Wednesday, May 30, 2012

How to Follow My Blog (I Think!!)

I've been asked how to become a "follower" of my little blog.   Thanks for asking Mom!!! (just kidding)

Because I am techno-challenged, I asked my fabulous college aged niece Amy to tell me how difficult it is to do.

If you have Gmail, Yahoo, or Twitter, just go down to "Members" on the lower left of the blog and hit one button and apparently it will alert you when any new content comes on.

OR.....scroll all the way to the bottom of the blog, into the dark blue section. Enter your email address on the "Follow by email" block and hit submit. It will send a one time message to your email address to confirm that you are a follower. Then it will alert you when there is new content.

This way, you don't have to check everyday if there is nothing new on the blog. won't tell you if the content is any good, just that it is new!!! : )

Tuesday, May 22, 2012

May is Melanoma Month-Part II, "Research is Hope"

When I read this article from The Lancet today,  I literally started crying.  After a long drought and many warriors lives lost, there are finally some newer drugs in the metastatic melanoma arsenal that bring us hope!!! 

The hour is late, so I will post more on these later.  But Melanoma Warriors,  check out this article below!!!

Yes, I know that these drugs are not for everyone, but they are a great start.  And to all of  you out there....when they unlock the key for one subset of patients, let's hope the next subset is not far behind.

Vemurafenib, Ipilimumab and now Dabrafenib (early phase, but promising!!).  Have hope Melanoma patients!!!  Long ago I was at a Southwest Oncology Group Meeting and I heard someone say, "Research is Hope", and that is the truth.

One of the doctors mentioned in the article below was one of the co-chairs of the Southwest Oncology Group Melanoma Committee for 20 years.  Dr. Vernon Sondak.  A truly good person,  a great surgical oncologist, and a researcher who has been fighting the war on melanoma for many years with his other amazing co-chair Lawrence Flaherty, MD.  Two great men doing great work (and they both are unbelievably humorous to boot!!)

Hopefully we will be hearing a lot more about all of these drugs (and many other drugs and other types of cancer) when reports start coming out of ASCO in two weeks.

Here's The Lancet article:

Dabrafenib Safe in Melanoma With Brain Mets

For a second time this week, a study has shown the BRAF inhibitor dabrafenib to be active and safe in advanced melanoma, with positive results in patients with brain metastases.

In a phase I trial, dabrafenib treatment (150 mg twice daily) elicited responses in 69% (95% CI 51.9 to 83.7) and confirmed responses in 50% (95% CI 32.9 to 67.1) of 36 patients with the most common form of BRAF-mutated metastatic melanoma, reported Gerald Falchook, MD, from MD Anderson Cancer Center in Houston, and colleagues.

The patients in this study carried the BRAF mutation Val600Glu, which is the substitution of valine with glutamic acid at amino acid position 600. This mutation locks in BRAF activity, making it at least 10 times more active than wild-type BRAF, the authors explained in The Lancet.

Earlier this week, results were released from another trial that combined dabrafenib with the MEK inhibitor trametinib, and demonstrated an acceptable safety profile and objective responses in patients with metastatic melanoma.

In addition to responses across all patients in the Falchook trial, dabrafenib showed efficacy in melanoma patients with untreated brain metastases, with nine of 10 patients demonstrating a reduction in the size of brain lesions and four experiencing complete resolution.

"This finding is impressive for two reasons," explained Geoffrey Gibney, MD, and Vernon Sondak, MD, in an accompanying Lancet commentary.

"No previous systemic treatment has shown this degree of clinical activity against melanoma brain metastases, and dabrafenib was not predicted to cross the blood-brain barrier in substantial quantities," wrote Gibney and Sondak, who are from the H. Lee Moffit Cancer Center and Research Institute in Tampa, Fla.

Patients with metastatic melanoma have a median overall survival of 9 to 11 months and those with brain metastases fare even worse, with a median survival of 4 to 5 months. Systemic treatments are not effective in these patients and they have been excluded from previous trials of other BRAF inhibitors, such as vemurafenib (Zelboraf).

The current dabrafenib dose-escalation study took place between 2009 and 2012 at eight centers in the U.S. and Australia. The authors enrolled 156 patients with incurable solid tumors including metastatic melanoma, melanoma with asymptomatic, untreated brain metastases, and nonmelanoma solid tumors.

