Chemotherapy Patient Handbook

When to Seek Help (Inside Cover)

If you have a temperature of 38 °C or higher or feel unwell, please present to the nearest Emergency Department and bring along the oncology card that was provided to you at the beginning of your treatment.

For all non-emergency related concerns

Please call the direct infusion center number 02 501 9218 or e-mail [email protected]

What Is Chemotherapy?

Chemotherapy is a type of cancer treatment. It uses medications to destroy cancer cells and prevent tumor growth. Not all medications used to treat cancer work in the same way.

What Is the Difference Between Chemotherapy and Targeted Therapy?

Chemotherapy is a treatment that kills fast growing cells in the body. This can include cancer & healthy cells, while targeted therapy works more specifically on cancer cells. Targeted therapy may be less harmful to normal cells compared to other types of treatment. Patients who receive targeted therapy may still have side effects.

How Will I Receive My Chemotherapy?

Your chemotherapy can be administered to you in various ways: through a vein (intravenously), by mouth (orally), through a shot under the skin (subcutaneously), or using other methods.

As you get ready for your intravenous therapy, your healthcare team might talk to you about using a central venous access device. It's a special tube that goes into a large vein in your chest or arm. It's there to make your treatment easier and more comfortable.

What Is Oral Cancer Therapy?

Oral chemotherapy is cancer treatment you take at home by mouth. When you think about chemotherapy, or "chemo", you might think of getting it directly into a vein. Many medications only work this way. But other medications work just as well, or even better, if you take them by mouth. Some other cancer treatments, such as hormonal therapy or targeted therapy, are also given as pills or liquid. These are different from oral chemotherapy. Be sure to ask your health care team what type of medication you have been prescribed.

What Is a Treatment Cycle?

A course of treatment repeated on a regular schedule with periods of rest scheduled in between. For example, treatment for 3 weeks followed by 1 week of rest is considered one treatment cycle. It is especially important to remember to take your rest period, if required.

What Should I Know About My Treatment?

• Never take your medication for longer than you have been prescribed
• Swallow the tablets or capsules whole (never crush, chew, or bite tablets and do not open capsules or dissolve tablets unless directed by your healthcare provider)
• If you cannot swallow or tolerate your tablets or capsules, contact your doctor or pharmacist
• Make sure you understand if your medication needs to be taken with food or on an empty stomach
• Make sure you understand how many times a day you should take your medication

Taking My Medication at Home: How Do I Keep Myself and Those Around Me Safe?

• It is best to administer your medication to yourself to minimize exposure to others
• If someone is pregnant or thinking about becoming pregnant, she should not handle the medication
• If you need someone at home to help you take your medication, make sure they put on gloves to avoid exposure to the medication
• Transfer one dose of the medication from its original container to a small disposable cup
• Immediately remove the gloves and do not use them for anything else
• Throw away the gloves and the disposable cup in household trash
• Wash hands with soap & water
• It can take up to a week after your last dose of anti-cancer medication for your body to get rid of the medication. It can be in your urine and stool, in your vomit if you are sick, and in other body fluids. It is important that your household members continue to avoid contact with your bodily fluids during this period

How Should I Store My Medication?

• Most medications are stored at room temperature, away from direct sunlight. Your healthcare team will inform you of additional storage requirements if required
• Keep your medication in its original container, in a safe place, and away from other family members
• Make sure to read the details on the product before using a pillbox. Some pills can't go in because of drying agents in their packaging

Can I Take Other Medications?

• It is important to tell your doctor or pharmacist about any medications you are taking, including herbs, vitamins and other alternative medications
• Do not stop or start any medications without asking your doctor, pharmacist, or nurse

What Side Effects Can I Expect From My Treatment?

Not everyone taking chemotherapy will experience side effects, but most people experience some side effects. Your doctor may prescribe other medications to help minimize these side effects. There are various techniques that you can follow to help yourself manage the side effects of chemotherapy medications; some of which will be explained in this handbook.

1. Neutropenia and Infection

Neutrophils are a type of white blood cells, which help fight infections. Chemotherapy can cause the neutrophil count in your blood to go down. When it becomes too low, neutropenia occurs, you have less ability to fight infections. Make sure to handle food safely by only using fresh ingredients, eating hot dishes while they are hot, and enjoying cold foods when they are cold.

When to Seek Medical Attention?

You must present to the nearest Emergency Department at all times if you develop any of the following symptoms:

• Fever (temperature of 38°C or higher)
• Pain, burning or blood in urine
• Pain, redness, heat, swelling or drainage from a wound/around an intravenous device
• Chills, shivers, or shakes
• Diarrhea (with fever)
• Sore throat (with fever)

2. Nausea and Vomiting

Unfortunately, certain chemotherapy medications can cause nausea and vomiting. Luckily, there are many medications that your doctor can prescribe to prevent, lessen, or relieve the nausea and vomiting associated with chemotherapy.

Things you can do to guard against nausea and vomiting:

• Eat small, frequent meals instead of three large meals a day, as these may be easier to digest
• Eat before you get too hungry
• Eat dry foods such as dry cereal, toast, or crackers without liquids especially first thing in the morning
• Avoid heavy, high fat and greasy meals right before chemotherapy
• Eat and drink slowly and chew your food well
• Avoid overly sweet, fried, fatty, or spicy foods, as well as foods with a strong smell. If the smell of hot food makes you feel sick, try eating cold or warm food
• Ginger and/or peppermint may help with nausea. Try ginger biscuits or peppermints/peppermint tea
• Avoid excessive fluid intake before meals
• Avoid alcohol and excess amounts of coffee

3. Mucositis and Stomatitis

It is common to experience a sore throat or dry mouth during chemotherapy treatment. Damage to the lining of the mouth is usually temporary, and most side effects will disappear once the chemotherapy has finished.

