Preparing your body for chemotherapy

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Preparing Your Body for Chemotherapy

Many people are apprehensive before their first chemotherapy appointment. Preconceived notions and misinformation can add to the stress. “I think it is important to emphasize that the effects of treatments vary enormously depending upon the specific drug,” affirmed Martin Edelman, MD, Professor and Chair of the Department of Hematology/Oncology. With the right information and a few tips, you can decide what preparations will help you minimize stress and reduce disruptions to your daily life during chemotherapy.

Before your first visit to the infusion center:

Let your oncology care team demystify chemotherapy for you. “It is important to emphasize that the effects of treatments vary enormously depending upon the specific drug,” Edelman said. Ask your team how to prepare for your first treatment. See if you may need a short break from home or work commitments right after treatment, so you can plan ahead. Let the team address any fears or concerns you may have going forward. Some patients worry that they will have hair loss or nausea. Edelman reassured that this may not happen, “Immunotherapy does not usually cause nausea or hair loss. Many of the chemotherapy regimens are also not associated with major hair loss.”

Keep your other medical care up-to-date. The oncology team may suggest a visit to the dentist to get oral care beforehand, and to ask about oral care during chemotherapy. Plan for contraception to avoid you or your partner getting pregnant. Take your regular medications on the day of your infusion appointment, unless your doctor instructs you otherwise, and bring medications to your appointment.

Eat well now and later. Stock up on healthy groceries so you can keep hydrated and so you have fruits, vegetables, and protein snacks on hand. Some people require calorie-rich foods. Remember to ask your care team about any nutritional products or supplements before you take them.

Arrange for help at home and work. Clear your schedule for your appointment. If your oncology team suggests you may need to rest afterwards, speak with your employer about accommodating your schedule. You may want to arrange for help with kids, pets, or household chores like making meals.

Ask someone to come to your first appointment for support and company. Most people can drive themselves to and from chemotherapy, but it’s nice to have back-up, especially for the first visit. “While I always think that having someone along for the first visit is extremely helpful from the moral support point of view, it is not necessarily essential from the standpoint of ability to drive,” Edelman said.

Prepare a bag to bring with you. Bring any personal items you want to have with you. The infusion center has free Wi-Fi for tablets and mobile devices. Reading material, crossword puzzles, notecards to write letters—bring things that will help pass the time. Many people like to bring a music player with headphones. The infusion center has coffee, tea, juice, ginger ale and crackers to eat, and you can also bring special snacks or drinks that appeal to you.

Dress for comfort. Wear comfortable clothing with layers, to adjust to temperature changes as needed. You can also bring sweaters, socks, and a hat.

After your first visit:

Listen to your body. You may want to rest after chemotherapy. Drink water in small sips to avoid dehydration. Eat what you can when you can.

Avoid contact with anything that may contain chemotherapy. Chemotherapy leaves the body through bodily fluids during the 48 hours after infusion. Ask your care team how to avoid contact with any fluids or soiled items.

Keep a journal. Write down your medical teams’ names and the dates of chemotherapy. Between infusions, jot down how much sleep you’re getting, what you’re eating and how you’re feeling. This can help you and your team understand what works best for you.

A cancer diagnosis can be overwhelming. The infusion team at Fox Chase is focused on helping you navigate the chemotherapy part of your journey. Joan Lautenbacher was so impressed with her therapy at Fox Chase that she started volunteering at the infusion center. “My Fox Chase doctors formed a team with a single goal of providing me, the patient, with the best possible outcomes. I became mentally stronger, educated, and proactive. My retirement plan focused on regaining my full strength and giving back to Fox Chase. I volunteered at the Infusion Room check-in desk Monday and Friday mornings for 18 months. ”

Preparing for Your First Day of Chemotherapy

Days in the chemotherapy infusion suite are often long. It is best to be prepared for this, which will help to ease the stress and anxiety that comes with being treated for cancer. Below are some suggestions for making your first day of chemotherapy as stress free as possible. Decide which tips will work best for you on the days you spend in the infusion suite.

Organize your information

On your first day of treatment you will encounter a lot of new, possibly overwhelming, experiences. It’s a good idea to have information prepared for the questions you may be asked. You can use the OncoPilot section to print out logs to organize your information. Putting these forms into a binder that can travel with you to appointments is a good way to keep organized going forward.

Plan how you will get there

Because you don’t know how your body will react to the different medications, it is a good idea to have someone drive you to and from treatment, at least the first time. You may find that you tolerate it well and can come alone for future visits if you prefer. It is best to familiarize yourself with directions to the cancer center, where to park and where to sign in upon arrival.

What to expect upon arrival

Arrive on time for your appointment. You may need to fill out paperwork and you will likely have blood work drawn prior to your treatment. The results of this blood work may influence your treatment, so there will likely be a delay after the blood is drawn while the team awaits the results. You will also need to wait for the pharmacist to mix the medication.

Dress comfortably

You may be sitting in the treatment area for an extended period of time, so it is important to be comfortable. Ensure that there is easy access to your central line, if you have one. A PICC in your arm will require the nurse to have access to your upper arm. If you are wearing a top with long sleeves make sure the sleeves are loose enough to pulled up past your PICC line. If you have a port-a-cath in your chest that will be accessed for your treatment you want to wear a top with a loose fitting neck line or you can pull your shirt up while it is being accessed and then put your shirt back down once you are attached to your treatment. Most treatment areas are cold, so bringing a blanket is a good option since you will be attached to your chemotherapy infusion making removing and adding clothing difficult.

You may also want to bring a lip balm or lotion with you to keep your skin hydrated. Avoid perfume and cologne since your sense of smell and that of those around you may be very sensitive.