Among melanoma patients without brain metastases, 75% carried Val600Glu BRAF mutations while 25% had the less common Val600Lys (lysine) mutation. Among patients with brain metastases, 90% had Val600Glu mutations and 10% had Val600Lys mutations.

"We deliberately enriched for patients with non-Val600Glu BRAF-mutant metastatic melanoma and are the first, as far as we are aware, to report progression-free survival in this group," the authors wrote.

They began with a dose of oral dabrafenib at 12 mg daily in a 21-day cycle. The dosage was escalated up to 300 mg twice daily. On the basis of pharmacokinetic and response data, they chose 150 mg twice daily as the phase II dose.

Among 27 patients with Val600Glu BRAF-mutant melanoma, 78% (95% CI 57.7 to 91.4) responded to treatment and 56% (95% CI 35.3 to 74.5) had confirmed responses. Among 18 patients with Val600Lys mutant melanoma, 22% (95% CI 6.4 to 47.6) responded to treatment.

In all cases of Val600 BRAF-mutant melanoma, the responses were durable, with 47% remaining on treatment for more than 6 months.

The median progression-free survival (PFS) for patients with brain metastases was 4.2 months (95% CI 3.3 to 5.3). While this result is impressive, Gibney and Sondak pointed out that the PFS was longer for those who only had active extracranial disease, at 5.5 months (95% CI 4.1 to 8.3).

In patients with BRAF-mutant nonmelanoma tumors, anti-tumor activity was seen in gastrointestinal stromal tumors, papillary thyroid cancers, and non-small cell lung cancer (NSCLC), as well as ovarian and colorectal cancers, the authors stated.

At all doses, the most common grade 2 or higher treatment-related adverse events were cutaneous squamous-cell carcinoma or keratoacanthoma, fatigue, and fever. Squamous-cell carcinoma was seen in 11% of patients given 50 mg or more of dabrafenib twice daily, with a median onset of 67 days. Treatment-related fever of any grade was seen in 20% of the participants with a median onset of 31 days.

The authors stressed that there were no cases of photosensitivity, which is commonly reported with vemurafenib. Again, the result is laudable, Gibney and Sondak noted, but dabrafenib did seem to cause more fever compared with vemurafenib.

Falchook and colleagues acknowledged that their study was limited by sample size, as is the case with most phase I trials. Larger studies that includes patients with non-Val600Glu mutant melanoma, as well as those with melanoma brain metastases, will give more accurate estimates of dabrafenib's anti-tumor activity, they said.

There currently are two trials in the works with dabrafenib in melanoma: a phase II study in patients with asymptomatic brain metastases and a phase III randomized, controlled trial of dabrafenib compared with dacarbazine (Dtic-Dome).

The study was funded by GlaxoSmithKline (GSK).
Many of the study authors reported financial relationships with GSK, Roche, Merck, Sharp and Dohme, Pfizer, Genentech, Bristol-Myers Squibb, Arqule, the Cancer Council Trials, and Sir Charles Gairdner Hospital.
Some of the study authors are past or present employees of GSK and hold stock options.
The editorialists declared no conflicts of interest.

Monday, May 21, 2012

There's a Fungus Among Us (Toenails)

Toenails.   I am absolutely not expecting a large readership with this post!!  

Certain chemotherapies can affect your fingernails and toenails.  The Taxanes:  Taxol (Paclitaxel),  Taxotere (Docetaxel) are notorious for doing this.  Also the Anthracyclines:  Adriamycin (Doxorubicin) and Doxil (Liposomal Doxorubicin), Epirubicin, Daunorubicin.  There are other chemotherapies that can affect your nails, but these are the main ones that I work with.

Chemo can cause the nails to lift, become dry, brittle, cracked, ridged or fall off altogether.

In many of my patients (particularly my African American patients), the nails can look blackened.  Do you know when you slam your finger in a door or hit your nailbed with a hammer by mistake?  That is the way the nails can look.  The discoloration can also be a yellow color, or sometimes bright white.


You know how you can tell the age of a tree by looking at a cross section of the tree trunk?   Sometimes the fingernail of a cancer patient getting chemo can resemble this with layers of different dark lines alternating with yellow or white lines.   Some people swear that they can count the cycles of chemo by looking at their fingernails.

What to do?  Not much.  Wait for them to grow out.

In the meantime:

Keep your nails clean and your hands and feet lathered up with lotion.  Try to avoid dry cracked skin as that is an entry for bacteria.

Avoid nail wraps or fake nails.  These can trap bacteria or fungus behind them.

