Helping yourself during chemotherapy

Many people feel they have no control over their treatment when they are receiving chemotherapy. However, there are many things you can do to help yourself.

Some chemotherapy side effects are common and to be expected however any unusual or serious side effects should be reported to your doctor. Contact your doctor urgently if any of the following problems occur:

1. fever over 38°C or chills
2. sweating, especially at night
3. easy bruising or any unusual bleeding
4. sore throat
5. mouth ulcers
6. persistent or severe vomiting more than 24 hours after treatment
7. severe constipation, diarrhoea or abdominal pain
8. burning or stinging on passing urine
9. tenderness, redness or swelling around the place where the injection goes in
10. any serious unexpected side effects or sudden deterioration in health.

Common side effects

• 1. Feeling tired and lacking energy
• 2. Feeling sick or vomiting
• 3. Constipation or diarrhoea
• 4. Mouth problems Mouth sores or infections
• 5. Hair loss and scalp problems

• 6. Itching skin and other skin problems
• 7. Nerve and muscle effects
• 8. Change in hearing
• 9. Effects on the blood
• 10. Fertility

1.Feeling tired and lacking energy

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Some people are able to carry on with life as usual, but many people find they can't do as much and feel tired during and after treatment. Your weakness and weariness may develop slowly over the course of treatment but should go away gradually after treatment is over.

Tips

1. Save your energy by doing less and taking time to rest. Try to get more sleep at night and take naps during the day if needed.
2. Let other people help you. Family members, neighbours and friends may be glad of the chance to help you with tasks like shopping, child-care, housework and driving.
3. Plan to take a few weeks off work during or after your radiotherapy, work fewer hours or if possible, work from home.

2.Feeling sick or vomiting

Not everyone feels sick (nauseous) after chemotherapy. If it does occur, it usually starts a few hours after treatment and may last many hours. If you still feel nauseous after a few days, contact your doctor. Changes to your diet are to be expected. Sometimes you may not feel hungry. Try to catch up on days when you do feel hungry and eat small, frequent meals or snacks if your appetite is poor. Be willing to change your meals around. If you happen to feel hungrier at breakfast time, have your main meal then and a light meal (such as breakfast cereal) at a time when you feel less like eating. It is important you find a diet that meets your needs.

 Tips

1. Eat a light meal before your treatment (for example, soup and dry biscuits) and drink as much fluid as possible.
2. Drink small amounts more often rather than large drinks after treatment. Soda water, dry ginger ale or weak teas are all good choices. Ice cubes, icy-poles or jellies are other ways to increase your fluid intake.
3. Avoid foods that usually upset your stomach, eat dry toast or crackers - they often help.
4. Eat slowly and chew well to help you digest your food better.
5. Don't do anything too strenuous after a meal; have a lie down for a while.
6. Try breathing deeply through your mouth whenever you feel like being sick.
7. Prepare meals between treatments and freeze them for the days you don't feel like cooking.
8. Try to avoid odours that bother you such as cooking smells, perfume or smoke.

Anti-nausea medication can help. If you have intravenous treatment, anti-nausea medication may be added to the drip before and during treatment. If nausea is likely, you will be given anti-nausea tablets to take at home. These are best taken regularly. Several anti-nausea medications are available. It may take some time before you find the medication that is right for you, but keep trying. Anti-nausea suppositories are sometimes used to help control nausea or vomiting. These are placed in the back passage (rectum), where they dissolve.

Constipation or diarrhoea

Some chemotherapy drugs, pain relief medicines and anti-nausea drugs can affect the lining of the digestive system and cause constipation or diarrhoea. Let your doctor or nurse know if you experience constipation as your medication may be changed or other medication given to relieve the constipation. At first, diarrhoea can be treated with medication at home. If the diarrhoea is severe, it could cause dehydration and you may need to be admitted to hospital. If you have diarrhoea, it is important to return to a balanced diet that includes fresh fruits and vegetables and wholegrain bread and pasta after the diarrhoea has stopped.

 Tips

1. If you have constipation, eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
2. If you have diarrhoea, avoid spicy foods, dairy products, coarse wholegrain products, fatty or fried foods, rich gravies and sauces and raw fruit or vegetables with skins or seeds. Instead, try snacking on clear broth and toast, biscuits, or cooked rice.
3. Drink plenty of fluids. This will help loosen the bowels if you have constipation and replace the fluids lost through diarrhoea. Warm and hot drinks work well.
4. Get some light exercise. Walking is a good option.
5. Eat small, frequent snacks instead of big meals.

Mouth problems Mouth sores or infections

Some chemotherapy drugs can cause mouth sores or infections, particularly in people with head and neck cancer. Ask your doctor or nurse whether you need to take extra care.

Tips

1. Use a soft toothbrush to clean your teeth twice a day. You may be given special mouthwashes to try to prevent mouth infections such as thrush.
2. Rinse (swill and spit) with a teaspoon of salt in a glass of warm water at least four times a day.
3. Don't use commercial mouthwashes without first asking the doctor. Sometimes they can irritate your mouth.
4. Sip fluids, especially water, and eat moist foods such as casseroles if you have a dry mouth. It may also help to suck on frozen pineapple or chew sugar-free gum.
5. Other ideas include: blending foods and eating soups and ice-creams.

If you notice any change in your mouth or throat, such as sores or thickened saliva, or find it difficult to swallow, contact your doctor. Discuss any dental problems with your doctor. Before you have any dental treatment, tell your dentist you are having chemotherapy.