Bring a snack

Unless indicated by your provider or nurse, there is no reason why you can’t have a snack or drink during your treatment. It is important to maintain proper nutrition and to stay hydrated. You may want to pick a snack that is high in nutritional value and somewhat bland in smell and taste. Some infusion suites are open, meaning that there is more than one patient being treated in the room, so you want to be mindful to exclude any foods that have a strong odor to them. Some good snack ideas include: nuts, whole grain crackers, hard cheese, hummus, granola bars and fruit. Most treatment centers will provide water.

Entertainment

Most infusion suites allow for a visitor to stay with you during your treatment. A family member or friend can be a great distraction and it is also helpful to have someone else with you who can take in the information given to you. You can also bring a book, electronic device, craft, etc. Some infusion suites have a television. Bring anything with you that will help you pass the time.

Ask questions

No question is a bad question! Medical staff are there to answer your questions. You can ask your nurse for handouts about each medication you are being given. If you brought a support person with you, make sure they are there when you are asking questions so that you have a second set of ears to absorb the information. If you haven’t already you can use OncoLink’s “Build My Treatment Binder” for information about your treatment course and managing side effects.

Going home

When you are done your first day of chemotherapy you may be emotional, exhausted, overwhelmed or ecstatic. You won’t know exactly what to expect until you are living it. Once you are home, it is important to follow any instructions given to you. Take your medications on time, rest, hydrate and eat. Keep track of any side effects or new feelings you have to report back to your provider. Keep a list of questions that come up to bring to your next visit.

If you develop nausea, diarrhea or other side effects, call your provider. They can’t help you if they don’t know it is going on! There are many tips and medications for managing the side effects of cancer treatment and your provider can help you determine what works best for you.

Take time to reflect on what worked best for you while at your appointment. Did you pick a snack that you actually wanted to eat? Did you receive adequate support from your support person? Did you have all the information you needed with you? Did you receive adequate teaching information about your treatment and medications from your nurse? These are some things to think about for future chemotherapy treatments.

Keep in mind that everyone’s disease process and treatment is unique. Many people will want to give you advice and it is your job to take the advice that works for you and leave the rest behind.

Medically reviewed by Clare Sullivan, BSN, MPH, CRRN

If you have your first chemotherapy appointment coming up, you’re likely thinking about a hundred things. If you’re also wondering about the logistics of it all, here are some practical tips for your first chemotherapy session, gathered from patients who have been there.

A breast cancer patient talks about preparing for her first chemotherapy.

Wear comfy clothes. Comfortable clothes are key. So, too, is a short sleeve shirt – or one that you easily can roll up your arm – to allow access for the IV.

Bring things to read. The duration of chemotherapy infusion varies, but even in the shortest ones, you’ll be in a comfy chair, waiting. At Dana-Farber, there are magazines, televisions, and a volunteer who comes by with a book and magazine cart, but it’s good have your own stash of reading materials.

Dana-Farber offers iPads for patients to use. You can sign them out in the Shapiro Center for Patients and Families. If you do bring your own iPad or other tablet – or any electronic device such as a laptop or cell phone – remember the chargers! There are plugs available to keep the power flowing.

WiFi is available. At Dana-Farber, there’s a guest WiFi hotspot that you can log into, to check your email, Facebook, or whatever else you need to check.

Headphones help. Sometimes to listen to music, sometimes to tune out other noises and rest. The infusion rooms also have TVs with individual speakers, so you can relax and watch what you want.

Bring someone. All the infusion areas – both semi-private and private areas – have room for friends and family. It’s a good idea for someone to come along to offer support and a ride home, particularly on that first appointment.

Eating is okay. Check with your care team, but generally speaking if you’re not fasting for CT exams or other specific reasons, and you are feeling well, it’s okay to eat before you come in for that first infusion. Although there are snacks available in the infusion areas, you might want to bring snacks, lunch, or drinks that you like.

Lucky charms. A few patients said they brought either good luck charms, or mementos that friends or family had given them. It made them comfortable, and reminded them that their friends and family were with them in spirit.

Advice from other patients on preparing for chemotherapy

Preparing for chemotherapy may cause you anxiety, but talking to fellow cancer survivors can help.

We asked our Facebook community for advice on preparing to start chemo during cancer treatment. Here’s what our patients suggested:

Pack a bag.

  • Bring warm clothing layers in case you get cold. Pack jackets, sweatshirts, scarves and warm socks. At MD Anderson, we have blankets available for all patients and a bed or recliner available depending on what type of chemotherapy you’ll receive.
  • Bring something to do. Patients recommend books, laptop computers or tablets. We provide television and Internet access for our patients. Many patients also suggest listening to music that makes you feel good.
  • Include healthy snacks or chewing gum.

Stay healthy and strong.

  • Take it easy.
  • Don’t compare your body to how it was before chemotherapy.
  • Drink lots of water.
  • Go for a walk every day, if possible.
  • Try to eat something. Find foods you can keep down. Many patients recommend bland foods.
  • Read the provided handouts regarding chemotherapy and its side effects.
  • Try acupuncture to help alleviate pain and nausea. MD Anderson provides acupuncture in its Integrative Medicine Center. Discuss with your MD Anderson physician whether this would be beneficial and appropriate for you, and ask that an internal consultation request be submitted.
  • Some patients recommended trying a variety of things to help with side effects including pickle juice, flaxseed oil, fish oil, ginger ale and tea tree oil. Be sure to talk to your doctor about any products, minerals or supplements before you use them.
  • Keep a chemo journal. Track your medical team members’ names and the dates your chemo is administered. Between infusions, write down how much sleep you’re getting, what you’re eating and how you’re feeling.

Focus on the positive.

