What If I Don't Feel Like Eating?
Can I Drink Alcoholic Beverages?
Can I Take Extra Vitamins and Minerals?
What Causes Side Effects?
How Long Do Side Effects Last?
Fatigue
Pain
Infection
Symptoms of Infection
Mouth, Gum, and Throat Problems
What Can I Expect During Chemotherapy?
Where Will I Get Chemotherapy?
How Often and for How Long Will I Get Chemotherapy?
How Is Chemotherapy Given?
How Will I Feel During Chemotherapy?
Can I Take Other Medicines While I Am Getting Chemotherapy?
How Will I Know if My Chemotherapy Is Working?
Questions to Ask About Side Effects

It is very important to eat well while you are getting chemotherapy. Eating well during chemotherapy means choosing a balanced diet that contains all the nutrients the body needs. Eating well also means having a diet high enough in calories to keep your weight up and high enough in protein to rebuild tissues that cancer treatment may harm. People who eat well can cope with side effects and fight infection better. Also, their bodies can rebuild healthy tissues faster.

What If I Don't Feel Like Eating?

On some days you may feel you just cannot eat. You can lose your appetite if you feel depressed or tired. Or, side effects such as nausea or mouth and throat problems may make it difficult or painful to eat. In some cases, if you cannot eat for a long period of time, your doctor may recommend that you be given nutrition intravenously until you are able to eat again.

When a poor appetite is the problem, try these suggestions:

The National Cancer Institute's booklet, Eating Hints for Cancer Patients: Before, During & After Treatment, provides more tips about how to make eating easier and more enjoyable. It also gives many ideas about how to eat well and get extra protein and calories during cancer treatment. For a free copy of this booklet, ask your nurse or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Can I Drink Alcoholic Beverages?

Small amounts of alcohol can help you relax and increase your appetite. On the other hand, alcohol may interfere with how some drugs work and/or worsen their side effects. For this reason, some people must drink less alcohol or avoid alcohol completely during chemotherapy. Ask your doctor if and how much beer, wine, or other alcoholic beverages you can drink during treatment.

Can I Take Extra Vitamins and Minerals?

You can usually get all the vitamins and minerals you need by eating a healthy diet. Talk to your doctor, nurse, registered dietician, or a pharmacist before taking any vitamin or mineral supplements. Too much of some vitamins and minerals can be just as dangerous as too little. Find out what is recommended for you.

What Causes Side Effects?

Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. This damage to normal cells causes side effects. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.

You may have none of these side effects or just a few. The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. Before starting chemotherapy, your doctor will discuss the side effects that you are most likely to get with the drugs you will be receiving. Before starting the treatment, you will be asked to sign a consent form. You should be given all the facts about treatment including the drugs you will be given and their side effects before you sign the consent form.

How Long Do Side Effects Last?

Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over side effects depends on many things, including your overall health and the kind of chemotherapy you have been taking.

Most people have no serious long-term problems from chemotherapy. However, on some occasions, chemotherapy can cause permanent changes or damage to the heart, lungs, nerves, kidneys, reproductive or other organs. And certain types of chemotherapy may have delayed effects, such as a second cancer, that show up many years later. Ask your doctor about the chances of any serious, long-term effects that can result from the treatment you are receiving (but remember to balance your concerns with the immediate threat of your cancer).

Great progress has been made in preventing and treating some of chemotherapy's common as well as rare serious side effects. Many new drugs and treatment methods destroy cancer more effectively while doing less harm to the body's healthy cells.

The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment's ability to destroy cancer. Medicines can help prevent some side effects such as nausea. Sometimes people receiving chemotherapy become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor or nurse. They may be able to suggest ways to make side effects easier to deal with or reduce them.

Below you will find suggestions for dealing with some of the more common side effects of chemotherapy.

Fatigue

Fatigue from cancer feels different from fatigue of everyday life. Fatigue caused by chemotherapy can appear suddenly. Patients with cancer have described it as a total lack of energy and have used words such as worn out, drained, and wiped out to describe their fatigue. And rest does not always relieve it. Not everyone feels the same kind of fatigue. You may not feel tired while someone else does or your fatigue may not last as long as someone else's does. It can last days, weeks, or months. But severe fatigue does go away gradually as the tumor responds to treatment.

How can I cope with fatigue?

