Side Effects and Coping Strategies

Before You Begin Chemotherapy
Check with your doctor about what medical or cosmetic details you should attend to before you begin your treatments. Here are some suggestions.

• If you need to have a dental check-up or dental work done, it's a good idea to do so before you start your treatments. In general, your doctor will not want you to have dental work during chemotherapy, as you may be at higher risk for infection.
• Discuss with your doctor your current method of birth control. Women may be advised to switch to a barrier method (diaphragm or condom), so scheduling a gynecologist appointment may be necessary.
• If your doctor tells you that you are certain to lose your hair and you decide that you want to wear a wig, get fitted for one at the beginning of your treatments. This way you can select a wig that closely resembles your own hair.

Nausea and Vomiting
In the past few years many new drugs called antiemetics have been developed that reduce and often eliminate nausea and vomiting. They almost always succeed but may need adjusting. If the antiemetics that have been prescribed are not working, make sure you tell your doctor and chemotherapy nurse. These drugs can be adjusted accordingly for your subsequent treatments, or another drug can often be used. It is important that you continue to take your anti-nausea medication as prescribed even if you don't feel nauseated.

The following techniques may help:

• Eat lightly an hour or two before chemotherapy.
• Always take anti-nausea medication as directed.
• Avoid big meals, instead eat smaller meals throughout the day.
• Eat and drink slowly.
• Avoid fried or fatty foods.
• Avoid odors that make you feel queasy, such as cooking smells or perfumes.
• Suck on ice cubes or mints.
• If you feel nauseated, breathe deeply and slowly to help you relax.

Fatigue
Cancer patients often complain about fatigue. Even if your blood counts are not low, you may feel weak and tired at different times during chemotherapy. The most important step you can take to help your body build back its strength is to get enough rest.

There can be many reasons for fatigue besides low blood counts, such as anxiety, depression, poor nutrition and sleep patterns. Make sure you tell your doctor or chemotherapy nurse as specifically as possible how tired you feel. Most cancer patients make the mistake of trying to live their lives as if nothing is different. While this is entirely understandable, it is easy to overdo it. During treatment, you need to get plenty of rest and perhaps adjust activities such as exercise. You don't have to give up important activities, just reduce some of them and save your limited energy for those things you consider priorities. If possible, extra help with shopping, cooking and child care can be a big help. The following suggestions may help you conserve and sustain your energy.

• Try to sleep longer at night.
• Schedule naps during the day whenever possible.
• Set your priorities; don't try to do everything you did before you were undergoing chemotherapy.
• Learn to ask for assistance when you need it. Accept help from friends and family when it is offered.
• Try to eat a balanced diet.
• If you exercise regularly, cut back on intensity and length, but try not to eliminate it altogether. It is not, however, a good idea to begin a new sport that requires high energy.

Hair Thinning and Loss (Alopecia)
Whether or not you lose your hair depends on the type, dose and duration of the drugs you receive. Ask your doctor if hair loss is likely to occur with your treatment. When it does occur, it can happen all over the body, not just on your head. The hair always grows back after your course of chemotherapy is complete. To protect and maintain the health of your hair during chemotherapy, avoid bleaching, coloring, perming or using hot rollers. When blow-drying your hair, use the low-heat setting. Always remember to gently brush your hair.

Maintain good scalp care with a mild shampoo and conditioner even if you do experience hair loss, because the scalp can become very dry. If your hair does fall out, you may decide to wear a wig, hairpiece, turban, scarf or cap. Alternatively, you may choose to leave your head uncovered or try different approaches on different days. If you decide to cover your head with a wig or hairpiece, purchase one before you lose most of your hair. This way, it will be easier to closely match the color and style of your natural hair. There are a variety of stores that sell wigs, including several specialty shops that cater to cancer patients. (See "Resources" section of this guide.)

Diarrhea and Constipation
Chemotherapy can cause irritation of the lining of the intestines, which may result in very loose or liquid stools. If you have diarrhea that continues for more than 24 hours, call your doctor. Make sure you drink fluids to replace those you have lost. Clear liquids, such as broth, apple juice, ginger ale and water, are best.

Some drugs trigger constipation. Inform your doctor if you have not had a bowel movement for more than two or three days. Do not use over-the-counter remedies such as laxatives or suppositories without checking with your doctor. Drink eight to ten glasses of fluids a day.

