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The
Regional Cancer Center's Table of Contents Introduction This booklet describes chemotherapy and its possible side effects. It also discusses some guidelines for self-care and those times when you should call your doctor. The Regional Cancer Center provides outpatient chemotherapy and radiation therapy treatments for patients of the hematologist/medical oncologists and radiation oncologists who have offices at The Center. The Medical Oncology Department of The Regional Cancer Center consists of the medical oncologists, an oncology nurse practitioner and registered nurses. A pharmacy with a chemotherapy preparation area and a laboratory are located near the medical oncology nursing station. In addition, support services including a nutritionist, a financial counselor and a chaplain, along with social services and a diagnostic x-ray department, are available at The Center. It is important that you know that the doctors, nurses and other staff members are available to help whenever necessary. If you have any questions or concerns, do not hesitate to give us a call. Someone is always available to help. Office Hours: 8:00 a.m. to 5:00 p.m. Monday - Friday The Regional Cancer Center is a facility open during weekday hours, not a hospital or clinic that is open 24 hours a day. Please call for prescription refills, including pain medications, only during office hours. However, one of the hematologist/medical oncologists from The Center is on call 24 hours a day, 365 days a year for urgent or emergency problems. If you call The Regional Cancer Center with an emergency after hours, the answering service will take your name and one of the doctors will return your call. The Regional Cancer Center Telephone: 814-838-9000 or 1-800-477-6647 Cancer chemotherapy is the treatment of cancer with medication. It is one method of treating cancer and may be used alone or in combination with surgery, radiation therapy or hormonal therapy. There are many different types of cancer. Chemotherapy may cure some cancers or may keep the cancer under control for months or possibly years. Some cancers may not respond to chemotherapy. Most patients receive their chemotherapy treatments in the Medical Oncology Department of The Regional Cancer Center. There are some patients who require hospitalization for their therapy. Other patients may take their treatments at home. The chemotherapy medications may be given by mouth, by injection into a vein, by injection into a muscle or under the skin, by injection into the spinal canal or by infusion into a body cavity. The duration and type of therapy varies greatly from one person to another and depends upon the type of cancer as well as the body's response to therapy. It is common for patients to receive several medications at the same time. Doses of chemotherapy are calculated for each individual. Medication doses and schedules may need to be changed during the course of therapy. There are several methods used to measure how your treatments are working. Your doctor and nurses will discuss your specific needs with you. How Chemotherapy May Affect You Chemotherapy medications target rapidly dividing cells in the body. In addition to cancer cells, rapidly dividing cells are present in the hair follicles, mouth, skin, intestine, bone marrow and other organs. Because these medications affect normal cells as well as cancer cells, some of the results may be unpleasant. These are called side effects. The presence or absence of side effects has no bearing on the effectiveness of the medication; it seems to be a matter of a person's makeup. Your doctor and nurses will explain the common side effects of your medications, and you can refer to your specific medication information cards for side effects that may occur with the medications you are taking. Although unpleasant, some side effects are "normal" in that we expect them to occur. The most common side effects are discussed in this booklet as well as ways to deal with them. Fever/Infection Chemotherapy may lower the white blood cell count. This may occur after each treatment. When the white blood cell count is low, you are more susceptible to infection. The first sign of infection may be fever. If you feel ill, or think you may have a fever, take your temperature by mouth using a digital or glass thermometer. If your temperature is 100 - 101 degrees, take your temperature every 4 hours. If this low-grade temperature persists for 48 hours do not panic, but call The Regional Cancer Center. If your temperature is greater than or equal to 101 degrees for 2 times in a row, call The Regional Cancer Center immediately. If your temperature is greater than or equal to 102 degrees, call The Regional Cancer Center immediately. The guidelines for calling staff at The Regional Cancer Center are not the same for every patient. Your individual routine may be different from that listed above. If so, the doctor or nurse will tell you and/or write it below. In addition to fever, other signs of infection include a sore throat, pain when urinating or a feeling of needing to urinate frequently. If you have these symptoms, take your temperature regularly. Call The Regional Cancer Center if you have a fever or if these symptoms persist or worsen. To help prevent infections,
follow these measures: Platelets are blood cells that control bleeding. Chemotherapy may lower the platelet count. This may occur after each treatment but usually returns to adequate levels before you are due for your next chemotherapy treatment. When the platelet count is low, you become more susceptible to bleeding. Some signs of low platelets
