Please call us at 408-384-9284 (San Jose office)/408-847-6191 (Gilroy office) or email us at firstname.lastname@example.org to schedule an appointment.
Please call 408-847-6191 or fax 408-847-6196 or email us at email@example.com with the following information:
First and Last name of patient
Patient's date of birth, address and phone number
Name of medication, dosage and frequency
Name and phone number of pharmacy
We accept cash and Medicare and PPO (Preferred Provider Organizations) insurance plans and, as a courtesy, will bill your insurance company directly for your care. If you have an HMO (Health Maintenance Organization) plan such as Kaiser Permanente or Blue Cross HMO, your plan may cover a second opinion consultation if requested by your primary care physician or you may pay out-of-pocket for the initial consultation cost only. Typically, if you are enrolled in a clinical trial at GCRI, the costs are covered even if you have an HMO plan based on a California law adopted in 2002.
Please inform us immediately if your insurance information changes. If your insurance plan requires a co-payment or co-insurance, you will need to make payment at the time of service. An office visit co-payment will be required on the days you receive treatment even if you are not examined by your physician or nurse practitioner. You will be responsible for any deductibles, co-pays, out-of-pocket maximums or claims unpaid by your insurance company for services rendered. Our insurance reimbursement specialists are ready to assist you with any questions you may have regarding the financial aspects of your care.
We accept payment for services in cash, Visa, Mastercard, Discover, and American Express credit cards. Co-pays are due at the time of the visit.
Don't see your question(s) answered below? Please email us with your question(s).
How does chemotherapy cancer treatment work?
Cancer cells are rapidly dividing cells. Therefore, chemotherapy works by killing these rapidly dividing cells in a variety of ways, depending on how the cancer grows, the types of cells it affects, and the stage it has reached. For example, some chemotherapy drugs work by damaging the cells' DNA, while others prevent cells from dividing. Other chemotherapy drugs also disrupt cell metabolism or perform other functions.
What kind of chemotherapy will I have?
The kind of chemotherapy treatment will be based on numerous factors, including:
•The stage of your cancer
•The expected behavior of the cancer
•Where the cancer originated
•Your age or performance status
•Other medical problems you may have
•Potential side effects
How is chemotherapy given?
Chemotherapy can be given in a pill form, subcutaneously (underneath the skin in the fat tissue), through an intravenous line (an injection into a vein), or directly into the spinal fluid. Chemotherapy can be administered in a hospital, outpatient facility, or even at home depending on the type of therapy.
How often will I have chemotherapy treatments?
A course of chemotherapy usually comprises of several cycles of treatment and rest. Your specific schedule will depend on the type of cancer and the drug combination being used. An individual treatment session may take a few minutes or a few hours. The treatment cycle may last anywhere from one day to one month or more, with treatments given daily, weekly, or every few weeks. There are usually four to six treatment cycles, and may be longer or shorter depending on the benefit or side effects you may experience from the treatments.
Why do side effects arise, and how can they affect treatment?
Side effects arise because chemotherapy drugs cannot differentiate between cancer cells and rapidly dividing healthy cells. The drugs often attack normal tissues or organs, causing inconvenience, discomfort and even death. Side effects may be temporary or chronic, mild or life-threatening. If side effects prevent the administration of chemotherapy on schedule at the proper dosage, they may reduce the effectiveness of the treatment.
What side effects can I expect?
Chemotherapy’s most common side effects include anemia (low blood counts), nausea, vomiting, hair loss and fatigue. Neutropenia (low white blood cell count) is also another chemotherapy side effect. It can lead to severe infections and/or interrupt treatment.
Your doctor will discuss with you the expected side effects with the course of your chemotherapy.
Will I feel sick?
The most common side effects of chemotherapy include nausea and vomitting after a treatment. Therefore, most patients will experience some degree of these side effects after a treatment session. Anti-nausea/anti-emetics can be given during or after a treatment to prevent or reduce these symptoms.
Will I lose my hair?
Hair loss is a side effect of many chemotherapy drugs usally about two to three weeks after the start of the treatment. It then reverses about two to three weeks after a completed treatment. The severity of hair loss depends on the type and the dosage of the drug. Hair loss can result in slight thinning to complete baldness on the scalp, eyebrows, eyelashes, armpits, legs, and pubic areas.