Mouth and Gum Care
Some chemotherapy may cause temporary sores in the mouth and throat. Usually, they come and go rapidly. However, to avoid developing an infection from the many germs in the mouth, it is important to maintain good hygiene.

• Before starting chemotherapy, see your dentist to have your teeth cleaned and any necessary dental work done.
• Brush your teeth gently after each meal using a soft toothbrush.
• If you wear dentures, check underneath the dentures for mouthsores.
• If you do develop sores, make sure you contact your doctor or nurse because you may need medical treatment. There are medicines that can relieve any discomfort.

Skin and Nail Care
Your skin may undergo changes while you are having chemotherapy. Side effects may include dryness, itchiness, cracking, peeling, redness and increased sensitivity to sunlight. The skin along the veins where you receive chemotherapy may darken. It will usually fade a few months after treatment ends.

These suggestions may help you:

• Apply creams and lotions while your skin is damp to alleviate dry and cracked skin.
• Wear a sunscreen with a skin protection factor (SPF) of 15 or more.
• Wear long-sleeved shirts, pants and hats to block the suns rays.
• Avoid perfume or aftershave that contains alcohol.
• Avoid long, hot baths.

Effects on Sexuality
Chemotherapy may or may not affect sexual and reproductive functioning in both men and women. Side effects vary depending on the drugs used, and the individual's age and general health.

Women
Some chemotherapy drugs can affect ovarian function. Your menstrual periods may become irregular or stop completely while you are having chemotherapy. Others experience no change in their cycles. Whether or not a woman's periods will resume after chemotherapy is influenced by her age at the time she begins her treatment. Menstrual periods are more likely to stop if you are in your forties or older. Some women experience hot flashes, sweating, burning or vaginal dryness. Speak to your doctor about various methods, such as lubricants, to relieve dryness which can make intercourse uncomfortable. It is not advisable for you to become pregnant while on chemotherapy. The drugs may cause birth defects. Even if your periods have stopped, it is still possible to become pregnant. Use a barrier method for birth control. Sometimes oral contraceptives, which contain estrogen and progesterone, cannot be used during chemotherapy. Make sure your doctor is aware of what type of contraception you are using.

Men
The effects of chemotherapy may lower sperm count or cause abnormalities in sperm. This may result in temporary or permanent infertility. It is, however, still necessary to use birth control. Discuss fertility issues with your doctor before your first treatment, as some patients may want to consider the option of freezing their sperm for future use.

Sexual Feelings
While you are undergoing treatment, you may find that your attitudes and feelings about sex are temporarily different from how you felt before. Or, you might find that your sexual desire and energy level remain unchanged. For most people, a cancer diagnosis and subsequent treatments are a source of stress. You may be troubled by how your illness is affecting your family or your work. You may be worried about a change in appearance. Sometimes these fears and anxieties can affect sexual relationships. It is important to share your thoughts and feelings with your partner. Generally, there is no overriding reason why physical intimacy must cease. However, it is also important to recognize that there are many ways of expressing love--hugging, touching, cuddling. You and your partner should explore all avenues to intimacy. You should also discuss your sexual concerns with your doctor or nurse. Social workers, psychologists and psychiatrists may help you to adjust to changes during treatment.

Low Blood Cell Counts
Your circulating blood cells are produced in the bone marrow. These cells are constantly growing and dividing in order to replace older, senescent blood cells. Because bone marrow cells are rapidly dividing, chemotherapy may decrease the number of cells produced to circulate in the blood. This may result in lower white cell, red cell or platelet counts.

Low White Blood Cell Counts
When the number of white blood cells drops, you become more susceptible to infection. Your physician will be monitoring your counts continually to let you know when you are at greater risk for infection and will advise you how to reduce that risk. If, when your white blood cell counts are checked and your numbers drop too far below normal, your doctor may postpone your next treatment. New drugs have become available that may help shorten the time that the white blood cell count stays low. These are called colony stimulating factors, commonly known as growth factors. One is called granulocyte colony stimulating factor (GCSF) and another is called granulocyte macrophage colony stimulating factor (GMCSF). They are given by daily injection. Growth factors are only given under certain circumstances. Your doctor will tell you if it is necessary for you to have those drugs.

Low Red Blood Cell Counts (Anemia)
A drop in the second blood element, red blood cells, can be a complication of chemotherapy. The red blood cells carry oxygen throughout the body. If the red cell count becomes very low, you may require a transfusion. An injectable hormone, erythropoietin, is sometimes beneficial in reducing or avoiding transfusion requirements.

