| Booklet:
Chemotherapy and You |
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COPING WITH SIDE EFFECTS
If you have questions about side effects, you are not alone. Before
chemotherapy starts, most people are concerned about whether they will
have side effects and, if so, what they will be like. Once treatments
begin, people who have side effects want to know the best ways to cope
with them. This section will answer some of your questions.
If you are reading this section before you start chemotherapy, you may
feel overwhelmed by the wide range of side effects it describes. But
remember: Every person doesn't get every side effect, and some people get
few, if any. In addition, the severity of side effects varies greatly from
person to person. Whether you have a particular side effect, and how
severe it will be, depends on the kind of chemotherapy you get and how
your body reacts. Be sure to talk to your doctor and nurse about which
side effects are most likely to occur with your chemotherapy, how long
they might last, how serious they might be, and when you should seek
medical attention for them.
What Causes Side Effects?
Because cancer cells grow and divide rapidly, anticancer drugs are made
to kill fast- growing cells. But certain normal, healthy cells also
multiply quickly, and chemotherapy can affect these cells, too. When it
does, side effects may result. The fast-growing, normal cells most likely
to be affected are blood cells forming in the bone marrow and cells in the
digestive tract, reproductive system, and hair follicles. Anticancer drugs
can also damage cells of the heart, kidney, bladder, lungs, and nervous
system. The most common side effects of chemotherapy include nausea and
vomiting, hair loss, and fatigue. Other common side effects include an
increased chance of bleeding, getting an infection, or developing anemia.
These side effects result from changes in blood cells during chemotherapy.
How Long Do Side Effects Last?
Most normal cells recover quickly when chemotherapy is over, so most
side effects gradually disappear after treatment ends, and the healthy
cells have a chance to grow normally. The time it takes to get over some
side effects and regain energy varies from person to person. How soon you
will feel better depends on many factors, including your overall health
and the kinds of drugs you have been taking.
While many side effects go away fairly rapidly, certain ones may take
months or years to disappear completely. Sometimes, the side effects can
last a lifetime, as when chemotherapy causes permanent damage to the
heart, lungs, kidneys, or reproductive organs. And certain types of
chemotherapy occasionally may cause delayed effects, such as a second
cancer, that show up many years later.
It is important to remember that many people have no long-term problems
due to chemotherapy. It also is reassuring to know that doctors are making
great progress in preventing some of chemotherapy's more serious side
effects. For instance they are using many new drugs and techniques that
increase chemotherapy's powerful effects on cancer cells while decreasing
its harmful effects on 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. People getting
chemotherapy sometimes 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. It may be that your medication or the
treatment schedule can be changed. Or your doctor may be able to suggest
ways to reduce side effects or make them easier to tolerate. Remember
though, your doctor will not ask you to continue treatments unless the
expected benefits outweigh any problems you might have.
On the pages that follow, you will find suggestions for dealing with
some of the more common side effects of chemotherapy.
Nausea and Vomiting
Chemotherapy can cause nausea and vomiting by affecting the stomach,
the area of the brain that controls vomiting, or both. This reaction to
chemotherapy varies from person to person and from drug to drug. For
example, some people never vomit or feel nauseous. Others feel mildly
nauseated most of the time, while some become severely nauseated for a
limited time during or after a treatment. Their symptoms may start soon
after a treatment or hours later. They may feel sick for a few hours or
for about a day. Be sure to tell your doctor or nurse if you are very
nauseated and/or have vomited for more than a day or if your nausea is so
bad that you cannot even keep liquids down.
Nausea and vomiting can almost always be controlled or at least
lessened. If you experience this side effect, your doctor can choose from
a range of drugs known as antiemetics, which help curb nausea and
vomiting. Different drugs work for different people, and it may be
necessary to use more than one drug to get relief. Don't give up. Continue
to work with your doctor and nurse to find the drug or drugs that work
best for you.
You can also try the following ideas:
- Avoid big meals so your stomach won't feel too full. Eat small meals
throughout the day, instead of one, two, or three large meals.
- Drink liquids at least an hour before or after mealtime, instead of
with your meals.
- Eat and drink slowly.
- Stay away from sweet, fried, or fatty foods.
- Eat foods cold or at room temperature so you won't be bothered by
strong smells.
- Chew your food well for easier digestion.
- If nausea is a problem in the morning, try eating dry foods like
cereal,toast, or crackers before getting up. (Don't try this if you
have mouth or throat sores or if you are troubled by a lack of
saliva.)
- Drink cool, clear, unsweetened fruit juices, such as apple or grape
juice, or light-colored sodas, such as ginger ale, that have lost
their fizz.
- Suck on ice cubes, mints, or tart candies. (Don't use tart candies
if you have mouth or throat sores.)
- Try to avoid odors that bother you, such as cooking smells, smoke,
or perfume.
- Prepare and freeze meals in advance for days when you don't feel
like cooking.
- Rest in a chair after eating, but don't lie flat for at least 2
hours after you've finished your meal.
- Wear loose-fitting clothes.
- Breathe deeply and slowly when you feel nauseated.
- Distract yourself by chatting with friends or family members,
listening to music, or watching a movie or TV show.
- Use relaxation techniques.
- Avoid eating for at least a few hours before treatment if nausea
usually occurs during chemotherapy.
Hair Loss
Hair loss (alopecia) is a common side effect of chemotherapy, but it
doesn't always happen. Your doctor can tell you whether hair loss is
likely to occur with the drug or drugs you are taking. When hair loss does
occur, the hair may become thinner or may fall out entirely. The hair
usually grows back after the treatments are over. Some people even start
to get their hair back while they are still having treatments. In some
cases, hair may grow back in a different color or texture.
