any means (electronic, mechanical,
photocopying, recording or otherwise) without the prior written permission of the
publisher.
CANO has made every effort to ensure that information included within this program is
accurate. The information included cannot substitute for medical advice and the
association makes no guarantees, nor can it assume any legal liability for the accuracy,
completeness, or usefulness of such information or for any damage incurred directly or
indirectly from the information. Reference to any specific product does not imply its
endorsement, recommendation or favoring by the Canadian Association of Nurses in
Oncology.
®Registered Trade Mark of AMGEN Inc. DAY BY DAY 7

8 DAY BY DAY
Dedication
During nine years of travelling coast to coast,
spreading messages of hope and empowerment,
I have met the most amazing, dynamic and
vibrant people. Day by Day is dedicated to all
the cancer patients, their families and their
health care givers, who have inspired and
motivated me to continue on this journey.
Most of all Day by Day is dedicated to my
children, Ryan and Jody, who from the start
have given me the strength I need to go on
each and every day. They are wonderful,
talented and kind human beings.

Foreword
It was my privilege to work with Monica Wright-
Roberts as her medical oncologist. I first met Monica
only a few weeks after she was first diagnosed with
breast cancer. Monica was an independent woman
with a business and two young children whose life
had been ‘changed in a moment’. Monica’s world
was turned upside down more than once since that
time but she never stopped coping – and coping in
the most constructive and creative of ways. She raised
two lovely children, found a new career as a breast
cancer advocate and founded the National Breast
Cancer Fund which raised money for breast cancer
research and education across Canada. Monica also
spoke publicly about breast cancer from the point
of view of the patient to a wide variety of audiences
in a moving, unique and effective way.
In 1993, Monica wrote Side by Side – a practical
guide for wellness team members – which has been
a valuable guide for many cancer patients. This book,
Day by Day, once again provides practical and
accurate information to cancer patients dealing with
diagnosis and chemotherapy. It provides both
inspiration and a practical approach that will help any
patient in dealing with the physical and emotional
challenges they may face.
KATHLEEN I. PRITCHARD, MD, FRCPC
Dr. Kathleen
Pritchard is Head,
Division of
Clinical Trials
and Epidemiology
at Toronto-
Sunnybrook
Regional Cancer
Centre and
Professor,
Department of
Medicine, Faculty
of Medicine, at
the University
of Toronto.
DAY BY DAY 9

10 DAY BY DAY
Introduction
You have just received the news that you have
cancer. Your worst fears have been realized, and for
the moment you are unable to concentrate on what
your doctor is saying. His voice recedes as your mind
freezes, trying to come to grips with what this
diagnosis will mean to you. You know there is a
battle ahead, but how do you arm yourself to take
part? What do you need to know? How will it affect
your personal life, your business life? How will you
tell your family, friends and business associates? What
will be their reaction – and will they be there for you,
to support you when you need them the most?
Inevitably life will change, but it is possible to create
for yourself what Dr. Wendy Harpham, herself a
Lymphoma survivor, has termed a ‘new normal’.
(After Cancer: A Guide to Your New Life). There is
medication available to help reduce some of the side
effects you will experience as you go through
treatment. There are ways in which family and friends
can positively support you. Knowledge is power, and
the more knowledgeable you are about the silent
enemy that has invaded your body, the more
powerful you will be as you battle it day by day.
This book has been designed to give you that
knowledge. In her previous book, Side by Side,
Monica Wright-Roberts described how friends,

neighbours, and business associates put together a
team, designed to help her face the demands that
cancer placed on her day-to-day life. Dr. R.M. Clark,
former Professor, Radiation Oncology at The Ontario
Cancer Institute/Princess Margaret Hospital, says
that Side by Side “gives suggestions that could make a
real difference in the quality of someone’s life and
peace of mind.” Many of those suggestions, along
with Monica’s personal story, are included in this
book in the section beginning on page 35.
Day by Day takes the cancer patient a step further, on
an in-depth look at the physical and emotional
journey you will embark on as you undergo
chemotherapy. It outlines the questions you need to
ask, and gives insight on what to expect, and how to
deal with the changes in lifestyle that lie ahead of you,
as you seek to put in place some normality in the face
of what can feel like an overwhelming situation.
In understanding the needs of cancer patients across
Canada, AMGEN has developed, and will continue to
develop, informational and educational materials to
ensure that cancer patients are well informed, feel
empowered and are able to ‘take control’ of their
disease.
MIKE WOOLCOCK, DIRECTOR, MARKETING AND SALES
AMGEN Canada Inc.
“Good communication
between doctor
and patient is
critical. In your
initial visit with
your oncologist
it’s vital that you
are given the
information you
need and that you
have a chance to
ask your questions.
Because there is so
much information
to take in and
patients are
usually feeling
overwhelmed I
always arrange a
date for a follow-up
meeting.”
DR. STEFAN GLÜCK
MD, PH.D
Medical Oncologist and
Associate Professor
Tom Baker Cancer Centre
University of Calgary
DAY BY DAY 11

Inside
Improving the Chemotherapy Experience 13
More than fifty percent of people diagnosed
with cancer receive chemotherapy. Everyone’s
experience is different depending on their type
of cancer, their age, and the drug regimen
they are on, but the goal for all patients is for
them to have the best experience possible.
Questions and Answers 27
After the numbing disbelief come the
questions. Getting the answers you need can
make all the difference to your ability to cope
with what lies ahead.
Side by Side 35
SIDE BY SIDE has proven to be a valuable tool
for thousands of cancer patients. It could make
a world of difference to you in your fight.
Patient Information 55
After-hours clinic numbers; diagnosis and
treatment plan; prescribed medications;
treatment dates and personal drug plan
assessment forms. Keep all the information in
one place for easy access.
Resources / Notes 65
Books to lift your spirits; websites to visit;
organizations that understand what you are
going through, and a place to make notes.

Improving the
Chemotherapy
Experience

Improving the
Chemotherapy
Experience
14 DAY BY DAY
As you discuss with your doctor the treatments
available for your specific type of cancer, the words
‘surgery’, ‘radiation’ and ‘chemotherapy’ may all be
discussed. There are many stereotypes associated with
chemotherapy. You may have known someone who
has undergone treatment, but even if their
chemotherapy took place as recently as ten years ago,
your experience will be very different from theirs.
New treatments and supportive care medications are
now available, but your health team must be aware of
any side effects that you are experiencing in order to
help you. Communication is a key word in helping
you achieve the best possible experience as you
undergo chemotherapy.

