Guide to Managing Your Chemotherapy Treatment
Learn basic information about chemotherapy, including details about blood counts and infections, fatigue, mouth care, nausea, vomiting, diarrhea and constipation, other side effects and much more.
Chemotherapy: Basic Information What is chemotherapy? Chemotherapy is the use of drugs to treat cancer. It works throughout the body and can destroy cancer cells that have metastasized (spread) to lymph nodes and parts of the body far away from the primary (original) tumor. You may undergo chemotherapy alone or chemotherapy with other types of treatment. You may, for example, have surgery followed by chemotherapy, or you may have radiation therapy followed by chemotherapy or surgery or both. You may receive two or more different drugs during the same course of treatment. Combining different drugs and therapies reduces the chance of the cancer coming back. Talk with your doctor about your own special treatment plan. Chemotherapy can react with other drugs, causing unwanted side effects. Do not take any medications, including prescription, non-prescription (over-the-counter), nutritional supplements, vitamins, minerals or herbal products, without first discussing them with your doctor. Although vitamins and minerals are very important to one’s health, some of them, when taken in large amounts, can react negatively with chemotherapy and other drugs. It is important that you let your doctor know about any medications, herbs and herbal supplements, vitamins, or minerals you may be taking to help reduce the chance of drug interactions. How does chemotherapy work? Normal body cells grow and divide in a controlled way. Cancer cells are abnormal and grow and divide in a rapid, uncontrolled way. Chemotherapy works by attacking all rapidly growing cells in the body. The goal of chemotherapy is to stop cancer cells from growing and multiplying and to relieve symptoms that may be caused by cancer. Chemotherapy drugs may affect cancer cells by: • Breaking down parts of the cancer cell • Stopping the cancer cells from growing • Using up nutrients needed by the cancer cells What side effects will I get from chemotherapy? In addition to the intended therapeutic effects of chemotherapy, side effects often occur. Different people can have different reactions to chemotherapy. Chemotherapy affects all rapidly Chemotherapy: Basic Information © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 1 of 4 growing cells in the body, including normal, fast-growing, healthy cells. When this happens, side effects may result. Areas most often affected by chemotherapy are the: • Digestive tract (mouth, esophagus, stomach and intestines) • Bone marrow (where blood cells are made) • Skin and hair • Sex organs • Nervous system (nerves in the hands and feet) Most side effects are temporary, and can be managed with additional medications and proper care measures. Many of the side effects you might experience with chemotherapy treatment are addressed in this packet. Please refer to individual section tabs for information on how to cope with these side effects. Information has been provided on such side effects as nausea, vomiting, diarrhea, and constipation; mouth soreness and ulcers; appetite loss; low blood counts; hair loss, skin and nail changes; fatigue; sexuality and fertility-related issues; and pain. Other side effects may occur. Ask your health care provider for the patient information sheet on your specific chemotherapy medicine. If you have any questions, talk with your doctor, nurse or pharmacist. How will I get my chemotherapy? Chemotherapy drugs are given in several different ways, called routes. You may receive chemotherapy in the following ways: • By injection − Into a muscle, under the skin, or directly into the cancerous area − Into the cerebral spinal fluid (called an intrathecal injection) • By vein − Intravenous (IV) infusion through a needle connected to a tube in your arm or through a central venous catheter (CVC) line • By artery − Intra-arterial infusion through a catheter inserted directly into the area that has the tumor • By mouth − Pill, capsule or liquid form • Topically − Creams, ointments, or lotions rubbed into the skin Where will I go to get my chemotherapy? Some patients go into the hospital to receive chemotherapy, while others receive chemotherapy in a clinic. Some patients learn how to give themselves chemotherapy at home with infusion pumps. Talk with your doctor about the best method for you. Chemotherapy: Basic Information © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 2 of 4 How long does it take to receive chemotherapy? The amount of time needed for treatment is different for each patient. Your doctor will tell you how long it will take to give you the chemotherapy drug(s). Please allow extra time at the clinic in case you need to receive other fluids or medications during your treatment. When you arrive at the clinic, ask your treatment nurse how long your treatment should last. Chemotherapy drugs are given in cycles. Your first day of chemotherapy is Day 1 of the treatment cycle. You will receive chemotherapy for 1 or more days. Then you will stop chemotherapy (rest) for 1 or more days. The time between your first day of chemotherapy and your last rest day is one cycle. How can I stay on track with my treatment plan? To get the best results from chemotherapy, it is important that you follow your treatment plan completely and on schedule. Missing chemotherapy appointments or forgetting to take your chemotherapy medicine can cause your treatment to be less effective. It can be hard to stay on track with your chemotherapy. Here are a few tips to help. • Use a cell phone or watch alarm as a reminder to take your medicine. • Enter your appointments into a day planner or the calendar on your cell phone. • Stay motivated by talking with your doctor about the benefit of your treatment. • Talk with your social worker if you are having problems with finances or transportation. How should I dress for chemotherapy? Dress comfortably for chemotherapy treatment. You may want to bring layers of clothing to put on in case you get cold. What questions should I ask my doctor? You should understand the expected benefits, side effects and risks of chemotherapy. Consider asking your doctor the following questions. The answers to these questions should provide you with important information about your treatment and realistic expectations about the outcome. • What is the goal of chemotherapy for my cancer? (i.e., control growth of tumor, increase comfort level by reducing pain, shrink the tumor so it can be treated by other means.) • What are the chances that the chemotherapy will work? • How will I know if the chemotherapy is working? • What are the short-term and long-term potential risks of the chemotherapy drug(s) I will be taking? Chemotherapy: Basic Information © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 3 of 4 • How long will I be given my chemotherapy, how often, and for how long? How will my chemotherapy be given? • What can I do to help prepare myself for chemotherapy treatment and decrease my chance of side effects? • Are there any side effects I should report right away? • How will the treatment affect my diet, my activities, my work, my sexual activity, etc? This list is just to help you get started. To help you remember your doctor’s answers, take notes during your appointments. If you can, use a tape recorder during your visit so you won't miss anything. Consider taking a friend or relative with you to your appointment to help you understand what your doctor says during your visit and to refresh your memory afterward. For more information about chemotherapy (i.e., questions to ask, how to handle side effects) please refer to the following booklet: Chemotherapy and You: A Guide to Self-Help During Cancer Treatment National Cancer Institute 1-800-4-CANCER Copies of this booklet are also provided in The Learning Center. The locations include: • Law Learning Center Main Building, Floor 4, near Elevator A, Room R4.1100 – 713-745-8063 • Levit Learning Center Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120 – 713-563-8010 Patient Education Classes are also offered for symptom management. Please call the Patient Education Office at 713-792-7128 for days and times. Classes include: • Bowel Management • Cancer-related Fatigue • Treatment Side Effects: Ask the Expert Chemotherapy: Basic Information © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 4 of 4 The Ambulatory Treatment Center General Information The Ambulatory Treatment Center (ATC) provides care to patients receiving chemotherapy, immunotherapy, intravenous fluid replacement, injections and blood products. The ATC has patient care areas located in the Main Building and the Mays Clinic. Hours of operation vary with each location. Scheduling appointments The first day of your treatment will be scheduled by your home clinical center. When you come in for your first day of treatment, the ATC staff will help you schedule any future treatment days. They will work with you to find a suitable appointment time in one of the units. If you get treatment for several days in a row, you may go to more than one ATC area. If you need blood count results before your treatment, please have your home clinic select one of the following procedures to best fit your individual need. We need the results before starting your treatment. Schedule and have your blood drawn the day before your appointment in the ATC. Schedule and have your blood drawn at least two hours before your appointment time in the ATC. If your blood is drawn at another laboratory outside of MD Anderson Cancer Center, please bring a copy of your results to the ATC when you come for your appointment. If you received an implanted port at a facility other than MD Anderson Cancer Center, please bring the x-ray film showing the placement of the port to the Image Library. Do this at least one day before your appointment for chemotherapy. The Radiology Department will read and verify the placement of the port. The Image Library has two locations: Main Building, Floor 3, near Elevator D, Room B3.4400 Mays Clinic, Floor P1, near Elevator S, Room P1.2117 If you have a written x-ray report from the doctor that inserted your port, please bring that with you to your appointment, in addition to the card with information about your port. It is very important for the nurse to know the placement of the port before it is used for chemotherapy. The Ambulatory Treatment Center © 2006, 2012 The University of Texas MD Anderson Cancer Center, Revised 11/19/12 Patient Education Office Page 1 of 3 Arrival process Please sign in at the reception desk when you arrive. Signing in will start your appointment process. A patient service coordinator (PSC) will check that the local contact telephone number on file is still correct. You will also receive an identification band. We ask that you wear your identification band the whole time that you are getting treatment. This is a safety precaution and an MD Anderson policy. Please tell the PSC if you have waited thirty minutes past your appointment time and have not received an explanation for your wait. Please call the ATC number listed on your Patient Appointment Letter (PAL) if you are running late. During Your Treatment You are welcome to bring a book, magazines, handwork or a laptop to help pass the time. Wear comfortable clothing and bring a sweater for warmth. If you would like a pillow or blanket, please ask the receptionist. One visitor is allowed in the treatment room during your treatment. Cell phone use is not permitted in the treatment rooms. If you arrive early or late for your appointment, you may have to wait a little while before a bed is available and we can start your treatment. You may want to visit one of the volunteer run hospitality centers, which have comfortable and convenient waiting areas. There are three locations: Patient/Family Center Main Building, Floor 2, near Elevator D, B2.4314 Monday - Friday, 8:00 a.m. to 8:00 p.m. Saturday and Sunday, 9:00 a.m. to 4:00 p.m. Anderson Network Hospitality Centers Main Building, Floor 2, near The Sundial Monday – Friday, 9:00 a.m. to 3:00 p.m. Mays Clinic, Floor 2, near The Tree Sculpture, ACB 2.1002 Monday – Friday, 8:00 a.m. to 4:00 p.m. Meals and Snacks Room service is available from 12 p.m. to 2 p.m. and from 5 p.m. to 7 p.m. During your treatment, you also may ask for juice, crackers or soup. The Ambulatory Treatment Center © 2006, 2012 The University of Texas MD Anderson Cancer Center, Revised 11/19/12 Patient Education Office Page 2 of 3 The Ambulatory Treatment Center ÂŠ 2006, 2012 The University of Texas MD Anderson Cancer Center, Revised 11/19/12 Patient Education Office Page 3 of 3 Your Blood Counts and Chemotherapy Blood supplies the cells of the body with materials they need for nourishment, repair and removal of waste from cells. The blood contains cells that fight disease and cells that help repair cuts or bruised parts of the body. Blood cells are produced mainly in the bone marrow, which is the soft, spongy center part of the bone. The bone marrow can be thought of as a factory that produces blood. Anything that affects the bone marrow (such as cancer, chemotherapy, or radiation) also affects the blood cells. Chemotherapy can depress the bone marrow (change the way bone marrow functions) and, thus, lower the number of cells available in