Disclaimer & Warning: The information in this blog is only provided for informational purposes. This information is not designed to be used to treat any disease or health problem. Instead, always consult with your physician for proper treatment.

Saturday, October 4, 2014

Chemotherapy Guidelines

Chemotherapy (chemo) is the use of medicines or drugs to treat cancer. Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells.

Chemotherapy is one of the most common conventional treatments for cancer, either by itself or along with other forms of treatment such as radiation or surgery.

The thought of having chemotherapy frightens many people, especially given the low success rate of chemotherapy.

Chemotherapy Overview
If your treatment plan includes chemotherapy, a team of highly trained medical professionals, led by a medical oncologist, will work together to provide you with the best possible care. This health care team may include the following medical professionals.

Medical oncologist. A medical oncologist is a doctor who specializes in treating cancer with medication. This doctor will oversee your chemotherapy treatments and work closely with other members of the oncology team to develop your treatment plan.

Oncology nurse. An oncology nurse specializes in caring for patients with cancer, including giving chemotherapy. Your nurse can answer questions, provide information about the treatments, monitor your health during treatment, help you manage potential side effects, and offer support and counseling to you and your family.

Other health care professionals. There are a number of other specialists who will work to care for all of your physical and psychological needs during treatment, including pharmacists, social workers, nutritionists or dietitians, physical therapists, and dentists.

Before treatment
Consultation and informed consent. Before treatment begins, you will meet with a medical oncologist who will review your medical records and perform a physical examination. Based on the size and location of the cancer, your age, your overall health, and a number of other factors, the doctor will work with you to develop a specific treatment regimen (schedule). This treatment schedule may consist of a specific number of cycles given over a specific period of time or may involve treatment that continues for as long as your cancer responds. The doctor will also discuss the potential risks and benefits of chemotherapy with you.

If you choose to receive chemotherapy, you will be asked to give written permission (informed consent) and undergo tests to plan the treatment. The informed consent form confirms that you have received information about your treatment options and that you are willing to undergo chemotherapy. By signing the informed consent form you are also telling your health care team that you understand there is no guarantee the treatment will achieve the intended results.

Meanwhile, you will learn what you should or should not eat or drink on the day of your treatment so the chemotherapy will work most effectively. In addition, tell the doctor about all medications and dietary or herbal supplements you are taking, including prescription and over-the-counter drugs. This is also your opportunity to ask questions.

Other preparations. Depending on the most common side effects of the prescribed chemotherapy, your doctor may recommend making arrangements to address the following aspects of your health.
  • Nausea and vomiting: Nausea and vomiting are common side effects of some types of chemotherapy. Because the best way to manage nausea and vomiting is to prevent it, it is important to talk with your health care team about your risk of experiencing these side effects before treatment begins. Fortunately, there are many medications that can prevent nausea and vomiting in most patients.
  • Dental health: Chemotherapy can cause mouth sores and dry mouth, as well as reduce the body's ability to fight infection, so it is best to have a complete dental checkup and cleaning before beginning chemotherapy.
  • Heart health: Some types of chemotherapy affect the heart, so it may be helpful to measure your heart health before treatment for comparison. One test you may undergo is an echocardiogram (echo), which uses ultrasound waves to create a moving picture of the heart.
  • Reproductive health: Some types of chemotherapy can affect fertility (a woman’s ability to conceive a child or maintain a pregnancy and a man’s ability to father a child), so both men and women should discuss their options for preserving fertility before treatment. In some situations, women should schedule an appointment to get a Pap test (used to detect irregular cells on the cervix, which may turn cancerous) because chemotherapy can cause misleading test results.
  • Hair: Hair loss (either partial or complete) affects many people who receive chemotherapy. Ask your medical oncologist whether the treatment you will be receiving is likely to cause this side effect. If it will, you may want to think about whether you would prefer to keep your head covered during treatment and whether you’d like to buy a wig or head coverings, such as turbans, hats, or scarves, before treatment begins. 
In addition, this is the time to make logistical arrangements. For example, if your treatment is not fully covered by insurance, you may want to contact organizations that could provide financial assistance. Also talk with your employer to arrange time off from work for treatments and recovery.