are: When any of these occur, call The Regional Cancer Center. Contact The Regional Cancer
Center immediately if any of the following occur: Some preventive measures that
you may take if your platelet count is low include: Chemotherapy medications may also lower the red blood cell count (anemia). Some signs that you may notice
are: If these symptoms occur, report them to The Regional Cancer Center. Some people have little or no nausea and vomiting throughout the course of their chemotherapy treatment. The length and severity of nausea and vomiting vary from person to person and depend upon the medication(s) you receive. Nausea may last longer than vomiting. If you vomit, begin taking frequent small sips of fluid with soda crackers about an hour after you have vomited or as soon as you feel able, even if you are nauseated. Try to drink fluids to replace any fluids you may have lost. If after 24 hours you are vomiting as much as or more than you are taking in, call The Regional Cancer Center. If you have medication for the nausea and vomiting, be sure to take it as prescribed. A good rule is to take the anti-nausea pills when you start to feel nauseated. Suppositories can be prescribed to take if you are vomiting, so you will not have to take pills by mouth. Do not take anti-nausea pills and suppositories together, unless so directed. During times of nausea, eat only small amounts of food. Start with clear liquids such as tea, broth and apple juice. Then gradually increase the diet to include soft foods such as oatmeal, soups, egg dishes and milk products. Some general suggestions for
dealing with nausea: A few of the chemotherapy medications cause diarrhea as a side effect. If you do have diarrhea, it may be helpful to try a diet low in roughage and non-spicy foods, such as rice, cream of rice cereal, bananas, applesauce, dry toast and crackers. The fluid lost with diarrhea needs to be replaced. Drink plenty of fluids such as apple juice, water, weak tea, clear broth or Gatorade. Liquids should be lukewarm or at room temperature; they should never be iced or very hot. Let carbonated drinks lose their fizz before you drink them. Medication may be prescribed if necessary. If you have diarrhea, record the number and type of stools you are having. If you continue to have frequent loose stools for 48 hours or if the diarrhea is associated with cramping or bloating, call staff at The Regional Cancer Center. Constipation may be a concern, especially if you are taking pain medication. Try to include some bulk in your diet daily, such as bran cereals, salads and fruit. Drink plenty of fluids to help loosen the bowels. Medication can be prescribed for your bowels if necessary. You should have a reasonably normal bowel movement at least every third day. Do not let constipation become a problem. Call your primary doctor or The Regional Cancer Center for advice. Chemotherapy may cause the lining of the mouth to become dry and/or irritated. Occasionally, sores may form. Rinse your mouth with water after eating or drinking to clean out accumulated food. If possible, brush your teeth after meals with a soft bristle brush. This will improve your taste and decrease bacteria. If you notice more bleeding than usual when brushing your teeth, sores in your mouth or burning sensations, stop brushing and use one of the following rinses 3 to 4 times daily: • Salt water solution
• Baking soda solution If your mouth is sore, food and fluids that are lukewarm, non-spicy, non-acid or that have been pureed in a blender may be more tolerable. Avoid alcohol (this includes most mouthwashes) and abrasive foods that are hard to chew. If mouth soreness becomes bad enough that you cannot eat, call The Regional Cancer Center. If you have poorly fitting dentures, try to get them corrected. If you do develop sores in your mouth, do not wear your dentures until the sores heal. We can prescribe several medications to coat or soothe your mouth. Many people receiving chemotherapy will have little or no hair loss, but some may lose much or all of their hair. The amount of hair loss will depend upon the medications you receive; it varies greatly from person to person. The time it takes for hair loss to occur is also variable, commonly beginning a few weeks after the start of chemotherapy. Hair loss may involve all body hair, not just hair on your head. Hair loss is temporary, and hair will begin to grow again when treatment is stopped. All hair lost due to chemotherapy will eventually grow back. During the treatment, keep your hair and scalp clean with gentle products. Scalp itching and/or soreness may also occur after hair loss and is usually temporary. You may want to select a wig or toupee before hair loss occurs. Wearing a head covering when in the sun or cold weather is recommended. Administration of Chemotherapy Chemotherapy medications are often given intravenously. A small needle is inserted into a vein, the medication is infused and then the needle is withdrawn. The length of time for a chemotherapy treatment varies from a few minutes to several hours. For patients requiring long-term therapy that requires very frequent needle sticks, an indwelling intravenous catheter may be recommended. This is a small tube placed in a blood vessel in the chest or the arm that allows medication to be put in. Some catheters also allow blood to be withdrawn. These devices are usually removed after therapy is completed. Booklets are available at The Regional Cancer Center that describe the placement, use and