the blood. What are the different types of blood cells? There are three main types of blood cells: red blood cells, white blood cells, and platelets. Red Blood Cells Red blood cells carry oxygen to all parts of the body. They contain hemoglobin, which allows the red blood cells to carry oxygen from the lungs. The red blood cells then carry oxygen to cells in all parts of the body. If a person lacks enough red blood cells, he or she becomes anemic. An anemic person is usually pale, and may feel tired or become short of breath. Anemia can be corrected by making the bone marrow produce more red blood cells or by transfusing red blood cells into the anemic person (see page 4 for more information on red blood cell transfusions). White Blood Cells White blood cells are also called leukocytes, and specifically include neutrophils, monocytes, and lymphocytes. White blood cells have several functions. The most important function is to protect the body against infection. As your white blood cell count drops, your risk of infection rises. Although you cannot always prevent an infection while your counts are low, the following precautions should be taken. • Wash your hands often with soap and water. • Avoid people who you know are sick. • Avoid crowds. • Avoid getting cuts or breaks in the skin. • Always wear shoes. Your Blood Counts and Chemotherapy © 1984, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 1 of 4 • Wear gloves while working in the garden or doing housework. • Bathe daily and practice good mouth care. • Take your temperature at least twice daily. If you have a temperature of 101oF (38.3oC) or above, or if you have a temperature of 100.5 oF (38.1oC) for more than one hour, go to the nearest emergency center. • Do not take any aspirin or other pain relievers such as ibuprofen (Advil® or Motrin®) or naproxen (Naprosyn® and Aleve®) unless your doctor says it is okay, because these medications can mask a fever. • Avoid suppositories. If the rectum is injured, bacteria may enter more easily. For more information, please refer to “Preventing Infections.” Lymphocytes If you have too few lymphocytes or lymphocytes that are not working properly, you may get diseases more easily. When your immunity is low, you may also get diseases from immunizations that contain live viruses. Follow these guidelines: • Do not receive any immunizations until they are approved by MD Anderson Cancer Center doctors. • No one in your household should receive the (live) oral polio vaccine. • Avoid anyone exposed to measles or chicken pox. If you are exposed to anyone with these diseases, report this to your nurse or doctor immediately. • Upon request, a letter can be provided to a school to explain all precautions that should be taken to protect you. Platelets Platelets are produced in the bone marrow and are extremely important for blood clotting (to stop bleeding). If your platelet count is low, you may bruise more easily than usual. You may also notice tiny red dots under the skin. If you cut yourself, you may find that the bleeding takes longer than usual to stop. Report any of these symptoms (bruising, red dots or bleeding) to your doctor. When your platelet count is low, you can help yourself by following these guidelines: • Avoid vigorous activity, such as contact sports or rough bicycle riding. • Do not use suppositories or enemas. (They may cause rectal bleeding.) • Go to the nearest emergency room if you cough up blood or if you have bleeding that will not stop. • Do not take any aspirin or other pain relievers such as ibuprofen (Advil® or Motrin®) or naproxen (Naprosyn® and Aleve®) unless your doctor says it is okay, because these medications can mask a fever and/or affect your platelet count. • Tell your doctor or nurse about any dietary supplements that you are taking because many dietary supplements are blood-thinners. Your Blood Counts and Chemotherapy © 1984, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 2 of 4 What are blood counts? Blood counts show the amount of blood cells circulating in the blood stream. Your blood counts, especially hemoglobin, platelets, and white blood cells, will be checked regularly by the doctors and nurses. Normal Values For Blood Counts Are: • White blood cells 4 – 11 k/ul • Hemoglobin − Adult male 14 – 18 g/dl − Adult female 12 – 16 g/dl • Platelets 140 – 440 k/ul • % Neutrophils 42 – 66% (per 100 cells counted) • Neutrophil Absolute Count (ANC) 1.70-7.30 k/ul What happens to my blood counts after chemotherapy? Some types of chemotherapy can cause platelets and white and red blood cells in the bone marrow to stop growing. This, in turn, lowers the number of cells available in the blood. Within two to three weeks after your treatment, your blood counts will begin to return to normal. However, remember that the recovery of blood counts can vary from person to person. Recovery can also greatly depend on how much treatment you have had and your general health. Infections and some medications can delay the recovery of white blood cell counts. Before resuming normal activities of daily living (such as returning to work, gardening, having sex), discuss the risks with your health care provider. For information, please refer to “Blood Counts.” If you do not have this document, ask your health care professional for a copy. Will I need a blood transfusion? You will receive a blood transfusion if your doctor finds that your blood counts are too low and you are developing symptoms such as bleeding or severe fatigue with shortness of breath. If a transfusion is not necessary, medications may be given to stimulate blood cell growth. Platelet Transfusions Patients may need several platelet transfusions when their counts fall. Your doctor will determine your need for platelet transfusions. All of your family members and friends are urged to donate platelets regularly for MD Anderson patients. This helps to provide an adequate supply of platelets for all patients within the hospital. Family members and friends who wish to donate platelets should not donate whole blood, since they would not be able to donate other blood products for eight weeks. Your Blood Counts and Chemotherapy © 1984, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 3 of 4 About 20 percent of the donor’s platelets are removed when a donor gives platelets during a process call “apheresis”. These platelets are replaced by the donor’s bone marrow within three to four days. Donors may give platelets once or twice a week, depending on their platelet count. Platelets may be donated repeatedly without any permanent loss of platelets or other blood cells. There are two types of platelet transfusions: single donor and random donor. Single donor platelets are taken from only one donor. Random donor platelets are collected from a person donating whole blood. Platelets from several random donors must be pooled for a single transfusion. Red Blood Cell Transfusions When the red blood cell count is low, the patient may have symptoms of anemia such as fatigue, weakness, and shortness of breath. To combat these symptoms, the doctor may order a packed red blood cell transfusion. Your doctor will determine your need for a blood transfusion. This type of transfusion consists of 1 or 2 units of red blood cells, each given over a 2 to 4 hour period (unless ordered differently by the doctor). Any symptoms during the transfusion such as chills, hives, itching, or breathing problems should be reported to the nurse immediately. Because red blood cells (RBCs) have a longer lifespan than platelets, patients will usually not need as many RBC transfusions. Patients who have active bleeding, prolonged bone marrow recovery, or a prior history of anemia may have a greater need for red blood cell transfusions. Persons who wish to donate red blood cells for you are urged to donate replenishment blood. Their donated blood will be used by the blood bank for patients at MD Anderson and your account will be credited ($10.00 for each unit donated, not to exceed the blood charges). Your donor’s blood type does not need to match yours in order for him or her to donate replenishment blood for you. Persons who wish to donate blood to your account will need to know your name and your medical record number. Please be sure to give your donors this information before they make arrangements to donate blood. Many cancer patients have a critical need for blood transfusions. All persons are urged to donate blood when possible so that you and other patients have an adequate blood supply when needed. Contact the MD Anderson Blood Bank at 713-792-7777 for more information on blood donation. Your Blood Counts and Chemotherapy © 1984, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/02/12 Patient Education Office Page 4 of 4 Preventing Infections Preventing the spread of infection is critical to your health. It is especially important in a hospital, where many people are in close quarters and where cancer treatments are given that may lower the body's ability to fight infection. The most important way to prevent the spread of infection is through good hand hygiene, including hand washing and using hand sanitizers. Is there a proper way to wash my hands? Wet your hands and use enough soap for a good lather. Rub your hands together using friction for 15 to 30 seconds, making sure to scrub all surfaces. Then rinse well with water. The amount of time you wash is important. Use a paper towel to turn off the faucet to keep your hands clean. By following this procedure, dirt and germs will be removed. How do I use the hand sanitizer? Alcohol-based hand sanitizer kills the germs on your hands and is recommended for use when your hands are not visibly dirty. Using a hand sanitizer with at least 60 percent alcohol content, apply enough sanitizer to cover your hands. Rub your hands together using friction for 15 to 30 seconds until the product is dry. If your hands dry in less than 15 seconds it means that the amount of sanitizer was not enough. Repeat the process. When should I do hand hygiene? When your hands are dirty Before and after contact with another patient, family member or health care worker Before eating and drinking Before and after handling food After handling dirty items After blowing your nose, sneezing and going to the restroom What are other ways to protect myself against infections? Ask members of your health care team if they have done hand hygiene before seeing you. Do not touch your nose, eyes or mouth with contaminated (unwashed) fingers. Do not share personal items, such as dishes, towels, creams, toothbrushes, etc. Avoid anyone with an infectious illness. Preventing Infections © 1999, 2012 The University of Texas MD Anderson Cancer Center, Revised 07/06/12 Patient Education Office Page 1 of 2 Avoid anyone with an acute respiratory illness (sneezing, coughing, sore throat). If this is not possible, you and they should wear masks until their symptoms disappear. Be alert - take an active part in your own care or the care of your loved one. What else can I do to prevent infections? Avoid the following: Peak hours in public areas (theaters, restaurants, indoor playgrounds, etc.) Animal facilities (zoos, butterfly museums, pet stores) Pet Care (cleaning cat litter boxes, birdcages, dog waste, etc.) Who is at greater risk of infection? Cancer patients who are receiving treatment Neutropenic patients (patients with a low white blood cell count) Stem cell transplant (SCT) patients Leukemia, lymphoma and myeloma patients (hematologic cancers) If you are at greater risk for infection, there are more ways to prevent infections. Ask your health care provider if the strategies below are recommended for you: Wear a mask when outside your hospital room and/or outside your home. Wear a mask in crowded public areas. Wear a mask in construction areas. (This includes any area where parts of buildings or streets are being repaired, torn down or constructed. Large amounts of dust and debris may be present in the air.) Ask your visitors or family members to wear a mask. (In many cases, visitors should always wear a mask while in a patient’s room, and should change the mask when it becomes damp.) Who can I talk to if I have questions? If you have questions concerning how to prevent infections, ask your doctor or nurse or call the: Infection Control and Prevention Department 713-792-3655 Preventing Infections © 1999, 2012 The University of Texas MD Anderson Cancer Center, Revised 07/06/12 Patient Education Office Page 2 of 2 Over-the-Counter (OTC) Medications Use of Over-the-Counter (OTC) Medications Check with your doctor or pharmacist before taking any OTC medications while you are on chemotherapy or targeted therapy. This includes nutritional supplements, vitamins, minerals, and herbal products. Many OTC medications contain aspirin or aspirin-like compounds (salicylates), ibuprofen, naproxen, or ketoprofen that may affect your blood platelets and lower your temperature. Do not take these medications to relieve pain or lower your temperature unless your doctor says it is OK for you to do so. Also, many OTC medications contain acetaminophen that may lower your temperature. Do not take acetaminophen-containing products unless your doctor says it is OK for you to do so. It is also important to maintain communication and contact with your family physician during your treatment and inform him or her of the medications your oncologist has prescribed. Maintain a list of all the medications