Download General information on chemotherapy

General chemotherapy
General information leaflet for patients
receiving chemotherapy treatment
Contents
Page
Introduction
2
What is chemotherapy?
2
How does chemotherapy work?
2
How can chemotherapy be given?
3
How often is chemotherapy given?
3
Can I eat and drink as normal?
3
Should I take my normal medicines?
4
Where will I have my chemotherapy?
4
Agreeing to have chemotherapy treatment
4
Benefits of treatment
5
What are the side effects of treatment?
5
The effect on your blood cells
6
The effect on your mouth
7
The effect on your appetite
8
Sickness
9
The effect on your bowels
9
Your hair
9
Pregnancy and fertility
10
Care in the sun
11
Tiredness and fatigue
11
Skin and tissue damage
11
Risk of blood clots
11
Side effects of steroid tablets
12
Other information
12
Flu vaccinations
12
Other vaccinations
13
Clinical trials
13
If you’re unwell at home when having chemotherapy
14
Admission to another hospital during your chemotherapy 15
Contact telephone numbers
back cover
Useful websites
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General chemotherapy
Introduction
This leaflet gives general information for patients receiving
chemotherapy treatment. It explains what chemotherapy is,
how it works and how it is given. It tells you about the
benefits and side effects of chemotherapy and other general
information. The leaflet also tells you how to contact us if
you are unwell and need immediate attention. Contact
telephone numbers are included at the end of the leaflet.
We have also listed some websites that you can look for
further information.
This leaflet gives general information. We will discuss your
individual treatment with you in more detail.
What is chemotherapy?
Chemotherapy is taken from two words – chemical and
therapy. It is a drug treatment given to destroy cancer cells.
The type of chemotherapy you receive will depend on the
type of cancer you have. Your doctor from Velindre Cancer
Centre will give you a detailed explanation. Chemotherapy
can be used on its own or with surgery or radiotherapy.
How does chemotherapy work?
Chemotherapy works by destroying cells which are growing
and dividing. Cancer cells are constantly growing and
dividing so they are more affected by the chemotherapy
than healthy cells. However, chemotherapy can also
damage some healthy cells.
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General chemotherapy
How can chemotherapy be given?
Chemotherapy can be given in several different ways. The
most usual methods are:

By injection into a vein using a drip

By mouth as a tablet or liquid

Via a small pump which delivers the chemotherapy
through a fine tube called a PICC or Hickman line.
The pump is carried in a small bag worn around
the waist.
How often is chemotherapy given?
Depending on your treatment it can be given at various
intervals ranging from daily, weekly, every two/three weeks
or continuously. Your doctor will discuss how often your
chemotherapy will be given.
Can I eat and drink as normal?
Yes, we would recommend a light meal before your
chemotherapy treatment. Avoid large, heavy meals for the
first day or two afterwards.
You should drink plenty of fluids. It is best to avoid alcohol
for a few days after each chemotherapy treatment. Your
doctor will discuss with you if you need to avoid alcohol
completely.
Ensure that you eat food that has been prepared and stored
to a high standard of hygiene. Avoid unpasteurised food,
soft cheeses and pates.
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General chemotherapy
Should I take my normal medicines?
Please tell your doctor which medicines you normally take.
Unless they tell you otherwise you should continue to take
your normal medicines.
Where will I have my chemotherapy?
Depending on your type of treatment it could be in one of
the following places:





