Your Guide To Chemotherapy

CHEMOTHERAPY


Facing Chemotherapy

You probably would want to ask many questions when your doctor suggested using chemotherapy to treat your cancer. Chemotherapy, the use of drugs to treat cancer, is one of cancer treatment methods.

This guide to chemotherapy will give you an idea of how chemotherapy works. You will also learn how to take care of yourself during treatment.

Questions You May Ask

It is normal to have questions when starting treatment. Here are some questions you may want to ask your doctor.

• What is Chemotherapy ?
• Will Chemotherapy work for me ?
• Where will I get chemotherapy ?
• How is Chemotherapy given ?
• How often will I have it, and for how long ?
• Can I take other medicines while I am getting chemotherapy ?
• How will I feel ?
• Will I still be able to work ? Will I still be able to do the things I enjoy ?
• How do I talk about it with the people in my life ? How will it affect them ?

Many of these questions can’t be answered simply, or immediately. But learning to take care of yourself during treatment can help you have some control over how chemotherapy affects your life.

What You Can Do ?

Think of chemotherapy as helping you fight against cancer. Your doctor will work with you to come out with your treatment plan. Listen to what your doctors has to say. Keep a list of questions to ask at your appointment with the doctors.

Manage Your Side Effects !

You may have some side effects from chemotherapy. Learn why these side effects occur and how you can manage them.

Take Care of Yourself !

You can do things to make you feel better. Get enough rest. Exercise because it may help you sleep better. Learn to eat with good nutrition in mind. By doing these things, you can help give your body the extra strength it needs right now.


UNDERSTANDING CANCER AND CHEMOTHERAPY

Knowing about cancer and what chemotherapy does to fight cancer may make you feel less anxious about starting treatment.

What is Cancer ?

Cancer cells are normal body cells that changed to become abnormal. The abnormal cells grow and divide uncontrollably to become a lump or cancer. Sometimes, they even spread to other parts of the body. Why these cells changed to become abnormal is not known.

How Chemotherapy Works ?

Chemotherapy kills cancer cells. Chemotherapy can be in the form of a single drug or a combination of drugs. Chemotherapy may be used alone or along with surgery or radiation therapy to shrink a tumour.

The Goals of Chemotherapy

By reducing the number of cancer cells, chemotherapy may:

• Cure Cancer.
• Control cancer by making the tumour smaller or stop it from spreading.
• Reduce symptomps ( such as pain ) when it is not possible to completely control the cancer.
• Kill any cancer cells remaining after surgery.

The Treatment Cycle

Chemotherapy is given in cycles. First you have a treatment. Then there is a resting time for the body’s normal cells to grow before the next treatment. During this resting time, there is a period when certain blood cells temporarily decrease in number. Your doctor, nurse or pharmacist will help you learn what to expect during this period.

Your Treatment Plan

You are unique. This means that your health, the cancer you have, and many other factors determine:

• The type of drugs used.
• The treatment cycle and duration ( length)
• How the medications (drugs) are given.

Can I Take Other Medicines While I Am Receiving Chemotherapy ?

Some medicines may interfere with the effects of your chemotherapy. That is why you should give your doctor a list of all your medications before you start chemotherapy. Your doctor will let you know if you should stop taking them.

During your treatment, check with your doctor before taking any new medications and herbal treatment like Chinese herbs and natural health supplements. Your doctor will tell you if you can start any medication in addition to the ones you are already taking.


HOW CHEMOTHERAPY IS GIVEN

The aim is for the drugs to make contact with and damage the cancer cells. The drugs must be absorbed into your blood and carried around your body to the cancer cells.

Your doctor can give chemotherapy in different ways. The best way depends on your treatment plan. Chemotherapy can be given by mouth or by injection. Chemotherapy is most often given by IV infusion ( through a tube placed in a vein )

Your Intravenous ( IV) Experience

Depending on the type and number of drugs, the length of your IV treatment may range from minutes, hours to days. To make this time more pleasant, wear comfortable clothes. You can also read or listen to music.

The Most Common Types of IV Treatment

• Short Infusion may last few minutes to 8 hours. This type of infusion is often given in outpatient setting.
• Long Infusion may last for 8 hours or more. It may require an overnight stay or a few days in the Hospital.
• Continous Infusion may last for days or weeks at a time. The drugs are delivered by a portable pump that can be worn at home. This allows patients to receive chemotherapy and continue normal activities at the same time.