you are taking and bring it with you to all appointments. Read Labels Read the labels of over-the-counter products and look for the following ingredients: Salicylates: aspirin or aspirin-like compounds, acetylsalicylic acid, ASA, salicylamide, methyl salicylate, sodium salicylate, potassium salicylate, magnesium salicylate, etc. Ibuprofen: IB, IBU, ibuprofen Acetaminophen: APAP, acetaminophen Naproxen: naproxen sodium Ketoprofen Below is a partial list of brand name products that contain salicylates, ibuprofen, acetaminophen, naproxen, or ketoprofen. Many OTC products are not on this list, so become familiar with how to recognize what is in the OTC medication that you consider taking. For a more complete list of products, ask the pharmacist. Aspirin or Aspirin-Like Compounds Alka-Seltzer® Anacin® Aspercreme® Ascriptin® Aspirin Bayer® Ecotrin® Empirin® Excedrin® Flex-All® Goodys® Icy Hot® Over-the-Counter (OTC) Medications © 1997, 2012 The University of Texas MD Anderson Cancer Center, Revised 05/08/12 Patient Education Office Page 1 of 2 BC® Ben-Gay® Doans® Momentum® Pepto-Bismol® St. Joseph Aspirin® Acetaminophen Alka-Seltzer® Bayer® Benadryl® Comtrex® Dristan® Excedrin® Mapap® Ibuprophen Advil® (all products) IBU® Midol® Naproxen Aleve® Anaprox® Midol® Ketoprofen Orudis® Midol® Pamprin® Panadol® Sinutab® TheraFlu® Tylenol® Vicks® Motrin® Neoprofen Nuprin Naprosyn® Naproxen sodium Pamprin® Over-the-Counter (OTC) Medications © 1997, 2012 The University of Texas MD Anderson Cancer Center, Revised 05/08/12 Patient Education Office Page 2 of 2 Fatigue What is cancer-related fatigue? Fatigue means feeling tired physically or mentally. Cancer or cancer treatments can cause fatigue. Cancer-related fatigue can be overwhelming. Your caregiver can also become fatigued. What causes fatigue? Fatigue can be caused by one or more of the following factors: • Not pacing yourself; not getting enough rest, or doing too much too soon • Not having balance in your life − Lack of healthy foods or sufficient fluids − Lack of exercise; spending all your time sitting or lying down − Lack of support from family and friends − Lack of good, sound sleep • Cancer itself, and cancer treatment • Persistent pain • Untreated symptoms or side effects that result from anemia or medications • Other medical condition such as hypothyroidism or heart problems • Stress from other factors such as family problems, divorce or work • Depression that lasts for more than two weeks What are the warning signs of fatigue? Some of the warning signs of fatigue are: • A weak feeling over the entire body • Difficulty concentrating • Waking up tired after sleep • Lack of energy or decreased energy • Lack of motivation to be physically active • Increased irritability, nervousness, anxiety or impatience • No relief from fatigue, even with rest or sleep What can I do to prevent fatigue? Here are some things you can do that may keep feelings of fatigue from getting worse: • Prioritize your activities so that you complete the most important tasks of the day when you have the most energy. Delegate activities when you can. • Place things that you use often within easy reach to save your energy. Fatigue © 1995, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 1 of 2 • • • • • • Unless you were given other instructions, drink 8 to 12 eight-ounce glasses (2 to 3 liters) of non-alcoholic, non-caffeinated fluids each day. Unless you were given other instructions, eat a balanced diet that includes protein (fish, lean meat/poultry, low-fat dairy, eggs/egg whites, legumes). Exercise; take short walks or do another physical activity. − Before you start any exercise program, discuss it with a health care professional. − If appropriate, your doctor may arrange for you to see a physical therapist. Use methods such as exercise, relaxation, visual imagery, meditation, talking with others, and professional counseling to reduce stress. Balance rest and activities. Schedule activities so that you have time for plenty of rest and sleep. Treat other medical problems that may be contributing to fatigue Do I need to notify a doctor about fatigue? First, try the previous suggestions for preventing fatigue. Talk with your doctor if any of the following occur: • Your fatigue does not get better, keeps coming back, or becomes severe. Signs of severe fatigue include spending all day in bed and inability to do daily activities. • You are much more tired than you should be after an activity, or if feeling tired has nothing to do with any activity. • Your fatigue cannot be relieved by rest or sleep. • Your fatigue disrupts your social life or daily routine. Depending on the cause of your fatigue, there may be prescription medications your doctor can prescribe to help reduce it. Your doctor may refer you to the Fatigue Clinic. Additional information? For more information, please refer to the documents “Energy Conservation” and “Fatigue Management Tips: Good Sleep Hygiene” or the brochure “A Patient Guide for Managing Cancer-Related Fatigue.” If you do not have these, ask your health care professional for copies. The video, “Cancer-related Fatigue,” is available for viewing through MDA-TV, an in-house cable television system that allows you to watch videos 24 hours a day, “on-demand.” This video also can be viewed in The Learning Center or at home on myMDAnderson (https://my.mdanderson.org). A Cancer-related Fatigue Class meets every first and third Thursday of the month, from 12 noon -1:00 p.m. For more information, call the Patient Education Office at 713-792-7128. You may also want to ask your doctor for a referral to the MD Anderson Fatigue Clinic. For more information, talk to your doctor or nurse, or contact the Fatigue Clinic at 713-563-7100. Movement classes such as Yoga, Tai Chi, Qigong and Pilates are available in the Integrative Medicine Center. For more information, call 713-794-4700. Fatigue © 1995, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 2 of 2 Fatigue Management Tips: Good Sleep Hygiene To help you sleep during the night, you may want to do the following: During the Day • • Exercise regularly. Even a 20-minute walk during the day can help you relax. Don’t exercise in the evening. Limit naps if you can. If you must sleep, limit your nap to 30 minutes. Before Bedtime • • • Avoid alcohol, caffeine, chocolate and nicotine in the late afternoon and evening. Limit liquids in the evening before going to bed. Turn off the TV one hour before bedtime; listen to quiet music or take a warm bath. If you worry or “can’t turn your brain off” when you try to sleep, make a list of things you need to do the next day. That will allow you to not worry about forgetting anything and you will be able to relax. At Bedtime • • • • • • Go to bed and get up at the same time every day, even on weekends. A bedtime snack of warm milk, turkey or a banana may make you sleepy. Use your bedroom for sleep and intimacy only; don't read, watch TV or work in the bedroom. If you are a “clock watcher,” turn the clock around. To fall asleep, lie in the position that you normally find yourself in when you wake up. Spouses should go to bed at the same time. If You Can’t Fall Asleep or Wake Up During the Night If you haven’t fallen asleep in 15 minutes, go to another room. Listen to quiet music. Avoid things that provide mental stimulation (TV, exciting books). Go back to bed when you feel sleepy. If you still can’t fall asleep, get up again and repeat these steps as necessary. Fatigue Management Tips: Good Sleep Hygiene © 2001, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 1 of 1 Energy Conservation Tips Conserving energy during regular daily activity helps decrease fatigue. How you stand, walk, and move your body, as well as the spacing of your work area, can affect your energy use. The following information will provide you with helpful tips and suggestions of things you can do to help conserve energy and decrease your level of fatigue. Planning and Organizing Alternate tasks that take lots of energy with those that take less. Plan activities daily as well as weekly to better alternate tasks. Delegate as much as possible. This helps you get tasks done and makes others who want to help feel useful. Eliminate steps or tasks that are not essential by combining chores or errands. Arrange your household so that most activities can be done on one level of the house. Organize ahead of time so you don’t have to rush. Pacing Balance activities so you are doing, resting, doing, resting. Stop to rest before you get tired, even if it means stopping in the middle of a task. Do not rush to do everything in one day. Overdoing it on one day may make you so tired that you need more than one day to recover. Try to avoid spurts of activity; this can drain energy. Pace activities on good days as well as bad days. Develop a routine to prevent overdoing. Positioning Sit to do activities whenever possible. Use assistive devices to help you maintain good posture while walking or moving about. Examples of assistance devices are walkers, scooters, canes, handrails, crutches, and grab bars. Assistive devices or adaptive equipment can save energy by allowing you to do things without having to bend or reach. Avoid heavy lifting (such as children, pots and pans, laundry). Use carts or wagons to move things from room to room or place to place. Wear a fanny pack, carpenter’s belt, or a jacket or sweater with pockets to carry things. Prioritizing Focus on things you enjoy doing. Be realistic with yourself about how much you can do. For example, make a list of all your activities for the day, then number them according to priority. Perform activities with the highest priority first. Energy Conservation Tips © 1997, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 1 of 3 When You’re Too Tired to Eat When the thought of cooking or eating a meal makes you tired, try these hints to save energy: • Let others help prepare or bring food. Family or friends usually like to help! • Use canned, frozen, or other prepared foods, or try ordering out. • On days when you feel well, cook extra food and freeze it in small containers. Heat frozen food on days when you are tired. • Ask the doctor, nurse, or social worker about community resources that deliver prepared meals. • Eat small, frequent meals rather than several large meals each day. • Have snack foods readily available. • If you’re really exhausted, put some favorite foods and beverages in a cooler with ice next to you so you can eat while resting. • Make quick meals with a microwave or blender. Activities to Preserve Energy Basic Activities Dressing - Loose-fitting clothes are easier to get on and off. - Bring your foot to your knee to put on socks and shoes so you won’t have to lean over. - Wear slip-on shoes or shoes that have Velcro or elastic shoelaces. - Use a long-handled shoe horn or sock aid. - For women, fasten bra in front and turn it to back. - Wear clothes that button in front rather than pullovers or clothes with back buttons. - Use a reacher or dressing stick to help with zippers in back. - Place chairs throughout home to allow rest stops. Bathing and Grooming - Wash your hair in a shower rather than over a sink. - Use a terrycloth robe instead of towels to dry off. - Use organizers to keep items within reach. - Use a chair in the shower or tub. - Use a long-handled sponge or brush to reach your back and feet. - Rest your elbows on a computer or dressing table to avoid leaning unsupported. - Use long-handled brushes or combs to avoid holding arms overhead. - Use liquid soap or soap on a rope. - Use an elevated toilet seat. Miscellaneous - Install and use ramps. - Use a lift chair. - Use cruise control when driving. Energy Conservation Tips © 1997, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 2 of 3 Advanced Activities Housework - Spread tasks out over the week or month. - Hire help. - Use long-handled dusters, mops, and dustpans. - Use an automatic washer and dryer if possible. - Use a lightweight iron. Shopping - Make a list. - Organize list by store aisle. - Request store assistance. - Have groceries delivered if possible. - Shop at less busy times. Meal Preparation - Assemble all ingredients before starting. - Use mixes or pre-packaged foods. - Use cookware you can serve from. - Use small, lightweight appliances. - Use labor-saving devices. - Buy utensils that fit comfortably in the hand. - Store frequently used items at chest level to minimize bending or reaching. - Line ovens and drip pans with foil for easier cleanup. - Let dishes soak rather than scrubbing them. - Let dishes air-dry. Childcare - Plan activities or outings at a place that will allow sitting or lying down. - Take advantage of day care programs. - Teach children to make a game of household chores. Work - Plan your work around your best times of the day. - Organize work centers so equipment is within easy reach. - Create shortcuts. - Take rest breaks. - Work partial days if possible. Leisure - Plan activities that allow you to sit or lie down. - Plan social events at your peak energy time. Energy Conservation Tips ÂŠ 1997, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 07/27/12 Patient Education Office Page 3 of 3 Mouth Care for Chemotherapy Patients Chemotherapy treatment may cause side effects in the mouth. These side effects may include mouth or throat soreness and/or ulcers; problems with your teeth and gums; or problems with the glands that make your saliva (spit). These