  • Take along a small album with photos of your loved ones and favorite places. Looking at the photos may inspire you or help you build determination.
  • Trust your doctors. Ask questions. Be your own advocate.
  • Make a list of old friends. Call them or write them notes while you’re having chemotherapy infusions to help pass the time.
  • Form a support team. Bring a caregiver with you if possible, and make friends with your fellow patients.

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How to Prepare for Chemotherapy

Chemotherapy isn’t a one-and-done treatment — it’s a journey and, as with any journey, planning ahead can make the road less bumpy. “Chemotherapy encompasses a wide variety of medications and active chemical agents that work toward killing abnormal or cancerous cells,” explains Elizabeth Chabner Thompson, MD, MPH, a radiation oncologist and founder of Best Friends for Life, a company that focuses on supporting people with cancer.

While there’s no way of knowing what your individual experience with chemo will be like, there are practical steps you can take to prepare for the impact treatment might have on your day-to-day responsibilities as well as necessary tests to schedule to make sure your body is ready for the challenge.

Prep to Minimize Daily Living Disruptions

Anticipate downtime after chemotherapy treatments to give your body the rest you’ll need. By making arrangements for routine tasks prior to beginning chemo, you’ll have less to worry about once the effects of treatment sneak up on you. Create a list of tasks you do on a daily, weekly, and monthly basis, and create a support team to help you when you are not able to do them yourself. Here are more specifics when preparing for chemotherapy.

Plan ahead for healthy eating:

  • Have meals as a family or with a friend so that you are more likely to eat something. When nothing sounds good, have soft, bland foods cooled to room temperature, such as eggs, mashed potatoes, and cooked cereals.
  • Start eating healthy now to boost nutrition and set a pattern that can be followed for as long as possible once chemo begins.
  • Cook and freeze meals for the future or create a schedule for friends and family who offer to bring meals to your home while you are undergoing treatment.
  • Think about dividing meals you freeze into small portion sizes, since bigger meals may be harder to tolerate during treatment.
  • Stock up on non-perishable, healthy food items for times you are unable to get to the grocery store.
  • If you like bottled water, stock up so that you’ll be able to stay hydrated.

Plan ahead to avoid germs:

  • Hire a service or housekeeper to come in on a weekly basis to keep your living space as clean as possible, especially the bathroom.
  • If it isn’t already a habit, get used to washing your hands often. Start talking with family and friends now about the need for them to wash their hands any time they plan to be around you.
  • Adopt a no-handshakes and no-kiss policy to further limit your risk of exposure.
  • Keep anti-bacterial wipes in your pocket.
  • If your doctor gives the all-clear for sexual activity, practice safe sex with condoms.

Get finances set up:

  • Set up bills to be automatically paid from your checking account. Even if a specific company does not offer auto-pay, your bank may offer an online bill-pay service where they will generate the payment for you at a pre-determined time.
  • If finances are going to be tight, make arrangements for payment plans prior to beginning treatment. No one wants to deal with bill collectors in general, let alone while going through chemo.

Make arrangements at work:

  • Talk with your human resources representative or employer to let them know you will be taking time off. They can provide you with Family Medical Leave Act (FMLA) forms to complete. FMLA entitles eligible employees to take 12 weeks of unpaid job-protected leave from their jobs without losing their health insurance.
  • If someone will be taking over your duties while you are away from work, plan to train her or discuss responsibilities before you leave to ensure continuity.

Caring for kids and your home:

  • Make arrangements for someone to provide transportation to and from school for your children. If they are involved in after-school activities, ask a trusted parent with a child involved in the same activity if she would provide rides for your child.
  • If you have family nearby, ask them to attend games and performances when you can’t — your body’s defenses against illness will be weakened by the chemo, making it necessary to stay away from situations where you could be exposed to illness-causing germs.
  • Consider inviting a relative to stay with you to help care for your children. Even if another parent is in the home, chances are your spouse will be busy helping to take care of you.
  • Plan ahead for lawn maintenance and trash days. If necessary, hire services.

Planning for Chemotherapy: Health Preps

Your doctor’s office will outline pre-chemo requirements, but, in general, these are the steps you’ll likely need to take.

Standard blood tests. Your doctor will order blood tests prior to chemo treatment in order to establish a baseline record and to ensure your body is ready for chemotherapy. “Knowing certain blood levels of cancer markers before chemotherapy will help measure how the treatment is working — Is it effective or not? Do we need to change drugs to kill more cancer cells?” explains Dr. Chabner Thompson.

As treatment progresses additional blood tests will measure how your body is responding to chemo. “Chemotherapy can cause changes in blood cell counts and in blood chemistries, and the effect on the cancer cells dying can also lead to secondary effects that can be measured in the blood. Doctors can look for changes in liver, kidney, and heart function as the treatment progresses,” she adds.

Radiologic tests. X-ray, MRI, CT, PET, and ultrasound are all types of radiological imaging tests that may be used by your doctor before, during, and after chemo. Chabner Thompson says that these tests can be long and involve a lot of waiting room time. She recommends bringing something to keep yourself occupied during your wait. “You may need repeat tests after several cycles,” says Chabner Thompson. “This is normal. The physicians are measuring response to treatment.”

Dental exam. It is critical to see your dentist prior to beginning chemo in order to check for signs of infection that could lead to complications, Chabner Thompson urges. Begin using a baking soda and warm water rinse as part of your nightly oral care routine in order to ward off mouth sores once chemotherapy begins. The National Cancer Institute recommends adding 1/4 teaspoon baking soda and 1/8 teaspoon salt to 1 cup warm water, and then taking small sips and swishing around your mouth before spitting and rinsing with plain water. It is also recommends to use toothpaste that does not contain sodium lauryl sulfate, which can cause mouth irritation.

