Help with Side Effects - Chemotherapy

Chemotherapy drugs affect all cells - tumor cells as well as normal ones. The side-effects you experience are the result of the drug's affect on normal, actively dividing cells. The faster cells divide, the more sensitive they are to chemotherapy. Some of the fastest dividing cells in your body are bone marrow - the part of the body that makes new blood cells; the cells that line the stomach, mouth and intestines; and hair cells. That is why they are the most commonly affected cells. Chemotherapy may also affect organs such as your liver.

Normal cells are capable of repairing themselves following chemotherapy, while tumor cells have a limited ability to do so. The goal of chemotherapy is to give enough drug to kill tumor cells without causing permanent damage to normal cells. The amount of chemotherapy that can safely be given to a patient is based on that drug's potential to damage normal tissue - drug toxicity.

The severity of side-effects varies with the type of drug, how it is given, how much is given, and one's general health. When your doctor talks with you and your family about chemotherapy, ask about the potential side-effects of the drugs you will be receiving. Your doctor can put them into perspective and help you weigh the risks against the benefits.

The following are some points to consider when you discuss chemotherapy.

• Side-effects are drug specific; that is, certain side-effects are caused by certain drugs. For example, some chemotherapy drugs cause hair-loss and others do not.
• Side-effects vary with each individual. While you might experience a side-effect, someone else taking the same drug may not.
• Some side-effects occur during or immediately after the drug is given. Other side-effects are delayed and might not occur for days or weeks.
• Most side-effects are reversible when chemotherapy is ended.
• The drug dose can be modified by your doctor if the side-effects become uncomfortable.
• The decision to have chemotherapy is not a permanent one. If you change your mind, tell your doctor. Your treatment can be changed, modified or stopped completely. Discuss other options with your doctor.
• There are many successful methods of preventing or managing the side-effects of chemotherapy. Ask your doctor or nurse about new anti-nausea drugs, imaging and relaxation techniques and other coping tactics.

Blood cells are produced by bone marrow. If the marrow is affected, the production of blood cells is also affected.

Red Blood Cells (RBCs)

Red blood cells carry oxygen to all parts of your body. When you don't have enough red blood cells in your system, you are anemic. Anemia might cause you to feel tired, dizzy or chilly, or become short of breath. You may also look pale.

Management of low red blood cell counts

• Get plenty of rest, and eat a well-balanced diet.
• Eat foods that are high in iron such as green leafy vegetables.
• Don't be embarrassed or reluctant to ask for help when you need it.
• When you get up after sitting or lying down, move slowly and take deep breaths to avoid getting dizzy.
• Anemia may also contribute to a feeling of fatigue. 

Your doctor will check your red blood cell count regularly during treatment. If you experience severe anemia, medications can be prescribed to boost the production of red blood cells or a blood transfusion may be suggested.

White Blood Cells (WBCs)

White blood cells fight infection. If your WBCs are low, you are at risk for an infection. An infection in someone with too few WBCs can be life-threatening. Common symptoms of an infection include fever, chills, sweating, diarrhea, sore throat, cough, mouth sores or burning while urinating. If a cut or wound becomes red, swollen or has drainage, it is probably infected. Notify your doctor immediately if you think you have any kind of an infection.

Management of low white blood cell counts

The best way to combat infection is to prevent it. By practicing these techniques on a regular basis, they will become second nature:

• Wash your hands often, especially before eating and after using the bathroom. Wash your hands after handling pets. Make sure those who are helping you also wash their hands.
• Get plenty of rest, avoid fatigue, and eat a well-balanced diet.
• Practice good oral hygiene. Use soft toothbrushes and brush gently.
• Wash all fresh fruits and vegetables thoroughly before eating them.
• Use different cutting boards for produce (vegetables) and for meat.
• Use caution in the kitchen when using sharp utensils. Donít reach into a sink of soapy water unless you can see what lies below. Wear a pair of kitchen gloves when using a sharp knife.
• Use potholders or gloves when cooking.
• Avoid crowds wherever practical.
• Avoid people who are ill. Speak up for yourself, and donít be shy about asking people not to visit if they have a cold.
• Avoid children who have recently received immunization shots. Don't get any immunization shots yourself.
• Use lotion to prevent your hands from becoming dry or cracked.
• Use an electric razor for shaving.
• Clean cuts or other wounds immediately with warm water and soap.
• Use protective gloves when gardening.
• It's best to have someone else clean up after pets. If that's not possible, use gloves and wash your hands thoroughly afterward.