side effects can be painful, and can make it difficult for you to eat, talk, and swallow. In addition, chemotherapy increases one's risk of getting an infection. Mouth sores can become infected by the many germs that live in the mouth, and this can lead to serious problems. It is important to take every possible step to prevent these problems from occurring. Mouth Problems That May Be Caused By Chemotherapy Sores in the mouth or throat (ulcers) Painful mouth and/or gums Infection Burning, peeling, or swelling of the tongue Changes in consistency of saliva (thick, ropy, foamy) or dry mouth Changes in taste How to Keep Your Mouth from Getting Sore Take Good Care of Your Mouth If you have ever experienced a mouth or dental problem (i.e., bleeding gums when brushing teeth, broken teeth or fillings, teeth that are sensitive/painful to temperature changes, irritation or gum swelling from wisdom teeth, gum disease (periodontal disease/pyorrhea), loose teeth, or persistent irritation from dentures), inform your oncology doctor and/or his or her nurse of this condition. They may recommend a consultation with one of the hospital's oncologic dentists or see your own dentist for assessment and treatment plan. A visit to your dentist, prior to starting your chemotherapy, can help to prevent serious mouth problems and may help to lessen the amount of side effects you experience. You may also want to see the hospital oncologic dentist. Make sure to tell your dentist about your diagnosis, blood values, chemotherapy medicines, and treatment schedule. Make sure to give your dentist the name of your medical oncologist so that the two of them can communicate with one another about providing you with safe dental care. Use a soft-bristled toothbrush and regular- flavored fluoride toothpaste without tartar/whitening control. Try to brush your teeth, gums, and tongue after each meal and always at bedtime. Even Mouth Care for Chemotherapy Patients ÂŠ 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 10/02/12 Patient Education Office Page 1 of 3 if you are not eating, it is recommended you brush your teeth and remove the film and bacteria that can build up and lead to gum infections. After brushing your teeth, rinse your mouth with a baking soda solution. Do not use a mouthwash you can buy in a store. Such mouthwashes may contain alcohol or other chemicals that may irritate your mouth. You can make your own mouthwash at home. To make your own mouthwash at home, mix 1/2 teaspoon baking soda in an 8-ounce container of water. If you can't brush your teeth after meals, rinse your mouth with water. If you are flossing on a very regular basis (i.e., daily), floss your teeth with waxed dental floss. If flossing is not one of your routine hygiene habits, speak to your doctor before beginning to floss. Flossing must be done in respect to your blood counts. When your platelets drop below 50,000 (50 k/ul), you can modify your flossing to keep the floss above your gums when removing the food and bacteria between your teeth. Be careful when putting in or taking out dentures or partial dentures. If your dentures/partials are poor fitting, you may want to leave them out completely since they may injure your oral tissues during chemotherapy, causing a disruption in your treatment. At bedtime, soak your dentures in a store-bought denture soak. Remove your dentures on the days you will get chemotherapy. Dentures have been known to increase nausea and vomiting with chemotherapy. If your dentures do not fit well, leave them out until after your chemotherapy ends. Leave your dentures out if your blood counts are low. Your doctor or nurse will talk to you about your blood counts and tell you when you should leave your dentures out. Special Instructions If Your Platelet Count Is Below 50,000 (50 K/Ul) After eating and at bedtime, brush your teeth using a very soft toothbrush with toothpaste. Because the bristles on soft toothbrushes are softer, your brushing motion must be slower to allow the bristles to flow along the gum line and clean off the food and plaque deposits. After brushing, rinse your mouth with the baking soda solution. (See recipe for mouthwash above.) If you notice sores, bleeding, white patches, or a white coating on your tongue, notify your doctor or nurse. It is very important to keep your diet soft and non-irritating during low blood counts. (Do not eat crunchy, abrasive foods such as chips, popcorn, granola bars, etc.) If you have any questions, please contact your doctor or nurse. How to Keep Your Mouth and Lips Moist Your lips and the inside of your mouth may start to dry out because of fever or medicine. You can do the following things to keep your mouth moist: Rinse your mouth with water and/or baking soda solution very frequently. Drink 8 to 12 eight-ounce glasses (2 to 3 liters) of non-alcoholic, non-caffeinated fluids each day. Suck (do not chew) on ice chips or popsicles. You may also chew sugar-free gum. Mouth Care for Chemotherapy Patients ÂŠ 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 10/02/12 Patient Education Office Page 2 of 3 Lubricate your lips and corners of your mouth with an unflavored lip balm (not petroleum jelly or Vaseline®). Ask your dentist or pharmacist for suggestions on particular brands. Tell your doctor or nurse if your mouth continues to feel dry. How to Promote Mouth Care with What You Eat To prevent soreness, eat only those things that feel good in your mouth. Eat foods like broth, gelatin, puddings, milkshakes, cooked cereals and frozen juice bars on a stick. Eat warm or cool foods. Try not to go from eating a food that is very hot to eating a food that is very cold. Try taking smaller bites of food, chewing slowly, and sipping liquids with your meals. Drink 8 to 12 eight-ounce glasses (2 to 3 liters) of nonalcoholic, non-caffeinated fluids each day (including non-acidic juices and/or sports drinks.) How to Care For a Sore Mouth If your mouth becomes too sore to brush your teeth, there are some things you can do to help your mouth feel better. If your mouth continues to stay sore, tell your doctor or nurse. Rinse your mouth well with water after every meal. Your doctor may prescribe a prescription mouthwash as well, such as Sucralfate or OraMagic (alovera-based). Rinse every 2 to 3 hours while awake. This is also good practice if you throw up from your treatment. If you do throw up, first, get your nausea and vomiting under control, then rinse your mouth well. You can suck on ice chips or slowly drink something to flush the back of your throat. Do not eat acidic or spicy foods, like oranges and hot peppers, which may burn and sting. Do not eat hard foods such as potato chips or toast. If you have questions about what foods to eat, ask your nurse, doctor, or dietitian. You may also want to refer to “Mouth and Throat Soreness Management.” If you do not have this document, ask your health care professional for a copy. What to Do If You Develop Mouth Ulcers If you develop sores (ulcers) in your mouth, tell your doctor or nurse. If the sores are painful or keep you from eating, you may also want to ask your doctor to tell you about a non-prescription product you may apply to the sores to help relieve the pain. Eat foods that are cold or at lukewarm temperature; choose soft, liquid, blended, or moist foods; avoid irritating acidic, salty, spicy and highly seasoned foods. If the ulcers are severe, you may need to eat finely ground or pureed foods. For more information, please refer to “Mouth and Throat Soreness Management.” If you do not have this document, ask your health care professional for a copy. Mouth Care for Chemotherapy Patients © 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 10/02/12 Patient Education Office Page 3 of 3 Mouth and Throat Soreness Management Good nutrition can aid in healing, reduce fatigue, and help you to take an active role in your treatment. Sometimes side effects from treatment may affect your ability to eat well. Tolerance of different foods, textures and temperatures will vary between patients. Choose soft, moist foods that are easy to swallow. Avoid rough-textured, acidic, tart and spicy foods that may cause irritation. Cut foods into small bites to reduce the amount of chewing needed. Puree or liquefy foods with a blender or food processor by adding liquids such as milk or broth to your favorite foods. If spoons or forks cause pain, try drinking blended meals from a cup. Drink liquids through a straw to help push the food beyond painful areas. Avoid extremely hot foods and extremely cold foods, as they may cause discomfort. Try drinking fluids and eating foods that are at room temperature. Use liquid nutritional supplements, such as Boost , Ensure and Carnation Instant Breakfast to help you maintain adequate calorie and protein intake. Limit caffeine and drink plenty of fluids to prevent dehydration and dry mouth. Practice good mouth care as directed by your doctor. Ask your doctor about prescription mouthwashes, medication, lozenges or sprays to help relieve pain. The chart below includes foods that may cause irritation. Avoid them if they cause you discomfort. Food Group Beverages Try these foods... Milk (Cow, Soy, Almond, Rice) Decaffeinated tea and coffee at room temperature Juice and fruit-flavored drinks that are not acidic Boost速, Ensure速, Carnation Instant Breakfast速 Shakes and smoothies These foods may cause discomfort... Alcoholic beverages Carbonated beverages Acidic drinks and juices such as orange, grapefruit and pineapple juice; lemonade Mouth and Throat Soreness Management 息 1999, 2009 The University of Texas MD Anderson Cancer Center, Reviewed 10/03/12 Patient Education Office Page 1 of 3 Food Group Grains, Breads and Cereals Try these foods... Cooked cereals (oatmeal, cream of wheat, grits) Dry cereals soaked in milk Rice with gravy Pasta or noodle casserole Bread, cornbread or crackers soaked in milk or soup Pancakes or french toast with syrup Pureed, shredded or chopped meat with gravy Flaked fish with sauce Chopped eggs, tuna or minced chicken with mayonnaise Soft-boiled, poached or scrambled eggs Pureed beans, bean soup or lentil soup Tofu Creamy nut butters added to smoothies or hot cereal Fruit juices, such as apple, grape and cranberry Peach, pear and apricot nectar Canned pears, peaches and fruit cocktail Applesauce, soft melons, banana, papaya and guava Most vegetable juices Soft-cooked vegetables, such as broccoli, cauliflower, carrots, squash, zucchini, asparagus, turnips and green beans Avocado Creamed corn or spinach Mashed white or sweet potatoes Creamed vegetable soup or casseroles These foods may cause discomfort... Toasted bread, bagels, crackers, muffins and waffles Hard rolls Popcorn and pretzels Meats and High Protein Foods Tough, dry pieces of meat Fried meats Crisp bacon Crunchy peanut butter on bread Fruits Citrus fruits (lemon, orange, grapefruit) and pineapple Fruit with small seeds (strawberries) Dried fruits Tomato and V8ÂŽ juice Tomato-based soups and sauces Raw vegetables Vegetables Mouth and Throat Soreness Management ÂŠ 1999, 2009 The University of Texas MD Anderson Cancer Center, Reviewed 10/03/12 Patient Education Office Page 2 of 3 Food Group Dairy Try these foods... Milk and cream Cottage cheese Yogurt Soft, grated or melted cheese Ice cream, custard, pudding and milkshakes Butter and margarine Olive and canola oil Milk based salad dressings such as ranch Gravies and white sauces Mild herbs (basil, oregano, thyme) Popsicles and Jello® These foods may cause discomfort... Hard cheese Fats, Condiments, Misc. Salt Black or red pepper Mustard and ketchup Vinegar and vinegar based salad dressings such as Italian Chips, nuts and pickles Sample Menu Breakfast 1 cup oatmeal mixed with 1 tablespoon nut butter, 1 tablespoon honey and ½ cup whole milk Lunch ½ cup tuna salad with mayonnaise ½ avocado ½ cup applesauce Dinner 2 ounces shredded chicken and ½ cup rice with gravy ½ cup peas and carrots cooked with 1 teaspoon olive oil ½ cup pear nectar Mid-Morning Snack ½ cup grape juice 1 scrambled egg Mid-Afternoon Snack 1 cup smoothie, shake or liquid nutrition supplement Evening Snack ½ cup canned peaches ½ cup yogurt or cottage cheese This sample menu provides approximately 2000 calories and 90 grams of protein. Mouth and Throat Soreness Management © 1999, 2009 The University of Texas MD Anderson Cancer Center, Reviewed 10/03/12 Patient Education Office Page 3 of 3 Keeping Nausea Under Control This handout contains information to help you control nausea and vomiting, and provides suggestions that will help you maintain good nutrition. If you have mouth sores and you are having a difficult time finding foods you can eat, please ask your doctor for a consult with a dietitian. Most chemotherapy medicines cause nausea or vomiting within 24 hours of receiving the chemotherapy. Some chemotherapy drugs may cause nausea for a few days after the chemotherapy is completed. Your doctor may refer to this as “delayed” nausea and/or vomiting. How and why do nausea and vomiting occur? Nausea and vomiting are reactions to stress or to foreign substances in the body. The part of the brain that controls this reaction is known as the chemoreceptor trigger zone (CTZ). Chemicals released during treatment can stimulate the CTZ and cause nausea and/or vomiting. Possible causes for nausea and vomiting in cancer patients are: • Some chemotherapy drugs • Radiation therapy to the abdomen • Chronic unrelieved pain • Blockage in the