WHAT IS CHEMOTHERAPY?
Chemotherapy is the use of a drug, or a combination
of drugs, to kill tumour cells, or prevent further
growth. Clinical trials have proven that different
chemotherapy drugs damage cancer cells at various
stages of cell division and so a combination of drugs
is more effective. The best chemotherapy is
determined for each patient depending on the type
of cancer they have, the stage the cancer is at and
their overall health.
HOW DO I PREPARE FOR CHEMOTHERAPY?
Perhaps the greatest fear we have is that of the
unknown. Cancer capitalizes on that fear. We enter a
world of hospitals, surgery, medications, taking with
us a body that is fighting fatigue, nausea and pain.
We no longer feel in control of our own bodies –
they have betrayed us. Some of our fears are not easy
to put into words, even with those we trust the most.
But the more questions we ask about treatment, side
effects, and options available, the more we fight
those fears and gain back some control. Patients who
prepare for chemotherapy by asking questions about
what they should expect are better able to handle the
physical and emotional aspects of treatment. Talk to
others who have been through the experience.
Everyone’s cancer story is unique to them, but their
stories can bring hope and encouragement. Don’t be
“People have
individual styles
of learning. Some
learn by reading,
some by listening
to a tape or
watching TV.
We like to
encourage people,
when they begin
this journey, to
determine how
they learn best,
then we can direct
them to the resources
they need to learn
the most about
this challenging
situation they
are in.”
KATHY THOMSON
R.N., M.N.
Director, Breast Cancer
Centre of Hope, Winnipeg
DAY BY DAY 15

Improving the
Chemotherapy
Experience
16 DAY BY DAY
afraid to speak to your doctor or nurse about
concerns you have. Set goals for yourself. Techniques
such as meditation, relaxation and prayer can also
help to reduce anxiety. Most importantly of all, be an
active participant in how you are being cared for.
HOW DO I DEVELOP A CHEMOTHERAPY PLAN?
As you read through this book you will begin to
visualize what lies ahead of you. You will understand
and recognize the side effects that might take place
because of the treatment you are undergoing. You
will understand the emotional aspects that you will
have to deal with, and the benefit of making family,
friends and business colleagues aware of the new
needs you will have. Knowing what to expect and
what to plan for, will help decrease the anxiety and
fear that are a natural response to any stressful situation.
Your doctor and oncology nurse will help you
develop a chemotherapy plan which is best for you.
A good plan will contain:
• Timing of treatment
• Type and amount of drug or combination of drugs
• Potential timing of physical and emotional side
effects
• Potential obstacles and ways to avoid/overcome
side effects
• Flexible and realistic goals.

HOW LONG DOES CHEMOTHERAPY LAST?
Because a single dose of chemotherapy will only
kill a certain percentage of cancer cells, multiple
doses, or cycles, are necessary to eradicate all tumour
cells. Chemotherapy is scheduled as frequently as
possible to:
• Minimize tumour growth between cycles
• Prevent the development of resistance to
chemotherapy medications, and
• Achieve the best outcome.
Clinical trials have determined which schedules kill
the most tumour cells while minimizing side effects.
Postponing chemotherapy, or spacing chemotherapy
cycles farther apart, reduces cancer-free survival, just
as excessively decreasing the dose does. In addition
to that, disruption of your chemotherapy schedule
can also cause frustration. Monica, a breast cancer
survivor, remembers many times when she would
arrive at the hospital for chemotherapy. “I would go
straight to the blood clinic, give blood, and then
wait, sometimes as long as two-three hours only to
find out that my white blood count was too low and
I couldn’t have the chemo that day. It’s
tremendously exhausting to have mentally prepared
yourself for chemo and arranged the next few days
around how you will feel only to find that it’s been
“All along,
throughout my
chemo, I was
visualizing my
daughter’s first
birthday as a
milestone when my
treatment would
be complete. My
doctor prescribed
Neupogen when my
white blood cell
count began to drop
and it kept my
treatment on track.
If treatment had
been delayed it
would definitely
have affected my
coping skills and
my ability to
maintain a
positive attitude.”
MARILYN
Breast Cancer Patient
postponed because your body can’t handle it. You DAY BY DAY 17

Improving the
Chemotherapy
Experience
“The next
treatment session is
always anxiously
anticipated. If this
has to be cancelled
it can be very
distressing and
frustrating for the
patient.”
JEAN REMMER
Social Worker
Hope & Cope, Montreal
18 DAY BY DAY
have to wonder, if it’s so important that I keep on
this regimen, what is going to happen to me if I keep
on delaying the treatment?”
WHY MIGHT MY CHEMOTHERAPY
BE DELAYED OR POSTPONED?
The most common reason for reducing the dose of
chemotherapy or delaying the next cycle is the
development of potentially serious side effects,
particularly neutropenia (nu"tro-pe´ne-ah) – a low
white blood cell count which if left untreated may
result in a life threatening infection (for more
information see page 20). Other reasons for delay of
chemotherapy include severe fatigue and severe
nausea. In many cases these side effects can be
managed successfully with medication so that the
chemotherapy schedule is not interrupted.
PREPARE FOR PHYSICAL SIDE EFFECTS
Chemotherapy kills tumour cells by interfering with
one or more of the many stages of cell division.
Unfortunately, chemotherapy is not specific to cancer
cells; it also damages normal cells, especially those
that divide rapidly or frequently, including cells in
hair follicles, bone marrow cells, and cells lining the
mouth and gastrointestinal tract. Because of this,
typical side effects of chemotherapy include:

Hair loss
For most women this is still the first question – ‘Am I
going to lose my hair?’ Virtually all patients
experience some degree of temporary hair loss,
although it does depend on the drugs used. Even
though hair always grows back, the psychological
impact of hair loss can be immense. Many patients say
that hair loss is the chemotherapy side effect that they
fear the most. As well as head hair, most people can
expect to lose eyebrows, eyelashes, pubic and
underarm hair. Both men and women should consider
purchasing a wig, scarves or hats, and cutting their
hair very short or even shaving their heads when
chemotherapy begins. Look into the “Look Good....
Feel Better” program which is available at all cancer
hospitals across Canada. (www.lgfb.ca)
Nausea
If nausea or vomiting occurs it will be on the day of,
and possibly for one or two days after, chemotherapy.
Fortunately, effective antinauseants such as stemetil,
ondansetron and granisetron, which can completely
prevent or significantly reduce these symptoms, can
be given before and after chemotherapy.
Fatigue
A common side effect of chemotherapy, fatigue can
be brought on by the stress of adjusting to a cancer
“Drugs like
ondansetron have
really revolutionized
chemotherapy.
I was only physically
sick twice and
I had twelve
treatments. Also
my white count
held up very well
and I didn’t have
to start taking
Neupogen until
about treatment
number five or six.
My last
chemotherapy
appointment was
three years ago,
and I’m in the
clear.”
ANDREW
Hodgkin’s Patient
diagnosis, reduced red blood counts, and the effects DAY BY DAY 19

Improving the
Chemotherapy
Experience
20 DAY BY DAY
of the chemotherapy drugs themselves. Make sure
you get enough sleep, eat well, and minimize stress at
home and on the job. Relaxation therapies can be
very useful.
Mouth sores
These are common and usually occur several days
after chemotherapy starts. Before beginning
chemotherapy, have a dental check-up and cleaning
and when chemo begins start rinsing with mild
mouth-washes that contain no alcohol. Use a soft
toothbrush and eat soft foods.
Diarrhea
Although common, diarrhea is generally not severe or
long lasting and can usually be managed with
nonprescription antidiarrheal agents. If it lasts for more
than three days after your treatment you may need
medication and you may have to go to the hospital.
Neutropenia
Neutropenia, a low white blood cell count, is the most
serious common toxicity of chemotherapy.
Unlike other physical side effects of chemotherapy,
neutropenia has silent symptoms, which, if left
untreated, can have a serious outcome. Because white
blood cells play a very important role in fighting
infection, a low white count may predispose you to
developing serious or even life-threatening infections.