A lot of websites will say no to nail polish.  We understand that if your nails are blackened that you might want to cover them with polish.  We get it.  If  you do use polish, make sure that you are changing it frequently and do a good hand/foot soak and cleaning in between. 

Bring your own nail kit to the salon if you are having your nails done professionally.  Make sure it is a CLEAN place.  Watch them when they finish with your nails and make sure they are cleaning their equipment adequately.  Take your own nail kit home and clean the hell out of it.

Also, schedule your pedicure or manicure appointment for a time when you know your white blood cell count is up.  Don't schedule it around the time of your nadir (when your white blood cell counts are low, typically 7 to 10 days after chemo).

Try to wear a shoe with a widened area at the toe. No pointy toe-shoes!! 

I've had several patients who were runners. When they ran their nails jammed or pounded against their sneaker. Several of them lost most of their toenails.   I've seen this happen with one of my ladies who loved wearing pointy toed high heels too.

Keep toenails clean and dry to avoid getting a fungus. 

Make sure you wear flip flops in the locker room at your health spa or pool area.  Bacteria loves moisture and you can pick up some prime fungus if you are strolling around in bare feet here.

Wear gloves when using harsh detergents or cleaning products.  Also, always wear gloves while gardening.  This is especially true for you breast cancer survivors for lymphedema purposes too.

Some people swear by "cryotherapy" which is cold therapy.  They leave their nails soaking in cold liquid/water while their chemo is infusing.  This is based on the same theory of sucking on ice chips during chemo to prevent mouth sores, and the cryotherapy to the scalp to prevent hair loss.

If you lose a nail, keep the toenail bed as clean as possible.  Bacitracin or aquaphor with a dry bandaid over it to protect it.  Let your doctor know if you are having any drainage from your toenail area as this would be a sign of possible infection.

The good news?  The nail funk is temporary.  When chemo is over your nails will grow out until there is no discoloration left.

The bad news?   Of all of the side effects of chemo, this one takes the longest to "get back to normal" because nails are slow growing.

Here are two products to ask your oncologist about.  They are nailpolishes that have an "anti-fungal" substance right in them.  The goal is to prevent a nail fungus. 

DaniPro polish was supposedly invented by a podiatrist.  The nail polish is infused with Undecylenic Acid, a fungicide for skin.

I can't figure out if this would be beneficial to use at certain times during chemo (but not all the time), or not.  So, I am turfing this one back to you to ask your doctor about.  Because it is non prescription, it must be a very low level of whatever this stuff is, but still best to get it cleared by your MD.

If any of you have used these nail products, please let me know and I will update the blog!

Another nail polish supposedly created by podiatrists...
Dr.'s Remedy Enriched, Antifungal, Non-Toxic Nail Polish

Here's hoping that when chemo is over, you get your "Happy Feet" back!!!

Nail pictures:;year=2010;volume=42;issue=4;spage=243;epage=244;aulast=Kumar

Sunday, May 20, 2012

May is Melanoma Month

I hate melanoma. It is probably one of my most hated cancers. I have seen what stage IV melanoma can do. My advice? Do everything you can do to prevent getting it.

My favorite website for all things melanoma is Mike's Page. The founder of this website is Pete Tustison. He lists almost every resource you could imagine about melanoma on this website. He lost his son to melanoma and devotes his life to keeping this website updated for people to learn about melanoma. He also is responsible for running a list serve for melanoma survivors to contact each other. He is a truly great man. I encourage anyone who has melanoma or wants to know about melanoma to visit his website.

Most of the information you read below has come from these 3 resources.


"Melanoma = Melanocytes Gone South”…… Pete Tustison 

Melanocytes are cells located in the epidermis (outer layer of skin) that are responsible for producing melanin, a brown pigment that helps screen against the harmful effects of Ultraviolet light.

Melanocytes produce pigment producing melanin. Melanin is what protects you from damage due to excessive exposure to the sun and tanning beds. You know what? Excessive exposure to the sun, i.e. sunburns, etc. and tanning beds can damage those cells causing them to become malignant even years down the road.

If caught in the earliest stages, melanoma is entirely treatable with a great survival rate. If untreated and allowed to spread, there is no known cure at present (Although there are 2 new drugs on the scene now that give us hope for the first time in years in the fight against melanoma).

It begins in the skin cells which produce the dark protective pigment called melanin. Melanoma cells usually continue to produce melanin. This is why can appear in mixed shades of tan, brown and black.