Your physician will check your white blood count regularly during treatment. If it falls too low, medications to boost the production of WBCs might be prescribed. If your count becomes dangerously low you may need to be hospitalized.

Platelets

Platelets are the cells that help stop bleeding by forming blood clots. If your platelets are low, you bruise more easily and it takes longer for cuts and scrapes to stop bleeding. Other symptoms of a low platelet count include small, red spots on your skin, pink-tinged to red urine, bloody or black stools, and bleeding from the gums or nose. Women may experience heavier than normal menstrual bleeding.

Management of low platelet counts

Notify your doctor immediately if you experience any of the symptoms listed. Avoid medications that enhance bleeding, such as aspirin, ibuprofen and other anti-inflammatories. If you are unsure if you can take a medication, ask your doctor or pharmacist.

Try to avoid activities that can cause injury. Use work gloves and protective gear when gardening or doing other work that can lead to cuts or scrapes. Check with your doctor before participating in sports activities such as football, rollerblading, biking, etc. Try not to blow your nose too hard, cough harshly or strain at bowel movements.

If you cut yourself, put pressure on the wound for 10 to 15 minutes. If the bleeding doesn't stop, notify your doctor. If you suffer a major injury, go to the nearest emergency room.

Your doctor will check your platelet count regularly during treatment. If it is too low, you may require a transfusion.

The digestive system includes the mouth, esophagus, stomach and intestines. Inflammation of the cells lining these organs is called mucositis.

Mouth and Esophagus

Mucositis in the mouth is called stomatitis; in the esophagus, it is called esophagitis. Mucositis usually begins with a dry mouth, tongue and lips. Burning or tingling sensations may also occur. This may make chewing and swallowing uncomfortable. Notify your doctor immediately if you develop any sores or ulcers in your mouth or if swallowing becomes painful.

Management of mouth and esophagus problems

Good oral hygiene is extremely important for the prevention of mucositis.

• Brush your teeth with a soft toothbrush after meals and at bedtime.
• Floss regularly with unwaxed dental floss.
• Gargle with salt water or a mouthwash that contains no alcohol. Baking soda in water is another good mouth rinse, but some people don't like the taste.
• Hydrogen peroxide and water should not be used unless your doctor tells you to do so.
• Remember to remove dentures so the gums can be washed and rinsed.
• Don't use lemon glycerin swabs they dry out the mouth and might decalcify your teeth.
• Avoid alcoholic drinks. Don't smoke.
• Moisten your lips with lip ointment or water-soluble lubricating jelly.
• Use sugarless candy or gum if your mouth is dry. Different types of artificial saliva are available. Ask your doctor, nurse or pharmacist for their recommendations.
• Drink plenty of water.
• Avoid citrus fruits and juices and other acid containing foods. Avoid spicy foods.

If you develop sores in your mouth:

• Notify your doctor immediately.
• Eat bland foods at moderate temperatures.
• Moisten dry foods.
• Eat soft foods or foods prepared in a blender.
• Try milkshakes, applesauce and soft non-citrus fruits, mashed potatoes, scrambled eggs, puddings and gelatin.
• Use a topical anesthetic for mouth sores, available at your drug store.
• Use frozen popsicles, ice chips or other frozen foods to relieve mouth pain.

Stomach and Intestines

Diarrhea or constipation can occur if your intestines (bowels) are affected. Symptoms can begin one to six hours after chemotherapy and might last a few hours, several days, or a few weeks.

People assume they will have nausea and vomiting during chemotherapy. This is not always the case. This side-effect is highly dependent on the type of drug used, and many drugs used for primary brain tumors do not cause nausea and vomiting.

Antinausea medications, called antiemetics, help stop or limit nausea and vomiting. Your doctor will discuss these medicines with you when planning your chemotherapy.

Management of nausea and vomiting

• Relax. Don't assume you will be sick.
• Use imaging and other relaxation techniques before and during your therapy. Biofeedback, self-hypnosis, diversionary activities (videos, games, puzzles), accupressure and music therapy may be helpful.
• Avoid eating for a few hours before treatment, if you experience nausea.
• Stay away from fatty or spicy foods, sweets and strong smelling foods.
• Ice chips, ginger ale, unsalted pretzels, plain crackers, cool, bland foods can help combat nausea.
• Try small, frequent meals. Eat slowly.
• Have your favorite foods available and located conveniently.
• Drink plenty of water.