Because of this, white blood cell counts are closely
monitored during treatment. On the day that you are
scheduled to receive your next cycle of therapy, your
white count will be measured to ensure that you are
able to receive the next course of chemotherapy. Many
patients receiving chemotherapy develop neutropenia,
but the degree to which it is experienced cannot be
predicted. Patients who experience neutropenia, but
whose white blood cell counts rapidly return to normal,
require no treatment. If however, your counts have not
returned to normal, it is unlikely that you will be able
to receive your next cycle of chemotherapy on
schedule. One way to speed up the recovery of your
white blood cell count is to use a group of drugs called
growth factors, Neupogen ® (filgrastim) and Neulasta ®
(pegfilgrastim) help to decrease the duration and
severity of neutropenia, preventing chemotherapy dose
reductions and delays and decreases the likelihood of
serious infections. Once a physician prescribes
Neupogen or Neulasta it is likely that you will continue
using it throughout your remaining cycles of
chemotherapy. As a patient, it is important to recognize
possible symptoms of infection; if you experience a
fever (over 38°C), or flu-like symptoms contact your
doctor immediately. In this situation, admittance to
hospital and antibiotic treatment may be required.
“I generally explain
to my patients how
crucial it is to keep
to the full dosage
and timing of their
chemotherapy.
I arrange for them
to have their blood
work done one or
two days before
chemotherapy is due
and have the results
faxed to me. If the
white count is low
and they don’t
want to delay or
reduce their dose
we recommend
Neupogen. The
higher the risk of
recurrence the more
important it is for
them to get their
full dose on time.”
DR. STEFAN GLÜCK
MD, PH.D
Medical Oncologist and
Associate Professor
Tom Baker Cancer Centre
University of Calgary
DAY BY DAY 21

Improving the
Chemotherapy
Experience
“I was diagnosed
with Hodgkin’s
disease when I was
21. At that point I
was pretty shocked...
I can’t tell you how
great my oncologist,
Kevin Imrie, was.
He gave me all the
time I needed; he
gave me the feeling
that they had cured
people like me
before. He was
really straight with
me and that helped
calm me.”
ANDREW
Hodgkin’s Patient
22 DAY BY DAY
Anemia
If you have cancer, you may just think that feeling
tired is part of the disease. However, feeling unusually
tired may be due to anemia, a common side effect of
many chemotherapy regimens. Anemia occurs when
there is a significant decrease in your red blood cell
(RBC) levels. Because it is the hemoglobin in your
RBCs that carries oxygen throughout your body, a fall
in these oxygen-rich cells can cause your energy level
to drop. More than half of all cancer patients will be
anemic, regardless of the therapy received, and
approximately 1 in 5 of all patients undergoing
chemotherapy may require red blood cell transfusions.
Although it is not life-threatening, many patients
report that fatigue has a negative impact on their dayto-day
activities. Your doctor will check your blood
count often during treatment. If your red blood count
falls below normal levels you may need erythropoietin
to help increase the number of red blood cells in your
body and help prevent the need for blood transfusion.
Thrombocytopenia
This is a less common side effect of chemotherapy.
Platelets play a role in preventing bleeding, and thrombocytopenia
(throm"bo-si"to-pe´ne-ah) – a decreased
platelet count – may result in a severe drop in the count
which results in prolonged or excessive bleeding from
cuts. A platelet transfusion may be required.

HOW DO I HELP PREPARE MY FAMILY
AND FRIENDS?
The results of a study published in 1998 (Keller M,
et al. Psychotherapy Psychosomatic Med Psychol.)
revealed that distress levels in spouses were as high as
those in patients. Cancer is a family affair. As with
any life-threatening illness it affects all those with
whom it comes in contact. Just as you have to create
a ‘new normal’ for yourself, so do family members
and friends as they try to come alongside to help you
win this battle. In her book Side by Side, Monica
refers to this battle as a ‘deadly duel’. In every duel
there are ‘seconds’ ready to support the principal
players and you need to make sure that your support
team is there for you. Have family members, friends,
and close business associates read the Side by Side
section in this book so that they can learn how to
effectively help you fight the battle of your life.
HOW DO I PREPARE MY EMPLOYER?
One of the questions you need to ask your medical
professional is whether you will be able to continue
working (see page 34). Find out what policies your
company has regarding sick leave, disability,
prescription plan etc. Many companies now allow
employees to work from home several days of the
week. Find out whether you can set up a schedule
that will be flexible in terms of what you will require
DAY BY DAY 23

Improving the
Chemotherapy
Experience
“People’s belief of
how they will feel
when undergoing
chemotherapy may
be based on what
they’ve seen or
understood from
other people’s
experience – but
that will not
necessarily be their
experience. In the
last ten to fifteen
years there have
been a lot of new
medications and
new treatments for
side effects. We are
controlling them
very well.”
BARBARA JOUDREY
R.N., CON(C)
Nurse Coordinator
In-Patient Unit
Moncton Hospital
24 DAY BY DAY
as you undergo treatment. If you feel that your
company is not treating you fairly, talk to your
medical team to see whether they have any
suggestions for resolving the situation.
WHAT ADVANCES HAVE TAKEN PLACE
IN CHEMOTHERAPY?
Cancer care, cancer therapies and supportive care
medications are continually under review as clinical
trials of new chemotherapy combinations are
conducted and found to be effective. Along with a
greater effectiveness have come increased survival
rates, better tolerated treatments for the patient and
improved supportive care and pain control. The
chemotherapy treatment that you will receive will be
different from that prescribed twelve years ago.
Discuss treatment options with your physician and be
pro-active about asking for information on clinical
trials and newer treatments that may be available.
Discuss medications that will help to alleviate
common side effects, and the use of medications to
help avoid having to delay chemotherapy.
UNDERSTANDING THE EMOTIONAL IMPACT
Your needs and concerns in terms of emotional and
spiritual issues will shift depending on many factors:
the stage you are at in your treatment; the beliefs
that you hold about cancer; how the news has been
delivered to you by your physician; the support you

