CHEMOTHERAPY

What are the side effects of treatment?

Cancer chemotherapy produces different reactions in different people. Reactions may also vary from treatment to treatment. Since most side effects are temporary, they will gradually disappear when your treatment is complete. There is no connection between the extent of the side effects you experience and the effect of the drug on your cancer. In other words, it does not mean that the treatment is not working if you do not have any side effects.

Some side effects can be tiresome, but you and your doctor must weigh this against the benefits of treatment. Therefore, if you find it difficult to cope with any of the side effects, please discuss them with your doctor or nurse. There are many ways we can help you.

The main areas affected by chemotherapy are those where normal cells rapidly multiply such as your bone marrow, mouth, digestive system, hair, skin, and reproductive system.

Effects on your bone marrow

Bone marrow is a sponge-like substance that produces blood cells in the hollow spaces of bones. It is sensitive to most types of chemotherapy but the following blood cells are especially sensitive:

• White blood cells help your body to fight infection. If your white cell count (WCC) is low, you will be more at risk of infection. Signs of infection include a high temperature above 100⁰ F or 37.5⁰ C. If you feel unwell at any time, telephone CCO immediately. Whilst you are having chemotherapy you should avoid people with infections such as ‘flu or chicken pox.
• Platelets help your blood to clot. If you notice that you bruise easily, have pinprick type reddish/purple spots on your body, bleed from your nose or gums, or pass bloodstained urine please contact us for advice.
• Red Blood Cells carry oxygen to all the cells of the body. If you notice that you are unusually short of breath, feel tired or look pale please contact us for advice.

About 10 days after your treatment your blood count will be at its lowest. With most chemotherapy, we will ask you to attend your nearest hospital for a blood test around this time. We call this an interim count. The hospital will telephone the result to CCO and if there is a problem, we will contact you at home and advise you. You are welcome to telephone the ward or day case unit in the evening, if you would like to know the results.

Very occasionally, when your white cells are very low and you may develop signs of an infection we may bring you into CCO to give you intravenous antibiotics. You may also need to come into hospital for a blood or platelet transfusion if these become too low.

Effects on your mouth

Some drugs can make your mouth dry, sore, and occasionally ulcerated. This may happen five to ten days following treatment but usually settles within three to four weeks. Inform your GP, doctor, or nurse if it becomes very uncomfortable.

You can help yourself in the following ways:

General advice

• drink at least 8 cups of fluid per day
• keep your mouth moist and clean at all times
• avoid mouthwashes that contain alcohol. A simple mouthwash made from 1 teaspoon of salt to a pint of boiled, cooled water is ideal.
• avoid smoking and alcohol

Dry mouth

• try soft foods or moisten foods with sauces or gravy
• stimulate saliva production with fruit juice or ice cubes
• pineapple, either fresh or tinned, is refreshing and can help to keep your mouth clean
• suck strongly flavoured pastilles or mints to keep your mouth moist

Sore Mouth

• use a soft bristled brush or soft gauze wrapped around your finger to gently clean your teeth after meals and each morning and night
• avoid dental floss since it may damage the gums causing them to bleed
• avoid extremely hot or cold foods, sharp foods, highly spiced foods, salty foods, and tart beverages.

With some drugs, you may find that food tastes bitter or salty or you may experience a metallic taste. You can help yourself by sucking a mint or strong flavoured sweet during treatment. Normal taste usually returns when treatment is complete. Please ask for more information.

Effects on your digestive system

Nausea and Vomiting (feeling sick and being sick)

Not all drugs cause nausea and vomiting and many people do not experience it at all. If you are affected, it may begin within a few minutes of the treatment or not until several hours later, depending on the drugs given. It may last from several hours to a few days. We will give you a supply of anti-emetic (anti-sickness) drugs to take home and the nurse will explain the best way for you to take them. If they do not work effectively for you talk to your nurse or doctor. Other anti-emetic drugs may help you.