During treatment
On the day of the treatment, you may choose to bring a friend or family member who can support you and help you remember information provided by the oncology team. You may also bring items—such as MP3 players, DVDs, books, or a blanket—to make your treatment time as comfortable as possible.
If you are receiving chemotherapy by intravenous injection, one of the most common methods, you will:
  • Meet the nurse or other health professionals who will administer your chemotherapy
  • Undergo a brief physical examination to check your vital signs (blood pressure, pulse, respiration rate, and temperature)
  • Have your height and weight measured to calculate the appropriate doses of chemotherapy
  • Have an intravenous (IV) catheter (slender tube) inserted into a vein in your arm
  • Have a blood sample drawn
  • Meet with your oncologist who will review the results of your blood tests, assess your condition before each treatment, and order the chemotherapy
Many people undergo minor surgery before chemotherapy to receive an implantable port—a round metal or plastic disk that is used as the entry site for the IV medications, eliminating the need to find a vein at each treatment session.

The actual treatment includes pre-chemotherapy medications to prevent side effects—such as nausea, anxiety, inflammation, or possible allergic reaction—followed by the chemotherapeutic medications, which may be given in minutes, hours, or even days if given by continuous infusion.

Meanwhile, if your medication is oral or topical, you will simply pick it up at the pharmacy and take it at home. Your health care team will provide instructions about how often to take the medication or how to apply it. Ask what side effects you can expect and which ones should prompt you to call your doctor. Your pharmacist can also help answer your questions.

To receive the full benefit of chemotherapy, it is important to follow the schedule of treatments recommended by your doctor.

After treatment
After a session of chemotherapy is finished, the IV catheter will be removed (although implantable ports will remain for the duration of chemotherapy) and your vital signs will be checked.

Your oncologist and/or nurse will review what side effects to expect throughout the cycles of chemotherapy and provide medication and tips to manage them. Specific instructions may include:
  • Avoiding interacting with crowds of people or with children (especially those with illnesses or infections) while your immune system is temporarily weakened
  • Drinking lots of fluids over the next 48 hours to help flush the drugs through your system
  • Ensuring proper handling of urine, stool, vomit, semen, and vaginal secretions because chemotherapy typically remains in your system for 48 hours after treatment. For example, flushing the toilet twice after use will help protect family members from waste or other body fluids that may contain chemotherapeutic agents.
In addition, your medical team can tell you what type and level of activities they recommend on treatment days.

Before you leave, ask for the phone number of the office and your oncologist's answering service so that you can contact the doctor with any questions or concerns.

Chemotherapy Options
Chemotherapy may be given in different ways, depending on the type of cancer you have and the chemotherapy drugs used.
  • Most often chemotherapy is given by injection into a vein (intravenously). This is known as intravenous chemotherapy.
  • Some drugs are given as tablets or capsules (oral chemotherapy).
  • Some are injected into a muscle (intramuscular injection).
  • Others may be injected just under the skin (subcutaneous injection).
Drugs given in the above ways are absorbed into the blood and carried around the body so they can reach all the cancer cells.
  • For some types of cancer, chemotherapy may be injected into the fluid around the spine. This is known as intrathecal chemotherapy.
  • Sometimes the chemotherapy may be injected into particular body cavities such as the pelvic cavity or bladder: this is known as intracavity chemotherapy.
Drugs given in this way tend to stay in the area in which they are given and do not affect cells in other parts of the body.
  • Chemotherapy creams may be used for some cancers of the skin: they only affect the cells in the area of skin to which the cream is applied.
Sometimes, two or more types of chemotherapy may be used together; for example, intravenous and oral chemotherapy.

After Chemotherapy - Discharge
After chemotherapy treatment, your risk of infection, bleeding, and skin problems may be high. You may have mouth sores, an upset stomach, and diarrhea.

You will probably get tired easily. Your appetite may be poor, but you should be able to drink and eat.

Oral care
Make sure you take care of your gums and teeth.

  • Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
  • Let your toothbrush air dry between brushings.
  • Use a toothpaste with fluoride.
  • Floss gently once a day.
Rinse your mouth 4 times a day with a salt and baking soda solution. (Mix one half teaspoon of salt and one half teaspoon of baking soda in 8 ounces of water.)

Your doctor may prescribe a mouth rinse. Do not use mouth rinses with alcohol in them.

Use your regular lip care products to keep your lips from drying and cracking. Tell your doctor if you develop new mouth sores or pain.