IV Infusion

You may have a short term IV that is removed after each treatment. Or you may have a central venous catheter. This is a thin tube that is inserted into a large vein, usually in the chest. It is left in place as long as needed.

Short term IV

If you have a short-term IV, a fine tube, called a ‘cannula’, is inserted into a vein in the hand or arm between the hand and the elbow. You may feel coolness in the arm when the IV is started. Treatment usually takes from minutes to a few hours.

The Chemotherapy drugs can be injected slowly over a few minutes into the vein through the cannula. This is called a bolus injection.

Sometimes the drugs are diluted into a large amount of liquid, usually a salt or sugar solution. This combination is fed through a ‘drip’ into the vein in your arm.

Central Venous Catheters

The other way of giving IV chemotherapy is through a long plastic line called a ‘central line’. There are 3 types of central venous cathethers/lines.

1. A chest-placed cathether is one that is put into vein your chest.

2. A arm-placed catheter is one that is put into a vein in your arm.

3. Another type of central line is the ‘port-a-cath’. It is placed in the chest and hidden under the skin. To get the ‘port-a-cath’, a needle is inserted into the skin.




The Benefits of central catheter are that it :

• Allows blood to be drawn easily
• Limits repeated needle pricks.


MANAGING SIDE EFFECTS

Chemotherapy can cause side effects in different parts of your body. Side effects occur because chemotherapy also kills normal cells but these cells will regrow. So the side effects are temporary.

The normal cells most affected are those which make up the blood, hair resulting in hair loss, and the digestive tract leading to mouth ulcers or diarrhoea. Other cells like nerves are also affected, giving rise to tingling sensation in fingers or toes.

Keep in mind that a person may not have every side effect. If you do have side effects, try not to be discouraged. Your doctor, nurse or pharmacist will tick in the box the side effects you may have. They will also tell you ways that can make you feel better.

Side Effects You May Have :

 Alteration of Taste
 Mouth Sores
 Diarrhoea
 Bruising/Bleeding
 Body Aches
 Loss of Appetite
 Hair Loss
 Constipation
 Anaemia
 Numbness/Tingling Sensation in Hands and Feet
 Nausea/Vomitting
 Skin and Nail Changes
 Infection/High Fever
 Fatigue

Here are some tips that might help you feel better :

Reduce Risk of Infection

Chemotherapy can reduce the number of white blood cells your body makes. When this happens, you are less able to fight infection.

To Prevent infection :

• Be sure to wash your hands before you eat and after you use the toilet
• Stay away from people who have infections, such as cold or flu
• Avoid people who have recently received immunisations, such as vaccines for polio, measles, mumps and rubella ( German measles )
• Monitor your temperature when you feel unwell

Treat Anaemia

Chemotherapy can reduce the number of red blood cells that carry oxygen to all parts of the body. When there are too few red cells,body tissues don’t get enough oxygen to do their work. This condition is called anaemia.

Usually the anaemia is mild and there are no symtomps. When the anaemia is severe, you may feel tired. Other symptoms include dizziness and shortness of breath. If you have any of these, inform your doctor.

Prevent Bleeding

During chemotherapy your body may make fewer platelets (cells that help stop bleeding by making your blood clot). As a results, you may bleed or bruise more easily than usual, even from a minor injury.

Here are some ways to avoid problems :

• Avoid cuts and nicks from sharp objects like scissors, needles, knives, or tools.
• Use soft toothbrush to clean your teeth
• Avoid contact sports or other activities that may cause bruising.


Control Nausea

You may feel like vomiting during chemotherapy. This is because chemotherapy affects the cells lining your stomach and the part of your brain that controls vomiting.

Nausea and vomiting can be controlled or lessened. You can control nausea and vomitting by doing the following:

• Take your anti-nausea medications as directed.
• Eat small meals throughout the day.
• Eat and drink slowly.
• Have someone else cook for you.
• Breathe deeply and slowly when you feel nauseated.
• Avoid eating for at least a few hours before treatment if nausea occurs during chemotherapy.

