Download Management Strategies for Some Common Side Effects of

Management Strategies for Some Common Side Effects of Treatment for
Kidney Cancer
The very best strategy for managing any side effect is to
“Be Proactive instead of Reactive”.
We have put together a list of some of the possible side effects of your treatment for kidney
cancer and strategies that you, as a patient, may try to help you manage these side effects.
These strategies are suggestions only. Not all of them will work for everyone. Try a
different approach if you find that one approach is not working for you. Always remember
that your oncologist and oncology nurse are your best resources.
Notify your oncologist or nurse as soon as you first notice any side effects from the treatment.
Often early intervention to manage the side effects will decrease the severity of them and allow
your doctor to keep you on the full dose of your treatment without any interruptions.
Overall Tips
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Prior to starting your treatment, have a thorough dental exam and complete any dental
work that is deemed necessary by your dentist.
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Prior to starting your treatment, consider putting together a self-care kit with some or all
of the following items:
o Sport drinks (Gatorade®, Powerade®)
o Water- or aloe-based lip balm
o Creams for hands and feet (Aveeno®, Bag Balm®, Lubriderm®, Udder Cream®)
o Cetaphil® cleansing bars (mild, soap-free product)
o Body lotion (Aquafor®, Aveeno®, Curel®, Eucerin®)
o Fragrance-free shower gel
o Soft-bristle toothbrush
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Keep a side effect journal and take it with you to all of your medical appointments. In it
record the following:
o The date and time that a side effect first occurs;
o How problematic the side effect is on a scale from 1 to 10;
o How long the side effect lasts;
o Strategies that you have used to help manage the side effect.
NOTE: On the following pages, the drugs that may cause the side effects are listed for each
one. You may not experience these side effects and if you do, the side effects you experience
may range from the very mild to the most severe.
Page 1 of 27
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Table of Contents Diarrhea........................................................................................................................................... 3 Gastrointestinal Complaints ............................................................................................................ 5 Loss or thinning of scalp and body hair .......................................................................................... 6 Taste Changes ................................................................................................................................. 7 Mucositis ......................................................................................................................................... 8 Fatigue........................................................................................................................................... 10 Hand-Foot Skin Reaction.............................................................................................................. 12 Skin Rash and Other Reactions..................................................................................................... 14 Dry Skin and Itchiness .................................................................................................................. 16 Nail Changes ................................................................................................................................. 17 Loss of Appetite (Anorexia) ......................................................................................................... 18 Constipation .................................................................................................................................. 20 Cough with or without difficulty breathing .................................................................................. 21 Dry Mouth..................................................................................................................................... 22 Headache ....................................................................................................................................... 23 Insomnia ........................................................................................................................................ 24 Nausea and/or Vomiting ............................................................................................................... 25 Edema ........................................................................................................................................... 27 Page 2 of 27
Version date: January 16, 2011
Diarrhea Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Loose or watery stools three or more times a day
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Different foods may trigger diarrhea for different people
Take note of when you experience diarrhea and the foods that may
be triggering it for you and report this to your nurse or doctor
Drink plenty of fluids, 6-8 glasses per day (except at meals) but
only in small amounts at any one time. Sip fluids slowly.
You may want to try soy beverages or milk substitutes instead of
milk
You may try “sport” drinks (e.g. Gatorade®, Powerade®) or
broths
Eat often (5-6 times per day) but in small amounts only
Try to eat every 2-3 hours
Eat food at room temperature
Try a low fat, low fibre, low dairy diet (chicken, fish, white rice,
cooked fruits and vegetables, applesauce and toast)
The consumption of applesauce, bananas, rice, oatmeal, potatoes
and carrots may help to increase the consistency of the stools
Consider using the BRAT diet – Bananas, Rice, Applesauce and
dry Toast
Watch your overall food intake to ensure that you are getting
adequate nutrition and maintaining your weight
Nutmeg added to foods may slow down the movement of food
material through the intestines
Use bulking agents (e.g. Benefiber®, Metamucil®) to increase
stool consistency
Use sitz baths, tucks and haemorrhoid barrier creams as needed for
comfort
Cleanse the area around your anus with warm water (with or
without a mild soap) or use baby wipes after each bowel
movement. Pat dry, do not rub.
