Michelle --

Uou should meet with teh CCC's nutritionist (you and your mother, that is) and get some advice and instructions on daily caloric and fluid intake. Keep a log and make sure she is taking in enough. If she hets too debilitated they may have to stop treatment which can reduce efficacy.

Ask bluntly about whether they think she should have a PEG -- many CCC's virtually insist on these, others tend to see how things go. Usually if a certain percent of pre-treatment weight is lost, then the patient is encouraged to have the stomach tube. Ceraunly with an older person the risk of debilitation is greater. However it is also important to try and continue to swallow as much as possible throughout.

Also, meet with the radiation oncology nurses and get alerted to what "red flags" you need to watch for -- signs of thrush, mucositis, etc. -- and what can be done to ameliorate these problems.

Your RO nurse and your nutritionist are the most important CCC people with whom to interact, as well as the RO doctor -- do not be afraid to call on them and to ask the hard questions. Usually the RO will meet with you at least once a week -- at Hopkins we also saw RO nurse almost daily and the nutritionist once a week and more often if needed.

Gail