care of such intravenous catheters. A portable infusion pump may sometimes administer chemotherapy. This is used when the chemotherapy must be given continuously over a specified period of time, usually several days. • If redness or pain occurs at the chemotherapy injection site, tell the nurse or call The Regional Cancer Center. • Consult your doctor before having any dental work or other surgery during the course of your chemotherapy treatment. Ask your dentist to show you the best techniques for brushing and flossing your teeth during chemotherapy. • Notify any other doctors who treat you that you are receiving treatment at The Regional Cancer Center. Call The Regional Cancer Center or your pharmacist before taking any other medications, even vitamins, during your course of chemotherapy. Generally, aspirin or aspirin-containing medicines should be avoided. • Some patients have questions about having children while taking chemotherapy, or for a time after therapy has stopped. Some chemotherapy drugs might damage an unborn child. Therefore, if you are sexually active and of childbearing age, it is recommended that you use an effective form of contraception during active chemotherapy treatment. You and your partner should discuss this with your doctor. Women receiving some types of chemotherapy may notice changes in their menstrual cycles. If you have concerns about sexual problems, talk to your doctor or nurse. • Certain chemotherapy medications cause skin sensitivity to the sun. If you are taking these medications, your skin may be more likely to burn from the sun or the use of a sunlamp. Check with The Regional Cancer Center or your pharmacist to see if you are on one of these medications and for assistance in selecting the best sunscreen for you. • If you think of any questions about your disease or treatment, write the question down in a notebook and bring it to your next appointment so that you can remember to ask your doctor your questions. A family member or significant other is an extra set of ears to hear the information and answers to your questions. They are welcome anytime and are especially important during your first visit and when you receive chemotherapy. If there is anything you do not understand, do not be afraid or embarrassed to ask for more information from your doctor, nurse or other Regional Cancer Center staff member. It is important to maintain contact and keep appointments with your family physician. That physician will still be responsible for your overall health care. The Regional Cancer Center physicians will keep your physician informed of your condition. You should contact your family physician for other health problems. • We request that you bring all medications (or a list of them), even if prescribed by other physicians, to all visits to The Regional Cancer Center. • Very often your doctor or nurse will ask for a list of medications you are taking or for the name of your pharmacy. When you call The Regional Cancer Center, have a list of all current medications and the name and telephone number of your pharmacy with you. Persons taking chemotherapy who have exposure to children or grandchildren receiving vaccinations should contact The Regional Cancer Center. Some vaccinations contain live viruses that could cause infections if your resistance (immunity) is down. Weight loss can be a problem for some patients receiving chemotherapy. If your food intake decreases, try five small meals that are high in calories (meats, milk and bread products). There are nutritional supplements available for purchase at The Regional Cancer Center Pharmacy. If you need advice about your diet or the use of supplements, please contact the nutritionist at The Regional Cancer Center. The nutritionist has various booklets available on nutrition, complete with recipes. Some appetite stimulators include: Some people receiving chemotherapy notice a change in the taste of food. Chocolates and red meat seem to be the foods most commonly so reported. Do not be alarmed if some of your favorite foods seem to taste differently. Cancer is not always accompanied by pain. Some cancers are associated with more pain than other types. In addition, some people have a higher pain threshold and pain may not bother them unless it becomes severe. However, if pain does occur, there are many ways to relieve or reduce it. Medications are used most commonly to relieve pain. If pain medications are prescribed for you, take them as directed. It is very important that you notify The Regional Cancer Center when you have a new pain that is significant. Check with your doctor or nurse regarding what kinds of pain or discomfort to report. When you report pain, your
doctor or nurse will ask you to: Narcotic pain medications are difficult for pharmacies to refill at night or on weekends, so make sure to call refill requests during office hours. Do not let pain become an untreated problem. 1. I feel achy and feverish.
What should I do? 2. I have both pills and suppositories
to take when I am nauseous. When should I take the suppositories instead
of the pills? 3. I keep losing weight. Is
there anything I can do to help regain some of what I have lost? 4. I am very tired. Even walking
up a flight of steps is an effort. What is causing this? 5. My neighbor was just diagnosed
with cancer. Will she receive the same treatment that I do? 6. Every time I get a chemotherapy
treatment, it is more difficult for the nurse to find a good vein to use.
Is there another way to give my chemo? 7. My bowels haven't moved
for 5 days. What should I do? Back to the top |