Reduce Diarrhoea and Constipation

Diarrhoea (loose stools) and constipation (difficulty passing stool) can happen when chemotherapy or certain anti-vomiting medications affect the cells lining your intestines.
• If you have diarrhoea, drink more fluids. Avoid eating high fibre foods like vegetables, fresh and dried fruit, whole-grain breads and cereals. Contact the doctor if diarrhoea does not stop even when you take anti-diarrhoea medication.
• Avoid constipation by drinking plenty of fluids. Eat high fibre like vegetables, whole-grain breads and cereals, fresh and dried fruits.

Adapt to Skin and Hair Changes

If chemotherapy affets your skin and hair, try the following:

• Use sunscreen with SPF 15 or greater
• Apply moisturising cream and lotion to keep your skin moist.
• Avoid using perfume and cologne that contains alcohol.
• Cut your hair short to make hair loss less obvious.
• Wear a wig, hat, or scarf.

Care for Mouth Sores

Chemotherapy can affect the cells lining your mouth, causing mouth sores. To take care of your mouth:

• Brush your teeth after each meal. Always use a soft toothbrush.
• Do not rinse or gargle with mouthwash that contains alcohol. Ask your doctor, nurse or pharmacist about a mild mouthwash that you might use.
• Report to your doctor or nurse if you have any mouth ulcers or soreness from your chemotherapy treatment.

When to see the Doctor
See the doctor immediately if you have :

• Any signs of infection, including temperature of 38C or higher, chills, sweating, redness, swelling and pain around a wound
• Bleeding that won’t stop
• Sore that won’t stop
• Vomitting or diarrhoea that won’t stop
• Chest pain or difficulty in breathing


Fatigue and nerve problems are other side effects that can occur with chemotherapy. The following are some tips that might help.

Fight Fatigue

You may find that you feel more tired than usual. The cancer itself or the chemotherapy treatments may be the cause. Or it may be that you are worried, depressed, or not getting enough sleep. You may not be getting the right nutrition or you may have anaemia.

To relieve fatigue:

• Try some light exercise each day. Take a short walk with a relative or friends.
• Do your work when you tend to have the most energy. Finish only what you can. Degelate the rest to others.
• Do things that relax you before bedtime so that you can sleep better. You might try taking a bath or reading.

Cope With Numbness

Chemotherapy can affect the cells of your nervous system. As a result, you may have numbness, tingling, or weakness in your hands, feet, or limbs. Your sense of balance may also be affected. To avoid injury :

• Always report these symptoms immediately to your doctor. It may or may not be serious.
• Use glove when grasping hot or sharp objects.
• Move with care. Use handrails and bathmath to avoid falling.


Questions and answers

You may have questions about how chemotherapy could change your life. Here are some answers to common questions, and some the adjustment you may need to make.

Will I Still Be Able To Work ?

Many people still work during chemotherapy. If you find have less energy, you may need to talk with your employer about adjusting your work schedule.

• Do some work at home or reduce the number of hours you work.
• Plan so that your time off fits with your treatment cycle.

Should I Exercise ?

Ask your doctor about starting an exercise programme. It may help you sleep better and sometimes even helps control nausea. It will also give you a sense of well-being.

• Exercise when you feel most energetic.
• Keep the pace moderate. Even small amounts of exercise can help. Instead of jogging, walk, swim or ride a stationary bicycle.

Will I be Affected Sexually ?

Chemotherapy can cause sexual changes in both men and women.

• You may notice changes in your desire to have sex. Hugging and cuddling one another may seem more important now.
• Chemotherapy can cause short-term or permanent infertility. Talk to your doctor if you are planning on having children. Men may want to bank, or freeze their sperms.
• Use birth control throughout treatment.

Eating Right To Feel Better

It is very important to eat well during chemotherapy. The energy from a healthy diet can help you rebuild normal cells. It can also give you strength and help fight infection. You will then feel better and be more able to cope with side effects.

Ask your doctor, nurse and pharmacist about your nutrition needs. Be sure to take in enough calories to keep your weigh up and proteins to build and repair skin, hair, muscles and organs.

Also drink extra amounts of fluid to protect your bladder and kidneys during chemotherapy.

Fluids

Fluids help the body produce urine and prevent constipation. They help prevent kidney and bladder problems. They also replace fluids lost from vomiting and diarrhea. Try water, fruit juice and beverages like milo, ovaltine, soya bean milk and chrysanthemum tea.