During chemotherapy many people experience dry mouth. Chabner Thompson recommends having Biotene mouthwash on hand to help relieve this uncomfortable sensation.

Podiatric evaluation. Chemotherapy can affect nails and skin and lead to infection if any existing health concerns aren’t addressed before starting chemo, warns Chabner Thompson. If you have problems with poor circulation, diabetes, or other health conditions that cause issues with feet or wound healing, schedule an evaluation with a podiatrist before beginning chemo.

Rest. Chemotherapy can leave you feeling wiped out. Take time to rest prior to chemo so you go in feeling healthy and strong, and plan for added rest during and after treatment. Fatigue also results because chemo drugs can cause blood counts to drop. When blood counts are at their lowest point, you’re at risk for infection and must rest to rebuild strength. This is when your living space needs to be as clean as possible, and you need to be separate from anyone who may have an infectious disease. When your blood counts are low, simple viruses can have serious and life-threatening implications.

Planning for Chemotherapy: Your Emotional and Mental Health

The effects of chemotherapy aren’t all physical. “One of the first things I tell my patients who are going to start chemotherapy is to prepare themselves intellectually, emotionally, and physically,” says Paul Hokemeyer, PhD, JD, a licensed family therapist based in Manhattan.

From a physical aspect, rest, a healthy diet, and exercise can help to ensure you begin chemotherapy treatments with the strongest, most resilient body possible. Intellectually, train your mind to focus on health and recovery, not on illness and death, says Dr. Hokemeyer. “This requires considered practice.” Guided meditation is a helpful tool for maintaining a positive outlook.

Emotionally, look for a support group where you can go to express your fears and anxiety about the process, Hokemeyer encourages. The love and support of family and friends is a crucial element of healing, but it can be difficult to share your true emotions if you feel like you have to put on a happy face to keep loved ones from worrying about you. Hearing friends and family tell you “everything is going to be fine” may be comforting, but seeing and hearing from people in an outside support group, who have recovered from similar circumstances as yourself, can be valuable to your emotional health.

Coping with Chemotherapy

  • Keep a thermometer in your home and know how to take your temperature. Do not eat, drink or smoke for 10 minutes before taking your temperature. Leave the thermometer under your tongue for three minutes. If you are still unsure of how to take your temperature, ask your doctor or nurse.
  • Call your doctor or nurse as soon as possible if you develop a cough, sore throat, pain or burning when you urinate.
  • Wash hands frequently with soap and water to prevent infection.
  • Avoid rectal intercourse, tampons, douches, enemas and rectal thermometers.
  • Do not eat raw foods such as sushi and sashimi, Caesar salad or milk shakes made with raw eggs, until you complete chemotherapy and your blood counts have returned to adequate levels. Raw foods may carry bacteria that can lead to infection. Make sure to thoroughly wash fruits and vegetables.
  • Wash hands and cutting boards well after food preparation.
  • Always tell your doctor before going to the dentist.
  • The table below will help you understand your temperature in both Fahrenheit and Centigrade:

    Fahrenheit

    Centigrade

    98.6°

    37°

    99°

    37.2°

    100°

    37.8°

    101°

    38.3°

    102°

    38.9°

    Remember, always call your doctor if you have a temperature of 101° Fahrenheit (38.3° Centigrade) or higher.

    Flu-Like Symptoms

    Around the third day following a chemotherapy treatment, some people may experience flu-like symptoms such as muscle aches and pains. If you experience these aches, you can take over-the-counter medications such as Tylenol or Advil. If necessary, contact your doctor for stronger medication.

    Nausea

    Medications called antiemetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your doctor or nurse will recommend what is expected to work best for you.

    If possible, have your prescriptions filled before your treatment day. Please call your doctor or nurse if your medications do not give you adequate relief or if you experience side effects with the anti-nausea medication.

    Practical Hints for Nausea

    • Eat a small, light meal before your chemotherapy appointment. Most people do better if they have something in their stomach.
    • Eat what sounds good to you. In general, starches such as rice, bread, potatoes, hot cereals and puddings are well tolerated.
    • Try not to skip meals. An empty stomach will worsen all symptoms. If you don’t feel like sitting down to a meal, try nibbling on something that appeals to you.
    • Drink plenty of fluids. Herbal teas, water, sports drinks and diluted juices are recommended more than soda.
    • Avoid unappealing smells.
    • Freeze meals so you don’t have to cook. Ask your family and friends to help with meals, especially following chemotherapy when you are most likely to feel nauseated.

    For more practical tips on dealing with nausea, schedule a free appointment with the dietitian by contacting the Patient and Family Cancer Support Center.

    Fatigue

    Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy.

    Most people have to make some adjustments in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. As much as possible, try to maintain your everyday activities. It can be very beneficial to both your physical and emotional recovery. The fatigue will go away after you recover from chemotherapy.

    The Patient and Family Cancer Support Center also hosts monthly fatigue management workshops to address these concerns.

    Practical Hints for Fatigue

    • Plan your activities, such as grocery shopping, for a time when you feel the best.
    • If you have children, rest when they are napping. When you feel most tired, consider hiring a babysitter for a few hours so that you can relax or take a nap.
    • Take naps early in the day so you do not disturb your sleep pattern at night.
    • Consider exercising every day or several times a week. Good forms of exercise include swimming, walking and yoga. Contact the Patient and Family Cancer Support Center for information on free exercise classes.

    Hair Loss

    Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect.

    Most often, hair loss begins about two to three weeks after starting chemotherapy. Some people will lose relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you most comfortable. Many people choose different head coverings for different situations.

