Chemotherapy

WHAT YOU SHOULD KNOW

Chemotherapy is the term used for treating cancer with drugs. The powerful medications used in chemotherapy can cure some cancers by preventing malignant (cancerous) cells from duplicating themselves. Chemotherapy can also keep the disease from spreading to other parts of the body, and can be used to shrink cancerous lymph nodes. Cancer drugs are designed to attack cells that multiply rapidly---one of the hallmarks of malignancy. Unfortunately, cells in the hair, intestines, bone marrow, testicles, and ovaries are also subject to rapid division, and are often harmed along with the cancer cells. This can lead to one or more of the following side effects:

• Hair Loss: When your normal hair cells are damaged, you may lose some or all of your hair.
• Bowel Problems: If the drugs damage your intestines, you may have nausea, vomiting, constipation, or diarrhea.
• Blood Problems: Because blood cells are produced in the bone marrow, chemotherapy can lead to anemia (not enough red blood cells) or leave you without enough white blood cells to fight infection. You may also find that cuts bleed more easily and in greater amounts, due to a shortage of clot-forming blood platelets.
• Low Sperm Count: Chemotherapy can damage a man's testicles and thus lower his sperm count.
• Amenorrhea (A-men-uh-REE-uh): If the drugs damage a woman's ovaries, she may stop having her monthly periods.

Chemotherapy medications are given in a variety of ways. Depending on the drug your doctor has chosen, you may receive it by any of the following routes:

• Intramuscular: Injection into a muscle. The injection may cause pain or muscle cramps, or lead to itching or hives.
• Intrathecal: Injection into the spine. This route is often used when there is a danger that the cancer will spread to the nervous system.
• Oral: Medicine in pill form. Taking the pills with milk or a snack will help prevent nausea.
• Peripheral IV: Medicine added to the bloodstream through an IV needle in a vein in your hand or arm. Administration of the medicine can cause pain, redness, swelling, itching, or hives in the area near the needle---especially if the medicine leaks into the tissues around the vein. You may also get cramps in the arm.
• Long Term IV Catheter: Medicine added to the bloodstream through a tube inserted in a vein in the chest or neck. This route may be used if your veins are very small or you've already had many other IVs. The IV tube may be placed entirely under the skin or inserted with the end sticking out. It can remain in place for months or even years. As in a peripheral IV, the medicine can cause local damage and side effects if it leaks out of the catheter.

Care:

You will need a number of blood tests before, during, and after chemotherapy to gauge the effect of the treatment. If one drug fails to do the job, or causes dangerous side effects, your doctor may try others. Surgery or radiation therapy to eliminate any remaining cancer may also be necessary. To relieve side effects, your doctor can prescribe a variety of additional medications. These include:

• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Pain Medicine: To ease pain, your doctor can prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls the vomiting sometimes caused by chemotherapy.
• Stool Softeners: If you develop constipation, these medications will make bowel movements softer so you won't need to strain.
• Steroids: This medicine decreases swelling and inflammation. While it can be helpful, it may have side effects of its own. Steroid treatments must be tapered off gradually. Don't stop taking the drugs on your own.
• Prednisone: This type of steroid is often given with other chemotherapy drugs. It helps shrink lymph nodes back to their normal size and controls the number of leukocytes (a type of white blood cell) in the body.