are receiving from your health care team and from
family and friends. There is a very difficult emotional
shift that has to be made if you are undergoing
palliative care – treatment designed to prolong your
life and make it as comfortable as possible – as
opposed to active treatment. The goals for you and
your health care team, however, should remain the
same: to communicate with your health care team
how you are feeling so they can help you work your
way through the symptoms, both physical and
emotional. Depression can be a fairly common side
effect of serious illness and can be treated. Having
faith and trust in the health team you are working
with is an essential ingredient, and can help give you
peace of mind that everything possible is being done.
Dr. Alam, Medical Oncologist at the Windsor
Regional Cancer Centre, feels strongly that the
physician, nurse and the rest of the support team
needs to have a rapport with the patient and equally
the patient needs to have confidence in the team. If
that is not there she believes it may be a good idea to
look for an alternative team. “It’s a critical point. You
may not like the physician or the nurse, but if you
trust them then likeability itself may not be an issue.
If the patient doesn’t have that faith, that trust, it
makes it very difficult as they will question everything.”
Dr. Gary Rodin, Head of the Psychosocial Oncology
“I think medicine
has sometimes
been so focused on
treating the disease
that we have
forgotten that there
is a person attached
to that disease, and
a family attached
to them. We have to
treat the whole
person.”
DR. GARY RODIN
Head, Psychosocial Oncology
Program, Princess Margaret
Hospital
DAY BY DAY 25

Improving the
Chemotherapy
Experience
“Patients should be
prepared for the
fact that after
treatment is
finished and they
are disease free
there can be a
feeling of ‘let
down’. After being
used to having a
team of people
surrounding you,
you can feel as if
you are suddenly
on your own. There
are some centres
that have services
such as support
groups that will
help you through
what may prove to
be a difficult
time.”
DR. STEFAN GLÜCK
MD, PH.D
Medical Oncologist and
Associate Professor
Tom Baker Cancer Centre
University of Calgary
26 DAY BY DAY
Program at Princess Margaret Hospital, emphasizes
how important support is in helping to relieve much
of the emotional stress which will inevitably be
experienced. “By support, I don’t just mean support
in terms of family and friends, but support in the
medical context. That support has a great deal to do
with the way in which the diagnosis is first
communicated and then the support which is
provided afterwards. People often have a lot of
unrealistic fears.”
Joining a support group can be a way of sharing your
fears and concerns. A member of your health team
will be able to assist you in either joining a group or
working one-on-one to help with some of the
emotional distress you may experience. This kind of
support helps you to feel less overwhelmed and
provides you with a supportive environment as you
are helped to process your feelings. Peer support
groups can also be extremely helpful in processing
feelings and helping you to feel less isolated.
A serious illness, such as cancer, disrupts your usual
ways of coping and makes most people feel extremely
vulnerable. Because active coping skills are taken
away, it’s important to work with your team to
develop strategies that will give you back some
control.

Questions
&
Answers

Questions
&
Answers
28 DAY BY DAY
The amount of information that you suddenly
have to acquire when you are told your diagnosis can
be overwhelming. Add to that the stress that you are
experiencing and it is no wonder that many cancer
patients just turn off, and are initially unable to make
sense of the medical terminology and options that
make up a new language that they have to come to
terms with. Taking a close friend or relative with you
to your appointment is one way of making sure that
you come away with a better understanding of what
was said. Another is to have your own list of
questions that are important to you written out, with
room to write down the answers. Never be afraid to
ask questions of your healthcare professional. The
more knowledgeable and involved you are with your
treatment, the better equipped you are to work with
your doctors to reach a successful outcome.

What type of cancer do I have and what type of
treatment are you recommending? Why?
What is the long term goal of my treatment?
How successful is this treatment?
“I was handed
reams of tightly
printed material
about the potential
side effects of the
drugs I was going
to receive on the
test program and
asked to sign off.
You think, ‘I’m
going to look like a
fool if I ask
something because
it’s probably
written down here
somewhere’, but
don’t ever be
afraid to ask
questions.”
MONICA
Breast Cancer Patient
DAY BY DAY 29

Questions
&
Answers
30 DAY BY DAY
Are there any ongoing clinical trials that I may want
to participate in?
How will my chemotherapy be given?
How often?

Who will give it to me, and where?
Who should I call if I have questions?
What are the long- and short-term risks
of treatment?
Ask your physician
about taking part
in a clinical trial.
Whether or not
you participate is
your choice and
all patients are
assured of
receiving the
best available
treatment.
DAY BY DAY 31

Questions
&
Answers
“I think keeping
a diary of how you
are feeling on
your medication is
very useful.
We need the patient
to be able to tell us
what is happening
to them so that
we can prescribe
medication that
will help them with
side effects if this
is necessary.”
DR. YASMIN ALAM
FRCP(C)
Medical Oncologist, Windsor
Regional Cancer Centre
32 DAY BY DAY
How soon will side effects start?
How long will they last?
Are there symptoms that I should call you about
right away?

Who should I call?
Why may my chemotherapy be delayed or reduced?
What can be done to make sure this does
not happen?
“What does it
mean to be part of
a clinical trial?
Have I made the
right decision?
How am I going
to feel physically?
Will the nausea
be as bad as
I anticipate?
We have to help
people work
through basic
questions in order
that they feel more
in control again.”
JEAN REMMER
Social Worker
Hope & Cope, Montreal
DAY BY DAY 33

Questions
&
Answers
“More than onethird
of patients
say they experience
depression/
emotional stress.
Your health team
must know you are
having problems in
order to be able to
help you. Patients
must communicate
these needs and not
feel that they have
to ‘soldier on’.”
KATHY THOMSON
R.N., M.N.
Director, Breast Cancer
Centre of Hope, Winnipeg
34 DAY BY DAY
Will I need to be in the hospital? Why?
What resources are available if I feel emotionally
troubled?
Can I keep working?

Side by Side

Side by Side
36 DAY BY DAY
MONICA’S STORY
When Monica took her first, unplanned steps
along a route which carried a roadsign labelled
‘Cancer’, she had no idea of the many friends and
business associates who would ultimately choose to
take parts of that journey with her.
Like most survivors of a life-threatening illness, her
story is the stuff of which major motion pictures are
made. A single mother with two young children, she
also ran a very successful public relations company.
Her life was a parody of the character played by
Goldie Hawn in the movie Overboard, where she says
“Everyone wants to be me”. But not many people
wanted to be Monica on December 9, 1988 when
she was told, at the age of 35, that she had breast
cancer.
From then on Monica’s life took on a pattern of its
own that had very little to do with how successful
she was in business; took no account of education,
background, or money. She became a statistic: a
hospital gowned figure who looked identical to all
the other patients who were attempting to cope not
only with surgery, chemotherapy and radiation
treatments, but also trying to come to terms with the
fact that their lives had changed, probably for ever.

