Chemotherapy Is an Individual Experience
Every person experiences chemotherapy differently, both physically and emotionally. Each person experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects.
For many cancer patients, you may look and feel just fine until you begin chemotherapy. It is during chemotherapy that you begin to feel truly ill, and this is also when family, friends, neighbours colleagues will notice something wrong. Fortunately, as the science of cancer treatment has advanced, so has the science of managing treatment side effects.
Many people feel fine for the first few hours following chemotherapy. Usually, some reaction occurs about four to six hours later. However, some people don’t react until 12 or even 24 to 48 hours after treatment. Some people experience almost all of the side effects described below, while others experience almost none.
We have many treatments and methods available to help you deal with side effects. There is a delicate balance between the benefits of chemotherapy and the occurrence of possible side effects. We will work with you to achieve that balance.
Before Starting Chemotherapy
Before starting chemotherapy, we suggest that you take care of some of your basic health needs. If time permits, have your teeth cleaned before rather than while you are having chemotherapy. If you need major dental work e.g. extraction, please postpone it until after chemotherapy. If you need your teeth cleaned while receiving chemotherapy, please let your doctor or nurse know beforehand. Please discuss any concerns with your doctor or nurse.
You can have a family member, friend or support person accompany you to your chemotherapy sessions. This will help you have someone to talk with, keep you company, and help you go home after. At the end of this leaflet, you’ll see contact details for a few support groups and NGOs that can help you along this journey.
Fever and Infection
Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are made in the bone marrow and help fight against infection. Neutrophils are one type of WBC that fights infection. You will hear your doctor talk about your Absolute Neutrophil Count (ANC) which will determine whether or not you will receive chemotherapy on schedule.
A fever (temperature of 38.3° Celsius), or chills with or without a fever, can be a serious sign of infection. You must call your cancer specialist even if it’s at night or on the weekend.
An infection is most likely to occur when your neutrophil count is low. You are most susceptible to a bacterial infection about seven to 12 days after your chemotherapy infusion. Most bacterial infections result from your body’s inability to fight off normal bacteria present in your gastrointestinal tract or skin. Bacterial infections do not commonly result from being in a crowded place. So, if you are feeling well, we encourage you to continue to go out and live your normal life.
However, viral infections such as colds and flu are common and are transmitted easily from other people. To reduce your chance of infection, wash your hands frequently and avoid close contact with anyone who is ill during this time.
Practical Points Regarding Fever and Infection
- If you have a fever (temperature 38.3° Celsius), with or without chills, come to the center immediately. If it is after hours, please go to an emergency room.
- Keep a thermometer in your home and know how to take your temperature. If you feel like your body is warm, check your temperature to be sure.
- Call the center and book an appointment to come in as soon as possible if you develop a cough, sore throat, pain or burning when you urinate.
- To help prevent infection, we encourage frequent hand washing with soap and room-temperature water.
- During; and for some time after chemotherapy; Avoid rectal intercourse, tampons, douches, enemas and rectal thermometers.
- Do not eat raw food such as sushi and sashimi, raw or runny eggs, or any undercooked food until you complete chemotherapy and your blood counts have returned to adequate levels. Raw foods may carry bacteria that can lead to infection. Make sure to thoroughly wash any fruits and vegetables.
- It may also be advisable to avoid pork inn this period
- Wash hands and cutting boards well with soap and water before and after food preparation.
- Always tell your doctor before going to the dentist.
Remember, always come I to the center if you have a temperature of 38.3° Centigrade or higher.
Around the third day following a chemotherapy treatment, some people may experience flu-like symptoms such as muscle aches and pains. If you experience these aches, you can take over-the-counter medications such as Paracetamol or Ibuprofen. If it does not abate, book an appointment to see your doctor.
Medications called antiemetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your doctor or nurse will recommend what is expected to work best for you.
Practical Hints for Nausea
- Before your chemotherapy appointment, eat a small, light, non-oily meal. Most people do better if they have something in their stomach.
- Eat what sounds good to you. Generally starches such as rice, bread, potatoes, and yam are well tolerated.
- Try not to skip meals. An empty stomach will worsen all symptoms. If you don’t feel able to take down an entire meal at a time, try nibbling on something that appeals to you slowly.
- Drink plenty of fluids. Water, teas and juices are recommended more than carbonated (soft) drinks. Avoid very hot drinks as they can worsen or even cause mouth sores.
Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy. Most people have to make some adjustment in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. As much as possible, try to maintain your everyday activities. It can be very beneficial to both your physical and emotional recovery. The fatigue will go usually go away after you recover from chemotherapy.
Practical Hints for Fatigue
- Plan your activities for a time when you feel the best.
- Get help at home, and accept help from family, and friends
- Try to take any naps earlier in the day so you do not disturb your sleep pattern at night.
- Try to do some light exercise every day or several times a week. Good forms of exercise include swimming, walking and yoga.
For many people, hair loss is one of the most distressing aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your doctor or nurse about what to expect.
Hair loss usually begins about two to three weeks after starting chemotherapy. Some people will lose relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body hair. You may want to wear a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you most comfortable. Many people choose different head coverings for different situations.