    We have many resources to assist you during this time, including the Friend to Friend Gift Shop and the Look Good… Feel Better! program. Please visit the Patient and Family Cancer Support Center for additional referrals and resources for wig and head covering boutiques.

    If you decide to buy a wig, try to buy one while you still have your own hair so you can better match color and style. You may want to ask your doctor for a prescription for a “cranial prosthesis” (i.e., a wig), as some insurance companies will only pay for a wig with a prescription for a cranial prosthesis.

    Your hair will begin to grow back after you stop chemotherapy. It usually takes from two to three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its original texture after some time.

    Practical Hints for Hair Loss

    • It is not always necessary to buy a real wig. Synthetic wigs can look as good and are less expensive, easier to care for, lighter in weight and may be more comfortable to wear.
    • Before possible hair loss, some people like to cut their hair short. The hair loss won’t be quite so shocking if there is less hair to lose.
    • Put a towel over your pillow so that clean up in the morning will be easier while you are shedding your hair.
    • Buy a drain catch for your shower. Other people choose to shave their head hair when hair loss begins.
    • Refer to our wig information sheet for places to shop near you.
    • Refer to the Friend to Friend Gift Shop or the Cancer Resource Center for more information.
    • When buying a wig, take a friend for emotional support and maybe even a laugh!

    Appetite and Taste Changes

    During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to odors. Don’t worry if you don’t have an appetite the first few days or a week following chemotherapy; it is not unusual. As you feel better, your appetite will improve.

    Reflux – when food backs up into your esophagus – burping, or a burning sensation may worsen nausea. Please report these symptoms to your physician or nurse so that they can be treated. You may find that you can only tolerate certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids: eight to 10 eight-ounce glasses per day, more if you have a fever or diarrhea.

    Recommendations for healthy nutrition include a diet low in fat (less than 20 percent fat) and high in whole grains, fruits and vegetables, and plant-based proteins. Some people want to begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed. Some people prefer small, slow changes, while others benefit from a “major overhaul.” We encourage you to become informed and make healthy dietary and lifestyle changes.

    Many people gain weight while on chemotherapy for reasons that are not well understood. Again, if you have concerns about nutrition, please consult our staff dietitian.

    Practical Hints for Taste and Appetite Changes

    • Eat what appeals to you during this time.
    • Eat foods that are warm rather than hot.
    • Avoid places where food is being cooked, such as the kitchen at dinnertime.
    • Avoid unappealing smells.
    • Try to drink eight to 10 glasses of fluid a day.

    Diarrhea or Constipation

    Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24 hours or blood in your stool, call your doctor or nurse. Do NOT use over the counter anti-diarrhea medications like Imodium unless advised to do so by your physician or nurse.

    Some chemotherapy and anti-nausea drugs can cause constipation. Also, you may be more prone to constipation because your activity level and diet have changed. If you experience constipation, contact your doctor or nurse the same day.

    Practical Hints for Constipation

    • To help prevent constipation, drink eight to 10 glasses of fluid a day.
    • Take a stool softener (not a laxative) such as ducosate sodium, also known as Colace, one tablet once or twice a day. Senekot or Senekot-S also may be suggested. Ask your doctor or nurse for a recommendation.
    • Stay as active as you can. Consistent regular exercise can reduce constipation.
    • If you can tolerate them, try high-fiber foods such as prunes, bran, fruits and vegetables.

    Practical Hints for Diarrhea

    • To replenish lost fluids, drink eight to 10 eight-ounce glasses of non-caffeinated fluids per day.
    • If your rectum is sore, use soft toilet paper and A&D ointment (used for diaper rash in infants) or Anusol, which can help numb the rectum and soothe soreness.

    Mouth Sores

    Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed.

    Practical Hints for Mouth Sores

    • Brush your teeth with a soft toothbrush three times daily.
    • Rinse your mouth with a solution of one teaspoon baking soda and one teaspoon of salt, diluted in a glass of lukewarm water, three or four times daily.
    • Most commercial mouthwashes contain alcohol. Ask your health care provider about mouthwashes that are not irritating to your mouth.
    • Ulcer-ease is a commercial product that may provide temporary relief from sores.

    Neuropathy

    Neuropathy, which means disease or dysfunction of the nerves, can happen to some people. Some of the most common symptoms of the type of neuropathy caused by chemotherapy include tingling and burning, numbness or pain in the affected areas, loss of your sense of position – knowing where a body part is without looking at it – and loss of balance. The most commonly affected areas are the tips of fingers and toes, although other areas are sometimes affected as well.

    Tell your doctor about any symptoms that you experience. Early detection and treatment are the best way to control your symptoms and prevent further nerve damage.

    Practical Hints Regarding Neuropathy

    • Tight shoes and socks can worsen pain and tingling, and may lead to sores that won’t heal. Wear soft, loose cotton socks and padded shoes.
    • If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice a day.
    • Massage your hands and feet, or have someone massage them for you, to improve circulation, stimulate nerves and temporarily relieve pain.

    Menopause

    For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause.

    With menopause, you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. If you experience any of these symptoms, talk to your doctor or nurse to get information and treatment for the symptoms.

    If your periods continue during treatment, they are likely to change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause.

    Practical Hints for Menopausal Symptoms

    • If you have breast cancer, we DON’T recommend hormone replacement therapy.
    • Eat soy products or take vitamin E (400 units only) to reduce hot flashes.
    • Your doctor may recommend prescription medications for hot flashes.
    • Wear light cotton pajamas to help prevent overheating when sleeping.
    • Use vaginal moisturizers on a regular basis or other water-based lubricants as needed, especially during and before sexual activity. These products will help with vaginal dryness and irritation.
    • Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.
    • There are prescription medications that give a local dose of estrogen to the tissues in the vagina to treat vaginal dryness.