bowel • Some medications • Fatigue • Fluid and mineral imbalances • Changes in taste or smell • Anesthesia Remember that not all chemotherapy drugs cause nausea and vomiting. There are many chemotherapy drugs and many combinations of these drugs. Whether you have any nausea and/or vomiting with chemotherapy will depend upon the following factors: • The type of chemotherapy drug you are taking • Your dosage • The way you are given the drug (for example, i.v. or pill) • The time span used to give the drug (30 minute infusion or infusion lasting several days) Your pharmacist has a list of all chemotherapy drugs with their side effects. Ask your pharmacist if nausea is a common side effect of your particular treatment plan. Keeping Nausea Under Control © 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 09/05/12 Patient Education Office Page 1 of 5 Nausea Nausea is an uneasy, uncomfortable feeling in your stomach, which may or may not lead to vomiting or “throwing up.” Vomiting Vomiting is throwing up the contents of the stomach through the mouth. It is not the same as coughing up drainage from the lungs or throat. “Retching” is the rhythmic tightening of the chest and stomach that goes along with vomiting. If no food is thrown up, this is called “dry retching” or “dry heaves.” What is anticipatory nausea and vomiting? Is it real or just in my mind? Anticipatory Nausea and Vomiting, or ANV, is a conditioned, or learned response. For example, the nausea and vomiting that occur with a certain therapy may become linked with something else, such as the appearance of the hospital or a certain odor. That reminder or stimulus is then able to trigger ANV on its own. About one-third of the cancer patients who experience nausea develop ANV. It occurs more frequently among people who are young, highly anxious, prone to motion sickness, or taking treatment known to cause nausea. Medications can prevent this from occurring. Be sure to tell your doctor, nurse or pharmacist if this occurs. What medications are available to help control nausea and vomiting? Ask your nurse, doctor or pharmacist if your treatment commonly causes nausea and vomiting. If it does, ask your doctor to prescribe an antiemetic. Antiemetics are drugs that help control nausea and vomiting. There are a number of effective antiemetics available to prevent or control chemotherapy-related nausea and vomiting. The best protection against chemotherapy-related nausea and vomiting is to prevent it by starting antiemetics before the chemotherapy is given and taking them for as long as the chemotherapy agent is likely to cause vomiting. Your doctor may prescribe an antiemetic to be taken 30 minutes to 1 hour before your chemotherapy starts. This is typically given to you in the infusion area before receiving your chemotherapy. The antiemetic may be given by mouth or in the vein. The doctor may also prescribe a different antiemetic to be used at home if you develop nausea after the chemotherapy has been given. You may be told to take this medicine around the clock or on an “only when needed” schedule. Different antiemetics work for different people. No one medicine controls nausea and vomiting 100 percent of the time, and it may be necessary to try more than one before you get relief. Do not give up. Tell your doctor, nurse or pharmacist if you have nausea or vomiting so that they Keeping Nausea Under Control © 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 09/05/12 Patient Education Office Page 2 of 5 can help identify the medicines that work best for you. It is not unusual to take two or more different medicines to prevent or relieve nausea and vomiting. It is important to know that some of these medicines may make you feel drowsy. What should I eat on the day of chemotherapy treatment? To decide what to eat on treatment days, you must find out what works best for you and eat what agrees with you. Appetite and interest in food can change from day to day. Since the body's first need is fluid, choose from the following: • • • Fruit juice Jell-o® Popsicles® • • • Lemonade Kool-aid® Water • • • Soup Fruit punch Sports drinks Adequate fluid intake is necessary to avoid dehydration. Try eating foods such as toast, crackers, salads and fresh fruits (if allowed). These foods are light and easily digested. What should I eat when I'm nauseated? • • • • • • Try eating toast, crackers or other dry foods. Tart foods such as lemonade or pickles (dill or sour) may be helpful. Beef jerky and salty foods may taste good. Your sense of smell may change during treatment. Cold and/or bland foods like sandwiches, fruit, cottage cheese, and ice cream offer good nutrition without a strong odor. Drink plenty of fluids such as water, ginger ale, sports drinks, fruit-flavored drinks made from dry mixes, frozen fruit bars on sticks, ice chips and carbonated drinks. Gelatin desserts or ice cubes can be made from these fluids. Do not force yourself to eat. It is all right to avoid eating for a short time (i.e., 2 days at most). If nausea continues to be a problem, tell your doctor or nurse. What foods should I avoid? • • • • Avoid fatty and fried foods, because they are harder to digest. Foods high in fat will cause a feeling of fullness and possibly trigger nausea. Avoid spicy, highly seasoned foods. Eat bland foods instead. Avoid food with a strong odor, which may trigger nausea. Cold and/or bland foods have less aroma and may be easier to eat. Avoid your favorite foods when you are nauseated. It may be difficult to enjoy them later. Tips on Eating Remember, nutrition is an important part of your treatment. • Take your nausea medicine as you have been told. • Avoid an empty stomach. Keeping Nausea Under Control © 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 09/05/12 Patient Education Office Page 3 of 5 • • • • • • • • • • Eat 6 to 8 small meals a day. Avoid overeating at one meal. Drink 8 to 12 eight-ounce glasses (2 to 3 liters) of non-alcoholic, non-caffeinated fluids each day. Drink carbonated drinks such as cola or ginger ale to settle your stomach. Drink liquids between meals instead of with meals. This may help lessen queasiness. Try sipping your beverage slowly through a straw. Chew foods well and eat slowly. Swish out your mouth with water before and after meals. Nausea and vomiting are sometimes associated with poor bowel function. Adequate fiber contributes to good bowel function. High-fiber foods include whole grains, legumes, and raw vegetables. After you sleep or rest, eat dry foods, such as crackers, toast, dry cereals or bread sticks before you become active. Medications can easily alter your sense of taste. Foods that are normally your favorites may taste differently. If a food does not taste right, try another food. What else can I do to prevent nausea and vomiting? • • • • • • • • • • • • Take your anti-nausea drug 30 minutes to 1 hour before you eat. Avoid lying down flat immediately after eating. If you wish to rest, sit or recline with your head elevated for at least 30 - 60 minutes. Eat in an open area to avoid the smell of food. Apply a cold, wet rag to your forehead or throat. Before your treatment, remove dentures or retainers. Avoid unpleasant odors. If you have a bad taste in your mouth, try sucking on peppermint candy or lemon drops. Practice good mouth care. Avoid commercial mouthwashes because they contain alcohol and can dry your mouth. If you are coughing and gagging due to thick secretions and this triggers nausea and vomiting, talk to your doctor about cough medicine. Open a window to feel and smell the fresh air. Go for a walk. Wear loose-fitted clothing. Move slowly so your sense of balance will be maintained. Get plenty of rest. Try to take a nap during the times you feel nauseated. Focus your attention on music, handwork, crossword puzzles, games, TV, jigsaw puzzles, letter writing or reading. Learn relaxation techniques to help you control nausea. DVDs and books are available through The Learning Centers (Main Building, Floor 4, near Elevator A or Mays Clinic, Floor 2, near The Tree Sculpture). Relaxation videos can be viewed in patient rooms through MDA-TV. Yoga, meditation and other relaxation and stress management classes are offered through the Integrative Medicine Center. For more information, call 713-794-4700. Ask about patient education classes and support groups. Ask your doctor for a consult with a dietitian for additional ideas. • • Keeping Nausea Under Control © 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 09/05/12 Patient Education Office Page 4 of 5 If you have a question regarding the above, call your home or clinic nurse. If you have any other questions or problems call any of the following numbers: Ambulatory Treatment Center (ATC) 713-792-2312 ATC Pharmacy 713-792-2367 or 713-792-2873 Keeping Nausea Under Control ÂŠ 1985, 2012 The University of Texas MD Anderson Cancer Center, Revised 09/05/12 Patient Education Office Page 5 of 5 Diarrhea Diarrhea (also called liquid stool) is a symptom that can be caused by many things. It is important to treat all causes of diarrhea. This information will explain some of the causes of diarrhea and their treatment. Impaction A severe impaction can cause diarrhea. An impaction is the collection of a large amount of body waste (called stool) that remains in the colon. The stool can be hard or soft. Diarrhea occurs when liquid stool in the small intestine seeps around hard impacted stool in the colon. Do not take anti-diarrhea medicine because the impaction will get worse. The treatment for this kind of diarrhea is removal of the impaction. Your nurse will help you if you have an impaction. Lactose Intolerance You may have diarrhea if your body lacks the enzyme to digest milk and milk products. Milk products are anything made from milk, such as yogurt, cheese, cottage cheese and ice cream. Treat this kind of diarrhea in one of two ways: 1) take LactaidÂŽ when eating or drinking milk or milk products; or 2) stop eating or drinking milk products. Food Allergies If you have food allergies, you may get diarrhea after you eat foods that you are allergic to. You should stop eating the foods that cause diarrhea and discuss your food allergies with your doctor. Antibiotic Therapy Antibiotics (medicines prescribed to treat an infection) may cause diarrhea by destroying the bacteria that normally live in the intestinal lining. If you have diarrhea when taking antibiotics, follow the tips below to help normalize your intestinal lining: Eat two servings of yogurt per day that contain acidophilus or live cultures. Avoid yogurts that can cause your gastrointestinal (GI) tract to become more active (such as those containing bifidus regularis). Drink buttermilk. Take acidophilus or lactobacillus in pill form, available in pharmacies or health food stores. Ask your pharmacist about over-the-counter products that can help with diarrhea that is caused Diarrhea Developed by Annette Bisanz, BSN, MPH, RN ÂŠ 1996, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/18/11 Patient Education Office Page 1 of 4 by antibiotics. Radiation Therapy Radiation therapy over the abdomen will affect the lining of your colon – causing diarrhea. Treat this diarrhea with loperamide (brand name Imodium®, available without a prescription) or Lomotil® (prescription only) or both. These medicines will slow the movement of stool through the intestine. Tell your doctor if these medicines do not give you relief. Also, a low-fiber diet will help relieve this type of diarrhea. Ask your doctor for a consultation with a dietitian to help you with your diet. For more information, see the handout “Bowel Management for Frequent Stooling.” Cancer Surgery Having surgery to remove part of your intestine may cause you to have frequent stools because stool now moves more quickly through your intestine. Often these stools are soft and formed, not liquid stools. To help slow down stools, take Imodium or Lomotil at the time your doctor or nurse suggests. You may take medicinal fiber, such as psyllium (Metamucil®) or methylcellulose (Citrucel®) with about 2 ounces of water to slow the movement in the GI tract. The fiber absorbs the excess fluid like a sponge. When you take an appropriate amount of psyllium, other medicines may not be needed. For more information, see the handout “Bowel Management for Frequent Stooling.” As you increase the dose of psyllium, decrease the dose of Imodium or Lomotil. Ask your nurse or dietitian for more information on fiber. Spicy foods, deep fried foods and hot liquids can cause frequent stooling after surgery. The BRAT diet is helpful in slowing movement in the GI tract. The BRAT diet includes: bananas, white rice, applesauce and dry toast. Chemotherapy Certain types of chemotherapy drugs cause diarrhea for a brief time. Use guidelines that your doctor gives you to control diarrhea. If you do not receive instructions from your doctor, you may take Imodium to control diarrhea. Do not take Imodium if you are being checked for Cdifficile or other organisms. When taking Imodium, do not take more than 8 tablets (16 milligrams) per day (read the label on the package). Do not take over-the-counter medicine for your diarrhea unless your doctor says it is okay. Some products may have additional medicines that can hide a fever and/or affect your platelet function. If you continue to have diarrhea, call your doctor for help. Diarrhea Developed by Annette Bisanz, BSN, MPH, RN © 