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Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Cancer and cancer treatments may decrease the effectiveness of the body’s natural defense, the immune system.1 Some types of chemotherapy may temporarily reduce the blood cells, including a type of white blood cell called neutrophils.2 These are responsible for fighting infection. If the neutrophils count drops significantly (neutropenia), the patient be at a greater risk for infections.3

Dexamethasone, a type of steroid medication, is commonly used in cancer treatment. It can also suppress the immune response. High doses and prolonged use of immunosuppressive drugs such as chemotherapy and dexamethasone increase the likelihood of developing an infection.4 Older adults and those who were in poor health before treatment or had poor nutrition are also at greater risk for infection.5 Some opportunistic infections are especially common in those undergoing treatment for cancer (e.g., shingles and yeast infections).6

Vocational implications

If the patient is receiving treatment that is known to pose a risk of infection, they should not work in close quarters with those who are sick, especially with contagious illnesses. Nor should they work in close contact with the public, especially at certain times of year (e.g., flu season). Patients at risk of infection should not handle human or animal waste. They need access to a washroom or to have hand sanitizers readily available to reduce infection risk.

What patients can do

Speak to your patient about the risk of infection and its signs and symptoms. Show them how to monitor for side effects of cancer and its treatment. Encourage your patient to contact their healthcare team or seek urgent medical care when they have concerns.

Signs of infection include:

  • fever (greater than 100.4° F or 38° C), chills or sweating
  • sore throat
  • shortness of breath and cough
  • painful or frequent urination
  • diarrhea
  • mouth sores
  • abdominal pain
  • redness or swelling at any wound, injury, or site of catheter or tube

One of the simplest and most effective ways to prevent infection is through frequent hand washing. Sometimes antibiotics are required to treat infections.

It is important to diagnose and treat infections as quickly as possible to prevent them from spreading into the bloodstream (sepsis), which may be fatal.

To lower risk of infection, encourage your patient to wash their hands frequently, avoid those who are sick, eat a nutritious diet, drink adequate fluids, exercise regularly, and get plenty of rest. Consult the BC Cancer Agency’s page on neutropenia for more information.

Job accommodations

There are several ways that jobs can be modified to lower the risk of infection:

Modify work tasks and schedules:

  • Work from home as much as possible.
  • Meet by telephone or video-conferencing instead of in person.
  • When possible, designate work materials and tools for the patient’s use only (e.g., phones, computers, heavy equipment).
  • Use personal hand sanitizer, disposable sanitizing wipes and disposable gloves when handling shared equipment is necessary.

Modify the work environment:

  • Relocate the workstation away from others to minimize exposure to germs.
  • Request hand sanitizer and antibacterial soap in all bathrooms and kitchens.
  • Request hand hygiene education for all staff.
  • Ask that the employer educate staff about the compromised immune systems of employees with cancer.
  • Request air-purification systems and proper ventilation to reduce air-borne illness.
  • Try to gain access to a private washroom.
  • Request a mini-fridge to keep the patient’s food and medication separate from that of their colleagues.

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