Hair loss and scalp problems

Most people having chemotherapy worry about losing their hair. Some drugs may cause hair to thin or fall out but many others do not cause hair loss. If you do lose some or all of your hair, it will usually grow back when your treatment stops.

When hair loss does occur, it usually starts two to three weeks after the first treatment. Some people lose all their hair very quickly; others lose it after several treatments, while others may only lose a little hair or none at all. Your scalp may feel hot or itchy just before your hair starts to fall out. Although losing head hair is most common, some people may also lose hair from their arms, legs, chest, pubic region and eyelashes. If hair loss occurs, you can wear a hat, scarf or wig. The important thing is to do whatever feels comfortable and gives you the most confidence.

Tips

1. Keep your hair and scalp very clean, using a mild shampoo like baby shampoo.
2. Comb or brush your hair gently using a large comb or a hairbrush with soft bristles.
3. Use a cotton, polyester or satin pillowcase--nylon can irritate your scalp.
4. Avoid hair perms and dyes which may increase hair loss.
5. Avoid daily use of hair dryers and rollers and harsh hair care products.
6. Use sunscreen, a hat or scarf to protect your head from the sun.
7. Wear a light cotton turban or beanie to bed, if you are cold at night.
8. If your eyelashes fall out, wear glasses or sunglasses to protect your eyes from the sun and dust when outside.

It takes between four to twelve months to grow back a full head of hair. When your hair first grows back it may be a little different. Sometimes it will be curly even though you have always had straight hair. In time your hair will return to its normal condition and you will be able to continue your usual hair care routine. Your scalp may be itchy when your hair is growing back. Frequent shampooing can relieve the itching.

Cancer care specialists at Hong Kong Cancer Fund Support Centres or staff within the Cancer Patient Resource Centres throughout numerous public hospitals can help you find a suitable wig.

Itching skin and other skin problems

You may notice that your skin darkens, peels, becomes dry and itchy or more sensitive to the sun during chemotherapy.

Tips

1. Apply corn flour over the affected area to keep skin dry and free from irritation
2. Use a lotion or cream to stop dryness. Ask your doctor for advice if these suggestions don't work.

Nerve and muscle effects

Some drugs can cause tingling and loss of sensation in the fingers and/or toes, and muscle weakness in the legs. If this happens, tell your doctor or nurse before your next treatment. A slight change in the treatment is usually all that is needed to stop this happening in the future.

Change in hearing

Some chemotherapy drugs can cause the loss of ability to hear high-pitched sounds. They can also cause a continuous noise in the ears known as tinnitus. Let your doctor know if you notice any change in your hearing.

Effects on the blood

The soft and spongy material inside bones (the bone marrow) makes three types of blood cells:

1. white blood cells: fight infection
2. red blood cells: carry oxygen to cells throughout the body
3. platelets: help blood to clot and stop bleeding.

The bone marrow's job is to maintain normal levels of blood cells (the blood count) to keep you fit and healthy. Some chemotherapy drugs can occasionally affect the bone marrow so that your blood count is reduced. The count may fall with each treatment. Blood tests will be done regularly to make sure your blood cells return to normal before your next treatment. Occasionally, a low blood count will cause some complications related to the type of blood cell affected.

(1) Infection

During chemotherapy, colds and flu may be harder to shake off and scratches and cuts may get infected easily. See your doctor if you are unwell: don't wait out a cold when you are having chemotherapy. Sometimes doctors recommend taking antibiotics as a precaution against infection. If you are having chemotherapy in winter, check with your doctor about having a flu injection.

Granulocyte-colony stimulating factor (G-CSF) is a treatment given by injection to some people after chemotherapy. It helps to increase the number and function of a type of white blood cell called neutrophils, which help to protect against infection. G-CSF is not prescribed for everyone after chemotherapy; you may wish to check with your doctor if it is an appropriate option for you.

Fertility

Chemotherapy may affect sexual organs and function in both women and men. This may have a temporary or permanent effect on your ability to have children (fertility). It is best for you and your partner to talk about these issues and fertility preservation options with your doctor before commencing any treatment.

For women

Some women's periods become irregular during chemotherapy but return to normal after treatment. For other women, chemotherapy may cause periods to stop completely (menopause). After menopause, women can't have children. The signs of menopause include hot flushes, sweating, particularly at night, and dry skin. Talk to your doctor about medication for relieving the symptoms of menopause. Early menopause (before age 40) may cause bones to become weaker and break more easily. This is called osteoporosis.

For men

Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. This can cause infertility, which may be temporary or permanent. The ability to get and keep an erection may also be affected but this is normally temporary. Women may be able to store eggs (ova) and men may have sperm stored before treatment starts for use at a later date. Ask your doctor about this.

Contraception

Although chemotherapy reduces fertility, it is possible for some women to become pregnant while having chemotherapy and a man having chemotherapy could still make his partner pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the unborn baby. Birth control (contraception) must be used. Ask your doctor about your contraceptive options. The Pill may be prescribed to some young women as a contraceptive and to help protect the ovaries from the effects of chemotherapy. Should you or your partner become pregnant, talk to your doctor urgently.

It is also important to use contraception (condoms) during sexual intercourse while on active chemotherapy treatment as there is a chance drugs can be passed through bodily fluids potentially causing harm to your partner.