Protein

Protein builds muscle, bone, skin and blood. It helps your body heal and fight infection. Good choices include chicken, lean meat, peanut butter, eggs, cheese, and yoghurt.

Calories

Calories give the body energy. The body uses this energy to perform all its function, including healing. To get enough calories, eat food such as ice cream, eggs, milk products, honey and syrup drinks and cakes if you can’t tolerate your usual diet.


Eating right during treatment

Side effect may make it all little harder to eat well on some days. Try these tips to help you eat :

Go easy on yourself

• Have a friends or family member sit with you while you eat.
• Take your anti-nausea medications as directed.
• Do what pleases or relaxes you. Listen to soft music while you are eating.
• Eat some of your favourite foods, if that’s what you are craving for.

Use a new approach

• Be open to new foods and recipes.
• Eat small portions often and slowly. Have a healthy snack instead of a meal if you are not very hungry.
• Try eating in new place.
• Take a walk before eating.

Let others help

• Let friends or family cook for you.
• If you live alone and are not up to cooking, cater your food.


Support from others

When you first knew you had a cancer, you might have felt fearful, angry or depressed. These a normal reactions but you may not want to share them immediately. Now that you are having chemotherapy, you may have new concerns in addition to the ones that you are already feeling.

You may or may not want to talk about your feelings. And if you do want to talk, these are some people who can listen and give you support.

Doctors, nurses, and pharmacists

If you have questions or worries about your chemotherapy, talk with your doctors, nurses or pharmacists.

Counseling professionals

There are many kind of counselors who help you talk, understand, and cope with your feelings caused by having cancer and chemotherapy. You can ask your doctor to refer you to psychiatrist, psychologist, or social worker. You may also talk to someone from your religious institution.

Friends and family members

Talking with friends or family members can helps you feel better. But many people do not understand cancer and here are some tips about how you can talk to them :

• Be open and honest : people will be more willing to help if they aware of what you are going through. Talk openly honestly about your condition., the treatment and how you are feeling. If people offer to help, talk about they can help you.
• Ease their discomfort : people may be afraid to say or do something wrong. Tell them that showing they care is helpful. Let them know that there may be no perfect thing to say.
• Expect different reactions : people will respond in different ways. Some may seem angry. Others may refuse to hear any more. Others may seem too attentive. Understand that each of them means well. People often don’t know what to say to someone with a serious illness.

Support groups

Supports groups are made up of people who are going through a same kind of experiences as you. Many people with cancer find they comfortable about sharing thoughts and feelings with someone who is like them. Supports groups can also show you how to live with cancer. Ask your doctors and nurses about joining a support groups.

Tips for family and friends

• Don’t pressure a person to talk. Just let the person know that you willing to listen.
• You or the person who has cancer may be feeling angry. This is a normal reaction. Be understanding and do not take anger personally.
• Don’t make empty statements like “ Don’t worry. Everything will be fine.” Instead offer practical help like doing house work, errands and driving the person for hospital appointments.

Looking to sources of help

You are not facing chemotherapy alone. Seek the help of loved ones, support group, and counseling if you need it. To better understand your treatment, make a list of questions to ask your doctors and nurses.


Conclusion

We hope that Your Guide to Chemotherapy will help you and your family better understand chemotherapy.

Discuss the information in this blog with your doctor, nurses, and pharmacists. Take a good care of your self during your chemotherapy. By working together, you, your family, and your health care providers will make the strongest team in your fight against cancer.


Managing side effects of chemotherapy

 Alopecia

What is alopecia ?

Alopecia or hair loss occurs with certain chemotherapy drugs that cause hair loss. Hair loss usually begins 10 to 21 days after the drugs are given, with total loss occurring in one to two months. Hair on the head is often lost first, but hair over the entire body can also be lost.

How does alopecia affect you ?

Hair loss may change the way you feel about yourself but always remember that hair loss is a temporary side effect of chemotherapy.

It is common and perfectly normal to feel angry or depressed about this loss. Talking about your feelings can help. If your feelings are stopping you from doing important things, share them with your doctor or nurse.

How to manage alopecia ?