Do not eat foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.

Take care of your dentures, braces, or other dental products.
  • If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your chemotherapy. Do not wear them at other times during the first 3 to 4 weeks.
  • Brush your dentures 2 times a day. Rinse them well.
  • To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing infections
Take care not to get infections for up to 1 year or more after your chemotherapy.
Practice safe  eating and drinking during cancer treatment.
  • Do not eat or drink anything that may be undercooked or spoiled.
  • Make sure your water is safe.
  • Know how to cook and store foods safely.
  • Be careful when you eat out. Do not eat raw vegetables, meat, fish, or anything else you are not sure is safe.
Wash your hands with soap and water often:, including:
  • After being outdoors
  • After touching body fluids, such as mucus or blood
  • After changing a diaper
  • Before handling food
  • After using the telephone
  • After doing housework
  • After going to the bathroom
Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. Do not do yard work or handle flowers and plants.
Be careful with pets and animals.
  • If you have a cat, keep it inside.
  • Have someone else change your cat's litter box every day.
  • Do not play rough with cats. Scratches and bites can get infected.
  • Stay away from puppies, kittens, and other very young animals.
Ask your doctor what vaccines you may need and when to get them.

Other self-care 
Additional self-care guidelines from the NIH website may include some of the following.

  • If you have a central venous line or PICC line, know how to take care of it.
  • If your doctor or nurse tells you your platelet count is still low, learn how to prevent bleeding during cancer treatment.
  • Stay active by walking. Slowly increase how far you go based on how much energy you have.
  • Eat enough protein and calories to keep your weight up.
  • Ask your doctor about liquid food supplements that can help you get enough calories and nutrients.
  • Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 30 or higher on any exposed skin.
  • Do not smoke.

You will need close follow-up care with your cancer doctor and nurse. Be sure to keep all your appointments.

When to call the doctor
Call your doctor if you have any of these symptoms:
  • Signs of infection, such as fever, chills, or sweats
  • Diarrhea that does not go away or is bloody
  • Severe nausea and vomiting
  • Inability to eat or drink
  • Extreme weakness
  • Redness, swelling, or drainage from any place where you have an IV line inserted
  • A new skin rash or blisters
  • Jaundice (your skin or the white part of your eyes looks yellow)
  • Pain in your abdomen
  • A very bad headache or one that does not go away
  • A cough that is getting worse
  • Trouble breathing when you are at rest or when you are doing simple tasks
  • Burning when you urinate

Freifeld AG, Kaul DR. Infection in the patient with cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology

National Cancer Institute. Chemotherapy and you: support for people with cancer.
http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you.Accessed May 7, 2014.

Perry MC. Approach to the patient with cancer. In: Goldman L, Schafer AI.Goldman's Cecil Medicine

Sideras K, Hallemeier CL, Loprinzi CL. Oral complications. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology

Website Source: 

Radiation therapy treats cancer by using high energy radiation to kill tumor cells. The goal is to kill or damage cancer cells without hurting too many healthy cells.

Different people have different side effects with radiation. You may have little or only mild side effects from your treatment; someone else may have many or very severe side effects. Unfortunately, it's impossible to predict who will have what side effects. In addition, the specific side effects you may have depend on the type of radiation being used, the dose of radiation, the area of the body that's being targeted, and the state of your health.

Radiation therapy is led by a radiation oncologist. That's a doctor who specializes in radiation medicine. If you are being treated with radiation, it's important to talk with the doctor about possible side effects and ways to cope with them if they occur. Keeping your health team informed about what you experience during treatment makes it easier to manage the side effects.


Surgery is the removal of the tumor and surrounding tissue during an operation. A doctor who specializes in treating cancer using surgery is called a surgical oncologist. Surgery is the oldest type of cancer therapy and remains an effective treatment for many types of cancer today.

The goals of surgery vary. It is often used to remove all or some of the cancerous tissue after diagnosis. However, it can also be used to diagnose cancer, find out where the cancer is located, whether it has spread, and whether it is affecting the functions of other organs in the body. In addition, surgery can be helpful to restore the body's appearance or function or to relieve side effects.

The location where you have surgery depends on the extent of the surgery and how much recovery is needed. Surgery may be performed in a doctor's office, clinic, surgery center, or hospital. Outpatient surgery means that you do not need to stay overnight in the hospital before or after surgery. Inpatient surgery means that you do need to stay in the hospital overnight or longer to recover after the surgery.