Hair loss can occur on all parts of the body, not just the head. Facial
hair, arm and leg hair, underarm hair, and pubic hair all may be affected.
Hair loss usually doesn't happen right away; more often, it begins
after a few treatments. At that point, hair may fall out gradually or in
clumps. Any hair that is still growing may become dull and dry.
To care for your scalp and hair during chemotherapy:
- Use mild shampoos.
- Use soft hair brushes.
- Use low heat when drying your hair.
- Don't use brush rollers to set your hair.
- Don't dye your hair or get a permanent.
- Have your hair cut short. A shorter style will make your hair look
thicker and fuller. It will also make hair loss easier to manage if it
occurs.
- Use a sunscreen, sunblock, hat, or scarf to protect your scalp from
the sun if you lose a lot of the hair on your head. Some people who
lose all or most of their hair choose to wear turbans, scarves, caps,
wigs, or hairpieces. Others leave their head uncovered. Still others
switch back and forth, depending on whether they are in public or at
home with friends and family members. There are no "right"
or "wrong" choices; do whatever feels comfortable for you.
Here are some tips if you choose to cover your head:
- Get your wig or hairpiece before you lose a lot of hair. That way,
you can match your natural color and current hair style if you wish.
You may be able to buy a wig or hairpiece at a specialty ship just
fo0r cancer patients. Someone even may come to your home to help you.
You also can buy a wig or hairpiece through a catalog or by phone.
Call the American Cancer Society for more information.
- Consider borrowing a wig or hairpiece, rather than buying one. Check
with the local chapter of the American Cancer Society or with the
social work department at your hospital.
- Remember that a hairpiece needed because of cancer treatment is a
tax- deductible expense and may be at least partially covered by your
health insurance. Be sure to check your policy.
Losing hair from your head, face, or body can be hard to accept. It's
common--and perfectly all right--to feel angry or depressed about this
loss. Talking about your feelings can help.
Fatigue/Anemia
Chemotherapy can reduce the bone marrow's ability to make red blood
cells, which carry oxygen to all parts of your body. When there are too
few red blood cells, body tissues don't get enough oxygen to do their
work. This condition is called anemia.
Anemia can make you feel very weak and tired. Other symptoms of anemia
include dizziness, chills, or shortness of breath. Be sure to report any
of these symptoms to your doctor.
Your doctor will check your blood cell count often during your
treatment. If your red count falls too low, you may need a blood
transfusion to increase the number of red blood cells in your body
Here are some things you can do to help yourself feel better if you
develop anemia:
- Get plenty of rest. Sleep more at night and take naps during the day
if you can.
- Limit your activities: Do only the things that are most important to
you.
- Don't be afraid to get help when you need it. Ask family and friends
to pitch in with things like child care, shopping, housework, or
driving.
- Eat a well balanced diet.
- When sitting or lying down, get up slowly. This will help prevent
dizziness.
Infection
Chemotherapy can make you more likely to get infections. This happens
because most anticancer drugs affect the bone marrow and decrease its
ability to produce white blood cells, the cells that fight many types of
infections. An infection can begin in almost any part of your body
including your mouth, skin, lungs, urinary tract, rectum, and reproductive
tract.
Your doctor will check your blood cell count often while you are
getting chemotherapy. Your doctor also may add colony stimulating factors
to your treatment to keep your blood count from getting too far below
normal. In spite of these extra steps, however, your white blood cell
count still may drop. If this happens, your doctor may postpone your next
treatment or give you a lower dose of drugs for a while.
When your white count is lower than normal, it is very important to try
to prevent infections by taking the following steps:
- Wash your hands often during the day. Be sure to wash them extra
well before you eat and before and after you use the bathroom.
- 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 diseases you can catch, such as a
cold, the flu, measles, or chickenpox. Also try to avoid crowds.
- Stay away from children who recently have received immunizations,
such as vaccines for polio, measles, mumps and rubella (German
measles).
- Don't cut or tear the cuticles of your nails.
- Be careful not to cut or nick yourself when using scissors, needles,
or knives.
- Use an electric shaver instead of a razor to prevent breaks or cuts
in your skin.
- Use a soft toothbrush that won't hurt your gums.
- Don't squeeze or scratch pimples.
- Take a warm (not hot) bath, shower, or sponge bath every day. Pat
your skin dry using a light touch. Don't rub.
- Use lotion or oil to soften and heal your skin if it becomes dry and
cracked.
- Clean cuts and scrapes right away with warm water, soap, and an
antiseptic.
- Wear protective gloves when gardening or cleaning up after animals
and others, especially small children.
- Do not get any immunization shots without checking first with your
doctor to see if it's all right.
Most infections come from the bacteria normally found on the skin and
in the intestines and genital tract. In some cases, the cause of an
infection may not be known. When your white blood cell count is low, your
body may not be able to fight off infections. So, even if you take extra
care, you still may get an infection.
Be alert to the signs that you might have an infection and check your
body regularly for its signs, paying special attention to your eyes, nose,
mouth, and genital and rectal areas. The symptoms of infection include:
- Fever over 100 degrees F.
- Chills.
- Sweating.
- Loose bowels (this can also be a side effect of chemotherapy).
- A burning feeling when you urinate.
- A severe cough or sore throat.
- Unusual vaginal discharge or itching.
- Redness or swelling, especially around a wound, sore, pimple, or
intravenous catheter sites.
Report any signs of infection to your doctor right away. This is
especially important when your white blood cell count is low. If you have
a fever, don't use aspirin, acetaminophen, or any other medicine to bring
your temperature down without first checking with your doctor.
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