    Questions and Concerns

    If you have a question or concern, staff will take your message and your nurse or physician will call you back. Please allow two days notice for medication refills.

    If your call is urgent, please tell us immediately when you call.

    If you are calling at night, on a weekend or a holiday, please call the same clinic number. You will speak with a staff member of the answering service who will take your name and number. A physician will be paged and will call you back. Please be prepared to tell the answering service:

    • Your name and doctor
    • Your type of cancer
    • The type of chemotherapy and the date you last received treatment
    • The names of any other medications you are taking
    • Your pharmacy’s phone number

    Please remember that we are here to make this time less difficult for you and call us with any questions or concerns.

    Keeping a Clean Home During Cancer Treatment

    By Emily Smith

    A clean home is an important part of staying healthy at any age, but it’s especially important for a cancer patient’s home to be very clean due to their lowered immune system. Keeping a house constantly organized and sanitized can be difficult for anyone… trying to keep up with all of the necessary chores while dealing with the side effects of cancer treatments can become overwhelming and feel next to impossible. Find below some practical tips that anyone going through cancer treatments can use to keep their home clean.

    Plan Cleaning Chores Beforehand & Break Tasks Up Into Manageable Sessions
    Patients undergoing cancer treatments often feel so tired and weak that even small tasks like washing the dinner dishes or vacuuming the carpets can seem insurmountable. Attempting to keep up the same cleaning schedule that they had prior to the cancer treatment often becomes too much. It’s easier to plan to break cleaning sessions down into smaller chores taking shorter amounts of time so that excessive energy isn’t spent. Planning more frequent cleaning sessions ahead of time makes it easier to fit everything that needs to be done into a busy schedule.

    Ask or Allow Others to Lend a Hand Cleaning or Cooking
    Those that are struggling with cancer often get many offers of help but the majority of people do not take advantage of them. We all have individuals in our lives who would love to serve us in our time of need: friends, family members, neighbors, and coworkers all may offer to clean to clean, do yard work, prepare meals, or fold laundry.

    Accepting help can be hard but there comes a time when it makes sense to allow others to lend a hand with cleaning and other household duties to get through a challenging experience. Allowing others to help will strengthen relationships and relieve a burden.

    Consider Hiring a Professional Cleaning Service
    Another terrific option that works for many cancer patients is to hire a professional cleaning service to take care of some household chores allowing the patient to rest and conserve the little strength they have. Most cleaning services offer a variety of rates and services allowing a client to select the most suitable option for their situation. Cleaningforareason.org is a nonprofit organization that offers free cleaning services to any cancer patient undergoing treatment for any form of cancer and can be a great resource for anyone unable to pay for a professional cleaning service.

    Make the Home Safe & Clean for Cancer Patients with Lowered Immunity
    When a cancer patient comes home following advanced cancer treatments, they often have a lowered immune system that makes it easier for them to become sick. Families can prepare for this by ensuring that all surfaces have been cleaned, live plants have been removed from the home, and the proper supplies are on-hand like face masks for family members to wear if they are ill.

    A cancer diagnosis is hard for patients and families and the ensuing treatments often require some lifestyle adjustments. While a patient’s process for keeping their space tidy and sanitized may need to change, it’s possible for them to maintain their standard of cleanliness by asking for help, modifying their approach to cleaning, and outsourcing to a cleaning company.

    Emily Smith is a professional freelance writer with a passion for family caregiving born from a close relationship with her ailing grandmother. She’s a frequent contributor to InHomeCare.com and can often be found trail hiking in her native Utah. Published with permission of InHomeCare.com.

    The oncology reimbursement landscape continues to present challenges for all those that work with patients with cancer. Help is available through the NCCN Virtual Reimbursement Resource Room.

    The Navigate Cancer Foundation provides free consultation services by experienced cancer nurses to answer patients’ questions about cancer. Experienced nurses will work with you and your loved

    Imerman Angels was created on the belief that no one should have to face cancer alone and without the necessary support. At 26 years old, Jonny Imerman was diagnosed with testicular cancer and began

    The National Cancer Institute’s website includes information for adolescents and young adults that provides accurate information about the challenges cancer can bring. It addresses topics such as:

    The Oncofertility Consortium is a group of researchers and medical professionals dedicated to exploring and expanding options for the reproductive future of cancer survivors. The online patient

    Ask your health care team about the best ways to prepare for your treatment sessions. Find out if you need lab work. Your provider may have advice or give you a prescription for medication that can help you avoid side effects such as nausea.

    Prepare a Treatment Bag

    Many cancer patients prepare a special tote bag or backpack to bring along to treatment sessions. Include items that will provide comfort and entertainment during treatment, such as:

    • Sweater and comfortable clothes.
    • Music player, headphones and favorite music.
    • Blanket and pillow.
    • Reading materials.
    • Crossword puzzles or other activities.
    • Deck of cards.
    • Lip balm.
    • Body lotion.
    • Calming teas like peppermint.
    • Notepad or journal and pen.
    • Bootie socks.
    • Cookies, crackers or other snacks.
    • Stress ball.

    Common Treatment Side Effects

    Some treatments bring side effects. Knowing what you might experience can help you feel more in control. Talk with your health care team about any side effects you could have. Medical care can often lessen the effects and problems associated with treatment. Ask about what to avoid eating or drinking during your treatment. Also, Chemocare.com provides information on the aftereffects of chemotherapy drugs and how to manage those effects.

    The following is an overview of the three most common types of cancer treatment and some of the possible side effects.