Discuss the use of loperamide (Imodium) with your doctor (some
patients find that the use of loperamide 30 minutes prior to meals
helps to reduce diarrhea
Avoid drinking fluids with meals and for 1 hour after all meals
Avoid spicy foods, fatty foods, sugary foods, dairy products, and
high fibre foods
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Doctor Strategies
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Avoid caffeinated beverages, alcohol and tobacco
Avoid very hot or cold foods or fluids
Avoid milk and dairy products
Avoid orange and prune juices (reminder: you should be avoiding
grapefruit juice at all times)
Avoid eating raw vegetables
Avoid skin, seeds and membranes from fruits and vegetables
Limit corn, broccoli, beans, peas, green leafy vegetables, prunes,
berries, dried fruit, legumes, lentils
Avoid prunes, rhubarb and papaya
Avoid sugar-free gum and candies containing sorbitol (sorbitol
acts like a laxative)
May prescribe loperamide (Imodium), diphenoxylate (Lomotil) or
cholestyramine
May refer you to a dietician
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Gastrointestinal Complaints Symptoms
Causes
Patient StrategiesWhat to Do
Patient StrategiesWhat to Avoid
Possible
Doctor Strategies
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Heartburn
Belching (burping)
Flatulence (passing gas)
Bloating
Difficulty swallowing
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Use antacids
Eat products containing acidophilus bacteria (e.g. some yogurts,
some cheeses)
Avoid eating gas-producing foods (e.g. beans, legumes, bulky
vegetables)
Avoid drinking carbonated beverages
May prescribe medications to aid in the motility of your digestive
system
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Loss or thinning of scalp and body hair Symptoms
Causes
Patient StrategiesWhat to Do
Patient StrategiesWhat to Avoid
Possible
Doctor Strategies
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Hair that becomes thin, brittle or falls out
Some people may experience hair colour changes
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Use scarves, wigs/hairpieces, hats
If you have a private drug plan, it may cover the cost of a wig
Wear hats in cold weather to prevent heat loss from your scalp
Inspect your scalp for rashes, sunburn, scratches or blisters
Use a satin pillowcase
Brush hair gently
Use a neutral pH shampoo
Avoid sun exposure
Avoid high heat on hair dryers
Avoid curling irons and hair straighteners
Avoid hair dyes and permanents
Do not braid your hair
May write a prescription for a wig if you have a drug plan
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Taste Changes Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Doctor Strategies
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Bitter taste while eating
Metallic or chemical taste while eating
An aversion to certain foods
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Use a straw for drinking to get the fluids to the back of your mouth
Use bottled drinks instead of cans
Use plastic knives, forks and spoons and glass cups and plates
Use fresh or frozen fruits and vegetables
Season your foods with tart flavours
Use new spices, herbs, sugar, lemon or condiments to flavour
foods
Cold or frozen foods may taste better than hot foods
Try marinating meats (eg. fruit juices, sweet wines, salad
dressings, bottled marinades)
Room temperature or cold foods may be easier to tolerate
Switch up your foods. If one food’s taste is not appealing, try
substituting another (e.g. chicken for beef)
Have someone else prepare your food to limit exposure to food
odours
Before meals, rinse your mouth with ginger ale
Try brushing your teeth before meals too
Rinse your mouth with a weak solution of salt and baking soda (½
teaspoon of salt + ½ teaspoon of baking soda in 1 cup of water)
before meals
Brush your teeth often to keep your mouth clean
Sucking on sugar-free lemon candies may help with a metallic
taste
Suck on sugar-free candies or mints
Chew sugar-free mint gum
Avoid canned fruits and vegetables
Avoid mint-flavoured toothpastes
Avoid hot foods
Avoid smoking
Avoid canned drinks
Stay away from food odours
May prescribe zinc sulphate supplements
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Mucositis Symptoms
Causes
Patient StrategiesWhat to Do
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Red, sore mouth
Red, sore throat
Open sores on the mouth, gums or tongue
Sore gums
Difficulty swallowing or talking
Increased mucus or thicker saliva
Sutent (sunitinib)
Torisel (temsirolimus)
Afinitor (everolimus)
Brush your teeth gently after eating and at bedtime with a very soft
toothbrush
An infant toothbrush may be used
Place your toothbrush under hot running water to soften the
bristles before using
Floss your teeth gently
Use non-abrasive toothpastes (children’s toothpastes, Sensodyne®
toothpastes)
Use Biotene® products
Clean dentures every day
Remove dentures at night and frequently throughout the day
Rinse your mouth often (swish, gargle & spit) with a weak
solution of salt and baking soda (½ teaspoon of salt + ½ teaspoon
of baking soda in 1 cup of water). Good times to do this are before
and after meals and at bedtime.