• Plan your day so that you have time to rest.
• Take short naps or breaks, rather than one long rest period.
• Save your energy for the most important things.
• Try easier or shorter versions of activities you enjoy.
• Take short walks or do light exercise if possible. You may find this helps with fatigue.
• Talk to your health care provider about ways to save your energy and treat your fatigue.
• Try activities such as meditation, prayer, yoga, guided imagery, visualization, etc. You may find that these help with fatigue.
• Eat as well as you can and drink plenty of fluids. Eat small amounts at a time, if that is helpful.
• Join a support group. Sharing your feelings with others can ease the burden of fatigue. You can learn how others deal with their fatigue. Your health care provider can put you in touch with a support group in your area.
• Limit the amount of caffeine and alcohol you drink.
• Allow others to do some things for you that you usually do.
• Keep a diary of how you feel each day. This will help you plan your daily activities.
• Report any changes in energy level to your doctor or nurse.

Pain

Not everyone with cancer or who receives chemotherapy experiences pain from the disease or its treatment. But if you do, it can be relieved. The first step to take is to talk with your doctor, nurse, and pharmacist about your pain. They need to know as many details about your pain as possible. You may want to describe your pain to your family and friends. They can help you talk to your caregivers about your pain, especially if you are too tired or in too much pain to talk to them yourself.

You need to tell your doctor, nurse, and pharmacist and family or friends:

• Where you feel pain.
• What it feels like — sharp, dull, throbbing, steady.
• How strong the pain feels.
• How long it lasts.
• What eases the pain, what makes the pain worse.
• What medicines you are taking for the pain and how much relief you get from them.

Using a pain scale is helpful in describing how much pain you are feeling. Try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that is getting worse. A 10 means the pain is as bad as it can be. You may wish to use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure to let others know what pain scale you are using and use the same scale each time, for example, "My pain is 7 on a scale of 0 to 10."

The goal of pain control is to prevent pain that can be prevented, and treat the pain that can't. To do this:

• If you have persistent or chronic pain, take your pain medicine on a regular schedule (by the clock).
• Do not skip doses of your scheduled pain medicine. If you wait to take pain medicine until you feel pain, it is harder to control.
• Try using relaxation exercises at the same time you take medicine for the pain. This may help to lessen tension, reduce anxiety, and manage pain.
• Some people with chronic or persistent pain that is usually controlled by medicine can have breakthrough pain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. If you experience this pain, use a short-acting medicine ordered by your doctor. Don't wait for the pain to get worse. If you do, it may be harder to control.

There are many different medicines and methods available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible. If you are in pain and your doctor has no further suggestions, ask to see a pain specialist or have your doctor consult with a pain specialist. A pain specialist may be an oncologist, anesthesiologist, neurologist, neurosurgeon, other doctor, nurse, or pharmacist.

Infection

Most infections come from bacteria normally found on your skin and in your mouth, intestines and genital tract. Sometimes, the cause of an infection may not be known. Even if you take extra care, you still may get an infection. But there are some things you can do.

How can I help prevent infections?

• Wash your hands often during the day. Be sure to wash them before you eat, after you use the bathroom, and after touching animals.
• Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories.
• Stay away from people who have illnesses you can catch, such as a cold, the flu, measles, or chicken pox.
• Try to avoid crowds. For example, go shopping or to the movies when the stores or theaters are least likely to be busy.
• Stay away from children who recently have received "live virus" vaccines such as chicken pox and oral polio, since they may be contagious to people with a low blood cell count. Call your doctor or local health department if you have any questions.
• Do not cut or tear the cuticles of your nails.
• Be careful not to cut or nick yourself when using scissors, needles, or knives.
• Maintain good mouth care.
• Do not squeeze or scratch pimples.
• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Do not rub too hard.
• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
• Clean cuts and scrapes right away and daily until healed with warm water, soap, and an antiseptic.
• Avoid contact with animal litter boxes and waste, bird cages, and fish tanks.
• Avoid standing water, for example, bird baths, flower vases, or humidifiers.
• Wear protective gloves when gardening or cleaning up after others, especially small children.
• Do not get any immunizations, such as flu or pneumonia shots, without checking with your doctor first.
• Do not eat raw fish, seafood, meat, or eggs.
• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
  
  

Symptoms of Infection

Mouth, Gum, and Throat Problems

This patient summary on oral complications of cancer and cancer therapy is adapted from the summary written for health professionals by cancer experts. This and other accurate, credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Oral complications are common in cancer patients, especially those with head and neck cancer. This summary describes oral complications caused by chemotherapy and radiation therapy and various methods of prevention and treatment.

Oral complications are common in patients receiving chemotherapy or undergoing radiation therapy to the head and neck.

The oral cavity is at high risk of side effects from chemotherapy and radiation therapy for a number of reasons.