What are the coping mechanisms that spring into
place? Initial denial, before surrendering to the
overwhelming realization that this isn’t going to go
away; turning to friends and family for emotional
support; humour – although oftentimes this can only
take place with other survivors who have earned the
right to joke; strong religious faith; positive thinking
– all these have their place and Monica found herself
using them all. But one very significant event
occurred in the early days of her illness that had an
overwhelming impact on how she was ultimately able
to get her life back on track.
A business associate who was well aware of what was
ahead, took the time to put together a ‘team’; people
who knew Monica, and challenged each of them to
commit to doing something on a regular basis that
would enable her to devote her energy to the healing
process. Monica credits this associate – whom she
calls ‘The Coach’ – as being a key ingredient in her
ability to have some normality in her life in spite of
everything she was undergoing.
Working side by side with Monica, her Coach was
able to make sure that her basic needs were met by
putting together a team of people, all of whom were
prepared to commit to doing something on a regular
basis.
“Being an independent mother made it easier for
“We have over 500
resources in our
library, but we also
have a small pack
of ‘have to have’
resources that we
give people when
they are newly
diagnosed. Side by
Side is one of the
‘have to have’.
It is probably the
most practical
resource that we
can give patients
on how to work
their way through
living with cancer.”
KATHY THOMSON
R.N., M.N.
Director, Breast Cancer
Centre of Hope, Winnipeg
DAY BY DAY 37

Side by Side
“I think that in
this day and age
most people want to
know how to get the
most information
about their cancer,
their prognosis and
the stage they are
at. That knowledge,
that information,
helps to empower
them.”
DR. YASMIN ALAM
FRCP(C)
Medical Oncologist, Windsor
Regional Cancer Centre
38 DAY BY DAY
friends and family to help. My needs were blatant
and there was obviously no husband to help. Too
often though, we think people are cared for when
they’re not. Life needs to continue as normally as
possible, so extra hands from outside the home allow
the homelife itself to continue.”
Over 12 years have passed since Monica underwent
surgery. Cancer took away her business and her
lifestyle as she knew it. It made huge inroads on the
energy she took for granted; it brought pain and fear.
But for a woman who prided herself on her
independence and her ability to cope with everything
life threw at her, it brought something else: the
realisation that there are times when you can’t do it
all; you can’t cope; you can barely hang in. What she
experienced through someone systematically putting
a support system in place for her is what she shares in
her book Side by Side. This ‘team’ approach goes far
beyond merely sending flowers to the hospital or
dropping off a meal when a friend returns home
from surgery. It answers the question we all have
when someone we know is seriously ill – “What can I
do?” and gives specific guidelines on how to
practically and lovingly discern their needs and meet
them.
BARBARA J. MURRAY
EDITOR

THE CHALLENGE
In Arthur Frank’s book, At the Will of the Body, he
makes the comment that anybody who wants to be a
caregiver must not only have real support to offer
but must also learn to convince the ill person that
this support is there. The support I received through
my Coach and Team was overwhelming. It gave me
encouragement at my lowest points; it enabled me to
still treasure my uniqueness as a human being while
coping with the indignities of a body which was
suffering from the aftermath of surgery,
chemotherapy and radiation. Most importantly, it
didn’t fail.
To discover that you have a life-threatening illness is
devastating. I could not have put together a team of
people to help meet my needs, but someone who was
a true caregiver did that for me. I needed help at a
time when I was vulnerable in a way I had never
before experienced – and that help was carefully
orchestrated and organized to meet each need as it
arose.
This is not about how I survived cancer, it’s about
how you can help someone survive. It’s not just my
story, it’s the story of one person being committed to
help, and the many people who helped him fulfil that
commitment. It could be your story.
MONICA WRIGHT-ROBERTS
DAY BY DAY 39

Side by Side
“Cancer is a
traumatic event
for everybody.
You don’t have
to be especially
vulnerable, and
that kind of
normalizing of
this situation
makes it easier for
people to receive the
help and support
they need.”
DR. GARY RODIN
Head, Psychosocial Oncology
Program, Princess Margaret
Hospital
40 DAY BY DAY
WHAT CAN IDO?
You’ve just received the news that a friend has been
diagnosed with cancer and your heart drops. You feel
the immediate need to do something – but what?
The question most frequently asked by friends and
family when someone is ill or in the midst of
treatment – and the one most difficult to answer – is
‘What can I do?’ Many people are too embarrassed to
suggest an idea in case it’s inconvenient, let alone
face the fact that they’ve gone from being a normal,
capable person to someone whom people now feel
sorry for.
If you’re a family member you should know the
patient well enough to be sensitive as to the areas in
which they will need help, and hopefully are close
enough to them to offer both emotional and
financial support if this is needed.
Wanting to become involved is great; putting the
onus of deciding what that involvement should be on
someone who is already trying to cope with their
sickness is unrealistic.
If you are a casual acquaintance – a neighbour or
business associate – then you need to ask yourself
what you are capable of doing.

Ask yourself the following questions:
How much time can I give without it causing a
major disruption in my schedule?
What am I good at? Are there practical skills
that I have that this person needs?
Do I live nearby? Don’t let distance stop you from
becoming involved; taking out a gift subscription
to a magazine; sending cards on a regular basis;
arranging for the local pizza shop to deliver once
a month (charged to your credit card), or
sending flowers, are just a few of the things that
can be arranged no matter how far away you
live.
DAY BY DAY 41

Side by Side
42 DAY BY DAY
Are our lifestyles similar?
Do we have any similar tastes? (In books, movies,
music, food, hobbies.)
Who else might want to help? (Are there other
people who should know who would want to do
something?)