• It may not be possible to stop hair loss. So, it is important to think about getting a wig and / or head covering early in your treatment schedule, before you lose your hair. This is because enough hair will allow a good math of colour and style while fitting a wig.
• Some people who lose all or most of their hair choose to wear caps, scarvers, wigs, or turbans. Others leave their head uncovered. Others change the type of covering depending on whether they are in public or at home with friends and family members. Choose whatever makes you feel comfortable.
• Have you hair cut short. A shorter style will make your hair look thicker and fuller. It will also make hair loss easier to manage when it occurs.
• Exposed scalp can be sensitive to the effects of sun and temperature and must be protected. Use sunscreen when exposed to sunshine.
• Use mild shampoo and soft hair brushed.
• Use low heat when drying your hair.
• Do not dye your hair.

Resource

You may want to participate in the national cancer centre’s ‘look good, feel better’ classes for people who have hair loss during cancer treatment. Ask your doctor or nurse about these classes.

 Arthralgias and myalgias

What are arthralgias and myalgias ?

Arthralgia is having pain in your joints and myalgia is having pain in your muscles. It is a side effect of your chemotherapy. This discomfort occurs in the large joints such as the hips, the knees, or the shoulders and can range from a mild ache to severe pain.

Pain in the large joints of the arms and legs can occur any time from 48 to 72 hours after you receive chemotherapy. This side effect may not occur with every treatment ; you may experience pain during one treatment and not feel aches after the next treatment.

How to manage these side effects at home ?

• Take the medication prescribed by your doctor.
• Get plenty of rest, and plan your activities to include rest periode.
• A heating pad or hot water bottle may help give comfort to the achy area. Keep the pad or bottle covered with a towel when putting it next to your skin. Use for short periods, 5-10 minutes for 4 to 5 times per day.
• Maintain your nutrition by eating healthly, regular meals.
• Relaxation techniques, such as guided imagery and meditation may be helpful.
• Taking a warm bath is comforting.
• Massage therapy to affected areas may help.

If you need additional information on trying out these measures, you can ask your doctor or nurse.


 Bleeding

What is bleeding ?
Bledding occurs when blood escapes from a blood vessel. Bleeding can happen anywhere in the body. It can happen as an open cut, nosebleed, or bleeding haemorrhoid, or it may occur inside the body like the stomach, lung, brain, or bladder.

Slow bleeding can have little effect or can make you tired, weak and short of breath. Sudden bleeding can cause severe weakness, dizziness, and pain.

When does bleeding occur ?

Chemotherapy can affect the bone marrow’s ability to make platelets. Platelets are blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even from a minor injury.

How can you prevent Bleeding from happening?

• Do not take any medicine without first checking with your doctor or nurse. This includes aspirin or aspirin-free pain relievers.
• Do not drink any alcoholic beverages unless approved by your doctor.
• Shave using an electric razor.
• Trim and cut nails.
• Use skin lotion to prevent dryness and breaks in skin.
• Use a very soft toothbrush to clean your teeth.
• Blow your nose gently. Do not use fingers to clean nose.
• Take care when using knives or tools.
• Be careful not to burn yourself when ironing or cooking. Use a padded glove when you reach into the oven.
• Avoid contact sports and other activities that might result in injury.
• Wear heavy gloves when digging in the garden or working near plants with thorns.

Go see a doctor if you have any signs and symptoms of bleeding. The signs and symptoms are:

Skin
• A fine red rash that looks like pinpoint dots, usually appearing on the feet and legs.
• Increase bruising.

Eyes
• Bleeding into the whites of the eyes.
• Inability to see normally.

Mouth and nose
• Blood blisters
• Blood oozing from gums
• Blood –tinges saliva
• Bleeding mouth sores
• Nosebleeds

Digestive system
• Blood in vomitus
• Blood in stools
• Black tarry stools

Urination / Genitals
• Blood in urine
• Pain or burning on urination
• Cramping and frequency
• Unusually heavy vaginal bleeding ( or any bleeding if you are past menopause)

Others
• Severe headaches, dizziness, increased weakness, difficulty waking up, pain in joints and muscles.


 Constipation

What is constipation?

Constipation means being unable to move your bowels, having to push harder to move your bowels, or moving them less often than usual. Faeces will be small, dry and hard.

When does Constipation happen?

Constipation happens when you get less exercises, or when you eat and drink less than usual. Some medicines also cause constipation.