Preventive measures may lessen the severity of oral complications.

Oral side effects may make it difficult for a patient to receive all of his or her cancer treatment. Sometimes treatment must be stopped. Preventing and controlling oral complications will enhance both the patient's quality of life and the effectiveness of cancer therapy.

Preventing and treating oral complications of cancer therapy involve identifying the patient at risk, starting preventive measures before cancer therapy begins, and treating complications as soon as they appear.

Description and Causes

Radiation therapy and chemotherapy may cause some of the same oral side effects, including the following:

Oral complications associated with chemotherapy and radiation therapy may be caused directly by the treatment or may result indirectly from side effects of the treatment. Radiation therapy may directly damage oral tissue, salivary glands, and bone. Areas treated may scar or waste away.

Slow healing and infection are indirect complications of cancer treatment. Both chemotherapy and radiation therapy can affect the ability of cells to reproduce, which slows the healing process in the mouth. Chemotherapy may reduce the number of white blood cells and weaken the immune system (the organs and cells that defend the body against infection and disease), making it easier for the patient to develop an infection.

Complications can be acute or chronic.

Acute complications are those that occur during therapy. Chemotherapy usually causes acute complications that heal after treatment ends.

Chronic complications are those that continue or develop months to years after therapy ends. Radiation can cause acute complications but may also cause permanent tissue damage that puts the patient at a lifelong risk of oral complications. The following chronic complications commonly continue after radiation therapy to the head and/or neck has ended:

Invasive dental procedures can cause additional problems. The dental care of patients who have undergone radiation therapy will therefore need to be adapted to the patient's ongoing complications

Oral Mucositis

Mucositis is an inflammation of mucous membranes in the mouth.

The terms "oral mucositis" and "stomatitis" are often used in place of each other, but their meanings are different.

Mucositis may be caused by either radiation therapy or chemotherapy. In patients receiving chemotherapy, mucositis will heal by itself, usually in 2 to 4 weeks when there is no infection. Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on the duration of treatment.

The following problems may occur:

Swishing ice chips in the mouth for 30 minutes may help prevent mucositis from developing in patients who are given fluorouracil. Medication may be given to help prevent mucositis or keep it from lasting as long in patients who undergo high-dose chemotherapy and bone marrow transplant.

Care of mucositis during chemotherapy and radiation therapy focuses on cleaning the mouth and relieving the symptoms.

Good oral care is important during cancer treatment. Some anticancer drugs can cause sores in the mouth and throat, a condition called stomatitis or mucositis. Anticancer drugs also can make these tissues dry and irritated or cause them to bleed. Patients who have not been eating well since beginning chemotherapy are more likely to get mouth sores.

In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Every step should be taken to prevent infections, because they can be hard to fight during chemotherapy and can lead to serious problems.

How can I keep my mouth, gums, and throat healthy?

• Talk to your doctor about seeing your dentist at least several weeks before you start chemotherapy. You may need to have your teeth cleaned and to take care of any problems such as cavities, gum abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay.
• Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch. Brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special toothbrush and/or toothpaste if your gums are very sensitive. Rinse with warm salt water after meals and before bedtime.
• Rinse your toothbrush well after each use and store it in a dry place.
• Avoid mouthwashes that contain any amount of alcohol. Ask your doctor or nurse to suggest a mild or medicated mouthwash that you might use. For example, mouthwash with sodium bicarbonate (baking soda) is non-irritating.

If you develop sores in your mouth, tell your doctor or nurse. You may need medicine to treat the sores. If the sores are painful or keep you from eating, you can try these ideas:

How can I cope with mouth sores?

• Ask your doctor if there is anything you can apply directly to the sores or to prescribe a medicine you can use to ease the pain.
• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat.
• Eat soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, yogurt, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat.
• Avoid irritating, acidic foods and juices, such as tomato and citrus (orange, grapefruit, and lemon); spicy or salty foods; and rough or coarse foods such as raw vegetables, granola, popcorn, and toast.

How can I cope with mouth dryness?

• Ask your doctor if you should use an artificial saliva product to moisten your mouth.
• Drink plenty of liquids.
• Ask your doctor if you can suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum. (Sorbitol, a sugar substitute that is in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)
• Moisten dry foods with butter, margarine, gravy, sauces, or broth.
• Dunk crisp, dry foods in mild liquids.
• Eat soft and pureed foods.
• Use lip balm or petroleum jelly if your lips become dry.
• Carry a water bottle with you to sip from often.

Some people with cancer want to know every detail about their condition and their treatment. Others prefer only general information. The choice of how much information to seek is yours, but there are questions that every person getting chemotherapy should ask.

