Chemotherapy Tips

The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately.