Understanding your treatment can help lessen your anxiety and help to resolve concerns. No two people experience cancer and chemotherapy in the same way. It is normal to feel angry, afraid, or depressed. At other times you may feel hopeful, peaceful, or confident. Whatever you feel now, or later is okay. Questions, concerns, and mixed feelings about receiving chemotherapy is common, and we are here to help with those.  Below are some frequently asked questions we hear from our patients.

Q. What is chemotherapy?

Chemotherapy is a type of treatment that includes a drug or combination of drugs to treat cancer. The goal of chemotherapy is to stop or slow the growth of cancer cells. Not all cancers are treated with the same drugs or in the same way. You may receive one drug, or a combination of drugs. In addition to chemotherapy you may receive other services such as surgery, or radiation therapy.

Q. How does chemo work?

Chemotherapy works to destroy fast growing cells. When chemotherapy enters the blood stream, the blood carriers the drugs to the cancer cells throughout your body.

Q. How is chemotherapy given?

Some chemotherapy delivery methods include orally (by mouth as a pill or liquid), intravenously (by infusion into a vein), or injection.

Q. How long will I receive chemotherapy?

The duration of treatment will depend on what kind of cancer you have and how it responds to treatment. In most cases your doctor can give you a general idea of the planned length. This time period can change.

Q. Does chemotherapy cause side effects?

Not all chemotherapy drugs produce side effects, and side effects vary on the person receiving it. People receiving similar treatments can experience different side effects.

Q. Possible Side Effects of Chemotherapy.

Infection

Treatment can decrease your white blood cell count which can increase your chances of developing an infection. To avoid infections, take the following precautions.

  • Wash your hands before eating or brushing your teeth. Always wash your hands after using the bathroom.
  • Avoid contact with people who have colds, the flus, cold sores, or other infections.
  • Check with your doctor about when to have the flu shot.
  • Avoid  babies, children, or adults who have received a live vaccine with six to eight weeks. Examples of live vaccines include chicken pox, measles, mumps, rubella, and smallpox. You have a higher risk for contracting the virus when exposed to even a small amount.
  • Clean your mouth after every meal, and at bedtime using a soft bristle toothbrush. If you notice any sores or white patches in your mount or on your lips tell your doctor or nurse.
  • If you wear dentures make sure they fit properly so that they do not irritate your mouth.
  • Women should avoid douching.
  • Do not use enemas unless directed by your doctor.
  • Clean the rectal area thoroughly, but gently, after each bowel movement.
  • Avoid cleaning cat litter boxes, fish tanks, or birdcages. Ask your doctor if you should limit close contact with pets.
  • Eat foods high in protein and vitamin C. If you are losing weight increase you calorie intake and discuss weight loss with your doctor.
  • Cook all foods thoroughly, especially meat, fish and eggs.
  • Take extra precautions to avoid cutting or burning yourself.
  • Always wear shoes.
  • Moisturize your skin, and soften cuticles with hand lotions instead of cutting them.
  • Keep your fingernails and toenails clean.
  • Avoid squeezing or scratching pimples or blemishes.
  • Use an electric shaver instead of a razor.
  • If you cut or scrap your skin, wash the area with soap and water. Cover with a clean bandage, and change the bandage daily until healed. If redness develops contact your nurse.

Symptoms of infection:

  • Fever. Speak with your nurse if your temperature reaches 100.5 F or higher
  • Chills
  • Shortness of breath, difficulty breathing, chest pain or tightness
  • Stiff neck
  • Sore throat or other cold symptoms lasting more than 48 hours
  • New cough, or a change in an old cough
  • Unusual weakness, dizziness, or fatigue
  • Tenderness or ulcers
  • White patches in your mouth
  • Nausea and vomiting lasting more than 12 hours
  • Diarrhea
  • Rectal tenderness or discharge
  • Difficulty urinating
  • Abdominal pain
  • Red, swollen, or tender areas of skin
  • Any new or unusual pain

Always call immediately if your temperature reaches over 100.5 F or higher. Do not take Tylenol, aspirin, ibuprofen, or any other over the counter medications without talking to your doctor first.

Q. Bleeding

If your platelet count is low, you may notice easy bruising. It is also possible to develop small red dots under your skin called petechiae, this can look like a rash. If you notice patechiae inform your nurse, as this could be a side effect of your treatment.

If your platelet count is low, it is important to prevent cuts and injuries. If you do cut yourself, press a clean bandage or cloth directly to the area until the bleeding stops. Make sure to move anything that can block your way, or that you could trip over.

Here are other precautions you can take.