Remember, the illness and subsequent treatment
might continue over a long period – months or even
years.
As you look at your own lifestyle and compare it with
your friend’s you will probably find several points of
similarity.
You both have children who are involved in Little
League? Then offer to pick up and drop off the kids.
You live next door? How about mowing their lawn
along with yours?
You always bump into each other at the local video
store on a Friday night? Make a note of the movies
they are interested in and pick one up each time you
pick up yours, and drop it off.
The key is to find ways to make their lifestyle as
normal as possible without it becoming a burden
for you. If it’s too time consuming you won’t be
able to keep it up.
To sum up – ask yourself what you can do; make
some suggestions and let this be a starting point to
discovering their real needs.
“Cancer made it
acceptable for me to
turn and get help.
That’s one of the
privileges of the
illness. Definitely
the support I
received from the
team of people
that my business
associate put
together for me,
and from my
family doctor
and psychiatrist,
emotionally got
me through when
I was at my very
lowest point.”
MONICA
Breast Cancer Patient
DAY BY DAY 43

Side by Side
44 DAY BY DAY
THE COACH
Whenever I tell my story it quickly becomes obvious
that without ‘The Coach’ the support I received
from friends and business associates could well have
started to collapse at a point where it was still very
necessary to me.
If you’ve asked yourself the question ‘What can I
do?’ this could be the role that you are prepared to
take on, or you may at least have a good idea of who
would be suited to it. It’s a role that is critical to the
success of putting together a team that will continue
to offer support for as long as the person undergoing
medical treatment requires it.
How do you define the Coach? He or she is a
member of the support team who is responsible for
coordinating the needs of the patient with the
talents of the team members. He’s responsible for
encouraging the team to continue, and to adapt
to the changing needs of the patient.
Should the Coach be a spouse or parent? This can be
a difficult role to handle for a close family member.
As a husband or wife it can be hard, if not
impossible, to confront people and tell them they are
not delivering on their promises. Also close family
members have their own emotional needs, high and
low points, and the stress of organizing and running
a team is probably not a good idea.

The Coach does not have to know all of the team
members personally, but does need to know who
wants to become involved and what their level of
involvement will be.
It is important that the Coach be someone that
the patient can talk to, convey needs to, and feel
comfortable discussing their illness with.
My Coach hosted a lunch at which he discussed my
cancer and its implications. He challenged everyone
to share what they would do to help. You might feel
more comfortable contacting people on a one-on-one
basis. If you have some common interests such as a
club, church group, or other organization, you might
want to present this as a care-project. No one person
can contact everyone and undoubtedly as well as the
‘official’ team there will be many people who, on an
occasional basis, will do things like send flowers, make
dinner reservations, pick up the kids, etc.
What the Coach needs to ensure with the team is
that basic needs are being met.
Needs of course are individual: a single mother
undergoing cancer treatment has different needs
from those of a retired businessman with a wife and
grown children.
Sometimes needs are not apparent in the first stages
of illness. I found that something as simple as doing
laundry became impossible during chemotherapy – I
“We have to be
flexible in
responding to the
myriad of feelings
and changing needs
that cancer patients
experience.”
JEAN REMMER
Social Worker
Hope & Cope, Montreal
DAY BY DAY 45

Side by Side
“There are times
in life when we
recognize we can’t
go it alone.
To see our lives
within a larger
cosmic reality is to
open ourselves to
forces beyond
medical ingenuity
and our own
personal ability.
The marvellous
resource of prayer
is that medium by
which we connect to
the source of our
creation, and the
chorus of prayer
that comes from
countless friends
assures me that
I am not walking
this path alone.”
BRIAN C. STILLER
President
Tyndale College & Seminary
46 DAY BY DAY
was not able to use my arm to lift the wet clothes out
of the washing machine and into the dryer. It’s
important that the Coach be someone who continues
to be sensitive to changing needs.
To be an effective Coach you need to:
Be a good organizer.
Take time to follow up with each team member.
Be outgoing. This is not the job for an introvert!
Be able to cope with facing someone who is going
to look very sick at times.

THE TEAM
My team was made up of people who knew me from
many different areas of my life: business associates;
parents of my children’s friends; family members;
church friends; and the casual acquaintances that we
all make as we go through our normal daily routine.
Most people want to help; most people want to do
something. It’s defining that ‘something’ that is so
difficult.
Team members are the legs to run around, the
arms to help, the minds to think, the hearts to
care, the mouths to read, the eyes to watch, the
ears to hear and the bodies to be close to.
The team member is the person who wants to help in
some way – whether big or small – and do it
consistently over an extended period of time.
One of my team members regularly treated me to a
formal English Afternoon Tea at a nearby hotel.
Another close friend moved in every other weekend
to give me company and help give support while I
was going through chemotherapy. A business
associate in the music industry sent concert tickets to
my children; while another friend made up their
school lunchboxes – for an entire year. People did
what they did best; what they could commit to; what
they felt comfortable doing.
DAY BY DAY 47

Side by Side
“Side by Side is a
useful tool for
patients with
cancer. It gives a
personal touch; it’s
practical and
encouraging and
written by someone
who’s ‘been there’.
Friends and
family love this
book as it gives
them a host of
practical and
useful suggestions
that they can do to
help – without
getting in the way
of the patient or the
medical team.”
DR. YASMIN ALAM
FRCP(C)
Medical Oncologist, Windsor
Regional Cancer Centre
48 DAY BY DAY
Not all of the team members knew each other. In
some instances even I did not know who was
responsible for some of the gifts I received. People
found their own way of showing love and concern.
In Judy Hart’s book – Love Judy – she talks about the
time she switched on her answering machine only to
find that someone had left a barber shop quartet for
her! I too found that many of my friends were very
creative in the things they planned for me.
Team members find the perfect role by assessing
their talents and interests, available time and
energy, and marrying that to the areas that suit
the patient.

Remember:
• Make it easy for someone to accept help from you;
don’t act like a martyr letting everyone around you
know just how much you’re doing for ‘poor soand-so’.
Help preserve their self respect.
• Give people space. Just because you’ve offered
your help doesn’t mean you have the right to know
everything about their life.
• Respect their privacy. If you’ve left message after
message on their voice mail or e-mail asking how
they’re doing and they haven’t got back to you,
accept the fact that they are obviously not up to
talking at the moment. Maybe it’s taking all of
their strength just to make it to the hospital for
their chemo.
• Continue doing what you can do, and let them
battle with the things they have to battle with.
DAY BY DAY 49

Side by Side
50 DAY BY DAY
PLAYERS’ ROLES
You’ve been asked by the Coach to join the team.
You’ve got the chance to be a player and to make a
real difference in the quality of someone’s life. Their
experience of cancer could be affected by how well
you play your role. So now the ball’s in your court –
what areas are there for the players?
The following list of ideas include many that I found
especially helpful. As you work through this section
you’ll find that the suggestions will help to trigger
ideas that will be most effective – and welcome – in
your situation and for the person you are committed
to helping.
Be creative! Everyone has their own familiar lifestyle
patterns. Try to do things that help to keep those
patterns intact.
Remember: your role is not to step in the way of
the doctor/patient relationship. Negative
comments about treatment and prognosis cause
alarm and confusion and don’t help. They also
detract from the efforts of the medical team.
ACCOMPANY TO MEDICAL CARE. This could be a case
of driving your friend back and forth to
appointments, or even staying with them as they talk
to their medical team.
ARRANGE MEAL PREPARATION. Either volunteering to
supply an occasional meal or actually setting up a

oster to show who’s responsible and on which days.
Take the time to find out food preferences, and
whether there are any foods that cannot be tolerated
during treatment. Remember to check the likes and
dislikes of other family members who will be sharing
the meal, especially children.
DON’T FORGET HOW EASY TAKE-OUT CAN BE!
If cooking is just not your style, you can always make
use of the many companies and stores that will home
deliver. On Valentine’s Day the local bakery delivered
a pink, heartshaped cake for my children. It made the
day really special for all of us.
SEND FLOWERS.
DROP OFF MAGAZINES, or take out a gift subscription
in their name. An avid reader, I found that during my
worst days of treatment I didn’t have the energy to
pick up and read a book; leafing through a magazine
was easier and helped distract me.
CHECK FAVOURITE TELEVISION PROGRAMS, tape them
and deliver them to be watched at a later date. Watch
out for television specials and documentaries that
might be of interest and tape these too.
SET THEM UP ON VOICE MAIL OR E-MAIL. If they don’t
already have one of these services they’re going to
need it in the days ahead. My voice mail kept me in
touch with people even when I didn’t have the energy
to talk to them on the telephone.
DAY BY DAY 51