in one of the day case treatment areas at Velindre
Chemotherapy in-patient ward (as an inpatient)
In an Outreach Clinic in your local hospital
In your own home
On the mobile chemotherapy unit
You will usually have your treatment in the same place each
time. However there may be times when we need to move
your treatment to a different place. If this is to a different
department within Velindre we may not always be able to
tell you in advance. If we change the time of your treatment
we will always ring you or send you a letter to tell you.
If you have any queries about your treatment appointments
please contact the booking team. Their telephone number
and email address is on the yellow back cover.
Agreeing to have chemotherapy treatment
When chemotherapy is discussed with you, we will explain
the risks and benefits. You can ask any questions you have
about the treatment. Chemotherapy can only be given with
your agreement. We will ask you to sign a consent form.
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General chemotherapy
You can choose to stop treatment at any time. Please talk
to your doctor or nurse if you have any worries.
Benefits of treatment
The benefits of chemotherapy depend on the type of cancer
you have and how advanced it is. The aims include:
 To cure the cancer by destroying all of the cancer
cells
 To reduce the chances of cancer coming back by
destroying any cancer cells that are still in the body
but are too small to detect
 To reduce the size of the cancer before surgery or
radiotherapy
 To control the growth and spread of the cancer to
relieve possible symptoms
What are the possible side effects of chemotherapy?
There are many possible side effects to chemotherapy
treatment. These will depend on the type of chemotherapy
you are prescribed. We will give you a separate information
leaflet on your particular chemotherapy which will explain
your treatment and side effects in more detail.
This leaflet explains the general side effects that may be
expected with most types of chemotherapy treatment.
Please remember:
 You will not get all of the side effects mentioned
below.
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General chemotherapy
 Side effects are often predictable in terms of when
they start, how long they last and how severe they
will be.
 Side effects are almost always reversible and will go
away after you finish your treatment.
 Side effects are usually quite manageable. There are
many options to minimise or prevent them.
The important thing to remember is that side effects which
are reported early are much easier to treat. Most can be
managed easily with expert advice. Please follow the
information we give you about when to contact us for advice
(see back inside page) as some side effects if not treated
can become life threatening.
The effect on your blood cells
There are three main types of blood cells, these are:
 white blood cells
 red blood cells
 platelets
The number of blood cells you have can be lowered by
chemotherapy treatment. Therefore you will have regular
blood tests.
White cells: If these are lowered by your chemotherapy
treatment, then your body’s ability to fight infections is
reduced. One way that we can tell if you have an infection
is a rise in your body temperature. If your temperature is
37.50C or above, or if you notice any signs of infection
such as a sore throat, cough, cold or diarrhoea you
should contact Velindre Cancer Centre immediately (see
back inside page). A nurse will advise the best action to
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General chemotherapy
take. Be prepared to visit Velindre for a blood test if that is
their advice. If your white blood cell count is too low we may
need to delay your treatment.
Red cells: These carry oxygen to all parts of the body. If
these are reduced you may become tired and pale, this is
known as anaemia. If your red cells are below the normal
range you may need a blood transfusion.
Platelets: These cells are needed to allow the blood to clot,
for example if you have a cut. If your platelets are too low
because of the chemotherapy you may notice that you
bruise easily, have nose bleeds or that your gums bleed. If
this happens you should phone Velindre Cancer Centre
immediately (see back inside page). If your platelets are
below the normal range you may need a platelet infusion or
we may need to delay your treatment.
The effect on your mouth
Chemotherapy treatment can affect the cells that line the
inside of your mouth. This can make your mouth red and
sore and it is more likely to become infected. So it is
important that you look after your mouth during your
treatment.
You should keep your mouth as clean as possible. Clean
your teeth gently after each meal using fluoride toothpaste.
Use toothpaste for sensitive teeth if you have sore gums.
You should also gently brush your tongue if it is not too
sore.
If you wear dentures, you should brush them in the evening
and after eating with liquid soap and water. They should be
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General chemotherapy
soaked overnight in water and you should use a sterilising
solution daily to disinfect them. You should use sodium
hypochlorite 1% (Milton). Dilute 1 teaspoon in half a tumbler
of water. Soak plastic dentures for 3 minutes. Soak
dentures with metal parts for 1 minute.
Drink plenty of unsweetened fluids to help keep your mouth
fresh and moist. You may also find it helpful to rinse your
mouth with salt water (dissolve one level teaspoon in
500mls of warm water, rinse your mouth then spit out). If
you do not like to use salt you can do this with fresh water.
If your mouth becomes sore, you develop mouth ulcers or