Use baking soda instead of toothpaste if your gums are bleeding
Use a straw for drinking
Eat foods that require little or no chewing
Eat foods that are lukewarm or cold
Eat foods that are soft and creamy such as yogurt, pudding, ice
cream
Take sips of water or other liquids while eating to keep your
mouth moist
When eating and drinking, tilt your head back to help get the food
and fluids to the back of your throat for easier swallowing
Sit upright when eating or drinking
Use a blender to puree foods
Moisten dry foods with broth, sauces, milk or butter/margerine
Eat small frequent meals – whenever you are hungry
Choose foods that are high in calories and protein
Sucking on ice chips, frozen fruit pops may help
Drink 8-12 cups of fluid per day
Suck on sugarless candy or chew sugarless gum to keep mouth
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Patient StrategiesWhat to Avoid
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moist
Keep lips moist with a water- or aloe-based lip balm
Avoid alcohol-based mouthwashes
Avoid toothpastes with whiteners
Limit use of dental floss
Do not wear your dentures if you have severe mouth sores
Avoid alcohol, caffeine and smoking
Avoid citrus, acidic or carbonated drinks
Avoid foods that are acidic, salty, spicy or dry
Avoid very hot foods
Avoid very crisp, rough, hard foods (e.g. crackers, potato chips,
tortilla chips, pretzels, raw vegetables, dry toast)
Do not use Vaseline® or other petroleum-based products for lip
moisturization
May prescribe Orabase® or Gelclair®
May prescribe BMX solution (solution with benadryl, Maalox &
xylocaine)
May prescribe topical lidocaine or Magic mouthwash
May prescribe fluconazole (Diflucan) or clotrimazole (Canesten) if
fungal infection is also present
May prescribe pain medication
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Fatigue Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Feeling of exhaustion or being completely worn out
Inability to concentrate
Feeling that your body is weighed down and it is difficult to move
The kidney cancer itself
Any emotional aspects of coping with the cancer
Surgery for kidney cancer
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Conserve your energy by setting priorities, pacing your activities
and delegating as much as possible to family and friends
Take advantage of your good days to do the activities that
absolutely must be done or that give you pleasure and a sense of
accomplishment
Take rest periods throughout the day
Short naps (30 -45 minutes) may help as long as they do not
interfere with your night time sleep
Try to keep your normal sleep routine
Use relaxation techniques, massage, yoga, meditation to manage
stress
Try to maintain your normal work and social schedules whenever
possible
Re-energize with activities that you enjoy doing
Stay as active as possible for you – activity throughout the day
allows for better sleep at night
Increase your physical activity gradually. Take short walks or do
light exercise.