Tips for Managing Eating Problems and Your Diet after Chemo
Good nutrition for chemotherapy patients can be affected by poor mouth care, fatigue, pain, and fever, as well as the many symptoms that can occur during and after cancer chemotherapy treatments.  The goal is to know how to combat these symptoms and maintain an adequate diet after chemo.

Goals for managing symptoms to achieve a good diet after chemo:
Loss of appetite for food (Anorexia)
  • Plan ahead - plan a daily menu in advance.
  • Make every bite count - choose high calorie and protein foods (i.e. casseroles, fortified milkshakes, peanut butter added to snacks).
  • Pack snacks to keep on hand at all times.
  • Strive to eat at least 1/3 of your calorie and protein needs at breakfast.
  • Eat 5-6 small meals per day (this helps to sneak in extra calories and protein).
  • Don't be afraid to try something new, this might spark your appetite.
  • Be sure to follow good mouth care practices.
Difficulty swallowing (Dysphagia)
  • After chemo treatments, soft foods may improve swallowing problems.  These tend to go down easier.
  • Consider high calorie and protein milkshakes.  Liquids tend to be the best tolerated, especially if the difficulty swallowing is related to a narrowed esophagus.
  • Chew solid foods thoroughly.

Foods to avoid (especially for patients during and after chemo):
  • Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
  • Fatty, greasy or fried foods.
  • Very sweet, sugary foods.
  • Large meals.
  • Foods with strong smells (foods that are warm tend to smell stronger).
  • Eating or drinking quickly.
  • Drinking beverages with meals.
  • Lying down after a meal.
Diet tips to try:
  • Small meals throughout the day.
  • Refrigerated or room temperature entrees.
  • Rinse mouth with lemon water after eating.
  • Suck on ice cubes, mints, or hard candies.
  • Distractions such as TV, music, or reading may be helpful while eating.

Foods to avoid (especially for patients during and after chemo):
  • Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
  • High fiber foods (i.e. raw fruit and vegetables, coarse whole grains).
  • Fatty, greasy, or fried foods.
  • Rich desserts.
  • Nuts, seeds, or dried fruit.
Beverages to avoid (especially for patients during and after chemo):
  • Beverages that are very hot or cold.
  • Beverages containing caffeine (coffee, strong tea, soda, and possibly chocolate).
  • Use caution with milk products.
Diet tips to try:
  • Low total fiber or good soluble fiber source (i.e. rice, bananas, white bread, oatmeal, mashed potatoes, applesauce, skinless/boneless chicken or turkey).
  • Increase the amount of sodium (salt) and potassium in your diet.
  • Drink plenty of fluids.
Constipation can be caused by cancer treatments and pain medications.

Diet tips to try:
  • Increase the amount of fiber (fruits, vegetables, and whole grains).
  • Drink plenty of fluids.
  • In some cases a low residue diet (low fiber) may be appropriate with increased clear liquids. 
  • It is important to discuss which diet is right for you with your dietician and physician.
Dry mouth (xerostomia)

Diet tips to try:
  • Mouth care is important to maintain a good diet, especially during and after chemotherapy.
  • Try a "swish and spit" solution; mix 1/2-1 teaspoon of salt or baking soda with a glass of water.  Do this 4-5 times daily or more often.
  • Avoid oral care products that dry the mouth (i.e. products containing alcohol or peroxide).
  • Try lubricating your mouth with artificial saliva. 
  • Swish and swallow a mouthful of olive oil or vegetable oil.  This will lubricate the mouth and esophagus for about 15 minutes.  Some people cannot tolerate this.
Mouth sores (stomatitis)
  • Try a soft, pureed, or liquid diet to decrease chewing.
  • Avoid citrus and tomato based products.
  • Try to maximize calories and protein with fortified nutritional milkshakes (i.e. Boost).
Taste changes
  • Mouth care is important to maintain a good diet, especially during and after chemotherapy.
  • Try a "swish and spit" solution; mix 1/2-1 teaspoon of salt or baking soda with a glass of water.  Do this 4-5 times daily or more often.
  • Try to suck on mints or lemon hard candy to keep mouth fresh.
  • Try using plastic utensils.
  • Add herbs, seasoning, and marinades to foods to enhance flavor.  Avoid bland flavors (i.e. vanilla).  Try fresh fruit.
Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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Chemotherapy: What Can Be Done About Side Effects?
The following information from the website provides some guidelines concerning what can be done about side effects experienced during and after chemotherapy treatments.