You can help yourself in the following ways:

• take your anti-emetics regularly as prescribed especially during the first few days. Do not wait until you feel sick
• chilled fizzy drinks such as Coca-Cola and lemonade can help settle your stomach. Sip them through a straw so that you do not feel "bloated"
• if you are vomiting try to drink at least 8 cups fluid per day
• try to drink between meals rather than during meals
• eat room temperature foods for example sandwiches and salads or cheese and crackers
• eat small frequent meals
• ginger is a natural anti-emetic and you can take it in the form of ginger biscuits, ginger beer, ginger tea, ginger cake, or crystallised pieces of ginger
• eat a dry cracker, biscuit or some toast and relax for 15 minutes before you get out of bed
• avoid fresh citrus fruit drinks, full fat milk and alcohol
• avoid very sweet, spicy or greasy foods
• avoid preparing foods when you feel sick
• try and get plenty of fresh air
• some people find that relaxation techniques and acupuncture pressure bands help to reduce nausea
• if you have experienced nausea and vomiting in the past, think about what helped and try it

Diarrhoea (loose bowels)

Some chemotherapy can cause diarrhoea. Usually, diarrhoea will settle within 24-hours. You can help yourself in the following ways:

• drink at least 10 cups of fluid per day until it settles
• if you continue to have more that 3 episodes of diarrhoea per day or for more than 24-hours, ask your GP or local pharmacist for advice (don’t forget to tell them about your chemotherapy)
• if you are concerned, please do not hesitate to contact us.

• If you are receiving Irinotecan chemotherapy, please follow the advice sheet that the nurse gave you if you experience any diarrhoea at all.

Constipation (stubborn bowels)

Some drugs may cause constipation. You can help yourself in the following ways:

• try and increase your exercise
• drink at least 10 cups of fluid per day. Pure orange juice may help
• eat plenty of fresh fruit and vegetables
• try high fibre cereals such as Branflakes, All Bran, Shredded Wheat and porridge
• use wholemeal bread
• if you become uncomfortable, ask your GP or local pharmacist for advice (don’t forget to tell them about your chemotherapy).
• if you have experienced constipation in the past, think about what helped you then and try it.

Effects on your hair

Not all chemotherapy drugs will cause your hair to fall out but the nurse or doctor will advise you on this.

Sometimes hair loss is so small that you do not notice. Some drugs will cause partial or complete hair loss. The amount of hair loss will depend on the drug, the dose, and your reaction to the drug and usually begins within two or three weeks.

Hair loss can be upsetting - do not be afraid to discuss your feelings with the nurse. We will arrange for the hairdresser to visit you to discuss the right kind of wig for you. You can choose from a wide selection, illustrated in a colour catalogue and will take about 1 week. Most of the time, you will have your wig before your hair loss is noticeable.

You can help yourself in the following ways:

• you may find it helpful to cut long hair if you have been advised that you will lose it. This will reduce the weight of the hair on the scalp;
• avoid using perms or chemical dyes;
• use gentle shampoo designed for frequent use;
• let your hair dry naturally, do not use heated appliances,;
• apply a hairnet at night to contain hair loss caused by friction – you can dispose of this the next morning.

Effects on your skin

Some chemotherapy drugs may affect your skin causing them to become dry and itchy or your skin may become sensitive to sun. Sometimes the skin may develop dark patches, especially over the veins used for chemotherapy. This is temporary and it will gradually fade when your treatment is complete.

Your nails may discolour or white ridges may appear for a time and your nails may not grow as quickly as normal.

You can help yourself in the following ways:

• apply a moisturising cream or baby oil frequently to the affected area;
• add baby oil to your bath. This will make the bath slippery, so be careful when you get out;
• use a high factor sun-cream or a sunblock especially on your head if you have hair loss.

Effects on your fertility

Not all chemotherapy drugs will make you infertile. Infertility may be temporary or permanent, depending on the drugs, and the duration of the treatment. If fertility is important to you please discuss it with your doctor before you start treatment.

However, it is still possible to become pregnant or father a child during treatment. You must avoid pregnancy or fathering a child throughout treatment and for six months after your last treatment because the drugs are likely to affect the unborn baby. If you are sexually active, it is important to use an effective method of contraception during this time. You should discuss this with your partner and if necessary your nurse or doctor.

Women

Some drugs may affect your ovaries and stop production of eggs. This will make you infertile and may bring on symptoms associated with the menopause such as irregular or cessation of periods, hot flushes and dryness of your skin and vagina. Your doctor may be able to prescribe hormone tablets for you, to help reduce these symptoms. The hormones, however, will not make you fertile again.