Plan your exercise for times when your energy levels are at their
highest point
Talk with your employer about your level of fatigue and possible
scheduling adjustments that you may need to make
Plan activities that require concentration when most rested
Let family and friends know that you may have to cancel planned
activities if you are experiencing extreme fatigue
Limit visitors and ask them to call first to schedule their visit time
Avoid caffeine
Avoid driving a car or operating heavy machinery when feeling
tired
Avoid long naps during the daytime
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Possible
Doctor Strategies
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Avoid caffeinated beverages, smoking or alcohol before bedtime
Do not engage in strenuous activities before bedtime
May perform tests to rule out thyroid problems or anemia
May try reducing your dose, delaying the start of your next cycle
or a change in the treatment schedule
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Hand‐Foot Skin Reaction Symptoms
Causes
Patient StrategiesWhat to Do
Symptoms can occur on the palms of the hands and/or the soles of the feet
Mild to Moderate
 Redness
 Swelling
 Tingling or burning sensation
 Numbness
 Tenderness
 Rash
Severe
 Cracked, flaking or peeling skin
 Blisters, ulcers or sores
 Severe pain
 Causing difficulties walking or using your hands
 Sutent (sunitinib)
 Nexavar(sorafenib)
 Afinitor (everolimus)
 Strongly consider having a manicure and pedicure at a reputable
salon prior to the start of treatment to aid in the moisturization of
your hands and feet and to remove any calluses
 Continue to have manicures and pedicures or visits with a
podiatrist throughout treatment
 Reduce the exposure of hands and feet to hot water
 Take cool baths or showers
 Carefully pat your skin dry
 Use padded insoles or gel pads in footwear
 Try to wear loose footwear with ventilation (such as sandals)
 Wear loose-fitting slippers around the house
 Use cotton gloves and socks to keep the hands protected
 Frequently and liberally apply fragrance-free creams containing
lanolin or urea (5-10%) to the hands and feet, especially in all
creases, throughout the day
 Suggestions for creams are Bag Balm®, Udder Cream®, Aveeno®
or Lubriderm®
 Apply the creams gently
 Apply creams liberally to your hands and feet at bedtime and wear
a loose pair of gloves and socks while sleeping
 Apply cool compresses or ice packs to your hands or feet. Apply
only for 15 to 20 minutes at a time and cover the ice pack with a
towel before applying. A bag of frozen corn or peas works well as
it conforms to the shape of your hands or feet.
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Patient StrategiesWhat to Avoid
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Soak hands and/or feet in basins of cold water for 15 minutes at a
time, 3 to 4 times per day
Elevate your hands and feet frequently throughout the day
Talk with your doctor before using any new vitamins or
medications
Avoid the use of rubber gloves
Avoid rubbing as this causes friction to the skin surfaces
Avoid exposure to heat sources such as sun, saunas
Avoid hot showers or baths
Avoid any contact with harsh chemicals including laundry
detergents and cleaning products
Avoid creams and lotions with perfumes, alcohol or glycerin
Avoid constrictive footwear
Avoid tight-fitting socks or stockings
Avoid wearing tight-fitting jewellery
Avoid activities or exercises that put stress on the hands and feet
such as jogging, long walks
Avoid the use of tools that require you to grip them firmly in your
hand (eg. knives, garden tools, screwdrivers, hammers)
Avoid breaking any blisters if they form as they may become
infected
Oral or topical corticosteroids
Pain medications
Delay treatment
Adjust dosage or schedule of treatment
Refer to a dermatologist or podiatrist
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Skin Rash and Other Reactions Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Redness of the skin
Dry skin
Sensation of warmth or burning of the skin
Itching
Hair loss
Nail tenderness
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Use sun protection whenever outside (SPF of at least 30) and reapply every 2 hours or more. The sunscreen should contain
titanium dioxide or zinc oxide. Use an adequate amount of
sunscreen.