Side by Side
“I can get pretty
emotional
thinking about the
fact that my kids
have lived most of
their lives in an
incredibly stressful
situation. It was a
vow to them as
much as to myself
that I decided I
would do whatever
I could to make a
difference to other
families going
through this kind
of situation.”
MONICA
Breast Cancer Patient
52 DAY BY DAY
VOLUNTEER to be the one that everyone calls to get
health updates from.
STOP BY FOR A COFFEE OR A CUP OF TEA – but bring
everything with you including a thermos, cups and
muffins.
BABYSIT THE CHILDREN.
HAVE A SLEEPOVER PARTY at their house. There were
a lot of nights when I couldn’t sleep, and it meant a
great deal to share those lonely hours talking with a
friend.
INVITE THEM OUT FOR BREAKFAST, or lunch, or
dinner at a restaurant. Sometimes getting dressed to
go out and be surrounded with people living normal
lives really helps.
DROP BY TO WATCH TELEVISION. Being a busy career
woman I had rarely watched daytime television.
During my treatment, one friend dropped by every
day at the same time and we watched her favourite
Soap together.
DROP OFF BUBBLE BATH, soaps, a new lipstick,
earrings, scarves. Women particularly can feel that all
the ‘glamour’ has disappeared from their lives – help
put some back.
TRY A LITTLE HUMOUR. A tricky one, you really have
to know your friend well, but once they’re starting to
feel better leave jokes on their voice mail, or send

cards. One of my Team decided he was going to be
responsible for keeping some humour in my life, and
he did a great job! At Easter he arrived on my
doorstep dressed up as the Easter Bunny, complete
with chocolate eggs for the kids.
ARRANGE A VACATION. Buy the tickets, organize the
hotel booking.
KEEP THEM UP TO DATE with what’s happening at the
office.
CELEBRATE EACH MILESTONE.
HELP FINANCIALLY. This can be a very real concern.
If you’re able to help in this area don’t be too
embarrassed to offer.
WALK THE DOG.
TAKE THE KIDS TO SCHOOL. Be there for them at
special events – sports, school plays, whatever.
TAKE THEM OUT FOR A DRIVE.
OFFER TO RE-DECORATE THE BEDROOM. During
treatment I spent a lot of hours awake staring at the
walls. One of my Team came by and completely
redecorated the room and changed the furniture
around. It really helped relieve the boredom of
staring at the same four walls.
MOST IMPORTANTLY – BE YOURSELF.
DAY BY DAY 53

Side by Side
“When we
experience pain
we enter into
the crucible of
humanity where
we are all trying
to work out our
faith and hopes....
If we let it, grief
can help us see what
really matters.”
When Life Hurts
BRIAN C. STILLER
President
Tyndale College & Seminary
54 DAY BY DAY
EPILOGUE
I wrote Side by Side nine years ago. Cancer helped
define my goals of what I wanted to achieve in life. It
had always been important to me to ensure that my
children grew up to be content with who they are
and considerate of others. Cancer sharpened that
focus for me to encompass all families who are going
through the trauma of a life-threatening illness, and
what that means not only to the individual but to
their surrounding family members, most especially
the children. It’s been my privilege to see my
children, Jody and Ryan, grow up into the
independent, loving individuals they are. Cancer
truly is a ‘family affair’, and we have to remind
people that cancer takes prisoners of the whole
family, not just the person diagnosed with the
disease.
MONICA WRIGHT-ROBERTS

Patient
Information

Patient
Information
“On the whole
patients are much
better informed
today than they
were 20 years ago
when I started in
oncology. They
want to make
informed choices
and they want to be
able to take control.
Unfortunately
when people are
sick they feel that
much of that
control is being
taken away. It’s
important for them
to realize that we
can only tell them
what’s available –
the choice is still
theirs.”
BARBARA JOUDREY
R.N., CON(C)
Nurse Coordinator
In-Patient Unit, Moncton
Hospital
56 DAY BY DAY
After-hours clinic numbers; diagnosis and
treatment plan; prescription and non-prescription
medicines; treatment dates – keep all this information
in one place for easy access. Check with your
insurance plan(s) – supportive care medications
should be covered by most health plans. Full details
on what you should ask start on page 60.
Use the calendar pages to keep track of appointment
dates and any side effects you may experience from
your chemotherapy.
HOSPITAL PATIENT NUMBER:
HEALTH CARD NUMBER:

IMPORTANT NAMES/TELEPHONE NUMBERS
FAMILY DOCTOR:
TELEPHONE:
ONCOLOGIST:
TELEPHONE:
CANCER CLINIC:
TELEPHONE:
AFTER HOURS TELEPHONE:
CANCER CLINIC NURSE:
TELEPHONE:
SOCIAL WORKER:
TELEPHONE:
PHARMACY/DRUGSTORE:
TELEPHONE:
EMERGENCY CONTACTS
NAME:
TELEPHONE:
NAME:
TELEPHONE:
NAME:
TELEPHONE:
NAME:
TELEPHONE: DAY BY DAY 57

Patient
Information
58 DAY BY DAY
DIAGNOSIS AND TREATMENT PLAN
DIAGNOSIS:
DATE OF DIAGNOSIS:
TREATMENT PLAN:
PRESCRIPTION MEDICATION
NAME:
START DATE:
FREQUENCY OF DOSE:
SIDE EFFECTS EXPERIENCED:
NAME:
START DATE:
FREQUENCY OF DOSE:
SIDE EFFECTS EXPERIENCED:

PRESCRIPTION MEDICATION
NAME:
START DATE:
FREQUENCY OF DOSE:
SIDE EFFECTS EXPERIENCED:
NAME:
START DATE:
FREQUENCY OF DOSE:
SIDE EFFECTS EXPERIENCED:
NON-PRESCRIPTION MEDICATION
NAME:
START DATE:
FREQUENCY OF DOSE:
NAME:
START DATE:
FREQUENCY OF DOSE:
NAME:
START DATE:
FREQUENCY OF DOSE:
DAY BY DAY 59