    Surgery

    Improved surgical methods now help limit damage to normal tissue. They have also reduced risks and side effects. Surgery is often used to find out if cancer cells are present such as with a biopsy. It is also used to remove tumors. Sometimes surgery is done to rebuild (reconstruct) or reshape physical changes. A medical device (port) is sometimes surgically placed under the skin. The port can be used to give medications.

    Possible side effects of surgery:

    • Scarring.
    • Movement limitations.
    • Inability to do some activities on a temporary or long-term basis.
    • Changes in sexual function or fertility.
    • Changes in ability to judge, learn or remember (such as after brain surgery).
    • Fatigue.
    • Swelling or lymphedema.

    Chemotherapy

    Chemotherapy uses medications to kill cells and stop cell growth. These medicines can be given as an oral tablet. They can also be given by injection or through a vein (with an IV) or a port. The medicines get into the bloodstream and circulate through the entire body. Side effects occur because the medicines affect both cancerous and non-cancerous cells. Side effects can occur when healthy cells are damaged.

    Chemotherapy is done in repeated cycles to allow the body to recover between doses. High doses or repeated chemotherapy may cause side effects. Many of the medicines interfere with the rapidly growing cells of the body. These cells may be in the stomach and intestinal lining, hair, skin, nails or bone marrow.

    Before chemo: Talk with your health care team about what side effects you might expect. Chemotherapy treatments can cause nausea and vomiting. Ask your health care provider about anti-nausea medications that may help. Some patients recommend not eating your favorite foods right before or after treatments. Later, when it’s important to rebuild your appetite and weight, you might not feel like eating those foods again.

    Talk with your health care provider if you want to have children in the future. Be sure to let your provider know if there is any possibility that you or your partner could be pregnant. Chemotherapy can harm an unborn child. LIVESTRONG Fertility offers reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility. LIVESTRONG Fertility may be able to help reduce fertility preservation costs.

    Possible side effects of chemo:

    • Anemia.
    • Decreased immunity.
    • Fatigue.
    • Mouth sores.
    • Forgetfulness.
    • Nausea or vomiting.
    • Hair loss.
    • Skin rashes.
    • Bruising and bleeding.
    • Cataracts.

    After chemo: Chemotherapy affects people in different ways. Some have very few side effects, while others have more. Side effects have nothing to do with how well the treatment is working. Side effects usually begin to improve or go away as normal tissues repair themselves. This may start about three weeks after the treatment. Hair can start to grow back even before the treatment is finished.

    Chemotherapy may temporarily affect the ability to concentrate. The result may be mild forgetfulness. This is sometimes called chemo fog or chemo brain. Calendars, lists and messages on voice mail can be helpful if this happens to you.

    Always tell your health care provider about any side effects that occur during chemotherapy, including extreme fatigue, bleeding, numbness and tingling in limbs (neuropathy), difficulty breathing, eating or drinking problems, problems with urination or bowel movements, memory loss and inability to focus, pain, infection and fever.

    Radiation Therapy

    Radiation therapy is the use of X-rays directed at a tumor. This might be done externally (on the surface of the skin) or internally (inside the body). The doses may be high or low. They are not the same as the X-rays used to take a picture of a tumor.

    Lead shields are used to protect vital organs during treatment. This minimizes radiation damage to normal tissues that surround the cancer. It also helps direct treatment to the same location each time.

    Damage to normal cells or structures of the body can cause radiation side effects. The health care provider will try to limit radiation damage to those areas that are close to the tumor during treatment. Still, some healthy tissue and organs may be involved in an effort to be certain all of the cancer is treated.

    Before radiation: Talk with your provider if there is a desire to have children in the future. Decisions about fertility preservation options should be made before starting radiation treatment. Women need to let the health care team know if there is any possibility of pregnancy because radiation could harm a fetus.

    Ask your health care provider to discuss side effects that radiation therapy could bring for your type of cancer. Following treatment, report any side effects to your provider as soon as possible. Early medical care for side effects is very important.

    Possible side effects of radiation to head:

    • Hair loss and changes to hair.
    • Earaches.
    • Redness and irritation in the mouth.
    • Dry mouth, trouble swallowing or changes in taste.
    • Changes to teeth, gums, mouth or throat.

    Possible side effects of radiation to body:

    • Bone growth changes in children who are still developing.
    • Dry, irritated or reddened skin.
    • Nausea, vomiting or bowel changes.
    • Eating and digestive problems.
    • Irritation of the bladder.
    • Effects on fertility or sexual functioning.
    • Breast size changes.
    • Lung fibrosis (stiffening or scarring).
    • Osteoporosis or bone loss.

    General side effects of radiation:

    • Fatigue or weakness.
    • Swelling and soreness.
    • Cough or shortness of breath.
    • Low white blood cell counts or low levels of platelets (rare).
    • Emotional effects.

    Hormone Therapy

    Hormone therapy is a treatment that adds, blocks or removes hormones. During this type of treatment, surgery may be needed to remove a gland that makes a certain hormone. In some cases, hormones may be given to adjust low hormone levels. Synthetic hormones or other drugs may be used to block the body’s natural hormones in order to slow or stop the growth of certain cancers. This may be done for prostate and breast cancer. Talk with your health care provider about the benefits and risks (such as osteoporosis) of this type of treatment. If you want to get pregnant after undergoing this type of treatment, ask about risks and recommended waiting periods.

    Cancer Treatment and Fatigue

    Keep Track of What Happens Between Medical Appointments

    • Write down dates of side effects and symptoms as well as what you experienced.
    • Note how long the symptom lasted and what did and did not help.
    • If you develop pain or other serious concerns, contact your doctor right away or go to the hospital emergency room.

    Fatigue or feeling physically exhausted is a very common side effect of cancer treatment. You may have no energy to do things that are important to you. Fatigue can also affect you mentally and emotionally.