You must avoid becoming pregnant during treatment and for six months after your last treatment because the drugs may affect the unborn baby. There are many effective methods of contraception and you should discuss them with your partner and if necessary your nurse or doctor. If you are pregnant before your treatment starts, please tell your doctor. In rare situations, it may be possible to delay the treatment until the baby is born. This will depend on your pregnancy, your cancer, and the type of drugs you will receive. If you become pregnant during your treatment, please tell your doctor as soon as you know so that you are fully aware of the options available to you before you make any decisions.

If infertility is temporary, your periods will return to normal shortly after your treatment is complete. This happens in about a third of patients are temporarily infertile.

Men

Chemotherapy may reduce the number or quality of the sperm you produce and your ability to father children is affected. If your family is not complete before you start treatment, it may be possible for you to bank your sperm. You can retrieve the sperm when you and your partner wish to have a baby. This, however, does not carry any guarantee of success. It is best that you and your partner if you have one, discuss this with your doctor.

It is important to use an effective method of contraceptive during treatment to prevent pregnancy occurring as the drugs may harm the unborn baby.

Some men will remain infertile permanently, whilst for others their sperm count returns to normal.

How you feel

We realise that many people feel that the chemotherapy may also mean that they can no longer have children, and that this feeling can be one of great sadness and loss. The sense of loss may be acute in people of all ages and by people who did not have any plans for children. You may feel that your role in the family is changing and that you have lost some of your femininity or masculinity or that your self-esteem is low. Everybody reacts in different ways - there is no right or wrong way. It is important that you are able to discuss with your doctor or nurse how you feel and be fully informed and prepared of all your options before your treatment commences.

Sex and chemotherapy

There is no medical reason why you cannot continue with sexual relationships whilst having chemotherapy. However, some people find that some of the side effects such as tiredness, hair loss, and feeling sick may make you feel less attractive to your partner. Feelings such as anger, anxiety, or depression may also affect you.

Sexuality is much more than the act of intercourse. It is about your whole relationship with your partner. Many couples discover that talking about feelings and worries brings them closer together and helps them to cope better. If necessary, talk to your doctor or nurse about any specific difficulties you have.

Tiredness

Many patients experience extreme tiredness, which is not relieved by rest. This is quite normal. Try to do some gentle exercises and get plenty of fresh air. Rest when you feel you need to. If you have a social event approaching, take it easy for a while before and afterwards.

Relaxation techniques can be helpful and warm baths before bedtime are soothing and may help you to sleep. Try some lavender oil on a piece of cotton wool inside your pillowcase to aid natural sleep.

If you are waking early, try not to get agitated and cross. Make a hot drink and listen to some soothing music. Try relaxation techniques (we have a cassette tape available - ask your nurse).

You can help yourself in the following ways:

• set the alarm clock, then hide it. Remove all other clocks/watches from the bedroom.
• stay in bed only for the hours you intend to sleep. It is better to reduce the amount of time spent in bed by 1-2 hours, as remaining in bed longer typically leads to lighter sleep and an increased number of awakenings.
• establish a bedtime and wake time and maintain them. This can be difficult initially, but can soon settle into a reliable pattern.
• do not worry about getting enough sleep – the more you worry about getting to sleep, the less likely you are to sleep. Worry, anger, and frustration increase arousal, which, in turn, inhibits sleep.
• avoid stimulants like tea and coffee, and tobacco products;
• look at the timing of your medication, particularly if you are taking steroids. It is important that you do not take these late in the evening.
• alcohol may help sleep onset, but can be very disruptive to sleep quality and can lead to awakening after 1-2 hours sleep
• gentle exercise on a constant basis tends to improve sleep and promotes deeper levels of sleep.
• try a hot bath, for 20 minutes 2 hours before bedtime. This is good if you are unable to exercise
• ensure your bedroom is comfortable – a dark, slightly cooler environment is restful. Some people like a quiet environment, whilst others like the background noise of a fan, or radio.

What can I / can't I do?

Introduction

How does it work?

How is it given?

What are the side effects?

What can I / can't I do?

What if the chemotherapy does not work?

What happens when my treatment is complete?

Specific Treatments

Other resources