Download Coping with Chemotherapy

Coping with Chemotherapy
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Chemotherapy Is an Individual Experience
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It is important to realize that every person experiences chemotherapy differently, both physically
and emotionally. As the science for treating cancer has advanced, so has the science to manage treatment side effects. Each person experiences side effects from chemotherapy differently, and different
chemotherapy drugs cause different side effects. Whatever you experience, remember there is no
relationship between how the chemotherapy makes you feel and whether you derive benefit from your
chemotherapy. Many people feel fine for the first few hours following chemotherapy treatment. Usually some reaction occurs about 4-6 hours later. However, some people experience little reaction until 12
or even 24 – 48 hours after treatment. Some people experience almost all of the side effects described
below, while others experience almost no side effects.
We have many treatments to help you deal with side effects. Please let us know how you are feeling, so
we can address your concerns and help to make you more comfortable.
Your well being is very important to us. There is a delicate balance between the benefits of chemotherapy and the harms of possible side effects. It’s important for you to voice your concerns with your
doctor if you feel that the harms outweigh the benefits.
Before Starting Chemotherapy
Before starting chemotherapy we suggest that you take care of some of your basic health care needs. If
time permits, we suggest that you have your teeth cleaned. If you need major dental work, try to
postpone it until after chemotherapy. If you need your teeth cleaned while receiving chemotherapy,
please let your practitioner know beforehand. Please discuss any concerns with your practitioner.
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Emotional Support
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If you’d like, you can have a family member, friend, or support person accompany you to your chemotherapy sessions.
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We recognize that cancer has an impact on you as a whole person and also on your family and loved
ones. To varying degrees, all people with cancer struggle with the challenges of coping and adjusting to
these life changes. At the Cancer Center, we have a number of programs to support you through the
process, such as the Peer Support Program, support groups, and individual counseling that are available to all cancer patients. To obtain more information, please stop by the Cancer Resource Center
located on the first floor of 1600 Divisadero Street, or call (415) 885-3693.
Fever and Infection
Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are
made in the bone marrow and help fight against infection. Neutrophils are one type of the WBCs that
fight infection. Often the neutrophil count will determine whether or not you will receive chemotherapy on schedule. A fever of 101° F (38.3° C), or chills with or without a fever, can be a serious sign
of infection. You must call your oncologist should this occur even if you experience these symptoms
at night or on the weekend.
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PRACTICAL HINTS REGARDING FEVER & INFECTION
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An infection is most likely to occur when your WBCs or neutrophil count is low. You are most susceptible to a bacterial infection about 7 – 12 days after your chemotherapy infusion. Most bacterial infections occur as a result of your body’s inability to fight off normal bacteria present in your gastrointestinal tract or skin. Bacterial infections do not commonly occur as a result of being in a crowded place. So,
if you are feeling well, we encourage you to continue to go out to the movies or out for a meal. However, viral infections such as cold and flu are common and are transmitted easily. To reduce your chance
of infection, wash your hands frequently and avoid close contact with anyone who is ill during
this time.
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• If you have a fever of 101°F (38.3°C), with or without chills, call your care provider
immediately. If you cannot reach your oncologist, go to an emergency room.
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• Keep a thermometer in your home and know how to take your temperature in the following
manner: Do not eat, drink or smoke for 10 minutes before taking your temperature. Leave the
thermometer under your tongue for three minutes. If you are still unsure of how to take your
temperature, ask your care provider.
• Call your care provider as soon as possible if you develop a cough, sore throat, pain or burning
when you urinate.
• To help prevent infection, we encourage frequent hand washing with soap and water.
• Avoid rectal intercourse, tampons, douches, enemas, and rectal thermometers.
• Do not eat raw food such as sushi and sashimi, Caesar salad or milk shakes made with raw
eggs until you complete chemotherapy and your blood counts have returned to adequate levels.
Raw foods may carry bacteria that can lead to infection. Make sure to thoroughly wash any
fruits and vegetables.
• Wash hands and cutting boards well after food preparation.
• Always tell your doctor before going to the dentist.
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The table below will help you understand your temperature in both Fahrenheit and Centigrade:
Fahrenheit
98.6°
99°
100°
101°
102°
Centigrade
37°
37.2°
37.8°
38.3°
38.9°
*Remember, always call your physician with a temperature of 101°F or 38.3°C
Flu-Like Symptoms
Around the third day following a chemotherapy treatment, some people may experience flu-like
symptoms such as muscle aches and pains. If you experience these aches, you can take over-thecounter medications that you regularly use, such as Tylenol® or Advil®. You should contact your
doctor for stronger medication, if necessary.
Nausea
Medications called anti-emetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are
available, and your provider will recommend what is expected to work best for you.
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If possible, it would be a good idea to have your prescriptions filled before your treatment day.