1996, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/18/11 Patient Education Office Page 2 of 4 Chemotherapy Drugs That Cause Diarrhea 5-azacitidine High dose Cisplatin, Oxaliplatin, Paclitaxel and Cyclophosphamide 5-FU/Leucovorin Adriamycin (doxorubicin) Hycamtin (topotecan) Camptosar (irinotecan) Hydrea (hydroxyurea) Cytosine Arabinoside Methotrexate Daunorubicin Nitrosureas Thioguanine If you have been taking fiber prior to taking a chemotherapy drug that causes diarrhea, stop taking the fiber until after you have finished chemotherapy. Medicines The following medicines can cause diarrhea. Ask your doctor or nurse before taking these. Alcohol Antacids that are magnesium based Aldomet (methyldopa) Caffeine Cytotec (misoprostol) Enteral nurtrition supplements Laxatives Non-steroidal drugs Reglan (metoclopramide) Theophylline Infections and Parasites Some bacteria and certain types of parasites can cause diarrhea. Medicine may be an appropriate treatment. Your doctor may request a stool specimen in order to prescribe the correct medicine. If you are diagnosed with a clostridium difficile infection, please ask for a copy of “Clostridium Difficile-Associated Diarrhea.” Other Causes The following problems can also cause diarrhea: Gastroenteritis - inflammation of the stomach Diverticulitis - inflammation of areas in the intestine Irritable bowel syndrome Adding medicinal fiber too fast to the diet will increase diarrhea, cramping and bloating. To prevent these problems, introduce medicinal fiber in 1 teaspoon increments every five days. This is described in the handout “Bowel Management for Frequent Stooling.” Your nurse can give you a copy. Unknown Causes If you have diarrhea and don’t know why, talk to your doctor or nurse. Your treatment will vary depending on the cause of the problem. It is important to treat the causes, not the symptom. Diarrhea Developed by Annette Bisanz, BSN, MPH, RN © 1996, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/18/11 Patient Education Office Page 3 of 4 How much diarrhea is normal? When you have diarrhea, follow the guidelines below to check the amount of diarrhea or liquid stool you have. It is normal to have 1,000 cc or less of liquid stool per day. If you have more than 1,500 cc of liquid stool in 24 hours, contact your health care team for guidance. A “hat” is a container that can be placed in the back of your toilet to help you measure liquid stool at home. This is available through MD Anderson. Ask your nurse to give you a hat. Diarrhea Developed by Annette Bisanz, BSN, MPH, RN © 1996, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/18/11 Patient Education Office Page 4 of 4 Diarrhea: Managing With Nutrition Diarrhea is the passage of frequent and/or unformed, watery stools. If it becomes severe or prolonged, it may lead to loss of nutrients and dehydration. This handout provides nutrition tips on foods to include and avoid when you have diarrhea. If you have diarrhea, tell your doctor. Nutrition Tips Drink at least eight-12 glasses, 8-ounce size each, of non-alcoholic, non-caffeinated fluids each day. Drink the majority of your fluids between meals rather than with meals. Sodium and potassium are lost when you have diarrhea. Eat salted crackers, pretzels or broth to replace sodium. Include high potassium foods such as carrot juice, orange juice, potatoes (no skin), bananas and papaya juice as tolerated. Low carbohydrate electrolyte drinks will also help replace electrolyte losses. Some examples include half strength Gatorade® or Powerade® (equal parts of drink and water), G2® (Gatorade product), Pedialyte® and CeraLyte-70®. Eat small frequent meals. Limit high-fiber foods such as peas and beans; seeds; whole grains; and high-fiber fruits and vegetables or those with thick peels/skins. Limit high-fat foods such as fried food, rich desserts (pies, cakes and cookies) and excessive amounts of butter, oil and cream. Hot fluid (including soups) may make diarrhea worse. Allow hot fluids to cool to room temperature before eating. Avoid alcohol, caffeine and spicy foods which cause food to move more quickly though the intestines. Milk and other dairy products may make the diarrhea worse. You may need to limit dairy products to a 1/2 cup serving per meal, or you may need to avoid these foods until your diarrhea stops. Cultured milk products such as yogurt, buttermilk and hard cheeses may be better tolerated. Lactose free milk or the use of lactase enzyme supplements (Lactaid®) may be used instead of limiting milk and other dairy products. Limit use of sugar-free gums and candies that contain sorbitol or xylitol. Diarrhea: Managing With Nutrition © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/27/11 Patient Education Office Page 1 of 2 Food Group Meats and High-Protein Foods Suggested Foods to Include Baked, broiled or grilled meat, fish or poultry Eggs Hard cheeses Buttermilk, soymilk, lactose free milk Yogurt Tofu Smooth nut butters White bread, rolls, crackers Pretzels Farina, Cream of Wheat速, grits, oatmeal Low-fiber cereals such as corn flakes, Rice Krispies速 or Cheerios速 White rice Plain pasta Foods to Avoid Beans and peas Nuts and seeds Fried meat, fish or poultry Bologna, salami and hot dogs Bacon and sausage Breads, Cereals and Grains Whole grain breads Whole wheat pasta Brown rice Bran and granola cereals Cornbread Croissants Muffins Dried fruit Prune juice Broccoli Brussels sprouts Cabbage Cauliflower Corn Collard, mustard and turnip greens Fruits and Vegetables Soft, cooked vegetables without seeds or skin Fruit and vegetable juice without pulp Potatoes without skin Canned fruits Mandarin oranges Melons Apples without skin Applesauce Bananas Diarrhea: Managing With Nutrition 息 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/27/11 Patient Education Office Page 2 of 2 Preventing Constipation Emptying the large bowel (colon) on a regular schedule will keep stool soft and prevent constipation. It is very important to have bowel movements regularly while you are receiving cancer treatment. If you are constipated, your stool can become hard which may cause bleeding. Do not use enemas and suppositories if your platelet or white blood cell counts are low or if you are taking blood thinners. The following instructions will help you to: • have regular bowel movements; • set goals for expecting bowel movements; and • take over-the-counter medicine correctly to prevent constipation. Regular Bowel Movements • The best thing you can do to manage constipation is drink plenty of fluids and include fiber in your diet, unless you are on a low fiber diet: − Drink 2 quarts (eight, 8-ounce glasses) of non-alcoholic fluids each day. Half of the fluids you take in each day should be non-caffeinated. − To prevent constipation, eat 1 cup of General Mills Fiber One cereal with fruit. Eating high-fiber cereal will help you meet the 25-40 grams of fiber that you need daily (unless you are on a low fiber diet). If you are not used to eating fiber, start off slowly: Eat ¼ cup Fiber One each day for the first week. Eat ½ cup Fiber One each day for the second week. Eat ¾ cup Fiber One each day for the third week. Eat 1 cup Fiber One each day for the remaining time needed. You may need to take medicinal fiber (for example, Metamucil or Citrucel) as prescribed by your nurse or dietitian. Ask your nurse for a copy “Medicinal Fiber.” However, do not take medicinal fiber if: − you cannot drink large amounts of fluids; − you have a history of bowel obstructions; or − you are taking chemotherapy that affects the gastrointestinal (GI) tract. Include foods in your diet that help you have a bowel movement, such as prunes, prune juice and hot liquids. Take medicine as prescribed by your doctor or nurse. Some medicines cause constipation. Your doctor may advise you to take other medicines to help relieve the constipation. Daily physical activity helps keep the digestive system active. Talk to your doctor about how much physical activity is best for you. • • • • Preventing Constipation Developed by Annette Bisanz, BSN, MPH, RN © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/24/11 Patient Education Office Page 1 of 3 • When you feel the urge to have a bowel movement try to get to a bathroom right away, don’t wait. It is helpful to sit upright on the toilet. If your feet don’t reach the floor while you are sitting on the toilet, support them with a footstool. Setting Goals for Frequency of Bowel Movements • The frequency of bowel movements varies with each person. As described below, your frequency of bowel movements is affected by your food intake. − If you eat your regular amount of food per day, expect to have a bowel movement every day. − If you eat one-half your regular amount of food, expect to have a bowel movement every other day. − If you eat one-third your regular amount of food, expect to have a bowel movement every third day. If you do not have a bowel movement by 4 p.m. on the day you expect, drink 4 ounces of prune juice at room temperature, then immediately drink a hot liquid. If you do not have a bowel movement by bedtime, take 2 tablespoons or 2 caplets of milk of magnesia with 8 ounces of water. If you do not have a bowel movement after breakfast the next day, repeat the dose of milk of magnesia. If you have kidney problems, ask your doctor before you take milk of magnesia. Timing of bowel movements can be important. Work towards having a bowel movement after the same meal every day. Drinking a hot liquid after that meal will increase the “push down” effect of stool in your GI tract. Call your nurse or doctor if: − you go three days without having a bowel movement; or − your stool is hard and difficult to pass. • • • Over-the-Counter Medicines to Prevent Constipation Pain medicine, some chemotherapy drugs and other medicines can cause severe constipation by slowing down movement of stool in the bowel. When stool moves slowly in the bowel, it loses water, becomes hard and can be difficult to pass. Refer to the list on page 3 for other medicines that cause constipation. When you begin taking a constipating medicine, immediately begin to take a stool softener and a stimulant laxative daily. These will counteract the constipating effects of the medicines. The stimulant laxative moves the stool down in the intestines, and the stool softener helps keep water in the colon. You can safely take up to eight Senokot-S pills per day. Senokot-S in generic form is one 8.6 milligram dose of sennoside (senna) (also known as a stimulant laxative or vegetable laxative), and one 50 milligram dose of docusate sodium (a stool softener). Both senna and docusate sodium are non-prescription laxatives that can be purchased in pharmacies and most drug stores. If you need help finding these medicines, ask the pharmacist. Start with two doses Preventing Constipation Developed by Annette Bisanz, BSN, MPH, RN © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/24/11 Patient Education Office Page 2 of 3 per day, or as directed by your doctor or nurse. For example, take 1 Senokot-S twice a day, or 1 senna and 1 docusate sodium twice a day. Gradually increase the dosage until you have softformed stools on a regular basis; however, do not take more than 500 milligrams of docusate sodium (stool softener) per day. Ask your nurse or doctor about the possible side effects of your medicines, including over-thecounter medicines. A Partial Listing of Medicines That Cause Constipation • • • • Aluminum antacids with calcium Anti-inflammatories Antihistamines Calcium channel blockers • • • • Parkinson’s disease medicines • • • • Some anti-emetics (ie. ondansetron/Zofran) Iron Muscle relaxants Opiod pain medicine Diuretics (water pills) Neuroleptics Tricyclic antidepressants Points to Remember • • Know the possible side effects that medicines and cancer treatment may cause on your GI tract. Your nurse can give you information on your chemotherapy. It is important to prevent constipation rather than treating it after it happens. Contact your doctor, nurse or pharmacist if you have problems or questions. Preventing Constipation Developed by Annette Bisanz, BSN, MPH, RN © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/24/11 Patient Education Office Page 3 of 3 Constipation: Managing With Nutrition Constipation is the infrequent or difficult passing of a hard, dry stool (body waste). Constipation in cancer patients can be caused by the location of the tumor, cancer treatment, side effects of pain medicine or not eating or drinking enough food and/or liquids. Following the guidelines below can help relieve constipation and regulate bowel function. Increase Fiber Fiber is the indigestible substance in plant foods that promotes regular bowel movements. Fiber helps you have bowel movements by absorbing water, decreasing the amount of time stool is in the colon and adding bulk to the stool. This makes stools softer and easier to pass. Include 25-40 grams of fiber in your diet each day. A gradual increase fiber in your diet will help decrease the amount of gas, bloating and abdominal cramps that fiber can cause. Before you increase your intake of fiber, make sure you are drinking the amount of fluids that your dietitian recommends. See the bottom of Page 2 about how to contact your dietitian. Tips for increasing fiber in your diet: Eat dry cereals that have at least 9 grams of fiber per serving. Some examples are Kellogg’s ® ® ® ® Raisin Bran , All Bran , General Mills Fiber One , and Kashi Go Lean Crunch . Use whole wheat flour. Eat