Use a broad-brimmed hat when outside
Wear loose-fitting cotton clothing
Use a mild, fragrance-free soap (eg. Cetaphil®)
Shower with warm water
Liberally apply fragrance-free, hypoallergenic, moisturizing skin
lotions often, particularly after showering (within 15 minutes) and
before bedtime (e.g. Utterly Soft®, Eucerin® or Aveeno®)
If the skin is very dry, use urea-based lotions
Anti-dandruff shampoos are helpful for itchy scalps
Colloidal oatmeal lotion or oatmeal bath (Aveeno®) may be
helpful
Coverage make-up can be safely applied (Cover FX®)
Use a humidifier and keep your household environment on the
cool side
Avoid hot showers
Avoid sun exposure especially during the peak hours of 11 AM – 3
PM
Avoid tanning salons
Avoid scratching
Do not squeeze pimples
Avoid anti-acne products
Avoid use of anti-bacterial soaps
Avoid alcohol-based, fragranced products
Avoid products with alcohol, benzoyl peroxide, retinoids or
salicylic acid
Avoid shaving in affected area
Avoid chlorinated pools, hot tubs
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Avoid laundry detergents with strong perfumes
Topical medicated creams such as Elidel, tacrolimus, clindamycin
gels or corticosteroids
Tetracycline antibiotics
Prednisone
May suggest camphor-based creams for dry, itching skin
May prescribe antihistamines if itching is a significant problem
Referral to a dermatologist
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Dry Skin and Itchiness Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Dry, flaking skin
Itchiness of the skin or scalp
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Wash with warm water
Use liquid shower gels, preferably fragrance-free
Use a mild face cleanser (e.g. Cetaphil®)
Apply skin cream/lotion liberally immediately after baths or
showers
Use lotions with anti-itch formulations (Aveeno®, Udderly
Smooth®, Gold Bond®)
Use creams or lotions with aloe vera or dimethicone (Curel®,
Aveeno®, Eucerin®, Aquafor®
Use anti-dandruff shampoos and conditioners
Use an anti-dandruff shampoo as a body wash for itchy skin
Use a non-allergenic deodorant if you become sensitive to your
normal deodorant
Use an electric razor for shaving
Use sunscreen with an SPF of 30 or higher
Protect your skin from extreme heat or cold
Wear gloves during cold weather
Drink 8-10 glasses of fluids per day
Avoid products with deodorants or fragrance
Avoid hot water for bathing and showers
Avoid using straight-blade razors for shaving
Avoid irritating clothing fabrics (e.g. wool)
May prescribe methylprednisolone
May refer to a dermatologist
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Nail Changes Symptoms
Causes
Patient StrategiesWhat to Do
Patient StrategiesWhat to Avoid
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Doctor Strategies
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Weak nails
Nails break or lift off
Development of nail ridges
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Use a cuticle cream nightly
Wear rubber gloves when doing housework
Moisturize your hands
Keep nails cut short
Soak your nails in oil (e.g. vegetable or olive oil)
Massage vegetable or olive oil into your nails daily
Alternatively, use tea tree oils or Bag Balm®
Keep nails clean and protected if they break or lift off
Report any signs of nail infection (redness, swelling, warmth) to
your oncologist or nurse immediately
Avoid cutting your cuticles
Do not use artificial nails or gel nails
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Loss of Appetite (Anorexia) Symptoms
Causes
Patient StrategiesWhat to Do
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Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Eat light meals, 5 to 6 per day
Choose foods with the most calories per serving
Try to eat a few mouthfuls even if you do not feel hungry at the
time
Drink high calorie beverages (fruit juices, milk, hot chocolate,
shakes, smoothies, instant breakfast drinks, Ovaltine®) between
meals
Consider using commercial nutritional beverages such as Boost®
or Ensure®
Use gravies, sauces, butter, cheese, cream as additions to your
food to increase the calories
Choose high calorie snack foods (such as peanut butter, cheese, ice
cream, puddings, yogurt, cottage cheese, eggs, nuts, trail mixes,
cereal, granola bars)
Eat snacks frequently throughout the day
Keep snacks with you at all times to nibble on
Keep your favourite foods nearby for snacking
Try different foods and drinks. Sometimes new foods may have
more appeal.