There is a lot you can do to keep your mouth and throat healthy:

• Regular mouth care before bed and after eating, and by using a soft toothbrush and non-alcohol-based mouthwash
• Rinse mouth with water frequently (every 2 hours while awake & when awake during the night). May add salt or baking soda (mix half to one teaspoon in a cup of water)
• Eat soft, minced, or pureed foods
• Add extra sauces or gravies to moisten meals
• Avoid foods that are acidic, hot, coarse, or hard, and salty or spicy
• Consume small, frequent, high protein, high energy meals
• Speak to your treating team about options to quit smoking and stay away from drinking alcohol
• Speak to your treating team before you have any dental treatment, and let your dentist know that you are receiving chemotherapy/anti-cancer treatment

As symptoms can progress quickly, it is important to tell your doctor or nurse if you have:

• Trouble eating or swallowing
• Painful spots or sores in your mouth

4. Constipation

Constipation is when your bowel movements happen less often than normal or if your bowel movements are hard or painful to pass.

There are things you can do to prevent constipation, including the following:

• Drink plenty of fluid every day, such as water, fruit or vegetable juices, and other clear liquids, like broth, or sport drinks. Speak to your pharmacist or care team about oral rehydration solutions found over the counter at the pharmacy
• Warm liquids, such as coffee and tea, may help
• If you can, try to stay active daily. Walking is a good form of exercise that is convenient and easy to do. Even short walks around the house can help move your bowels
• Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, prunes, nuts, seeds, popcorn, and high-fiber cereals
• Your doctor may recommend medications to prevent or treat constipation. Take your medication as directed by your care team

5. Diarrhea

Diarrhea is when your bowel movements become more frequent and are watery, softer, or looser than normal.

To minimize the possibility of diarrhea, you can do the following:

• Avoid spicy, greasy, or fried foods
• Avoid eating a lot of raw food
• Avoid beverages with caffeine and alcohol
• Drink plenty of fluid every day to stay hydrated
• Discuss with your physician if you have frequent loose stools

6. Peripheral Neuropathy

Some chemotherapy can affect nerve endings. This is called peripheral neuropathy. Symptoms of peripheral neuropathy can begin any time after the treatment begins and can get worse as the treatment continues. It can cause sensations like tingling, burning, numbness or pins and needles in the hands and/or the feet. You may experience difficulties with your fine motor skills (e.g., buttoning a shirt).

Tell your doctor if you get any of these sensations, so they can be monitored and, if necessary, changes can be made to the dose or the type of medication you receive. Most of the time, these symptoms will get better after your treatment ends, although it may take some time.

Some practical tips to consider if you develop these symptoms:

• Adjust the water temperature to avoid burns
• Test your bath water or washing water with your elbow rather than your hands
• Use rubber gloves around the kitchen, potholders and oven mitts to handle hot or cold items
• If experiencing nerve damage (neuropathy), avoid driving or operating machinery
• Wear gloves and warm socks in cold weather
• Use simple comfort measures (massage, flexible splints, lotions and creams)

7. Fatigue

Fatigue is a daily lack of energy or an unusual feeling of whole-body tiredness that does not get better with simple rest or sleep.

To feel better, you can do the following:

• Manage your activity level to save your energy
• Drink plenty of fluids
• Maintain good nutrition
• Regular moderate exercise, which is one of the best ways to lessen fatigue
  • Exercise may include walking, riding a bike, or swimming unless your treating team has instructed otherwise
  • Most importantly, move your whole body for periods that you can tolerate

8. Hair Loss

In almost all cases of hair loss caused by chemotherapy, your hair will resume growth after treatment. It may take from three to six months after therapy is completed or it may start growing back while you are still receiving chemotherapy.

Here are some tips on what to expect and things you can do if you have hair loss:

• Choose a wig or hairpiece before your hair falls out if you want to match it to your normal hair color or style
• Consider having your hair cut short before it starts to thin or fall out
• Try using a hair net at night, so you do not have hair over your pillow and bed
• Wash your hair with a gentle shampoo like baby shampoo and pat it dry
• Brush gently with a soft baby brush
• Avoid using hair dryers, curling tongs, straighteners, or curlers
• If your scalp flakes or itches use an oil or moisturizer

9. Protecting Your Scalp

• Protect your scalp from sun damage by applying sunscreen and wearing a hat, turban, or scarf while outside
• Moisturize your scalp twice daily using a simple non-perfumed moisturizer

10. Infertility

Some chemotherapy drugs can cause infertility. Your doctor will discuss this with you before you start your treatment and will provide you with more information on preserving your fertility.

11. Hand-foot Syndrome

Hand-foot syndrome is a side effect which can occur with several types of chemotherapy or anti-cancer therapy. Exposure of your hands and feet to heat as well as friction on your palms and soles may increase redness, tenderness, and possibly peeling of the palms and soles.

Prevention is very important in trying to reduce the development of hand-foot syndrome.

Continue below measures approximately one week after intravenous medication, and as much as possible during the time you are taking oral medication.

Preventing and managing hand-foot syndrome:

• Use loose fitting clothing and avoid friction to the skin where possible
• Avoid long exposure of hands and feet to hot water such as long showers, tub baths or washing dishes
• Avoid increased pressure on the soles of the feet or palms of hands
• No jogging, aerobics, power walking, jumping, and avoid long days of walking
• Ask your healthcare provider if placing the palms or bottoms of your feet on an ice pack or a bag of frozen peas can help you. Alternate on and off for 15-20 minutes at a time
• Lotions and moisturizers provide excellent moisturizing to your hands and feet. Avoid excessive rubbing during application