This list is just a start. Always feel free to ask your doctor, nurse, and pharmacist as many questions as you want. If you do not understand their answers, keep asking until you do. Remember, there is no such thing as a "stupid" question, especially about cancer or your treatment. To make sure you get all the answers you want, you may find it helpful to draw up a list of questions before each doctor's appointment. Some people keep a "running list" and jot down each new question as it occurs to them.

Where Will I Get Chemotherapy?

Chemotherapy can be given in many different places: at home, a doctor's office, a clinic, a hospital's outpatient department, or as an "inpatient" in a hospital. The choice of where you get chemotherapy depends on which drug or drugs you are getting, your insurance, and sometimes your own and your doctor's wishes. Most patients receive their treatment as an "outpatient" and are not hospitalized. Sometimes, a patient starting chemotherapy may need to stay at the hospital for a short time so that the medicine's effects can be watched closely and any needed changes can be made.

How Often and for How Long Will I Get Chemotherapy?

You may get treatment every day, every week, or every month. Chemotherapy is often given in cycles that include treatment periods alternated with rest periods. Rest periods give your body a chance to build healthy new cells and regain its strength. Ask your health care provider to tell you how long and how often you may expect to get treatment.

Sticking with your treatment schedule is very important for the drugs to work right. Schedules may need to be changed for holidays and other reasons. If you miss a treatment session or skip a dose of the drug, contact your doctor.

Sometimes, your doctor may need to delay a treatment based on the results of certain blood tests. (See the sections on Fatigue, Infection, and Anemia.) Your doctor will let you know what to do during this time and when to start your treatment again.

How Is Chemotherapy Given?

By vein (intravenous, or IV, treatment)
Chemotherapy is most often given intravenously (IV), through a vein. Usually a thin needle is inserted into a vein on the hand or lower arm at the beginning of each treatment session and is removed at the end of the session. If you feel a coolness, burning, or other unusual sensation in the area of the needle stick when the IV is started, tell your doctor or nurse. Also report any pain, burning, skin redness, swelling, or discomfort that occurs during or after an IV treatment.

Chemotherapy can also be delivered by IV through catheters, ports, and pumps.

Catheters are usually placed in a large vein, most commonly in your chest, called a central venous catheter. A peripherally inserted central catheter (PICC) is inserted into a vein in the arm. Catheters can also be placed in an artery or other locations in your body, such as:

By mouth (orally)
The drug is given in pill, capsule, or liquid form. You swallow the drug, just as you do many other medicines.

By injection
A needle and syringe are used to give the drug in one of several ways:

Topically
The drug is applied on the surface of the skin.

How Will I Feel During Chemotherapy?

You may want to have someone available to drive you to and from treatment if, for example, you are taking medicine for nausea or vomiting that could make you tired. You may also feel especially tired from the chemotherapy as early as one day after a treatment and for several days. It may help to schedule your treatment when you can take off the day of and the day after your treatment. If you have young children, you may want to schedule the treatment when you have someone to help at home the day of and at least the day after your treatment. Ask your doctor when your greatest fatigue or other side effects are likely to occur.

Most people can continue working while receiving chemotherapy. However, you may need to change your work schedule for a while if your chemotherapy makes you feel very tired or have other side effects. Talk with your employer about your needs and wishes. You may be able to agree on a part-time schedule, find an area for a short nap during the day, or perhaps you can do some of your work at home.

Under Federal and state laws, some employers may be required to let you work a flexible schedule to meet your treatment needs. To find out about your on-the-job protections, check with a social worker, or your congressional or state representative. NCI's publication Facing Forward: Life After Cancer Treatment also has information on work-related concerns.

Can I Take Other Medicines While I Am Getting Chemotherapy?

Remember to tell your doctor about all over-the-counter remedies, including vitamins, laxatives, medicines for allergies, indigestion, and colds, aspirin, ibuprofen, or other pain relievers, and any mineral or herbal supplements. Your doctor can tell you if you should stop taking any of these remedies before you start chemotherapy. After your treatments begin, be sure to check with your doctor before taking any new medicines or stopping the ones you are already taking.

How Will I Know if My Chemotherapy Is Working?

Tests and exams can tell a lot about how chemotherapy is working; however, side effects tell very little. Sometimes people think that if they have no side effects, the drugs are not working, or, if they do have side effects, the drugs are working well. But side effects vary so much from person to person, and from drug to drug, that side effects are not a sign of whether the treatment is working or not.

Questions to Ask About Side Effects