    The causes of fatigue can include physical problems such as pain, stress, anemia or the side effects of treatment. Sometimes the cause is emotional such as depression. Other times, the cause might not be clear. Yet, fatigue can usually be successfully medically managed.

    Tell your health care provider if you are fatigued. Describe your level of fatigue by using terms like mild, moderate or severe. Your health care team will try to find out what is causing the fatigue so they can provide the best treatment to help relieve it.

    Dealing With Treatment Side Effects

    It’s very important to talk with your health care team about reactions to or side effects from treatment. Ask if your symptom is related to your treatment.

    Your health care team members can:

    • Tell you how to deal with a medical emergency such as a fever.
    • Provide information about your specific cancer treatment plan.
    • Describe risks of treatment and possible side effects.
    • Help you manage side effects.
    • Manage pain medically.
    • Identify specialized care that may be needed.
    • Refer you to other health care providers.
    • Create a plan for follow-up health care when treatment ends.
    Was this article helpful?

    FAQ: Caregiving During Chemotherapy

    Taking care of someone getting chemotherapy –chemo for short – can involve helping to make treatment decisions, making medical appointments, driving to treatments, preparing meals, doing laundry and other chores, providing companionship, comfort, and support, and many other tasks. Knowing what to expect as a caregiver allows you to be helpful while taking care of your own needs too.

    If you have more questions after reading this article, talk to the cancer care team. You can also call our Cancer Helpline at 1-800-227-2345.

    Q: How does chemo treat cancer?

    A: Chemo kills cells that grow fast, such as cancer cells. It may be used to keep cancer from spreading, make it grow slower, kill cancer cells that may have spread to other places in the body, shrink tumors to make side effects better, or cure cancer.

    Chemo can also affect normal cells that grow fast, including the ones that make blood, skin, and hair. Unlike the cancer cells, most normal cells are able to fix themselves and recover after chemo treatment ends.

    Q: What kinds of chemo are used to treat cancer?

    A: There are more than 100 different chemo drugs used today. Which drug someone gets depends on the type and stage of cancer, and other factors or problems a patient might have. Chemo can be given through a vein, called an infusion or IV (intravenous). Chemo can also come in liquid or pill form that’s swallowed, or it can be injected as a shot or rubbed onto the skin.

    Q: How long does chemo treatment last?

    A: How long a patient gets chemotherapy varies widely and depends on the type and stage of cancer, the goal of treatment, and other factors that might affect how a patient responds to the treatment. It may be given once a day, once a week, once a month, or more than one day in a row. It’s often given in cycles with breaks between treatments to give the body a chance to rest and heal.

    Q: What side effects can chemo have?

    A: Chemo can cause many different side effects depending on the drug, the dose, other medical problems a person has, and how they react to it. Most side effects go away over time after treatments end, but some can last longer. The cancer care team can help you know what to expect and how to deal with them. The more common chemo side effects include:

    • Fatigue. Cancer and chemo can cause extreme tiredness. For some people, fatigue is overwhelming and hard to deal with. It can last for weeks or months after treatment ends. Talk to the cancer care team for ideas that might help manage fatigue at home, such as healthy eating, brief napping, and taking short walks.
    • Low Blood Counts. Chemo may cause a loss of blood cells. Low red blood cells, called anemia, can make someone tired so they need more rest. Low white blood cells, called neutropenia, can raise the risk of infection. Protect the person you’re caring for from germs by washing your hands often and limiting their contact with other people. Low platelets can lead to bruising and bleeding. Protect the skin from cuts. Don’t give over-the-counter or other medications without first checking with the cancer care team. Read more about signs that you should call for help.
    • Nausea and vomiting. If the doctor prescribes drugs to help ease nausea and vomiting, it’s important to make sure the person you’re caring for follows the instructions. If nausea does happen, eating small snacks often throughout the day may help. If the person can’t keep liquids down or has been vomiting, call the doctor.
    • Hair loss. Some chemo drugs cause hair loss. Ask the cancer care team if the kind of chemo being given will cause hair to fall out, and when it might happen. With that information, you can help the person you’re caring for get ready. They can cut or shave their hair, decide to go bald, or shop for head coverings. Find out if their insurance company will cover wigs or scarves.
    • Mouth problems. Some chemo drugs can cause dryness and sores in the mouth and throat. Going to the dentist before getting chemo is a good idea if possible. Soft foods may help if it hurts to eat. Ask the cancer care team about ways to help.
    • Emotional changes. It’s normal for people getting chemo to be moody, and they may feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. It can help to talk to other people going through the same thing. Ask the cancer care team or the American Cancer Society about in-person or online support groups.

    Not every person gets every side effect. If the person you’re caring for is having trouble, call the cancer care team. You can read about more cancer side effects on cancer.org.

    Q: Is it safe to be around someone getting chemo?

    A: It usually takes a few days for the body to get rid of the drugs after a round of chemo is given. During this time, wear disposable gloves when cleaning up any body fluids, including urine, stool, tears, and vomit, and then wash your hands with soap and water. If chemo is being taken by mouth, talk to the cancer care team about how to be careful when touching the pills.

    It’s best to wash bed sheets and clothes in the washing machine separately from other clothes. Throw away adult diapers and sanitary pads by placing them in 2 plastic bags and throw them away with the regular trash. If you touch body fluids by mistake, wash your hands well with soap and water and ask the cancer care team for advice.

    Q: How can I take care of myself while caring for someone else?

    A: Taking care of someone getting chemo can be a stressful time. Studies show that caregivers often neglect their own health. Remember that as a caregiver you must take care of yourself in order to give good care. That means eating well, getting enough exercise, getting medical care including cancer screenings, and getting support when you need it.

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