How does constipation affect you ?

Constipation can cause pain and discomfort. Keeping your bowel routine regular and your bowel movements easy to pass is important. Your bowels should move every day with little or no strain.

How can constipation be prevented ?

• Drink at least 6 to 8 glasses of fluid each day
• Eat a lot of high-fibre foods, especially whole-wheat breads and cereals, cooked vegetables, fresh and dried fruits, and nuts.
• Exercises daily. If you are unable to increase you exercise, tighten and relax the muscles in your abdomen and move your legs often while sitting or in bed.
• Try to move your bowels at your usual times. Many people find that after breakfast is a good time to try to have a bowel movement.
• Avoid using the bedpan if possible. A natural position on the toilet or on a commode is best.

Call your doctor if :
You do not have bowel movement for more than two days. You may need to take a laxative or stool softener or use an enema, but do not use these remedies unless you have asked your doctor.


 Diarrhoea

What is diarrhoea ?

Diarrhoea is defined as more than 2 times of loose or watery stools per day. It can be caused by your cancer treatments. Diarrhoea may be worse if you are also receiving radiation treatments over your abdomen.

When does diarrhoea starts ?

Loose or watery stools may start a few days after you treatment.

How does diarrhoea affect you ?

If left untreated, diarrhoea can result in weakness, weight loss, skin soreness, and poor nutrition.

How can diarrhoea be controlled ?

• Eat smaller amounts of food, but eat more often
• Avoid high-fibre foods, which can lead to diarrhoea and cramping. High-fibre foods include whole-grain breads and cereals, raw vegetables, beans, nuts, seeds, and fresh and dried fruit.
• Eat low-fibre foods instead. Low-fibre foods include white bread, white rice or noodles, ripe bananas, canned or cooked fruit without skins, yogurt, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken without skin, and fish.
• Avoid coffee, tea, alcohol, and sweets. Stay away from fried, greasy or highly spiced foods. They are all irritating and can cause diarrhoea and cramping.
• Avoid milk and milk products if they make your diarrhoea worse.
• Drink plenty of fluids to replace those you have lost through diarrhoea. Mild clear liquids such as apple juice, water, weak tea or clear soup are best. Drink them slowly, and make sure they are at room temperature.

Call your doctor if :
• Diarrhoea is uncontrolled.
• You develop a temperature of 38o C or higher.
• You have bloody stools.
• You are not able to retain liquids.
• You notice your urine becoming dark in colour
• You become dizzy.

 Effects on skin and nails

What effect does chemotherapy have on your skin and nails ?

You may have minor skin problems while you are receiving chemotherapy. Possible side effects include redness, itching, peeling, dryness and acne. Your nails may become brittle or cracked or develop vertical lines or bands.

How do you take care of these problems ?

• Protect your nails by wearing gloves when washing dishes, gardening or perfoming other work around the house.
• Exposure to the sun may increase the effects some chemotherapy drugs have on your skin. Check with your doctor or nurse about using a sunscreen lotion with a skin protection factor of 15 to protect against the sun’s effects.
• Sometimes there is darkening of the skin all along the vein. Some people use make-up to cover the area. The darkened areas will usually fade on their own a few months after treatment ends.
• Avoid dryness by taking quick showers or sponge baths rather than long, hot baths. Apply moisturizing cream and lotion while your skin is still moist and avoid perfume, cologne or aftershave lotion that contains alcohol
• If your skin itches, apply calamine lotion.
• If you develop acne, try to keep your face clean and dry by using mild medicated creams or soaps.

Call your doctor if :

Develop sudden or severe itching, if your skin breaks out in a rash or hives, or if you have wheezing or any other trouble breathing. These symptoms may mean you are having an allergic reaction that may need to be treated immediately.

 Fatigue

What is fatigue ?

It is difficult to explain fatigue because it is so subjective. Fatigue can be differentiated into short-term (acute) and long-term (chronic).

Acute fatigue is tiredness that can be relieved by rest. Chronic fatigue is a continuous feeling of exhaustion not relieved by rest.

What are the signs and symtomps of fatigue ?

People who are fatigued have sensations such as weakness, dizziness, difficulty thinking and tiredness. People sometimes think they are just being lazy or depressed.