Facts about Melanoma:

·         It has a tendency to spread quickly. It is also sneaky. Can return years later.

·         Melanomas may turn red, blue or white and they also might crust and bleed.

·         In women, melanomas commonly occur on the arms and legs, while in men they may develop on the back.

·         Most start on a pigmented patch such as a mole or a freckle. Watch out for itchiness or change in the size, height, shape, color, texture, or sensation of a mole.

·         In a survey by the Center for Disease Control, 74% of young adults and 50% of older adults said that they had little or no knowledge about melanoma.

·         Melanoma is linked to excessive sun exposure in the first 10 to 19 years of life. During these years almost 80 percent of a person's lifetime sun exposure occurs, according to the American Academy of Dermatology.


Factors Known to Increase Risk:

·         Family History of malignant melanoma
·         Skin type and color
·         ³3 blistering sunburns before age 20
·         Outdoor summer jobs for ³3 years in adolescent years
·         Use of sunlamps, tanning beds
·         Actinic keratosis (“sun spots”)
·         Large amounts of freckling on upper back
·         Large number of normal nevi (moles)
·         Atypical nevi (unusual moles)
·         Congenital giant nevi (birthmarks that are larger than 20cm)
·         Each risk factor increases risk additively

Warning signs of skin cancer....catch it early!!

·         A skin abnormality that increases in size and appears multicolored, pink, red, black, brown, tan, pearly, translucent, or tan.

·         A mole that changes color, textures, grows, becomes irregular in shape, or that is bigger than a pencil eraser.

·         A spot or growth that continually itches, hurts, becomes crusty, scabs, or bleeds.

·         An open sore that does not heal after 4 weeks or one that heals and reopens. Regular skin self-exams could save an estimated 4,500 lives annually. Anytime you are concerned about a growth or spot on your skin, it is best to seek the advice of your physician or a dermatologist.

Years ago, a representative from the Schering-Plough Company gave me these slides.  There are some great pictures of melanotic lesions on them. 

Don't let it grow to resemble something like these pictures:

No Matter What the Signs Say it is Not Safe to use Tanning Beds!!!

·         People 35 or younger who used the beds regularly had a melanoma risk eight-fold higher than people who never used tanning beds.

·         Even occasional use among that age group almost tripled the chances of developing melanoma.

·         Lights used in tanning beds and sun lamps give off mainly ultraviolet-A (UVA) radiation, according to the study. UVA was classified as a probable human cancer-causing agent by the International Agency for Cancer Research (IARC) in 1992, according to the Swedish study. IARC is a part of the World Health Organization.

·         "They may think that a 'base' tan will protect them from skin cancer, but in reality, the lights just act as a radiation multiplier, further increasing their skin cancer risk," Dr. Weinstock says.


You need to be especially careful in the sun if you:

·         have lots of moles, irregular moles, or large moles
·         were previously treated for skin cancer
·         work indoors all week and then get a tan on weekends
·         live or vacation in tropical or subtropical climates
·         have freckles and burn before tanning
·         have fair skin; or blond, red, or light brown hair
·         have a family history of skin cancer, especially melanoma
·         live or vacation at high altitudes (ultraviolet radiation from the sun increases 4% to 5% for every 1,000 feet above sea level)
·         spend a lot of time outdoors
·         have had an organ transplant
·         have certain diseases, such as Lupus
·         take tetracycline, sulfa drugs and some other antibiotics
·         have had chemotherapy  
·         take naproxen sodium and some other nonsteroidal anti-inflammatory drugs

How to Protect Yourself:

Australia is the country with the highest rate of skin cancer in the world.  They have a great campaign that they start with young children to prevent skin cancer.  It is the "Slip-Slop-Slap" Campaign. “Slip on a shirt, slop on sunscreen (SPF 30+ waterproof and keep reapplying every 2 hours!!), and slap on a hat"

Wear a hat!

Wear UV Sunglasses!!!

My favorite sunscreens:

I first tried Planter's sunscreen in Italy and it was fantastic.  It doesn't have that sunscreen "smell" that you often get.  I'm not sure if you can buy it in the U.S. or not.  If you live in Italy, please send me some and I'll mail you the cash!!!!  Love it.
My fab niece introduced me to this Neutrogena sunblock in New Orleans.  No bad smell, very light and works great.

Be mindful. The highest level of ultraviolet rays: 10 a.m. to 4 pm.

Yearly Dermatology visit if you have a lot of moles and are fair skinned.