Low Blood Counts
Chemotherapy can make you more likely to get infections. This happens because most anti-cancer drugs affect the bone marrow, making it harder to make white blood cells (WBCs), the cells that fight many types of infections. The doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors. Raising the white blood cell count greatly lowers the risk of serious infection.

Most infections come from bacteria normally found on our skin and in your mouth, intestines and genital tract. Sometimes the cause of an infection may not be known.
Ways to prevent infection:
  • Wash your hands often during the day. Be sure to wash them before you eat, after you use the bathroom, and after touching animals.
  • Stay away from people who have illnesses you can catch, such as a cold, the flu, measles, or chicken pox.
  • Try to avoid crowds. Go to the mall or movie theaters when they are least likely to be busy.
  • Stay away from children who recently have received “live virus” vaccines such as chicken pox and oral polio, since they may be contagious to people with a low blood cell count.
  • If you have a catheter, make sure to watch for any signs of irritation or infection around the site.
  • Do not cut or tear the cuticles of your nails.
  • Be careful not to cut or nick yourself with scissors, needles, or knives.
  • Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
  • Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Do not rub hard.
  • Use lotion or creams to soften and heal your skin if it becomes dry and cracked.
  • Avoid contact with animal litter boxes and waste, birdcages, and fish tanks.
  • Avoid standing water—birdbaths, flower vases or humidifiers.
  • Wear protective gloves when gardening or cleaning up after others, especially small children.
  • Do not eat raw food, seafood, meat, or eggs.
Low platelet counts can also result from chemotherapy. If you notice unusual bleeding, including blood in your urine, stool, vomit, or bleeding gums, notify your doctor. Easier bruising or longer bleeding time after a minor cut is normal.

Red blood cells can also be affected by some chemotherapy drugs. Anemia is when you have not enough red blood cells to carry oxygen throughout your body. You may feel tired, short of breath, week, dizzy, faint, or like your heart is beating very fast. If you are anemic try to get as much rest as possible and limit how active you are.

Make sure to eat well-balanced meals and talk with your doctor about what type of diet may be best for you.

Call your doctor if you feel as though you may faint, your heart is beating very fast, or you feel short of breath.

Fatigue (Tiredness)
Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It can be due to the disease, chemotherapy, low blood counts, lack of sleep, pain, stress, poor appetite, along with many other factors. This type of tiredness does not always go away with rest. Not everyone feels the same kind of fatigue. Some things to try to help you cope with fatigue:
  • Plan your day so that you have time to rest.
  • Take multiple short naps or breaks, rather than one long rest period.
  • Try easier or shorter versions of activities you enjoy.
  • Take short walks or do light exercise, if possible. You may find this helps with fatigue.
  • Allow others to do some things for you that you usually do. Save your energy for things you enjoy.
  • Keep a diary of how you feel each day and talk to your doctor or nurse about if your level of fatigue changes over time.

Mouth Care
Good mouth care is very important while you are on chemotherapy. Chemotherapy can affect the normal rapidly growing cells lining the mouth.

If you have not been to a dentist recently or are concerned your teeth may have cavities please advise your nurse or doctor. Consult your doctor before having any dental work done during the time you are receiving chemo.

Mouth care should be done at least four times a day—after meals and at bedtime. You should brush your teeth using a soft bristled toothbrush and toothpaste. If you floss your teeth, usually you may continue to do so. Do not use dental floss if it causes pain, bleeding or if your platelet count is below 40,000. It is best to avoid commercial mouthwashes with high alcohol levels.

If you wear dentures, be sure to keep them clean and have them adjusted if they do not fit well. Do not wear your dentures if you have mouth sores.

Sores in or around the mouth are a sign of a more severe side effect. If they develop call your nurse or doctor. A special mouthwash or medication may be prescribed to help heal and/or lessen the pain.