Please call your practitioner if your medications do not give you adequate relief or if you experience
side effects with the anti-nausea medication.
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PRACTICAL HINTS FOR NAUSEA
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• Before your chemotherapy appointment, eat a small, light meal. Most people do better if they
have something in their stomach.
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• Eat what sounds good to you. Generally starches such as rice, bread, potatoes, hot cereals and
puddings are well tolerated.
• Try not to skip meals. An empty stomach will worsen all symptoms. If you don’t feel like
sitting down to a meal, try nibbling on something that appeals to you.
• Drink plenty of fluids. Herbal teas, water, “sports drinks” and diluted juices are recommended
more than soda.
• Avoid smells that are unappealing.
• Freeze meals so that you don’t have to cook. Ask your family and friends to help with meals,
especially following chemotherapy when you are most likely to feel nauseous.
• Schedule a free appointment with the dietitian by calling (415) 885-3693 for more practical tips
on dealing with nausea.
Fatigue
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Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with
more cycles of chemotherapy. Most people have to make some adjustment in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. As much as you can
maintain your everyday activities – do. It can be very beneficial to you both physically and emotionally.
Remember that the fatigue will go away after you recover from chemotherapy.
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The Cancer Resource Center also hosts monthly Fatigue Management workshops to address these
concerns. For more information, call (415) 885-3693.
PRACTICAL HINTS FOR FATIGUE
• Plan your activities, such as grocery shopping, for a time when you feel the best.
• If you have children, rest when they are napping. When you feel most tired, consider hiring a
baby-sitter for a few hours so that you can relax or take a nap.
• Take naps early in the day so you do not disturb your sleep pattern at night.
• Consider exercising everyday or several times a week. Good forms of exercise include
swimming, walking and yoga. Call the Cancer Resource Center for information on free exercise
classes, (415) 885-3693.
Hair Loss
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Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all
chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect. Most
often, hair loss begins about 2 – 3 weeks after starting chemotherapy. Some people will lose relatively
little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body
hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover
your head at all. Do what makes you feel most comfortable. Many people choose different head coverings for different situations. We have many resources to assist you during this time, including the
Friend to Friend Gift Shop and the Look Good... Feel Better! program. Please visit the Cancer Resource
Center on the first floor of 1600 Divisadero Street for additional referrals and resources to wig and head
covering boutiques.
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If you decide to buy a wig, it is helpful to buy one while you still have your own hair, because you can
better match color and style. You may want to ask your physician for a prescription for a “cranial
prosthesis” (i.e., wig), as some insurance companies will only pay for a wig with a prescription for a
“cranial prosthesis”.
Your hair will begin to grow back after you stop chemotherapy. It usually takes from 2 – 3 months to
see the change from no hair to some hair. Your new hair may be slightly different in color and texture
than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its
original texture after some time.
PRACTICAL HINTS FOR HAIR LOSS
• It is not always necessary to buy a real wig. Synthetic wigs can look as good and are less
expensive, easier to care for, lighter in weight and may be more comfortable to wear.
• Before possible hair loss, some people like to cut their hair short. The hair loss won’t be quite so
shocking if there is less hair to lose.
• Put a towel over your pillow so that clean up in the morning will be easier while you are
shedding your hair.
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• Buy a drain catch for your shower. Other people choose to shave their head hair when
hair loss begins.
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• Refer to our wig information sheet for places to shop near you.
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• Refer to the Friend to Friend Gift Shop or the Cancer Resource Center for more information.
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• When buying a wig, take a friend for emotional support and maybe even a laugh!
Appetite and Taste Changes
During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to
odors. Do not worry if you don’t have an appetite the first few days or a week following chemotherapy; it is not unusual, and as you feel better your appetite will improve. Reflux, burping, or a
burning sensation may worsen nausea. Please report these symptoms to your physician or nurse so that
they can be treated. You may find that you can tolerate only certain foods. We encourage you to eat
what appeals to you during this time, and to drink enough fluids (8 – 10 eight-ounce glasses per day;
more if you have a fever or diarrhea). Recommendations for healthy nutrition include a diet low in fat
(<20%) and high in whole grains, fruits and vegetables, and plant based proteins. Some people want to
begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed.
Some people prefer small, slow changes, while others benefit from a “major overhaul”. Regardless of
what is best for you, we encourage you to become informed and make healthy dietary and lifestyle
changes.
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Many people gain weight while on chemotherapy for reasons that are not well understood. Again, if
you have concerns about nutrition, please consult our staff dietitian at (415) 885-3693.
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PRACTICAL HINTS FOR TASTE AND APPETITE CHANGES
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• Eat what appeals to you during this time.
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• Eat foods that are warm rather than hot.
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• Avoid places where food is being cooked (for example, the kitchen at dinnertime).