Dermatology Visit if you notice a suspicious skin lesion that changes. Don’t just listen to your PCP.

Mole or skin mapping if available

Check your own skin or have someone else check it for you (makes a great pickup line!!)

Stay out of tanning salons!!!

Website for UV protectant clothing (search the web, there are quite a few of these):

One more should also be mindful to check your toenails and fingernails.  A black streak or blackened nailbed that looks like it has been injured can be a sign of melanoma under the nail.  This is also called subungual melanoma.  The fingernail on the far left is classic.  Check out your nails.  If you use polish, give them a good eyeballing when they change your polish.

Sunday, May 13, 2012

SAMFund Grant Period Opens Soon!!

Update 2015:

Just passing this info on to all young survivors.....

Important information about the
2015 SAMFund grants cycle


The SAMFund’s 2015 grant cycle is opening soon!
A link to Part I of the application will be posted on the Sam Fund website from May 27, 2015 until June 19, 2015. For more information about the 2015 application, please join us on May 14, 2015 at 3pm EST for a free Webinar.

As you probably already know, The SAMFund awards financial assistance annually to young adult survivors who are struggling to get back on their feet after cancer treatment. Our grants cover a wide range of needs, including medical expenses, living expenses, insurance premiums, family building costs and much more. Applicants must be between the ages of 17 and 35, finished with active treatment and residents of the United States.

When Part I is posted on our website, you'll also see links to Frequently Asked Questions as well as the Categories of Funding for this year's application. Please encourage everyone to take a few minutes to read through both of these documents carefully. Every year we are swamped with emails and phone calls from applicants, and we want to make sure that everyone's questions get answered on time -- we've put a lot of effort into making these two documents thorough so that they are as helpful to applicants as possible.

Thanks in advance for your help in getting the word out. We're excited to open up our annual grants cycle next month!

Sam, Michelle and everyone at The SAMFund

"Darling, Haven't You Ever Heard of a Delightful Little Thing Called Boarding School? " (Neutropenia Part II)

"Darling, haven't you ever heard of a delightful little thing called boarding school? "


In my post about low white blood cell counts,  I blathered on about neutropenia, fevers, and when you should come to the hospital if you are a cancer patient.  Many cancer patients will become neutropenic, but won't develop a fever and won't have to be admitted to the hospital.   Most likely you will get neutropenic, you'll observe precautions to keep you safe, and your bone marrow /white blood cell counts will come back on their  own in their own good time.  Or, if you are on Neulasta or Neupogen (growth factors that increase the production of white blood cells) they will come back a little more quickly due to the boost from those drugs.

As nurses, we get asked all the time, "Isn't there something I can eat or do to help my white blood cell counts (or red  blood cells, platelets) to come back more quickly? "  Not really.  Our best advice to you is to maintain a well balanced diet, drink plenty of fluids and follow the basic neutropenic guidelines for cancer patients undergoing chemotherapy listed below.

Try to stay away from people who are sick.  Sounds silly and obvious, right?  If you can possibly get out of going to that town meeting or concert in the middle of cold and flu season, do it.  If your aunt has a cold, postpone that lunch you had planned until your counts are higher and your aunt has recovered.  If everyone is hacking and coughing in the waiting room at  your doctor's office?   Put on a mask (ask  your nurse for a small stack of these for  your purse).   

Avoid air travel if you possibly can (or wear a mask if you have to fly) when your counts are low.  Do you have friends who are sick who want to come and visit you?  Tell them that you would rather visit by phone until they have recovered.  If you need to, designate a family "sentry" who will speak to them, drive that message home, and hold them off at the door.

Have kids?  Clearly this is easier said than done.  If you are a parent (especially with young children) you can't just schlepp the kids off to boarding school as my idol  Baroness Schraeder from The Sound of Music would suggest!  (Although you may want to!!)

If you have kids in your life, they will come home with germs and every cold and flu symptom under the sun.  When your neutrophils are low, you will be susceptible to get every single new infectious process that your kids (or grandkids) bring home to you.

What can you do?  Well, you may not be able to banish your own kids from your home, but you can keep their sick friends away when your counts are low.   Keeping the cancer patient safe and as germ free as possible should be a family goal.  It might take a lot of teaching and a lot of reinforcement until this becomes a reality.  I suggest starting your handwashing family campaign on the very first day of chemotherapy.   