Sometimes your chemotherapy will be changed if you have sores. Your doctor may also suggest you suck on ice chips right before and after your chemotherapy to prevent mouth sores.
There are ways you can lower mouth irritation:
  • Rinse your mouth with a warm salt water solution (1/2 teaspoon salt in 8 ounces of water) every two to three hours
  • Avoid foods that are hot, irritating or spicy
  • Eat foods that are soft, cool, nonspicy, and non-acidic. Foods that have been pureed in the blender may be easier for you to eat if your mouth is irritated.

Nausea and Vomiting
Chemotherapy may cause nausea and vomiting. This can vary in length and severity from person to person and also depends upon the medications you are receiving. You may receive anti-nausea medications to help control this. Be sure you understand the directions, because if the anti-nausea medication is taken properly, it is often possible to prevent or lessen nausea.

Eating a light meal before your chemotherapy treatment may prevent some of the nausea and vomiting that can occur. After your treatment, it may help if you take a nap or just rest quietly.

If the smell of food causes nausea, avoid strong smelling foods such as tuna, cabbage, or onions. If the food is kept covered until serving time, have someone remove the cover before you enter the room, thus letting the first strong aromas escape.

Nausea may last longer than vomiting. If you feel sick, you could try taking sips of 7-up, ginger ale, fruit juice, tea, broth, tonic water or bouillon. Continuing to drink fluids will help prevent dehydration. Be sure to use the anti-nausea medicine that your doctor has prescribed as directed.

Eating dry foods such as toast or crackers, particularly after getting up in the morning seems to relieve nausea for some people. Cold clear beverages such as soda pop or fruit juices may help, too. Small pieces of popsicles, fruit ices, or sucking on ice chips may help. If you have mouth sores, you should avoid tart or citrus flavors.

Some people have found that relaxation techniques or hypnosis can help them control their nausea and vomiting. If you are interested in trying either of these, ask your doctor or nurse.

If you have loose stools, eat frequent small amounts of cooked, easy to digest foods such as soups, and jello. Eating foods warm instead of hot or very cold and eating slowly may lower the likelihood of diarrhea. You should also drink frequent small amounts of fluids (7-up, ginger ale, tea, broth, water). Drinking eight or more glasses of liquids each day is best when having liquid stools.

For severe diarrhea, it is sometimes helpful to avoid dairy products. Your doctor may give you medications for diarrhea. It is important to take them as prescribed.

Lowering the fiber (also called roughage) in your diet may also help to control diarrhea. Fiber usually helps you have softer, more regular stools. However, when your intestines are irritated by therapy, normal levels of fiber may be too much.

Foods high in fiber include raw fruits and raw vegetables, bran, whole grain cereals, whole grain breads, and popcorn. You may need to avoid these foods while going through treatment.

If you have five loose stools in 12 hours, or if the diarrhea is associated with cramps or bleeding, call your doctor.

You may have constipation as a result of chemotherapy, pain medication, anti-nausea medications, or changes in your diet or activity. Constipation is when your bowel movements are less often and you have trouble going to the bathroom. Constipation can be lessened by increasing the fiber in your diet. Increasing fluids and activity may also help to prevent constipation.

If you do not have a stool for two or more days past what is normal for you, call your doctor or nurse.
If you are on pain medications such as narcotic pain medications (Codeine, Dilaudid, Morphine), you may need to start using laxatives or stool softeners. Try to keep your bowels moving regularly. Your doctor will advise you on which laxatives may be used.

Hair Loss
Some chemotherapy drugs affect hair. Sometimes chemotherapy can affect all body hair, including eyebrows, lashes, and pubic hair. The loss is usually temporary. You may lose some or all of your hair. It may come out gradually or it might happen all at once. Hair loss can vary but usually starts two to three weeks after your first treatment and can take about one week for all the hair to fall out.

You may want to wear scarves or buy a wig or toupee if you lose your hair. If you plan to wear a wig, you may want to look for it before you lose your hair. This way you can match the color and style of your hair more closely. There are some very good services which can help you cope with hair loss and any appearance changes. Let your nurse know if you would like more information.

If you lose your hair it will be important to protect your scalp, not only from the sun, but also from heat and cold. It is important to use sunscreen on your scalp if you choose not to wear a hat or scarf.

Most people will find their hair comes back two to three months after your last treatment, but this may be different for each person. The feel of and/or color of your hair may change temporarily or permanently.