oral thrush you should contact Velindre Cancer Centre for
advice (see back inside page).
It is important to change your toothbrush at least every 3
months and after a mouth infection.
If you haven’t recently had a dental check-up we would
advise you to do this before starting chemotherapy if
possible. If you need any dental treatment it is important
that you discuss this with your hospital doctor before having
any dental work carried out.
The effect on your appetite
Sometimes chemotherapy treatment can affect your
appetite. As a result you may lose or gain weight. We have
leaflets that tell you more about eating and drinking during
your chemotherapy treatment. Please ask your nurse for
more information. Your doctor or nurse can also refer you
to the dietitian for further advice.
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General chemotherapy
Your sense of taste may alter. This will usually return to
normal within two to three months of completing treatment.
Sickness
Chemotherapy treatment can sometimes cause nausea
(feeling sick) or vomiting (being sick). Some chemotherapy
treatments are more likely to cause sickness than others.
However, vomiting is uncommon these days as we will give
you anti-sickness medicines which are usually extremely
effective. If you are sick more than once in 24 hours despite
taking regular anti-sickness medicine then please contact
Velindre Cancer Centre for advice (see back inside page).
The effect on your bowels
Some chemotherapy treatments can affect your bowels.
Some can cause diarrhoea and some may cause
constipation. Only a small number of chemotherapy drugs
cause diarrhoea. If you are being prescribed one of these
we will give you specific advice. However, if you experience
either of these problems please tell your doctor or nurse as
they can usually be treated with medicine or by changing
what you eat.
If you have four or more bowel movements in 24 hours
above what is normal for you please contact Velindre
Cancer Centre immediately (see back inside page).
Your hair
Some chemotherapy drugs may cause hair loss. This
varies from thinning to complete hair loss. This is always
temporary and your hair will grow back again when you
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General chemotherapy
finish your chemotherapy treatment. We will tell you how
much hair loss to expect with your treatment.
Scalp cooling may be used for some types of chemotherapy
treatment to reduce hair loss. We have leaflets that tell you
more about scalp cooling and coping with hair loss. This
includes information about the HeadStrong service and
wigs. Please ask your nurse if you would like a copy.
Pregnancy and fertility
There is no reason not to have sexual intercourse, but we
recommend the use of a condom. This should protect your
partner from the possibility that there may be very small
traces of chemotherapy in your body fluids.
It is important that you do not become pregnant or father a
child during your course of chemotherapy treatment, or for
at least six months after treatment. This is because
chemotherapy can harm an unborn child.
Breastfeeding during chemotherapy is not advised as the
drugs could be passed to a baby through breast milk.
Some chemotherapy treatment may make you infertile. This
may be temporary or it may be permanent. If you would like
further advice about fertility or if you have any concerns
about sex you can discuss this with your doctor. You can
also contact the following Specialist Nurses:
Christian Smith Nurse Clinician
029 2031 6991
Sarah Burton
Macmillan Lead Gynae Specialist nurse
029 2061 5888 bleep 195
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General chemotherapy
Care in the sun
Some chemotherapy drugs can make your skin more
sensitive to the sun. If you are being prescribed one of
these drugs we will tell you to take some special
precautions. These include reducing the time you are in the
sun, staying in the shade wherever possible, wearing a hat
and using a high factor sun cream.
Tiredness and fatigue
Chemotherapy can make you feel more tired than usual. It
is important to listen to your body and rest if you need to,
but carry out your normal activities if you feel able. Some
people find it beneficial to take gentle exercise as well as
taking rest.
Skin and tissue damage
Some chemotherapy drugs which are given in a drip or by
injection may damage the skin and surrounding area if they
leak outside of your vein. This is known as extravasation. It
is extremely rare but it is important that you tell us
immediately if you notice any swelling, pain or burning at
the site of the drip. If this occurs whilst the chemotherapy is
being given, tell your nurse. If you notice pain, swelling or
redness when you’re at home please contact us
immediately (telephone number on back inside page).
Risk of blood clots
Cancer can increase your risk of developing a blood clot
(thrombosis), and having chemotherapy may increase this
risk further. It is important to tell your doctor immediately if
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General chemotherapy
you have symptoms such as pain, redness and swelling in
your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can
usually be successfully treated with drugs to thin the blood.
Your doctor or nurse can give you more information.
Side effects of steroid tablets
Many patients being treated with chemotherapy will also be
given steroid tablets. These are often given for a few days
after chemotherapy to prevent sickness, or starting just
before chemotherapy to prevent reactions to chemotherapy.
The most commonly used steroid tablets are
dexamethasone or prednisolone.
When taking these tablets you may notice:




A temporary increase in appetite
Indigestion
Mood swings, irritability and difficulty in sleeping
Feeling much more thirsty and passing a larger amount
of urine than usual. This may be a sign of an increase
in your blood sugar levels which if left untreated could
make you very drowsy, weak and unwell. If you are
diabetic this may be a particular problem.
To reduce the possibility of side effects you will be given
only a short course of steroid tablets (usually 3 – 5 days). If
you are having steroid tablets for longer we have a separate
leaflet that gives you information about long term steroids.
We advise that you should take steroids after food to reduce
the risk of indigestion. Avoid taking steroids after 2pm to
reduce the risk of difficulty in sleeping. If you are a diabetic
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General chemotherapy
please talk to us about how to manage your blood sugar
levels when taking steroid tablets.
If you have severe problems with indigestion, mood swings
or if you notice any of the signs of an increased blood sugar
level you should contact Velindre cancer centre for advice.
Other information
Small amounts of chemotherapy may be present in your
body fluids (blood, urine and vomit) for several days after
your treatment. Although the risk of harm is very low, it is
important to protect others from contact with chemotherapy.
Therefore we advise that you flush the toilet immediately
after use and wash your hands thoroughly. You should
wear rubber gloves if body fluids are spilled or handled.
Having chemotherapy treatment should not prevent you
from having close contact with your family and friends. This
includes kissing and cuddling. If you would like to discuss
this further then please ask your nurse.
SPECIALIST ANTICANCER MEDICINES
CAN ONLY
BE PRESCRIBED BY
SPECIALIST CANCER
DOCTORS you cannot OBTAIN ANTICANCER
MEDICINES FROM YOUR GENERAL PRACTITIONER
(GP)
Many anticancer medicines require specialist tests (i.e.
blood tests, hormone tests etc). These tests are done by
specialist doctors skilled in treating cancer. This is why
anticancer medications can only be prescribed by specialist
cancer doctors (oncologists).
If you run out of your anticancer medicines, it is important
that you contact your cancer doctor / specialist cancer nurse
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General chemotherapy
for advice. DO NOT GO TO YOUR GP TO GET FURTHER
SUPPLY.
Flu vaccinations
All patients receiving chemotherapy are at risk from flu. Flu
immunisation is recommended if you will be receiving
chemotherapy during the autumn and winter. Ideally you
should be vaccinated 7 – 10 days before your
chemotherapy treatment starts. The immunisation may not
be as effective if you have already started chemotherapy
because your immune response may be lowered. This
reduces your body’s ability to form the antibodies needed to
protect you from flu.
If you are vaccinated during a course of chemotherapy, this
should be done when your white cell count is at a normal
level. The flu vaccine would be best given the day of the
clinic appointment, or following day. You will need to attend
clinic, obtain your blood results, if they are normal, you will
then be able to have the vaccine with your GP. You should
avoid being vaccinated when your white cell count is low
because you may develop a raised temperature. This could
be confused with a fever, caused by infection, and could
result in unnecessary hospital treatment.
Shingles vaccine
The shingles vaccine is only given to people aged between
70 and 79 years. It is recommended for patients who are
going to start chemotherapy but it must be given at least 2
weeks but ideally 4 weeks before starting treatment. It
cannot be given after chemotherapy has started, or for 6
months after treatment, as it is a live vaccine.
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General chemotherapy
Other vaccines
You should not have any live vaccines while you are having
chemotherapy and for 6 months afterwards. Examples of
live vaccines include:
 MMR (the triple vaccine for measles, mumps and
rubella)
 BCG
 Shingles
 Yellow fever
You should avoid close contact with children who have had
the nasal flu vaccine for 2 weeks.
You should avoid close contact with anyone who has
recently been given a live vaccine by mouth (such as polio).
Vaccines are no longer given by mouth in the UK.
Clinical trials
Research into new ways of using chemotherapy and new
chemotherapy drugs takes place at Velindre Cancer Centre.
We may ask you to consider taking part in a clinical trial if
there is one suitable to your type of cancer and treatment.
Before you make your decision we will give you detailed
information. Taking part in a clinical trial is voluntary. Your
decision will not affect the standard of care you receive.
If you are unwell at home when having chemotherapy
If you feel unwell when you are at home whilst having
chemotherapy and you think this is due to the chemotherapy
you should contact us immediately. For example if you
have any of the following symptoms:
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General chemotherapy





A temperature of 37.5°C or above
Are sick more than once in 24 hours
Have diarrhoea
Unexplained bruising or bleeding
Feeling generally unwell / have a chesty cough or
problems passing urine
 Any pain, swelling or redness at the site of the drip
where the chemotherapy was given
You should phone Velindre Cancer Centre on 029 2061
5888 and say that you are a patient having chemotherapy
and you are unwell. You will speak to a nurse and they will
ask for the following information (these are found on your
chemotherapy alert card):
 Your hospital number
 Which chemotherapy drugs you are having
The nurse may give you advice over the telephone, may
refer you to your GP or may ask you to come to Velindre. If
you are asked to come in please bring an overnight bag with
your medication, clothing and toiletries so that you can be
admitted to a ward if required.
Admission to another hospital during your
chemotherapy treatment
If you are admitted to hospital it is important that you tell
them you are having chemotherapy treatment. You should
show the nurse or doctor looking after you, your alert card.
Ask them to let us know that you have been admitted. Our
telephone number is on the back inside page.
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