Tell your family that the very best thing that they can do to help you is to wash their hands. Good handwashing (by everyone, no matter what age they are) is the number one way to fight the spread of germs.   If your kids don't listen to you, have your doctor or nurse drive this point home to them. Good handwashing is still the best prevention. When I say good, I don't mean the 2 second "splash and wave" under the faucet. I'm talking soap, hot water, lots of friction and hand movement for several minutes.

How many bathrooms does the house have? If the home has 2 bathrooms, "banish" the kids to the other bathroom so that the cancer patient doesn't have to share with them.

Hand sanitizer should be used when you are unable to wash your hands with water. It should be considered "in addition to" good handwashing, but shouldn't replace it.  Keep small bottles of hand sanitizer in your purse, car, or anywhere handy. Get a stash of them going. Everyone in the family should do the same.

However, don't use hand sanitizer a thousand times a day. The reason why teenagers are drinking hand sanitizer now?  Most brands are loaded with alcohol. Products with alcohol tend to dry you out. If you use hand sanitizers with alcohol too much, they can dry out your hands and cause cracks in your skin. This is a portal for possible germ entry.

Same thing goes for mouthwash. Most mouthwashes have a high percentage of alcohol in them. They can dry out your mouth and potentially cause cracks or sores on your lips or in the lining of your mouth. Use Biotene or another alcohol free mouthwash. Use baking soda and saline mouth rinses four times daily. Keep your lips slathered with Aquaphor or Chapstick (or whatever your brand of choice happens to be).

Whether it is a crack in your skin, a mouth sore, a cut, a wound. Any break or crack in the skin's surface or your mucosal lining is a potential entry point for bacteria. So, just be mindful of this.

Are you someone who loves to garden?  Always wear gloves and wash  your hands afterwards.

If you are constipated, take a stool softener. Straining to have a bowel movement can cause tiny rectal tears which could be an entry point for bacteria. No rectal temperatures.

Use lubrication if you are having sex, as women can get tears in the vaginal lining which can also become an entry site for bacteria.

Use paper towels or those new "disposable towels" for handwashing. Absolutely no sharing of towels. Those little hand towels that everyone uses in the guest bathrooms? NO. Towels should be just for the cancer patient and should be on a separate rack from everyone else's. Also wash them frequently in good hot water.

Toothpaste and toothbrush need to be put in a medicine cabinet or as far away from the toilet as possible. If they have one of those Sonic Care electric toothbrushes, a nice gift would be a new one with that "autoclave" feature....UV sanitizer, that's it. 

FAMILY TOOTHBRUSHES SHOULD NOT BE KEPT NEXT TO EACH OTHER in one of those old cup holder/toothbrush dispensers. If you use a manual toothbrush (aka the "old school" kind) get one of those little plastic caps to keep the bristles covered.  

While we are on the subject of teeth, if you are getting chemo, don't go to a dentist unless you tell your oncologist. Cleanings should be "gentle cleanings" and dentists need to be aware that you are receiving chemo.  Dentist appointments should not be scheduled during your nadir (the time of your chemo cycle when your counts are the lowest).  

Have your kids help cleaning the bathrooms and the kitchens.  They should be spit shining them!!!  Let them feel like they are helping you.   NO MOLD. NO MOLD. NO MOLD. They need some serious cleaning going on and they need to maintain it .

Other suggestions for family members? Remind them that the very best way that they can help is to clean up after themselves, good handwashing, pots and pan cycle settings on dishwasher. Sometimes patients designate particular glasses as "their own".

A really nice thing to do for your friend with cancer,  would be to grab some friends and chip in for a professional maid/cleaning service to come in once a month for a few months. Even just a one time heavy duty cleaning would help. The cancer patient should be out of the house the day they come in, if possible, as they will be stirring dust up. 

Pets: If the cancer patient has a cat, someone else needs to take over litter box duty. Someone else should do "pooper scooper" duty if they have a dog. Same thing if they have a bird. You can get toxoplasmosis ( a type of infection) from cat boxes and bird cages. They should also use hand sanitizer or wash their hands after they pet the cat or dog.

Diet: there will be more about the neutropenic diet in a later post. Cook meats thoroughly. Single servings. If you have to eat out, make sure that you know that the kitchen is clean in a trusted restaurant. Avoid the salad bar at your local restaurant like the plague. Food that sits out, that multiple people are touching or coughing on is bad news.

No one wants the cancer patient living inside a bubble. As long as patients and families are using good handwashing techniques, common sense, and some of the advice above, you should be fine.