  • Using non-skid slippers and shoes
  • Avoid contact sports
  • If gardening, use heavy gloves and avoid working near plants with thorns
  • Take extra caution when using tools or knives
  • When cooking or ironing be careful not to burn yourself. Utilize hot pads and oven mits.
  • Use a soft bristle toothbrush. Check with your doctor or nurse before using dental floss.
  • When blowing your nose, blow one nostril at a time gently. (If you experience a nosebleed apply pressure to your nose and place an ice pack on the back of your neck until the bleeding stops. If the bleeding continues for more than 30 minutes call your doctor.)
  • Use an electric shaver instead of a razor.
  • Do not take aspirin or product containing aspirin without checking with your doctor

Your Doctor or nurse will inform you when your platelet count is low. If you notice any of the following symptoms during this time, contact your nurse or doctor.

  • Petechiae, red spots under the skin
  • Bleeding gums
  • Easy bruising
  • Headaches
  • Vision changes
  • Uncontrolled nosebleeds
  • Blood in urine or stool
  • Dark tar like stool
  • Abdominal pain or swelling
  • Unusual bleeding anywhere else on your body.
Q. Anemia, Fatigue, and Weakness

When you red blood cell count is low this can cause anemia. The most common symptom of anemia is fatigue. But it is possible for you to experience other symptoms such as:

  • Dizziness
  • Ringing in ears
  • Shortness of breath
  • Chest pain
  • Headaches
  • Fast heartbeats

Contact your doctor or nurse when experiencing these symptoms.

Other causes of fatigue could be your treatment, loss of appetite, lack of exercise, or even the cancer itself. Fatigue related to your treatment can happen suddenly, can be overwhelming, and may not be eased by rest. This can also affect your emotions, mood, concentration, even your ability to perform normal actives.

Here are some suggestions that may help you feel less tired:

  • Eating a well-balanced diet with protein, iron, and vitamins. If you are losing weight, eat high calorie foods
  • Try to maintain your normal activities as much as possible. Pace yourself
  • Rest and relax when possible (see page 3 for tips on relaxation)
  • Let others help, especially with household tasks
  • Develop a sleep pattern
  • Drink 6 to 8 glasses of fluid a day, unless your doctor informs you otherwise
  • Ask your doctor about taking an iron supplement
Q. Digestive System - Loss of appetite

Many people with cancer can lose their appetite, losing interest in food is common. Weight loss is often thought to be normal among people with cancer, although it is possible to avoid it sometimes. Here is how:

  • Eat more food that appeals to you
  • Eat smaller meals more often
  • Keep high calorie, high protein snack available. Try snacks like cheese, peanut butter, hard boiled eggs or yogurt.
  • Avoid fried food
  • Between meals drink nutritious liquids like juice, milk shakes, instant breakfast drinks, or hot chocolate, rather than water, coffee or tea
  • Take a short walk before meals, Exercising can increase your appetite.
  • Adding extra margarine, mayonnaise, or whipped cream to food. Each tablespoon adds an extra 50 to 140 calories.
Q. Weight Gain

Steroids or other hormones can attribute to weight gain.  Also some people can experience a larger appetite during weight gain. It is important that you do not try to lose weight while on treatment. If you notice an increase in your weight or appetite these ideas may help you to stabilize your weight.

  • Snack on fresh fruit and vegetables
  • Use low fat milk and dairy products
  • Cut down on margarine or butter
  • Avoid fried foods, or foods with heavy sauces or cheeses
  • Include some activity, such as walking into your daily schedule
  • Have a glass of water before meals
  • Serve yourself a portion of food and put leftovers away before you eat to avoid seconds

Although gradual weight gain may be expected, if you notice your weight increasing unexpectedly or swelling contact your doctor.

Q. Changes in taste and smell

Certain chemotherapy drugs can sometime notice a bitter, metallic taste in their mouths. This can cause foods that once tasted good to taste different or not have a taste at all. So people report that smells become stronger or even overpowering. This small can decrease your appetite. Try some of the following ideas to improve your appetite.

  • Soaking red meats in wine, marinades or juices before cooking, this can decrease the bitter aftertaste.
  • Instead of red meat eat more chicken, turkey, eggs, custards, milk shakes and cheese dishes.
  • Eat more food at room temperature. Cold decrease strange smells. Sandwiches or salads are some.
  • Try using different spices and seasoning.
  • Suck on hard candies, or eat more fruits between meals
  • Take good care of your mouth
  • Let someone else cook for you
Q. Sore Mouth and Throat

You may notice your or mouth may feel raw or very sore. You may even notice red areas, white patches, or sores. These suggestions may help you decrease the pain.

  • Eat soft foods. Casseroles, soups, and soufflés are easier to swallow.
  • Make foods easier to swallow by using extra mayonnaise, syrups, or creams
  • Avoid heavy spices, seasonings, or citrus foods.
  • Try cold or room temperature foods
  • If your mouth is dry chew sugar free gum, suck on hard candy or ice chips
  • Inform your nurse of white patches, or sore areas. Ask about pain relievers
  • Take care of your mouth
Q. Nausea and Vomiting

Some treatments can cause nausea or an upset stomach. You may also feel weak. There are may ways you and your doctor or nurse can lessen or control these symptoms. Take note of any patterns you notice and mention them to your doctor or nurse. Some people have found that the following suggestions may be helpful in decreasing nausea and vomiting.