WHAT YOU SHOULD DO

• Take all medicines exactly as directed. If one of the drugs doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• If you are taking pain medicine, especially as a shot or IV, ask you doctor to show you and your family how to give it. Take enough medicine to stay comfortable. Do not worry about becoming addicted to the drugs.
• Do NOT take any medicine that contains aspirin or ibuprofen-like ingredients. Ask your doctor before taking any over-the-counter medication.
• If you are undergoing chemotherapy at home, take your medicine exactly as you are told. Write on a calendar both the dates and times to take your chemo and other medicines and the dates and times you are to see your doctor or get lab tests.
• Chemotherapy increases your chance of infection. Call your doctor if you see any of the following signs:
• • Sores, swelling, or redness in your mouth.
  • Redness, pain, or hemorrhoids in your rectum.
  • Any change in your bowel habits.
  • Redness, swelling, or pain anywhere on your skin.
  • Pain or burning when you urinate, or bad smelling urine.
  • Coughing or trouble breathing.
• To help prevent infections:
• • Wash your hands often, especially after you go to the bathroom.
  • Shower every day making sure to wash between folds of skin. If you are feeling dizzy, take a bath or use a shower chair. Use an electric shaver to keep from nicking your skin when shaving.
  • If you have dentures, change the water in your denture cup every day.
  • Change the water in your humidifier or any other respiratory equipment every day.
  • Clean the area between your legs each time you go to the bathroom.
  • Do not give yourself an enema or take your temperature rectally unless your doctor says it's OK.
  • Stay away from people who have colds or the "flu" and avoid crowds. You may need flu or pneumonia shots to prevent your getting these diseases.
• Remember that chemotherapy can lower your blood platelet count, making it easier to bleed. Tell your doctor if:
• • There is blood in your urine, stool, or vomit.
  • You start to bruise more easily than usual.
  • You get frequent nosebleeds.
  • Your gums start to bleed. (Using a soft toothbrush will help prevent this problem.)
• If you are getting chemotherapy at home, you and anyone helping you must follow special rules when handling the medicines.
• • Do not touch the medicine; it can burn your skin.
  • Always wear latex gloves when handling the medicine. Wash your hands before putting the gloves on and after taking them off.
  • Wear a gown that closes in front and has long sleeves.
  • To soak up any spills, put a towel or disposable diaper under the part of your body where you will get the medicine.
  • If the medicine touches your skin, wash it off immediately. If the medicine gets in your eyes, flush them with water right away, then call your doctor.
  • Be careful to keep the medicine away from food and beverages. Do not eat or drink while getting ready for a dose of the medicine or while cleaning up afterwards.
  • Keep your hands away from your face or eyes while handling the medicine.
  • Keep all chemotherapy medicines and supplies out of the reach of children.
  • If you are taking the medicine intravenously, use needles and IV tubing with Luer locks. These locks keep the tubing and needle from coming apart and spilling the medicine.
  • Wear gloves when you throw away blood, sputum, bowel movements, or urine. This is especially important if you are using a bed pan instead of the toilet. Also use gloves when removing bed sheets and washing laundry.
  • Dispose of dirty gloves and gowns in a plastic bag that will not leak. Put the bag inside another plastic bag and mark it "DANGEROUS," then leave it in a covered garbage can. When disposing of needles, use a container that the needles can't poke through.
• To combat the nausea that often accompanies chemotherapy, try following these guidelines:
• • Don't lie down for 2 hours after eating. Lying down sooner can make both nausea and heartburn worse. Rest quietly while leaning back in a comfortable chair. Put a cool, damp washcloth over your forehead, face, or neck.
  • Before a dose of medicine, either eat a light, bland snack such as toast or crackers or eat nothing at all.
  • Try eating small meals 5 or 6 times a day instead of 3 large meals. Suck on ice chips or sip small amounts of clear, unsweetened liquids such as apple juice. Then try crackers or dry toast.
  • If you have trouble swallowing, eat soft foods and liquids.
  • Remember that sweets and fried or high-fat food can make nausea worse. Spicy foods and alcohol can aggravate heartburn.
  • To help prevent nausea from returning after you vomit, brush your teeth or rinse your mouth as soon as possible.
• Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• If constipation develops, follow these tips. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• To help slow down hair loss, do not brush or comb your hair any more than necessary, and wash it with a mild shampoo. You may want to buy hats, scarves, and wigs to help hide hair loss.
• Brush your teeth or rinse your mouth 2 to 3 times every day, preferably after meals. Gently brush your teeth and gums with a soft-bristle brush. See your dentist for regular check-ups. Your dentist may need to speak to your doctor before the exam.
• If you have white patches in your mouth, rinse your mouth more often. Use salt water if your mouth is sore. Your doctor may give you a medicated mouthwash.
• You will probably need more rest. Match your activity to your energy level. Nap a couple of times during the day. Going to bed early and getting up late may also help.

Call Your Doctor If...

• You are running a high temperature.
• You cannot keep food or liquids down.

Seek Care Immediately If...

• You develop chest pain.
• You have trouble breathing.
• You cannot think clearly.
• You have a headache and stiff neck.
• You develop a very high temperature.
• Your legs become swollen or painful.
• You become so depressed that you feel you can't cope.