Sudden changes in feelings of fatigue may mean there is a serious problem. Slower, gradual development of fatigue may lead to decreased ability to do everyday activities.

When does fatigue happen ?

Fatigue occurs whenever the cancer and treatment interfere with intake and delivery of oxygen, food and water resulting in decreased energy production.

How to manage fatigue ?

• Go to bed at a regular time. Take short naps during the day and walk around in between naps.
• Do low instensity exercises such as walking when you have the energy. Rest when energy low.
• Take well balanced meals and drink sufficient water. This helps produce energy and make you feel less tired.
• Don’t be afraid to get help when you need it. Ask your family and friends to help with things like cooking, shopping, housework, driving and child care.

 Infection

What is Infection ?

Infection is a problem of cancer treatment that can be lessened and treated. You may be at risk for infection due to cancer or the side effects of chemotherapy. If signs of infection are ignored, you can become very ill.

The body has many ways to protect you from infections. The body protects itself with skin, acid in the stomach and cough reflex. The body also protects itself by using white blood cells to destroy germs after they enter body.

When the number of white blood cells is lowered from chemotherapy, you become more prone to infection.

How can you prevent yourself from getting Infection ?

• Avoid large crowds or anyone with signs of infection.
• Keep your body very clean by bathing daily and washing hands after using the toilet
• Keep your mouth very clean by brushing your teeth twice daily and flossing once daily.
• Avoid uncooked foods.
• Avoid constipation and straining to have a bowel movement by using a medication that softens the stools. Do not use laxatives or enemas unless approved by your doctor.
• Remove fresh flowers and live plants from the rooms where you stay.
• Do not change cat litter or clean up excreta from animals.

When are the signs and symptoms of Infection ?

• Fever 38ºC or higher.
• Cough with or without sputum production.
• Burning sensation on urination.
• Pain at the site of an intravenous cathether.
• Sore mouth
• Any area with redness or swelling.

Telephone your doctor to make an appointment to see a doctor if:

• Your temperature is 38ºC or higher..
• You have chills and rigor.
• You have any other signs of infection such as cough, increase in sputum, burning sensation on urination, pain or soreness around any wound or mouth sores.

Be prepared to give the doctor the following information:

• When was the last treatment
• Highest temperature in the last 24 hours.
• Any chills
• Any symptoms of infection.

 Kidney and Bladder Effects

What effect does chemotherapy have on the Kidney and Bladder?

Some chemotherapy drugs irritate the bladder or cause temporary or permanent damage to the kidney.

How to prevent Kidney and Bladder effects?

Drink at least 8 glasses of fluid to ensure good urine flow and help prevent problems, this is especially important if your drugs are among those that affect the kidney and bladder.

Call your doctor if :
• Little urine output even though you are drinking plenty of fluids.
• Pain or burning sensation when you urinate.
• A feeling that you must urinate immediately (urgency).
• Reddish or bloody urine.
• Fever.
• Chills.


 Mucositis

What is mucositis or a sore mouth ?

Chemotherapy can sometimes cause mucositis or a sore mouth. A sore mouth is inflammation of the mucosa (lining) of the mouth and ranges from redness to severe ulceration.

How to manage a sore mouth ?

1. Examine you mouth at least once daily and look for changes.

• Use a torchlight and look in your mouth by standing in front of a mirror.
• Look for any ulcers, pimples, sores, red areas or patches.

2. Keep your mouth clean and moist

• Clean your teeth even though you mouth is sore. If it hurts to use a soft brush, use an oral swab which is a cleaning stick with a soft sponge tip.
• Hold the swab with the grooves at a 90-degree angle to the gum line so that the sponge can reach in between the teeth.
• Gently massage your gums, tongue and top of your mouth.
• Do not floss your teeth when there is pain or bleeding.
• Keep your dentures in only during meals.
• Rinse your mouth with salt solution (half teaspoon to 250mls of water) every 2 hours for 1 to 2 minutes. If your mouth is very sore, rinse every hour.
• Keep your lips and the inside of your mouth coated with a water-based mouth moisturizer.
• If your mouth is very dry, drink water and other fluids frequently throughout the day. Chew sugarless gum or suck sugarless hard candy to moisten your mouth. Artificial saliva is also available; apply frequently.

What to avoid that may be irritating ?