  • Eating small frequent meals
  • Eat bland foods like toast, crackers, apple sauce, and ginger ale
  • Try eating or drink your meals at room temperature
  • Sip liquids
  • Before treatment, eat foods that are easy to digest
  • If the smell of cooking food makes you nauseas, ask someone to cook for you. Arrange Meals on Wheels
  • Breathe through your mouth, try to slow your breathing when nauseas.
  • Avoid heavy spices, seasonings, or citrus foods
  • Avoid alcohol
  • Avoid unpleasant odors
Q. Diarrhea

Some treatments can cause diarrhea. Diarrhea can also result from stress, nutritional supplements, or abdominal radiation therapy. Some people have found that the following suggestions may be helpful in reducing diarrhea

  • Eat low fiber foods that are high in protein. (Examples: apples without peels, applesauce, avocados, bananas, white bread, crackers, cottage cheese, effs, pasta, potatoes, cook cereal, meat, low fat milk, pudding, custard, rice cooked vegetables.
  • Drink 6 to 8 glasses of fluids a day.
  • Add a small amount of nutmeg to food
  • If you have severe diarrhea switch to a liquid diet, check with your nurse first
  • Eat food rich in potassium. (Examples: bananas, peaches, avocados, potatoes, and oranges.)
  • Avoid food that irritate your digestive tracts or lead to cramping
  • Avoid alcohol , caffeine, fresh and dried fruits, and whole grain breads or cereals
  • Avoid gas forming foods
  • Avoid extremely cold or hot foods
  • Report severe diarrhea to your nurse or doctor
Q. Constipation

Some treatments can cause constipation. Use some of these tips to prevent or relieve constipation:

  • Eat food high in fiber
  • Drink extra fluids when eating high-fiber foods
  • Try fiber supplements (Metamucil)
  • Drink hot beverages
  • Establish a regular meal schedule
  • Try activities like walking to promote bowel movements
  • Ask your doctor or nurse about laxatives
Q. Hair Loss

Not all chemotherapy result hair loss, or even the amount of hair loss. Hair loss may happen suddenly or gradually. If you do lose hair it is possible to lose it from your head, face, armpits, pubic area, chest, and or legs. It is normal to feel upset about losing hair. However your hair will grow back after you complete your treatment. If hair loss is a possibility for you, you may find the following suggestion helpful.

  • Wash with a mild shampoo every few days
  • Pat you hair or scalp dry, do not rub
  • Do not color your hair
  • Limit your use of hair spray, electric curlers, blow dryers, and curling irons.
  • Continue to treat your hair gently as it grows back
  • Consider getting a shorter hair cut early in your treatment to make hair loss less noticeable
  • Consider turbans, scarves, and hats
  • If you plan to where a wig, buy it early in your treatment so that hair color can be matched. Your health insurance may cover the cost of a wig. Ask your doctor for a prescription for a “scalp prosthesis”. Wig cost are tax deductible. American cancer society can assist in obtain a wig. Or ask to view which wigs we have available in the office.
Q. Effects on Skin

Some treatments can cause your skin to be more susceptible to sunburn.

  • Avoid direct sunlight between 10am and 4pm
  • Apply sunscreen routinely to exposed skin
  • Do not use tanning booths or sun lamps
  • Wear a hat and lightweight clothing to protect your skin when you are outdoors

Some chemotherapy may cause skin rashes or darkening of your skin or nails. Contact your nurse or doctor if this occurs.

Q. Instructions for handling of waste

Chemotherapy usually remains in the body for 3 to 7 days after treatment, depending on the drug that you receive. Chemotherapy is excreted in the urine, stool, vomit, semen, and vaginal secretions during this time period, and it is necessary to take precautions during this time.

Toilet
Flush the toilet immediately. Then flush again.

Skin
If urine, stool, or vomit come into contact with your hands or other body parts, wash the area immediately with soap and water. If caretakers come in contact with these fluids they should be wearing gloves.

Bedpan, urinal, or emesis basin
Caretakers should wear latex gloves when handling the container. After each use, empty and rise the container well. Wash the item daily with gloves on, and discard gloves after each use. Then wash your hands with soap and water.

Diapers
Caretakers should wear latex gloves when handling the diapers or disposable bed pads. It is recommended that to double bag the waste. Discard gloves after each use. Then wash your hands with soap and water.

Linens and Clothing
If urine, stool, or vomit come into contact with your clothing, wash them immediately. These items should be washed separately from other items and should be washed twice.  If you cannot wash them immediately double bag and dispose of them in the trash.

Pregnant Women
Pregnant women helping patients should avoid coming in contact with the patient’s urine, stool, vomit, or semen during treatment and for the first 3 to 7 days after treatment.

Ostomy care
Caretakers should wear latex gloves when emptying or changing appliances. Double bag waste and discard in trash.

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