Patient
Reimbursement
Private insurance
plans vary, so it's
important to
familiarize
yourself with your
policy or program.
Some insurance
policies require
patients to pay for
a portion of their
medical care out of
pocket, usually in
the form of
deductibles or copayment.
Your
policy's handbook
will explain how
much of the cost of
prescription
medicine you will
have to pay.
60 DAY BY DAY
If your doctor prescribes supportive care medications,
you may be eligible for reimbursement under your
private insurance plan, your spouse's policy, a plan
provided by your province or a federal program
(Veteran/Indian Affairs/Armed Forces). If you are
eligible with more than one insurer when filing your
claim, contact both health plans to determine which is
your primary insurer and which is secondary, and how
your deductible and co-payment will be covered.
Supportive care medications should be covered by
most health plans. While many insurers cover
prescription medication obtained from pharmacies,
always check with your plan to be sure. If you
currently are not a member of one of the insurance
plans listed above, you may still be covered under a
federal government-funded health care program.
Please answer the following questions and be prepared to discuss
this information with one of your health care professionals.
1. Are you covered by Third Party Insurance/
Private Insurance? Yes❏ No❏
Coverage may be through you, your spouse or both.
You❏ Spouse❏ Both❏
Name of insurance companies?
(1)__________________________________________
(2)__________________________________________
Company #1 Plan # ___________________________
Group ID # ___________________________
Company #2 Plan # ___________________________
Group ID # ___________________________

2. Does your insurance plan provide full coverage
(100%) or partial coverage?
Full coverage❏ Partial coverage❏
If partial coverage, what percentage do you pay? ___%
If partial coverage, does the insurance plan have a
deductible? Yes❏ No❏
Deductible amount? $____________
Does your insurance policy have a yearly or
lifetime cap? Yes❏ No❏
Insurance cap amount: $________
Type: Yearly❏ Lifetime❏
3. Does your insurance plan require pre-approval for
some medications? Yes❏ No❏
If yes, please describe: ___________________
______________________________________
4. If not covered by private insurance, do you have
coverage through your provincial government plan?
Yes❏ No❏
Note: A special request may be required.
5. Are you covered by any other drug program not
mentioned above? Yes❏ No❏
If yes, name of plan? ____________________
______________________________________
Contact payer to
arrange details of
coverage as soon as
potential need for
supportive care
medications has
been identified.
Speaking with
your social worker/
pharmacist may
help to clarify your
reimbursement
situation.
In many situations
the health care
team can provide
innovative methods
in helping patients
with coverage of
supportive care
medications.
DAY BY DAY 61

Chemotherapy Treatment/Appointment Calendar
62 DAY BY DAY

DAY BY DAY 63

Chemotherapy Treatment/Appointment Calendar
64 DAY BY DAY

Resources

Resources
66 DAY BY DAY
SUGGESTED READING:
When Life Becomes Precious: A Guide for Loved Ones
and Friends of Cancer Patients
ELISE NEEDELL BABCOCK
This book offers hundreds of tips to help family
members, friends and co-workers improve their
communication with a cancer patient. Topics include
what to say (and not to say), how to be supportive
without being intrusive, how to build a winning
healthcare team and which gifts and gestures can do
the most good.
The Wellness Community Guide to Fighting for
Recovery from Cancer (Revised)
HAROLD BENJAMIN AND SUSAN LOVE
This guide, prepared by the largest cancer program in
America devoted exclusively to providing psychological
and social support, presents a unique source of information,
guidance, inspiration and hope for any patient
who wants to take an active role in fighting cancer.
After Cancer: A Guide to Your New Life
WENDY S. HARPHAM, M.D.
Lymphoma survivor Dr. Wendy Harpham addresses
issues facing cancer patients as they learn to move
forward and find a ‘new normal’ in their lives.
Presented in a question-and-answer format, the book
covers cancer prevention after treatment,
understanding reevaluation, follow-up and common
physical and social after-effects.

When a Parent has Cancer:
A Guide to Caring for Your Children
WENDY S. HARPHAM, M.D.
A survivor of non-Hodgkin’s lymphoma, Dr.
Harpham’s children were aged 2, 4 and 6 when she
faced surgery, chemotherapy, remission, a recurrence
and radiotherapy. This candid book addresses ways to
combat children’s fears, answer questions and
provide comfort and reassurance.
Living in the Lightning
NATALIE ROBINS
First serialized in Self Magazine, this book is a
compilation of Natalie Robins’s journal. She writes
frankly, with grace and realism of her personal
journey of learning to live with cancer.
Cancer Talk
SELMA R. SCHIMMEL AND BARRY FOX, PH.D.
Selma Schimmel found a way to help tens of
thousands of people when she created ‘The Group’, a
nationwide call-in cancer support group. Cancer Talk
brings together the personal stories of the show’s
diverse range of callers.
When Life Hurts
BRIAN C. STILLER
Dedicated to helping people who are in crisis and
hurting, the author describes the keys to healing life’s
hurts – hope, faith and love.
DAY BY DAY 67

Resources
68 DAY BY DAY
ORGANIZATIONS/WEBSITES
AMGEN MEDICAL INFORMATION
1-888-268-1191
www.chemotherapysideeffects.ca
www.chemoready.ca
CANADIAN ASSOCIATION OF NURSES IN ONCOLOGY
www.cos.ca/cano/cano.htm
CANADIAN CANCER SOCIETY
1-888-939-3333
www.cancer.ca
CANADIAN HEALTH NETWORK
www.canadian-health-network.ca
CANADIAN ONCOLOGY SOCIETY
www.cos.ca
CANCER ADVOCACY COALITION OF CANADA
www.canceradvocacycoalition.com
CANCER TREATMENT CONSULTANTS
www.411cancer.com
NATIONAL CANCER INSTITUTE
www.cancernet.nci.nih.gov
ONCOLINK
www.oncolink.com

NOTES
“The very act of
letting the patient
discuss their
problems fully in
an encouraging
and supportive
environment can
actually improve
recovery from
physical and
emotional problems
and enhance
psychological
recovery.”
IT HELPS TO TALK
developed by Health Canada
and The Manitoba Cancer
Treatment and Research
Foundation
DAY BY DAY 69

“In general, people
should be asking
their physician
for information
regarding their
individual
prognosis and
treatment plan.
If you need
clarification, ask
your nurse. We
really encourage
people to think
about the questions
they need to have
answered, make a
list and bring it
with them.”
KATHY THOMSON
R.N., M.N.
Director, Breast Cancer
Centre of Hope, Winnipeg
70 DAY BY DAY
NOTES