• Chewing tobacco or smoking cigarettes, cigars or pipes.
• Alcoholic beverages (beer, wine or liquor)
• Mouthwashes that contain more than 6% alcohol.
• Food and drinks that are hot, spicy or sour.

Call your doctor if :
• Redness or extreme dryness.
• Soreness or pain.
• Cracks, ulcer, blisters, white patches.
• Temperature 38o C or higher.
• Bleeding from your mouth.
• Difficulty swallowing.


 Nausea and vomiting

What is nausea ?

Nausea (feeling queasy or sick in your stomach) and /or vomiting (throwing up) may happen from your chemotherapy. Nausea and vomiting, if they happen, are usually worst on the day your treatment. Sometimes nausea and vomiting can last for three or more days after chemotherapy.

How does nausea and vomiting affect you ?

Nausea and vomiting are very unpleasant. Both side effects may not be noticeable or may be severe and cause you to be unable to do things that are important to you.

If you vomit a lot, you can get dehydrated and have other problems from losing body salts. If you are vomiting and cannot drink fluids, it may affect your kidneys or bladder.

How can you prevent nausea and vomiting ?

• Make sure you get your antiemetics. Antiemetics are medicines to control nausea and vomiting.
• Take the antiemetic (s) as your doctor has ordered. If you have vomiting and cannot take them, call your doctor or nurse.
• If your antiemetics help lessen your nausea and vomiting but not as much as you would like, call your doctor or nurse. The dose of the antiemetic may need to be changed, or the doctor may use a different antiemetic.

How to manage Nause and Vomitting ?

Besides taking antiemetics, you can try some of these helpful hints.

• Try eating foods and drinking beverages that were easy for you to take or have made you feel better when you had the flu, morning sickness, or were nauseated from stress. These might be pickles, dry crackers, sour candy and bland foods such as porridge and noodle soup.
• Do not eat your favorite foods when you are nauseated.
• Do not eat fatty or fried foods, very spicy foods, or very sweet foods when you are nauseated.
• If possible, have somebody else make the meals when you are nauseated.
• Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.
• Keep your mouth clean; brush at least twice a day.
• Ask your doctor or nurse if they can help you learn a relaxation exercise. This might make you feel less anxious and more in control, and decrease your nausea.

Call your doctor if :

• You have nausea that lasts for more than 2 days, or if nausea keeps you from doing things that are important to you.
• You have nausea and vomiting that are not controlled by the antiemetics ordered.
• You vomit more than once or twice a day for two days.
• You cannot keep any liquids (water, soup, juices) or food down.
• You are vomiting and you lose more than 1kg in a day (this is from losing water). You will usually feel thirsty and your mouth will seem dry when you are losing a lot of water.
• You are vomiting many times and your urine is dark yellow and you are not going to the bathroom as often as you normally do.
• You are vomiting and feel light-headed or dizzy or confused (mixed up)
• What are you throw up looks like coffee grounds (this could be blood)

 Peripheral neuropathy

What is peripheral neuropathy ?

One of the possible side effects from receiving chemotherapy is damage to the nerves in your body. This may result in a feeling of “pins and needles” or the feeling that your hands and /or feet are asleep (numb).
You may have difficulty picking up a coin or buttoning you shirt or blouse. Another problem may be constipation. It is important to tell your doctor or nurse if these or any other changes occur. Your treatment plan can be evaluated to prevent further nerve damage.

How to manage peripheral neuropathy ?

• Although it is not possible to prevent early nerve damage, it is possible to prevent it from worsening. The most important thing that you can do is to tell your doctor or nurse immediately if any of the above symptoms occur. Your doctor may order rehabilitation and physical therapy to minimize loss of function.
• If your fingers become numb, be very careful when grasping objects that are sharp, hot or otherwise dangerous.
• If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs and using bathmats in the bathtub or shower. Do not wear slippery shoes.


Inform a doctor or nurse if you have the following signs and symptoms :

• A feeling of “ pins or needles” or numbness in your hands and / or your feet.
• Difficulty picking up an object or buttoning your shirt or blouse.
• Loss of balance, clumsiness and walking problems.
• Ringing in your ears.
• Difficulty hearing.
• Changes in your vision.
• Pain in your hands or feet.
• Constipation or other changes in your bowel or bladder function.
• Any other changes.