Focus on the meal when your appetite is at its best and make it the
main meal of the day
Eat soft, high-caloric foods
Eat the most nutritious foods first
Try to engage in some physical activity before meals
Eat your meals with family and friends
Ask for help from family and friends to prepare your meals and
shop for groceries
Eat foods cold or at room temperature to control odours and reduce
tastes
Drink fluids at least 30-60 minutes before or after a meal
Consider the use of complementary approaches (eg. aromatherapy,
massage therapy, meditation, music therapy)
Take any required pain medications at least 30-60 minutes prior to
your meal
Create pleasant settings for your meals including music
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Patient StrategiesWhat to Avoid
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Avoid low fat foods
Avoid diet foods
Avoid spicy and fried foods
Avoid the sight or smell of food
Limit your fluid intake at meal times
Avoid empty calorie foods
Avoid tobacco products
May prescribe Megestrol acetate (Megace), steroid medications, or
metoclopramide (Maxeran)
May refer you to a dietician
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Constipation Symptoms
Causes
Patient StrategiesWhat to Do
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Having a bowel movement fewer than three times per week
Stools are hard, dry, small in size and difficult to pass
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Increase your intake of warm or hot fluids, especially in the
morning
Maintain a fluid intake of at least eight, 8-oz servings
(Consumption of caffeinated beverages should not be included in
this amount)
Increase your consumption of dietary fibre including whole grains
and fruits/vegetables
Choose foods that are natural laxatives (eg. prunes, papayas,
rhubarb)
Try to be more active with some daily exercise
Maintain a regular daily schedule for bowel movements,
preferably after breakfast
Talk with your healthcare team before starting over-the-counter
laxatives, stool softeners or enemas
Avoid chocolate, cheese, eggs, beef or fatty fried foods
May prescribe the use of a stool softener (docusate sodium, known
as Colace) and a laxative (sennosides, known as Senokot)
May suggest the addition of psyllium to your diet
Page 20 of 27
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Cough with or without difficulty breathing Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Doctor Strategies
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Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Use a forward-leaning position
Use a pursed-lip breathing technique
Consider relaxation training or meditation
Try to keep yourself distracted
Keep your head lifted on extra pillows when in bed
Prioritize your activities to conserve energy
Sit in front of a circulating fan
Lower room temperatures slightly
Open a nearby window
Use a cool-air vaporizer or humidifier too keep room air moist
If you experience sudden or significant shortness of breath (i.e.
a significant change from your usual symptoms), please get
urgent medical attention
A cough with Torisel (temsirolimus) or Afinitor (everolimus)
may be the first sign of a serious medical problem. Your
doctor needs to know about this immediately.
Avoid smoke-filled areas
Avoid pet dander
Avoid going outside on hot, humid days or extremely cold days
Avoid tight-fitting clothing especially around your neck and chest
May prescribe cough suppressants
May investigate for lung inflammation
Page 21 of 27
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Dry Mouth Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Doctor Strategies
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Sticky, dry feeling in the mouth
Sore or burning sensation in the mouth or on the tongue
Thickened saliva
Cracked lips
Fissures (cracks) in the corners of the mouth
Tooth decay and gum disease
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Visit your dentist at least two weeks before beginning treatment
Perform good oral hygiene at least four times a day (after each
meal and at bedtime)
Use a soft-bristle brush soaked in warm water
Use a fluoride toothpaste
Rinse your mouth and wipe your lips immediately after every meal
Rinse and brush your dentures after every meal
Keep the mouth moist with frequent sips of water
Keep water at your bedside and take sips throughout the night
Suck on ice chips
Use a salt and baking soda rinse 4-6 times a day (½ tsp. salt, ½ tsp.
of baking soda dissolved in 8 oz. of water)
Frequently apply a lip balm that is lanolin- or aloe-based
Use artificial saliva or salivary substitutes
Chew sugarless gum or suck on sugarless candies
Use a cool-mist humidifier, especially at night
Drink at least 8 glasses of water a day. Keep water with you at all
times.
Eat soft, moist foods that are cool or at room temperature
Moisten dry foods with gravies, sauces, broth or milk
Avoid beverages with a high sugar content (soda pop, fruit juices)
Avoid alcohol, caffeinated beverages, acidic fruit juices
Avoid alcohol-containing mouth washes
Avoid tobacco
Avoid acidic or spicy foods
Avoid dry, coarse or hard foods
May prescribe pilocarpine
Page 22 of 27
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Headache Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Doctor Strategies
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Pain or discomfort in the head
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Ensure that you are getting an adequate amount of sleep
Eat a nutritious, well-planned diet
Use complementary therapies such as massage, acupuncture,
visual imagery, relaxation techniques, yoga, meditation to reduce
your stress levels
Ask your healthcare team about the use of over-the-counter pain
relievers
May be caused by an increase in blood pressure and so you should
monitor your blood pressure and report any changes to your doctor
or nurse
Avoid bright lights
Avoid loud sounds
May prescribe non-narcotic or narcotic pain relievers
Page 23 of 27
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Insomnia Symptoms
Causes
Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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Doctor Strategies
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Difficulty falling asleep
Awakening multiple times throughout the night with inability to
get back to sleep
Early morning awakenings with inability to get back to sleep
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Establish a regular time for going to bed each night and a regular
time for getting up each morning
Establish pre-bedtime rituals
Take a warm bath, read or listen to music within two hours of your
bedtime
Drink a warm glass of milk or chamomile tea before bedtime
Use relaxation techniques such as massage, yoga, meditation
If unable to sleep, get out of bed and go to another room
Use your bed for sleep and sexual activities only
Keep your bedroom dark, quiet, cool and comfortable
Limit daytime naps to 30-45 minutes
Have dinner 3 hours before bedtime
Complete any physical exercise at least three hours prior to
bedtime
Discuss the use of any herbal product or over-the-counter sleep
aids with your healthcare team prior to use
Avoid daytime napping if possible
Do not nap after 3 pm.