• Avoid smells that are unappealing.
• To try drink 8-10 glasses of fluid a day.
Diarrhea or Constipation
Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24
hours, or blood in your stool, call your care provider. Do NOT use over the counter anti-diarrhea
medications like Immodium® unless advised to do so by your physician or nurse.
Some chemotherapy drugs, and some of the drugs we give to prevent nausea can cause constipation.
Also, you may be more prone to constipation because your activity level and diet have changed. If you
experience constipation, contact your care provider the same day.
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PRACTICAL HINTS FOR CONSTIPATION
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• To help prevent constipation try drinking 8 – 10 glasses of fluid a day.
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• Take a stool softener (not a laxative) such as ducosate sodium (DSS), also known as Colace®,
one tablet once or twice a day. Senekot® or Senekot-S® may also be suggested. Ask your
practitioner for a recommendation.
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• Stay as active as you can, as consistent regular exercise can reduce constipation.
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• If you can tolerate them, try high fiber foods: prunes, bran, fruits and vegetables.
PRACTICAL HINTS FOR DIARRHEA
• To replenish lost fluids, drink 8 – 10 eight-ounce glasses of decaffeinated fluids per day.
• If your rectum is sore, use soft toilet paper and A&D® ointment (used for diaper rash in infants)
or Anusol® which can help numb the rectum and soothe soreness.
Mouth Sores
Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth
sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such
as those that line your mouth and esophagus. Please call your practitioner should you develop painful
mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed for your use.
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PRACTICAL HINTS FOR MOUTH SORES
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• Brush your teeth with a soft toothbrush 3 times daily.
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• Rinse your mouth with a solution of 1 teaspoon baking soda and 1 teaspoon of salt, diluted in a
glass of lukewarm water 3 – 4 times daily.
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• Most commercial mouthwashes contain alcohol. You can ask your health care provider about
mouthwashes that are not irritating to your mouth.
• Ulcer-ease® is a commercial product that may provide temporary relief from sores.
Neuropathy
Neuropathy, which literally means “disease or dysfunction of the nerves”, can happen to some people.
Some of the most common symptoms of the type of neuropathy caused by chemotherapy include:
tingling and burning, numbness or pain in the affected areas, loss of your sense of position (knowing
where a body part is without looking at it), and loss of balance. The most commonly affected areas are
the tips of fingers and toes, although other areas are sometimes affected as well.
Tell your doctor about any symptoms that you may be experiencing. Early detection and treatment are
the best way to control your symptoms and keep from further nerve damage.
PRACTICAL HINTS REGARDING NEUROPATHY
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• Tight shoes and socks can worsen pain and tingling, and may lead to sores that won’t heal.
Wear soft, loose cotton socks and padded shoes.
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• If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice
a day.
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• Massage your hands and feet (or have someone massage them for you) to improve circulation,
stimulate nerves and temporarily relieve pain.
Menopause
For women, chemotherapy may cause temporary stopping of your periods or permanent menopause.
The effects depend on the type of chemotherapy administered, your age and how close you are to
naturally occurring menopause. With menopause, you may experience symptoms such as hot flashes,
decreased libido, vaginal dryness, mood changes and sleeping disturbances. If you experience any of
these symptoms, talk to your health care provider so that you can get information and possible treatment for some of the symptoms mentioned.
If your periods continue during treatment they will likely change in duration, flow and regularity. The
changes may be temporary, lasting only while on chemotherapy, or the changes may eventually lead to
menopause.
PRACTICAL HINTS FOR MENOPAUSAL SYMPTOMS
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• If you have breast cancer we DO NOT recommend taking hormone replacement therapy.
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• Eat soy products or take vitamin E (400 IU only) to reduce hot flashes.
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• There are prescription medications that your practitioner may recommend for hot flashes.
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• Wear light cotton pajamas to help prevent overheating when sleeping.
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• Try vaginal moisturizers on a regular basis or other water based lubricants as needed, especially
during and before sexual activity. These products will help with vaginal dryness and irritation.
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• Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.
• There are prescription medications that give a local dose of estrogen to the tissues in the vagina
to treat vaginal dryness.
Questions and Concerns
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Please remember that we are here to make this time less difficult for you. Please call us with any
questions or concerns, so that we may be of help to you. Staff will take your message and your nurse
or physician will call you back. Please allow two days notice for medication refill. If your call is urgent,
please tell us immediately when you call.
For additional information or resources, please visit the Cancer Resource Center at 1600 Divisadero Street on
the first floor, or call at (415) 885-3693. The information in this publication is designed for educational
purposes only and is not intended to replace the advice of your physician or health care provider, as each
patient’s circumstances are individual. We encourage you to discuss with your physician any questions and
concerns that you may have.
SDCAN0055
Rev. 12/01
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