Low Platelet Counts
Another blood element that is manufactured in the bone marrow, platelets, may also be affected. Platelets are necessary for normal blood clotting. When your platelet count drops, you may bleed or bruise more easily. Be alert to unexpected bruising, nosebleeds, pinkish urine, or black or bloody stools. If your doctor decides your platelet count has fallen too low, you may receive a transfusion to increase your platelet count.

Nutrition
Trying to eat a balanced diet will help your body cope with whatever side effects you may have and also help you regain your strength. Some chemotherapy treatments cause weight gain in patients; others are associated with weight loss. There may be times during chemotherapy when you will not feel like eating. Familiar foods may seem different. Some patients experience a slightly metallic taste when they are chewing. The following suggestions may help increase your appetite.

• Eat food when you feel hungry, don't wait until mealtime.
• Select foods that appeal to you. Try new dishes.
• Walk before meals; it may stimulate your appetite.

Some patients who receive certain chemotherapy treatments may actually gain weight. This probably happens because patients on chemotherapy tend to be less active and also tend to eat more "comfort" foods which may be higher in calories. For most patients, the extra weight is relatively easy to lose once treatment is completed.

Dieting
While dieting is not advised, many patients with cancer change their diets to reflect healthier eating patterns. A healthy diet, low in fat and rich in fruit and fiber, can improve your sense of control as well as your overall health. Our advice, if you wish to improve your diet, is to wait until after treatment. Many patients report that post-treatment lifestyle changes have helped them improve their quality of life. Additionally, if you are taking vitamin or mineral supplements, tell your doctor, as some supplements may lessen the effectiveness of your chemotherapy.

Alcohol
You may be advised to avoid alcohol, or to limit your intake, as it may interact with some of your drugs. Alcohol also causes dehydration, and during chemotherapy it is particularly important to stay hydrated. Ask your doctor for specific guidelines.

Recognizing an Infection
You should report any signs of infection to your doctor or chemotherapy nurse. These include:

• Cough
• Burning sensation when urinating
• Fever over 100.5 degrees F
• Chills with or without a fever
• Any redness, swelling or discharge from a wound or an intravenous catheter site.

Getting the Emotional Support You Need
Going through chemotherapy can be disruptive to your routines, your work, even your personal relationships. Emotional changes are triggered, too. Many people find they are anxious, depressed or angry at some time during their treatments. These feelings are entirely normal. Fortunately, there are coping mechanisms for your emotional ups and downs, just as there are for your physical side effects. Counseling professionals, including psychiatrists, psychologists, social workers, sex therapists and members of the clergy, are available to help you during this time.

When you are receiving chemotherapy, taking care of yourself must become your first priority. Be sure that all your questions about your medical treatment are answered. Think about what your concerns are--both physical and emotional--and communicate them to your physicians and nurses. Your questions help them to provide you with the care you need to be as healthy as possible.

Don't be too hard on yourself. It is unreasonable to expect that you are going to be able to perform your daily tasks and responsibilities at home and at work with as much energy and stamina as you did before. There will be some days when you feel lackluster and tired. On other days, however, you will likely feel as strong as you did before your treatments. After your chemotherapy ends you will regain your previous level of activity.

Try not to become exhausted. Whenever possible, call upon family, friends, neighbors and coworkers to help with errands and other tasks, such as taking your children to school. Many people want to help make this challenging time easier for you, but don't know what to do to help you--so tell them. Try asking for help with a specific task or responsibility. You can also help alleviate others' fears about your illness by talking about your treatments and making your needs clear.

Consider joining a support group. It is often helpful to share your thoughts and feelings with others who are going through chemotherapy. If you prefer, individual counseling is also available.

Relieving Stress
Concentrate on doing some of the things that make you feel better. It might be listening to music, taking a walk, working on a hobby or having a massage. Consult your doctor or nurse if you would like to be instructed in various techniques that utilize deep breathing or biofeedback to help you relax. Visualization, where you create a mental image of chemotherapy destroying cancer cells, is another approach that may add to your sense of control.

In coping with cancer and facing a course of treatment, some patients find they start to rethink their style of living. Focusing on issues of stress reduction, diet and exercise can be tools to cope with stress and can give you some sense of control. You don't have to be a passive observer while you are being treated. Instead, you can choose to be an active participant.

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