Avoid caffeine after noon
Do not go to bed hungry
Avoid watching TV in the bedroom
Avoid alcohol for 4-6 hours before bedtime
Avoid tobacco, especially at night
Avoid heavy or spicy meals before bedtime
Avoid clock-watching throughout the night
Avoid drinking too many fluids in the evening hours
May prescribe hypnotic medications (sleeping pills)
Page 24 of 27
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Nausea and/or Vomiting Symptoms
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Patient StrategiesWhat to Do
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Patient StrategiesWhat to Avoid
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“Sick” or “queasy” feeling in your stomach
“Throwing up” or expelling the contents of the stomach through
the mouth
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Drink 6-8 glasses of fluid per day
Recommended fluids are broth, Gatorade®, Jello®, fruit juices,
Popsicles®, soda, gingerale, peppermint tea, ginger tea, weak tea
with honey
Allow carbonated beverages to go flat prior to drinking
Sip liquids slowly
Cool liquids may be easier to drink than hot or cold ones
Eat dry, bland foods such as crackers, toast, dry cereal, pretzels,
bread sticks, ginger cookies
Eat small, frequent meals (5-6 per day)
Nibble on crystallized ginger
Sit up for 1-2 hours after each meal
Wear loose clothing
Place a cold cloth on your forehead
Rinse your mouth throughout the day, especially before and after
eating, with a solution of ¼ tsp. of baking soda diluted in 8 oz. of
water
Consider acupuncture, acupressure, guided imagery, music therapy
and muscle relaxation techniques
Ask family and friends to prepare your meals
Suck on mints or hard candies throughout the day
Keep your mouth clean; brushing at least 2 times per day
Take slow, deep breaths through your mouth during times of
nausea
Distract yourself with TV, radio, games, music
Avoid alcohol and caffeinated beverages
Avoid fatty, fried, or spicy foods
Avoid sweet desserts
Avoid acidic fruit juices and tomatoes
Avoid drinking fluids at the same time as your meals
Avoid making sudden movements
Avoid unpleasant or strong odours
Avoid combining hot and cold foods at the same meal
Page 25 of 27
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Doctor Strategies
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Avoid eating your favourite foods at this time as you may then
dislike them later
Avoid eating in a warm, stuffy environment
May prescribe antiemetic medications (drugs to stop vomiting)
May try reducing your dose, delaying the start of your next cycle
or a change in the treatment schedule
Page 26 of 27
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Edema Symptoms
Causes
Patient StrategiesWhat to Do
Patient StrategiesWhat to Avoid
Possible
Doctor Strategies
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Puffiness, swelling or a “heavy” feeling in the extremities
Clothes, shoes, rings, watches that feel tight
Decreased flexibility of the joints of the arms or legs
Shiny skin that feels tight or stiff
Indented skin when pressed
Sudden or rapid weight gain
Sutent (sunitinib)
Nexavar (sorafenib)
Torisel (temsirolimus)
Afinitor (everolimus)
Votrient (pazopanib)
Reduce the amount of salt in your diet
Elevate the affected area when sitting or lying down
Walk or increase your activity to help pump fluids back into your
circulation
Avoid standing for long periods of time
Do not sit with your legs crossed
May prescribe diuretics
May recommend the use of compression stockings
Page 27 of 27
Version date: January 16, 2011