whole grains such as brown rice, wild rice or barley instead of white rice and potatoes. Eat whole wheat pasta, as well as whole wheat or corn tortillas. Sprinkle wheat germ, bran, Kashi Go Lean Crunch or Fiber One on top of your favorite cereal, or add it in yogurt, casseroles or baked products. Eat beans and legumes. One-half cup of beans provides 6 or more grams of fiber. Eat at least five servings of fruits and vegetables daily, especially those with skin or seeds (such as: apples, oranges, pears, squash, tomatoes, spinach, berries). Smart snack choices include raw fruits and vegetables, nuts, seeds or popcorn. Eat breads made with 100 percent whole grains (wheat, rye and oats). Look for breads that also include nuts, seeds or bran for additional fiber. Some fiber bars do not contain whole grains. Read the ingredients list on the package. Be aware that products containing inulin (also called chicory root powder) may cause you to have more gas. Read the ingredients list on the package. Timing of Meals and Fluids To help stimulate bowel movements: 1) eat meals at about the same time each day; 2) drink 4 ounces of prune juice at the beginning of a meal; and 3) drink a hot beverage at the end of a Constipation: Managing With Nutrition © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/27/11 Patient Education Office Page 1 of 2 meal. Drink at least eight to 10 glasses, 8-ounce size each, of non-alcoholic fluid each day. Caffeinated beverages should make up no more than 50 percent of your total daily fluid intake. Fluids include: Water. To make a habit of drinking more water, carry it when you travel, keep it at your desk at work or near your chair while watching TV. Juices, sports drinks, milk and nutrition supplements. Any food that becomes liquid at room temperature, such as gelatin, popsicles, ice cream or soup. Drink 4 ounces of prune juice at room temperature and then drink a hot liquid. This will help bring on a bowel movement. Exercise Regular moderate exercise (as tolerated), such as walking, can strengthen and stimulate the muscles that help move food and stool through the digestive system. Consult Your Health Care Team If: You are unable to have a bowel movement or pass gas for more than three days. You have abdominal pain, cramping, nausea or vomiting associated with no bowel movements. You feel that you need help having regular bowel movements. Additional Information Medicinal fiber (such as Metamucil® or Citrucel®) is needed if you do not get 25-40 grams of fiber in your diet. Talk to your nurse or dietitian for instructions on how to take these. Watch the video, “Understanding and Managing Your Bowel Function.” This video can be viewed several ways: Option 1: View Through myMDAnderson 1. Log on to myMDAnderson at https://mymdanderson.org/. 2. At the top, move your cursor to the Resources tab. A dropdown list should appear. 3. In the dropdown list, click “Video Library.” 4. Under “Video Titles,” select “Understanding and Managing Your Bowel Function.” Option 2: View With Video on Demand 1. Press Menu on the nurse call/TV remote to see the Main Menu. 2. Select Patient Ed Videos. 3. Press the Number Keys to enter the video’s ID number: 115. For more information or to schedule a nutrition consultation, please call the Department of Clinical Nutrition at 713-563-5167. Constipation: Managing With Nutrition © 2001, 2011 The University of Texas MD Anderson Cancer Center, Revised 05/27/11 Patient Education Office Page 2 of 2 Bowel Management When Taking Pain Medicine (and other constipating medicine) How Medicines Affect Bowel Function Pain medicines and some chemotherapy and antinausea medicines commonly cause severe constipation. They affect the digestive system by: • Slowing down the movement of body waste (stool) in the large bowel (colon) • Removing more water than normal from the colon Preventing Constipation 1. Before taking opioid pain medicine or beginning chemotherapy, it is a good idea to clean out your colon by taking laxatives of your choice. If you have not had a bowel movement for five or more days, ask your nurse for advice on how to pass a large amount of stool from your colon. 2. After beginning treatment, you can prevent constipation by regularly taking stimulant laxatives and stool softeners. These will counteract the effects of the constipating medicines. For example, senna (a stimulant laxative), helps move stool down in the colon and docusate sodium (a stool softener) helps soften the stool by keeping water in the stool. Brand names of combination stimulant laxatives and stool softeners are Senna-S® and Senokot-S®. The ‘S’ is the stool softener of these products. You can safely take up to eight Senokot-S pills or Senna-S in generic form per day. Start at the dose advised by your nurse. Gradually increase the dosage until you have soft-formed stools on a regular basis. Do not exceed 500 milligrams (mg) of docusate sodium per day if you are taking the stool softener (docusate sodium) separate from Senokot-S or Senna-S generic. Stool softeners, stimulant laxatives and combination products can be purchased without a prescription at drug and grocery stores. Many store brand stimulant laxative/stool softeners work as well as brand names and cost less. Bowel Management When Taking Pain Medicine (and other constipating medicine) Developed by Annette Bisanz, BSN, MPH, RN © 2002, 2012 The University of Texas MD Anderson Cancer Center, Revised 04/26/12 Patient Education Office Page 1 of 3 3. If the doctor increases your pain medicine, gradually increase your intake of stool softener and stimulant laxative to keep your stool soft and formed. Do not let your stool become hard and difficult to pass. Relistor® If you are on opioids, and taking 8 Senna-S pills and Miralax® daily and are unable to have a bowel movement, talk to your doctor about Relistor. This is a prescription medicine that helps you have a normal bowel movement. Relistor is an injectable medicine that you give yourself every other day. Your health care team will teach you how to do this. Treating Unresolved Constipation To treat unresolved constipation, you need to empty the formed stool in your colon. If you are taking constipating medicine and have not had a bowel movement for three or more days, clean out your colon as directed by your nurse. You will receive specific instructions on how to use a laxative or give yourself an enema. If you become constipated while taking pain medicine, your health care team may prescribe a milk and molasses enema. Because this enema has a small amount of liquid, most patients have no problem using this. The enema will help break up the stool and move it down the colon so that you can easily pass it. For more information, ask your nurse for a copy of “Self Help for Severe Constipation.” Do not use an enema if: • You have symptoms of a bowel obstruction. This means that something could be blocking your small intestine or colon. If you have symptoms of a bowel obstruction, do not take a laxative without advice from your doctor or nurse. Symptoms of a bowel obstruction include: Loss of appetite Vomiting Abdominal pain Abdominal swelling and No bowel movement for several days along with one or more of the other symptoms Report any of these symptoms to your doctor or nurse. • You are on chemotherapy and your blood counts are low. Bleeding may occur. If you are taking chemotherapy and need help with constipation, ask your nurse or doctor for more information. Frequency of Bowel Movements Once you have cleaned out your bowel, try to determine how often you should have a bowel movement. As described below, your frequency of bowel movements depends on how much food you take in: • If you eat your regular amount of food per day, expect to have a bowel movement every day. Bowel Management When Taking Pain Medicine (and other constipating medicine) Developed by Annette Bisanz, BSN, MPH, RN © 2002, 2012 The University of Texas MD Anderson Cancer Center, Revised 04/26/12 Patient Education Office Page 2 of 3 • • • • • If you eat one-half your regular amount of food, expect to have a bowel movement every other day. If you eat one-third your regular amount of food, expect to have a bowel movement every third day. If you do not have a bowel movement by 4 p.m. on the day you expect, take 4 ounces of prune juice followed by a hot liquid. If you do not have a bowel movement by bedtime, take two tablespoons or two caplets of milk of magnesia with 8 ounces of water every six hours or until you have a bowel movement. If you do not a have bowel movement after breakfast the next day, repeat the dose of milk of magnesia. Do not take milk of magnesia if you have kidney problems. If you have to keep taking milk of magnesia, your maintenance bowel program is not strong enough. You may need to increase your dosage of Senna-S. Ask your nurse or doctor for instructions. If taking the maximum dose of eight Senna-S pills per day is not helping you to have a bowel ® movement, try this: mix 17 grams of MiraLAX in 8 ounces of water and drink this each day. If this does not help bring on a bowel movement, contact your nurse. MiraLAX is a laxative that is available without a prescription at most pharmacies and drug stores. Promoting Regular Bowel Movements • • • Drink at least eight, 8-ounce glasses (2 liters) of non-alcoholic fluid per day. Half of the fluids you take in each day should be non-caffeinated. Take medicines as directed by your doctor or nurse. Follow their advice on preventive measures when taking medicines that cause constipation. Eat 1 cup of General Mills Fiber One® Cereal (the noodle type) daily. One cup provides 28 grams of fiber and may be substituted for medicinal fiber (described below). or Take fiber as a medicine to control stool consistency and frequency. Once a day, take 6.8 grams of psyllium (brand name Metamucil®) or methylcellulose (brand name Citrucel®) mixed in 8 ounces of water. Then immediately drink 8 more ounces of fluid. For more information, ask for a copy of “Medicinal Fiber.” Avoid alternating between constipation and diarrhea. It is very important to have bowel movements regularly while you are on chemotherapy to help keep your stools soft and formed. • • • Contact your nurse, doctor or pharmacist if you have problems or questions. Bowel Management When Taking Pain Medicine (and other constipating medicine) Developed by Annette Bisanz, BSN, MPH, RN © 2002, 2012 The University of Texas MD Anderson Cancer Center, Revised 04/26/12 Patient Education Office Page 3 of 3 Sexuality and Chemotherapy Is it safe to have sexual activity while on chemotherapy? Most patients are able to continue sexual activity during chemotherapy. However, during chemotherapy you are at greater risk for getting an infection. Normal germs that are not a threat to others can cause an infection in a cancer patient during treatment. For this reason, practice good personal hygiene and bathe daily. Wash your hands and genitals before and after sexual activity. Even though treatment may lower a man's sperm count or cause a woman's periods to stop, a pregnancy may still be possible. Whether you are a man or a woman, you should prevent pregnancy during chemotherapy, as treatments may cause birth defects. If you are being treated with a newer type of biological cancer treatment, make sure to discuss risks of pregnancy with your doctor. Talk to your doctor or nurse about the best method of birth control for you. If you are not in a monogamous sexual relationship (having only one partner) where you are not sure of your partner's faithfulness, you should practice safer sex, using latex condoms and/or dental dams to avoid contact with your partner's body fluids. If you use a lubricant with latex condoms, choose a water-based lubricant, and not a lubricant that contains oil (i.e., baby oil or petroleum jelly), since such products can weaken the condom. Nonoxynol-9 is no longer recommended as an HIV preventive. How does chemotherapy affect sexuality? Men and women may experience less interest in sexual activity during and shortly after chemotherapy. Common causes include: • side effects of treatment, such as nausea or fatigue; • negative emotions like depression, anger, fear or guilt, which may keep you or your partner from wanting to have sex; • side effects of medications for pain, nausea, anxiety, depression or seizures; and • feeling unattractive as a result of changes in appearance (such as hair loss) Chemotherapy may, but does not always, affect hormone levels. These changes may affect sexual organs and functioning. The side effects that may result depend upon the drugs used and the person's age and overall general health. Sexuality and Chemotherapy © 2012 The University of Texas MD Anderson Cancer Center, 08/07/12 Patient Education Office Page 1 of 2 Men During treatment, men may experience difficulty in getting and maintaining an erection. Most men return to their prior level of sexual function once chemotherapy is over. Chemotherapy may reduce a man's sperm cell count. This can affect his ability to father children, but does not affect the ability to have sexual intercourse. A low sperm count may be temporary or permanent, depending upon the dose of chemotherapy, the type of drugs used, and the man’s age. Ask your doctor about the long-term effects of your treatment plan. Women Many types of chemotherapy affect the functioning of the ovaries. During chemotherapy, menstrual periods may become irregular or stop