There are many ways to help patients cope with hair loss and they include wearing hats and scarfs, a wig, and cutting hair to best fit you. Patients on chemotherapy should avoid strong chemicals, bleach, or coloring agents, and avoid direct sunlight as much as possible.
What tests will be performed?
Your doctor will determine the specific lab tests that need to be done based on your condition(s). Complete blood count (CBC), chemistry profile and any necessary cancer markers are usually ordered and they are ordered a week to several day before hand or on the day of the treatment. The CBC is usually repeated one to two weeks after treatment.
The CBC helps track red blood cell (RBC), white blood cell (WBC), or platelet (PLT) counts. These cells divide rapidly as similar to cancer cells. Therefore, chemotherapy drugs often attack these cells and that is why it is important to monitor the CBC. This way, your doctor can help determine the effectiveness/toxicity of the chemotherapy to your body and plan your future therapy accordingly.
Symptoms of reduced blood counts that should be reported to your doctor immediately include:
•Temperature of over 100.5º F
•Congestion or a cold
•Rash or blisters
•Easily bruised skin
•Signs of bleeding
•Itching or burning in the genital area
•Weakness, fatigue, or shortness of breath
What is a bone marrow biopsy and aspiration?
Bone marrow is a flexible or spongy tissue found inside some of your large bones, such as your hips and thighs. They contain immature cells, called stem cells, that turn into red blood cells, white blood cells, and platelets. It is a place where blood cells are formed. So examining the a bone marrow biopsy would give you detailed information about your blood cells and their conditions. A bone marrow biopsy is the removal of soft tissue/marrow fluid and cells by inserting a needle into your bone to check for any problems of blood cells. A bone marrow biopsy is used to determine the presence of blood cell-formation diseases, cancer cells, iron storage, chromosome irregularities, and to monitor the effectiveness of chemotherapy and/or other therapies.
How do I prepare for the procedure?
There are no restrictions nor preparation needed for this procedure. However, if you are allergic to Lidocaine, a local anesthetic commonly used during the procedure, please let your healthcare provider know.
What can I expect during the procedure?
The healthcare provider will talk you through the procedure. The bone marrow aspiration procedure usually takes about 15-20 minutes. Lidocaine, a local anesthetic, is used during the procedure. You will feel a stinging sensation at first, then numbness to the area that is being used for the bone marrow aspiration. You will be positioned on your stomach and the sample will be taken from your hip bone with a needle that is inserted into the bone marrow. The syringe attached will be used to remove the liquid portion from the bone marrow. This aspiration will cause a brief deep, dull ache in quality. A core biopsy will then be taken to sample the bone; you will feel pressure but no sharp pains during this procedure. After the procedure, 5-10 minutes or more of pressure is applied in the area to stop the bleeding.
What can I expect after the procedure?
Keep the pressure bandage on for at least 24 hours, then remove it after 24 hours.
A small amount of bleeding is expected. So it is normal.
Avoid getting the dressing wet (no showering or bathing) for 24 hours.
Avoid heavy exercises or lifting for 24 hours.
You may take Tylenol for soreness.
If there is any swelling at the biopsy site, fever of 100.4 degrees Fahrenheit or higher, increasing drainage or redness at the biopsy site, and worsening pain/discomfort - please call the clinic for further advice.
Are there risks associated with a bone marrow biopsy?
Complications are very rare with a bone marrow biopsy; however, like any procedure, there are risks associated with a bone marrow biopsy and they include:
Excessive bleeding (especially in patients on a blood thinner or have a low platelet count)
Infection at the biopsy site, especially in patients with a compromised immune system.
Long lasting pain at the biopsy site.
What other treatments might I receive?
Chemotherapy may be combined with other treatments including radiation therapy, surgery, targeted therapy, complementary procedures or other treatment modalities. Sometimes a tumor is shrunken before it is operated on and removed, so neoadjuvant chemotherapy can be used prior to the surgery. It is also common to use adjuvant chemotherapy (chemotherapy after the surgery) to eradicate any remaining cancer cells left to reduce the risk of cancer recurrence.
What are colony stimulating factors?
Colony stimulating factors (CSFs) are laboratory-made agents that is similar to growth factors that your body makes to stimulate the production of blood cells. CSFs are used to make more white blood cells in cancer patients to prevent an infection. CSFs are administered to the subcutaneous tissues (or fatty tissues) in the arm. Cancer treatments can compromise an immune system due to their effect on fast-growing cells. White blood cells, which help fight infections, are also fast-growing cells. Therefore, while chemotherapy can eradicate cancer cells, it also kills off white blood cells. With a low white blood cell count, the patient has an increased risk of infection. CSFs can then be used to help prevent an infection by stimulating the growth of white blood cells.