Your hair will usually begin to grow back after you stop chemotherapy. It usually takes from two to three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often, the new hair will be baby soft and curly, but will often return to its original texture after some time.
Practical Hints for Hair Loss
- Avoid a wig that makes your head feel itchy or uncomfortably hot.
- Before possible hair loss, some people like to cut their hair short. The hair loss won’t be quite so shocking if there is less hair to lose.
- When buying a wig, take a friend for emotional support and maybe even a laugh!
Appetite and Taste Changes
During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to odors. Don’t worry if you don’t have an appetite the first few days or a week following chemotherapy; it is not unusual. As you feel better, your appetite will improve.
Reflux — when food backs up into your esophagus — burping, or a burning sensation may worsen nausea. Please report these symptoms to your doctor or nurse so that they can be treated. You may find that you can tolerate only certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids: eight to 10 glasses per day, more if you have a fever or diarrhea. Many people gain weight while on chemotherapy for reasons that are not well understood. If you experience this, don’t be alarmed, work with your doctor to manage it.
Practical Hints for Taste and Appetite Changes
- Eat what appeals to you during this time.
- Eat foods that are warm rather than hot.
- Suck on ice chips and drnk cold water to help nausea
- Avoid smells that are unappealing.
- To try drink eight to 10 glasses of fluid a day.
Diarrhea or Constipation
Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24 hours or blood in your stool, call the center and book an appointment to come urgently. Do NOT use over the counter anti-diarrhea medications like Imodium unless advised to do so by your doctor or nurse.
Some chemotherapy and anti-nausea drugs can cause constipation. Also, you may be more prone to constipation because your activity level and diet have changed. If you experience constipation, contact your doctor or nurse the same day.
Practical Hints for Diarrhea
- To replenish lost fluids, drink eight to 10 glasses of non-caffeinated fluids per day.
- If your rectum is sore, use soft toilet paper and A&D ointment (used for diaper rash in infants) or Anusol, which can help numb the rectum and soothe soreness.
Practical Hints for Constipation
- To help prevent constipation, drink eight to 10 glasses of fluid a day.
- Take a stool softener (not a laxative) such as ducosate sodium (DSS), also known as Colace, one tablet once or twice a day. Senekot or Senekot-S also may be suggested. Ask your doctor or nurse for a recommendation.
- Stay as active as you can. Consistent regular exercise can reduce constipation.
- If you can tolerate them, try high-fiber foods such as prunes, bran, fruits and vegetables.
Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy can also affect rapidly dividing cells, such as those that line your mouth and esophagus. Please speak to the chemotherapy nurse or your doctor if you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed.
Practical Hints for Mouth Sores
- Avoid hot food or drinks, dry foods such as crackers crisps or chips.
- Avoid salted, smoked, spicy or peppered foods.
- Do not smoke. If you are a smoker, talk to your doctor or nurse about enrolling in a smoking cessation program.
- Brush your teeth with a very soft toothbrush and mild toothpaste. You can also clean your mouth with cotton wool or a thick cotton swab. Don’t use a hard toothbrush and don’t scrub your mouth
- Clean your mouth gently with alcohol-free mouth rinse prescribed for you by your doctor or try children’s mouthwash. Most commercial mouthwashes contain alcohol and should be avoided. You can ask about mouthwashes that are not irritating to your mouth,or try children’s formulations.
- If you are scheduled to begin therapy and have any dental problems, it is important for you to see a dentist before commencing treatment. Postpone any procedures such as extractions.
- Other medication to ease any pain/discomfort will be prescribed for you as needed
Neuropathy, which literally means disease or dysfunction of the nerves, can happen to some people. Some of the most common symptoms of the type of neuropathy caused by chemotherapy include tingling and burning, numbness or pain in the affected areas, loss of your sense of position — knowing where a body part is without looking at it — and loss of balance. The most commonly affected areas are the tips of fingers and toes, although other areas are sometimes affected as well.
Tell your doctor about any symptoms that you experience. Early detection and treatment are the best way to control your symptoms and prevent further nerve damage.
Practical Hints Regarding Neuropathy
- Tight shoes and socks can worsen pain and tingling and may lead to sores that won’t heal. Wear soft, loose cotton socks and padded shoes.
- If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice a day.
- Massage your hands and feet, or have someone massage them for you, to improve circulation, stimulate nerves and temporarily relieve pain.
For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally-occurring menopause.
With menopause, you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. If you experience any of these symptoms, talk to your doctor or nurse to get information and treatment for the symptoms.
If your periods continue during treatment, they are likely to change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause.
Practical Hints for Menopausal Symptoms
- If you have breast cancer, we DON’T recommend hormone replacement therapy.
- Eat soy products or take vitamin E (400 units only) to reduce hot flashes.
- Your doctor may recommend prescription medications for hot flashes.
- Wear light cotton pajamas to help prevent overheating when sleeping.
- Use vaginal moisturizers on a regular basis or other water-based lubricants as needed, especially during and before sexual activity. These products will help with vaginal dryness and irritation.