Management of constipation

• Drink plenty of fluids.
• Eat bulky, high-fiber foods such as bran and whole wheat products.
• Exercise daily, if possile even a short walk is helpful in preventing constipation.
• Notify your doctor if you are troubled by this side-effect. Medications can be prescribed.

Management of diarrhea

• Drink plenty of fluids to prevent becoming dehydrated. Fluids high in electrolytes, such as Pedialyte, are preferable. Sports drinks, such as Gatorade, may be used, but have a high sugar content and may worsen diarrhea in some people. Plain water, weak tea or apple juice can also be helpful.
• Eat high calorie, high protein, low residue foods.
• Eat small, frequent meals. Eat bland foods.
• Avoid foods at temperature extremes hot or cold.
• While you have diarrrhea, avoid high-fiber foods and foods that can irritate the bowel: bran, whole grain breads, fried foods, fruit juices, milk products, coffee, etc.
• Avoid gas-producing foods such as onions, cabbage, beans etc. Artificial sweeteners cause gas in some people.
• Dietary supplements, such as Ensure and Sustacal, may contribute to diarrhea. Avoid using these products until your diarrhea is under control.
• If you can tolerate them, eat foods high in potassium, such as cantaloupe, oranges, peaches, bananas and baked potatoes.
• Use mild soap and water to wash your anal area; pat dry. Sitz baths can be soothing.
• Use moisture barrier creams and ointments, such as A&D, ointment or Desitin, if your skin becomes irritated. Notify your physician if you develop any sores.

Skin Reactions

Management of skin reactions

• Wash with a mild, unperfumed soap or skin lotion. Look for hypoallergenic soaps. Softer soaps, such as Dove and Neutrogena, are closer to your skin's normal pH and will not cause dryness.
• Avoid perfumes, perfumed lotions and products that contain alcohol. Alcohol is drying to your skin.
• Use warm, not hot, water for bathing. Pat your skin dry rather than rubbing.
• Cornstarch patted on the skin may relieve itching. (Don't use talc.)
• Some chemotherapy medications cause you to sunburn more easily. Ask your doctor or pharmacist if the drugs prescribed for you have this side-effect. If so, use sunscreen and a hat when you are outdoors. Cover your arms and legs, and donít forget about the back of your neck!
• If chemotherapy is given through a vein, some skin discoloration might occur along the path of the vein. The darkened area usually fades when treatment ends.

Hair Loss

Some chemotherapy drugs cause hair loss; others do not. Ask your doctor if you can expect this side-effect from the chemotherapy you will be receiving.

Hair loss due to chemotherapy usually isn't permanent. Your hair should grow back after your therapy is completed. Sometimes hair may grow back a different color or texture.

Management of hair loss

To minimize hair loss, cut your hair short before you begin treatment. This reduces the weight on the hair shaft. Satin pillowcases help lessen tangling while you sleep. Use an infant comb and brush set when your hair begins to grow back. Don't over shampoo your hair. Use a mild shampoo which is "pH balanced," such as a baby shampoo. Don't use abusive products on your hair, such as hot rollers, curling irons, hair sprays or dyes.

Consider purchasing a wig or buy some scarves, turbans or caps before starting radiation. You might be able to purchase a wig from your hair stylist. Wigs can also be made from your own hair. Hair pieces and wigs might be tax-deductible or covered by your insurance. Get a prescription for a "cranial prosthesis" (wig) from your physician. Get a prescription for a "cranial prosthesis" (wig) from your physician. There are specialty stores which provide products that help people undergoing radiation and chemotherapy manage some of these treatment side effects. Your nurse, social worker or local cancer organization representative can suggest a store in your area. ABTA social workers can also help you locate wig and scarve manufacturers, wig donation programs, and helpful personal services for people undergoing cancer treatments. Call us at 800-886-2282, and ask for our social work office.

We maintain an extensive nationwide listing of wig manufacturers of both synthetic and real hair, places to find donated wigs, and resources for hair accessories such as scarves and turbans. If you would like that listing, please call us at 800-886-2282.

Additional tips for managing treatment side effects are available in the Treating Brain Tumors section of our web site. Or, visit other sections of the ABTA web site:  

About Us      Tumor & Treatment Info     Care & Support  

Research Progress      Donate      Events& Meetings      Advocacy

Healthcare Professionals      Press Room      ABTA Kids      ABTA Store

Current as of December, 2008