Side effects of CSFs can be mild to moderate. Mild side effects include mild swelling, redness, and discomfort at the injection site; bone pain; slight temperature elevations (usually less than 100.5 degrees Fahrenheit) after the injection for a short period of time. These side effects can be reduced by avoiding rubbing the skin before and after the injection; administering Tylenol/Motrin and Benadryl half an hour to an hour before the injection. Applying ice one minute before the injection and after the injection can also help.
Serious side effects are rare, but can occur. Call your physician IMMEDIATELY if you are experiencing the following side effects:
- Signs of infection (chills, sore throat, congestion, inflammation [warmth or redness], fever [>100.5 degrees Fahrenheit and continues over 24 hours],
- Signs of an allergic reaction (breathing troubles [e.g. wheezing, shortness of breath], fainting, skin rash, hives).
- Sudden weight gain or fluid-accumulation (e.g. swollen legs or feet, shortness of breath).
- Chest pain/discomfort, or a rapid/irregular pulse.
- Any other unexpected side effects/symptoms.
What is a prognosis?
A prognosis is a prediction of an outcome or the likely course of a disease. For cancers, it is a prediction of the chance of the patient’s recovery or recurrence (return) of the cancer.
What factors affect a patient’s prognosis?
Factors that affect a patient’s prognosis include the type and location; stage (how far the cancer has spread); and the grade (how quickly the cancer is likely to move and spread and how abnormal the cancer cells look) of the cancer. Specifically for hematologic cancers (blood and/or bone marrow cancers), chromosomal abnormalities and abnormalities of patient’s complete blood count can affect a patient’s prognosis. Other factors include the patient’s age, overall health condition, and response to treatment.
How do statistics contribute to predicting a patient’s prognosis?
After carefully reviewing all factors that affect a patient’s prognosis, a physician will make a prognosis that is research-based statistics that have been collected over the years on people with cancer. When data is available, the physician uses statistics that are based on the population that is similar to the patient’s condition(s) or situation(s). It is very important to note however that these are general population-based numbers, and may not be reflective or accurate as to an individual patient's medical situation and prognosis. Commonly used statistics that are used to help with the prognosis include:
Survival statistics of a certain cancer (the survival rate of patients for a certain type and stage or cancer after period of time after their diagnosis).
The 5-year survival rate - discusses the number/percentage of people that survive at least 5 years after their diagnosis.
Disease-free or recurrence-free survival rates - indicates the patient’s time that he/she lives without the cancer/disease.
The survival rates of cancer patients are based on large populations and are not specific to a particular patient. Therefore, statistics is only a factor amongst many to help with the prognosis of treatment modalities. How a patient responds to treatment is based upon other factors involved. So it is a good reminder to all patients that prognosis is only a prediction and may or may not come true for an individual patient.
Is it helpful to know the prognosis?
Knowing a prognosis helps patients and loved ones to cope and plan better with the treatments of their choice and how they would like their care to be carried out. It also helps prepare patients for the many unknowns as knowing a prognosis helps ease the anxiety of not knowing the possible outcome. A prognosis might change as a condition changes. So again, the emphasis and planning and coping strategies for patients and loved ones are key points in knowing the prognosis. However, it is entirely up to the patient whether to seek out information about his/her prognosis.
What is the prognosis if a patient decides not to have treatment?
Everyone’s condition and situation differs. For the most part, cancer unfortunately does not stop growing without medical intervention. Once a cancer has spread to other organs of the body (metastatic or stage IV), it is rarely curable. The goal of treatment then is to prolong or preserve life as long as possible, and with as much dignity and quality of life as possible. The patient's concerns and decisions should be discussed with his/her physician regarding different treatment options or no treatment as a personal choice. Risks versus benefits for no treatment can then be explained by the healthcare provider to help the patient decide. For some cases, no treatment may be better than treatment based on the patient's prognosis, other concomitant medical problems, toxicities of treatment and quality of life.
What are clinical trials and how do I participate in one?
Clinical trials provide patients access to new therapies that are not yet approved by the FDA and readily available in the community.
What are my costs if I participate in a clinical trial?
Typically, it does not cost you more than what you would normally pay for standard therapy.