Camp with Cancer

October and November are hunting months  in Ontario – from Ducks and Partridge to Moose and Deer. Fishing months are January, February (ice-fishing), and all other months are fishing or cottaging.  It’s never a bad time to go to the cottage or camp, with the exception of late March/April in some areas.

There are some things that a patient receiving treatment for cancer needs to think about when going to the camp/cottage/hunting lodge and cabin.  I’m going to focus for patients who may or may not be receiving medical anti-cancer treatments (i.e. chemotherapy, ‘targeted therapy’ and immune therapy) for advanced cancer.

I’ll be outlining some tips on the next pages:

  1. How far are you going?- be prepared from a medical point of view.

Some camps are basically houses, close to health care, and close to home, but the majority of camps/cottages have some remoteness to them.  This remoteness is part of the joy of camp (of any type), but also can be scary for some people with cancer who are used to being close to their hospital if things go wrong.

If you are on chemotherapy, targeted oral therapy (such as Tarceva, Iressa, Xalkori etc.), or Immunotherapy (such as Opdivo/Keytruda) etc., then you may end up visiting a hospital near your camp.  Odds are you won’t visit, and that you’ll be fine, but it’s best to be prepared.

Before going, speak to your oncologist or palliative care doctor about what medications you may need.   I recommend several items for patients traveling out to their camps (or those traveling anywhere else where they aren’t able to access health care.)

 

  1. Ask your care team for a treatment summary to bring with you.  It’s a good idea for people to have this anyway in case you end up in a hospital.  Newer agents (such as Opdivo or Keytruda, or Iressa/Tarceva etc.) have unique side effects and potential risks, that a doctor in a remote community or in an emergency room may not be aware of.

Specifically:

Hello, I am receiving chemotherapy for metastatic lung cancer. The regimen I am receiving is __________________. My last chemotherapy dosage was on this date _________________. If I have a fever, or am ill (over 38 degrees), please treat me as an emergency. (febrile neutropenia protocol). Please contact my physician/care team at ______ to inform them of my visit and to collaborate on a treatment plan.

Hello, I am receiving a drug called ______________ for metastatic lung cancer. This drug works different from usual chemotherapy. It stimulates my immune system to fight the cancer. By doing this, I am at some increased risk for a variety of inflammatory problems. I have been told to go to the hospital for assessment if I have severe diarrhea, weakness, or trouble breathing. Please contact my physician/care team/treating hospital at _________ to inform of them of my visit, and collaborate on a treatment plan. Steroid medicines may be needed.

I tend to give patients on chemotherapy some antibiotics that they can take if they develop a fever and feel unwell if they are going to be a couple of hours from a hospital. Patients on chemotherapy who get a fever can get sick very quickly, and urgent care is needed. It’s possible that the fever isn’t related to an infection caused by the chemotherapy, and doesn’t require antibiotics, but it’s impossible to know that without a visit to the hospital for a blood test. If someone is at their cottage/camp (or even Cuba), and they get a fever, it may be 3 or 4 hrs before they get to a hospital, get their blood taken, and get the result back. Because of this, a supply of broad spectrum antibiotics that they can take makes sense.

If patients are on immune stimulating drugs (such as Opdivo or Keytruda), then, again, the best thing to do is go to the nearest emergency room if they get sick with diarrhea, breathing problems, profound weakness etc. If patients are going to be remote from health care (camp, cottage, Cuba), then I’ll give a prescription for steroid medicines that they can start if they get ill. Of course, patients should get to the hospital when and if they can, and ideally before needing to start the medications, but it’s not always possible.

These are all fairly specific regimens, but the basic premise is this:  If you may be 2 hrs from a hospital (or more if the water is bad/weather is bad), then have the medications that you would need for an emergency.

Next:  Set expectations.

You may not be able to do all of the things that you normally do or enjoy at camp.  Focus on the things that you can do, and enjoy doing them.