Skin Reaction/Changes
The skin is another area of the body that may show some side effects of chemotherapy. If you receive your chemotherapy by injection and you develop redness, pain or a sore area at/or near the site, during or after treatment, be sure to let your nurse or doctor know. It is very important that you call your nurse or doctor if the area is red, swollen, forming a blister, or if there is an open sore.

Possible side effects of some medicines affecting the skin include itching, scaling skin, redness, peeling or acne. A few medicines may cause darkening of the skin, nails, or darkening of the skin directly over the vein. Talk to your nurse or doctor about any changes. These skin changes will gradually fade when the course of therapy is done.

It is important that you keep your skin clean and dry. Moisturizing lotion may be helpful, but check with your nurse or doctor if you are receiving, or have received, radiation therapy in the past.

Some types of chemotherapy can make your skin more sensitive to sunlight. Shielding yourself from the sun’s rays is important. Avoid sun lamps. You may be more sensitive to these rays and experience sunburn. You should use a sunscreen that has a Sun Protection Factor (SPF) of 15 or higher. Call your doctor if you have any concerns about any area on your skin.

Some chemotherapy medicines may cause eye irritation. Eye drops are sometimes prescribed by your doctor. It is important that you use them as directed. Check with your doctor before taking any over-the-counter eye medicine.

Pain or Nerve Changes
Some of the drugs used for chemotherapy may cause changes in your nervous system. These changes can be temporary or permanent. Other changes in the body can cause pain as well. It is important to talk with your doctor or nurse about any pain or nerve changes you may be having. Your cancer treatment center may have a pain or palliative care clinic or team that you can work with to manage your pain.

Changes in Fertility
Chemotherapy drugs may lower the number of sperm cells and reduce their ability to move. These changes can cause infertility, which may be temporary or permanent. Infertility affects a man’s ability to father a child, but not a man’s ability to have sexual intercourse. Other possible effects of these drugs are problems with getting or keeping an erection and damage to the chromosomes, which could lead to birth defects.
  • Before starting treatment, men should talk to their doctor about sperm banking—a procedure that freezes sperm for future use—if infertility may be a result of treatment.
  • It is important to use birth control with your partner during treatment. Ask your doctor how long birth control is needed.
  • Use a condom during sexual intercourse for the first 48 hours after each dose of chemotherapy because some of the chemotherapy may end up in the sperm.
  • Ask your doctor if the chemotherapy will affect your ability to father a child. If so, will the effects be temporary or permanent?

Anti-cancer drugs can affect the ovaries and lower the amount of hormones they make. Some women find their menstrual periods stop completely or become irregular while having chemotherapy. These changes may be temporary or permanent.

Damage to the ovaries may cause infertility, the inability to become pregnant. Infertility caused by cancer treatment can be either temporary or permanent. Whether infertility occurs, and how long it lasts, depends on many things, including the type of drug, the dosage given and the woman’s age.

Although pregnancy may be possible during chemotherapy, it is NOT advisable because some anti-cancer drugs may cause birth defects. Doctors advise women of childbearing age, from the teens through the end of menopause, to use some type of birth control during their treatment, such as condoms, spermicidal agents, diaphragms, or birth control pills. Birth control pills may not be appropriate for some women, such as those with breast cancer.

Ask your doctor about birth control options for you.

Changes in Sexuality
Chemotherapy can cause changes in how your body responds sexually. Changes can vary depending on whether you are a man or woman and which treatments you may be getting.

Men may have difficulty having or keeping an erection or having an orgasm. They may also be too tired, stressed, or not as interested in sex. Talk with your doctor or nurse about any symptoms you may be having.

Women may have symptoms of menopause, when their monthly cycles may stop due to treatment.
These symptoms could be hot flashes, vaginal dryness, or feeling irritable. Other common side effects of chemotherapy are bladder or vaginal infections, discharge, itching, or being too tired, stress or not being interested in sex.

There are ways to manage any changes your body is going through. Cotton underwear and loose fit clothing will make you more comfortable and less likely to develop any irritations or infections. Vaginal lubricants can be helpful for vaginal dryness or other medicines. Talk with your doctor or nurse about any symptoms you may be having.

UI Cancer Information Services
Website Source:

Other Website References About Chemotherapy Guidelines

What to Eat During Chemotherapy

Chemotherapy and other drugs for multiple myeloma:

After Chemotherapy | University of Michigan Comprehensive Cancer Center

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