completely. These changes can be temporary or permanent depending upon the woman's age, the type of drugs used, and the drug dose. Women on chemotherapy may experience hot flashes and other symptoms of menopause, such as vaginal dryness and itching. Vaginal dryness can be relieved by using vaginal moisturizers, which are used on a regular basis to keep the lining of the vagina moist. Vaginal lubricants are designed to be used during sexual activity and come in a variety of forms. Vaginal moisturizers and lubricants are available over the counter at any drugstore. For more information, ask your health care provider for a copy of the patient information sheet “Vaginal Dryness.” Occasionally, women on chemotherapy may develop vaginal mucositis, a painful irritation of the lining of the vagina. If you develop vaginal pain, report this symptom to your doctor. A woman's ability to have children after treatment will depend on the type and dose of chemotherapy she receives, and her age at the time of treatment. Ask your doctor about the longterm effects of your treatment plan. Where can I go for more information or for help? Discuss any questions or issues with your doctor or nurse. Health care providers are often focused on treatment, and unless you bring up the subject, they may never ask about your sexual health. MD Anderson has providers who specialize in sexual health services. Ask your doctor for a referral. For general information and questions about sexual health services at MD Anderson, call Dr. Andrea Bradford at 713-745-4466. For more information on sexuality and cancer, ask your health care provider for a copy of the patient information sheet “Sexuality and Your Cancer Treatment.” Sexuality and Chemotherapy © 2012 The University of Texas MD Anderson Cancer Center, 08/07/12 Patient Education Office Page 2 of 2 Fertility Options for Men and Women Before starting cancer treatment, men and women who want to have a child should consider his or her fertility options. Talk with your doctor. Men For men, fertility means being able to produce healthy sperm cells that can make a woman pregnant. Chemotherapy can affect sperm cells, but many men recover the ability to make healthy sperm after treatment has ended. Depending on the drug and dose, though, chemotherapy can damage fertility permanently. Any man who may want to have a child should consider banking sperm. Banking sperm involves providing a semen sample to be frozen. In the future, it can be thawed to use with fertility treatments to conceive a child. Unfortunately, health insurance usually does not pay for sperm banking, but many sperm banks have payment plans for cancer patients. It is not painful to give a semen sample, but it may be embarrassing. You usually ejaculate through self-touch at an infertility clinic or sperm bank. The clinic tests the semen for sperm count and motility. As long as they see some live sperm cells, they divide the sample into small amounts and freeze them. Frozen samples may be stored a long time. Men who are unable to provide a semen sample, or those with low sperm counts, may be able to have sperm extracted from testicular tissue during an outpatient surgical procedure. For more information on sperm banking, please ask for a copy of the patient information sheet â€œFertility Options for Men.â€? Women For a woman, fertility means being able to become pregnant or to carry a pregnancy successfully to a live birth. When a woman gets chemotherapy to treat her cancer, she is at risk for damage to her ovaries, which produce the eggs. The amount of damage depends on the type and dose of the drugs she receives. Women who want to have a child should consider freezing tissue from the ovaries, unfertilized eggs, or embryos (fertilized eggs) before cancer treatment. The frozen tissue is made available later in order to conceive a child. Frozen embryos and eggs can be stored indefinitely. Fertility Options for Men and Women ÂŠ 2012 The University of Texas MD Anderson Cancer Center, 08/07/12 Patient Education Office Page 1 of 2 The most widely available and successful way of preserving fertility is embryo freezing. This includes taking hormones to stimulate the ovaries to ripen more than one or two eggs. Then the eggs are removed in a minor, outpatient surgery. Once eggs have been removed, they can be fertilized in the lab with the sperm of your partner or a donor. Eggs that fertilize and start to form embryos are frozen and stored for future use. This process is called in vitro fertilization (IVF). IVF and other methods of fertility preservation for women are expensive. Unfortunately, most health insurance plans do not cover the cost. For more information, please ask for a copy of the patient information sheet â€œFertility Options for Women.â€? Resources Fertile Hope www.fertilehope.org This website provides information, support and hope to cancer patients and survivors about fertility. A financial assistance program is available to both men and women. Fertility Options for Men and Women ÂŠ 2012 The University of Texas MD Anderson Cancer Center, 08/07/12 Patient Education Office Page 2 of 2 Other Side Effects of Chemotherapy Pain, Nerve and Muscle Effects, Memory/Attention/ Concentration How does chemotherapy relate to pain? The pain you feel may be an early warning sign of the cancer itself or the side effects of cancer treatment. Whether you have pain and the amount of pain you have may depend on the type of cancer, the stage (extent) of the disease and your pain threshold (tolerance for pain). Most of the pain comes when the tumor presses on bones, nerves or body organs. Chemotherapy may help relieve this type of pain. Pain may also be caused by the treatment or procedures used for diagnosing cancer. You may also have pain that has nothing to do with your illness or treatment. Like anyone, you may get headaches, muscle strains, or other aches and pains. Pain is easier to treat when you first experience it, but harder when it is at its worst. Using a pain scale is helpful in describing how much pain you are feeling. Try assigning a number from 0 to 10 to your pain level, where 0 is no pain, and 10 is the worst pain you can imagine. Try to identify the location of your pain, describe exactly how it feels (sharp, dull, throbbing, steady, tight, pinching, tingly, etc.), and keep track of how long the pain lasts. Being able to effectively describe your pain to your doctor or nurse is the first step in helping him or her develop a plan to control your pain. Make sure to tell your doctor or nurse if your pain affects your daily activities. Effective pain medication is available. However, do not take any nonprescription or over-thecounter pain relievers without first checking with your doctor, nurse or pharmacist. He or she will be able to suggest the best medicine for you. Non-drug treatments such as relaxation techniques, biofeedback and imagery can also be used to treat pain. Relaxation audiotapes and books are available through both the Patient Family Library (located in the Main Building on Floor 1 near The Aquarium in Room R1.2212.) and The Learning Center. The Learning Center locations include: • • • Holden Foundation Learning Center Jesse H. Jones Rotary House International, Floor 1, 713-745-0007 Law Learning Center Main Building, Floor 4, near Elevator A, Room R4.1100, 713-745-8063 Levit Learning Center Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120, 713-563-8010 Other Side Effects of Chemotherapy: Pain, Nerve and Muscles Effects, Memory/Attention/Concentration © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 07/19/12 Patient Education Office Page 1 of 3 MDA-TV, the in-house television system, provides a Relaxation Channel and relaxation videos. The Integrative Medicine Center offers relaxation and stress management classes, such as yoga and meditation. The Integrative Medicine Center is located in the Mays Clinic on Floor 2 near The Tree Sculpture in Room ACB2.1041 and in the Main Building on Floor 1 near The Aquarium. (Exit the lobby's front doors and head left to access its separate entrance.) How does chemotherapy affect nerves and muscles? Your nervous system affects just about all of your body’s organs and tissues. It is not uncommon for people on chemotherapy to experience nerve and muscle-related side effects. Some ® chemotherapy drugs (i.e., Taxane ) can cause "peripheral neuropathy," a condition that causes tingling, burning, weakness or numbness in the hands and or feet. Other nerve-related symptoms and side effects can include dizziness, lightheadedness, loss of balance and clumsiness; difficulty picking up objects and or walking; shaking or trembling; changes in vision; changes in hearing; and other related effects. In addition, certain anti-cancer drugs can lead to weak, tired or sore muscles. Nerve and muscle effects, although sometimes annoying, are usually not serious. In most cases they are temporary and will get better with time. In other cases, nerve and muscle symptoms may indicate serious problems that need medical attention. Tell your doctor or nurse if you experience any nerve or muscle symptoms. To manage nerve or muscle related side effects: • Get up slowly if you have dizziness or lightheadedness. • Use caution when gripping objects that are sharp, hot or otherwise dangerous if you have numbness or tingling in the hands or feet. • Wear shoes or slippers to protect your feet when walking. • Use handrails when going up or down stairs if you experience balance or muscle strength problems. For more information on peripheral neuropathy, ask your health care provider for a copy of the patient information sheet “Peripheral Neuropathy.” How does chemotherapy affect memory, attention, concentration and other mental abilities? Some patients may experience changes in memory, attention, concentration and other mental abilities during chemotherapy treatment. Sometimes these changes are called “chemobrain.” Symptoms of chemobrain include: • taking a longer time to recall names, words and numbers, • being slower to do things, and • having trouble with doing more than one thing at a time. Other Side Effects of Chemotherapy: Pain, Nerve and Muscles Effects, Memory/Attention/Concentration © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 07/19/12 Patient Education Office Page 2 of 3 Chemobrain does not affect being able to reason or think logically. This means that patients have the same skills and talents they had before. These changes may be a result of chemotherapy treatment, or they may result from other causes such as anxiety, depression, low blood counts and other medications. The following tips may help with chemobrain: • Use a day planner or a personal digital assistant (PDA). • Create a daily list of tasks, then prioritize these tasks. • Keep a running master list across weeks or the month. • Follow an end-of-day routine checklist. • Write down any information you will need to remember. • Use devices with audible alerts, such as cell phones with alarms and reminders. • Designate a place in your home where all important items, such as keys, are placed. • Do activities on the same day each week or month. For example, pay bills the 20th of each month. • Recognize when you are stressed and ask for help. If you are experiencing chemobrain, ask your doctor for a referral to the Neuropsychology Service for testing and treatment. For more information on chemobrain, ask your health care provider for the patient information sheets “Chemobrain: Frequently Asked Questions” and “Chemobrain: Tips for Returning to Work.” Other Side Effects of Chemotherapy: Pain, Nerve and Muscles Effects, Memory/Attention/Concentration © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 07/19/12 Patient Education Office Page 3 of 3 Other Side Effects of Chemotherapy Skin, Hair and Nails Side effects such as hair loss, changes in skin color or texture, or cracked or brittle nails may occur during chemotherapy. Some chemotherapy medicines cause these changes, others do not. Ask your nurse or pharmacist about the specific medicines that you will be taking. Acne Your doctor may prescribe a lotion or other medication to treat acne. Dry Skin • Bathe in lukewarm water. Avoid long, hot showers and bubble baths. • Use mild soaps without perfume. • Pat yourself dry instead of rubbing. • Keep your skin moisturized. Use creams or lotions such as Eucerin®, Lubriderm®, ® ® ® ® Vanicream , Aquacare , Complex 15 Hand and Body , or Aquaphor after you bathe. • Avoid perfume, cologne or aftershave lotion – these products often contain alcohol, which can cause dryness and irritation to the skin. • Drink plenty of fluids to stay hydrated. • For more information, ask your health care provider for a copy of “General Instructions for Dry/Sensitive Skin Care.” Sensitivity to Sunlight • You may sunburn more easily. Sunlight may also cause a skin rash. • Avoid prolonged exposure to sunlight; do not use sunlamps or tanning beds. • Check with your doctor or nurse about using a PABA-free sunscreen (at least SPF 30 or greater) and lip balm, no matter what your skin tone. You may need to avoid direct sunlight completely. • Wear protective clothing (i.e., long-sleeved cotton shirts, hats, sunglasses, pants) to protect your skin from the sun. Skin Rash and/or Itching • Report any skin rash, blisters, itching, redness or peeling on your skin to your doctor or nurse immediately. • Ask your doctor about medications to relieve itching. Over-the-counter antihistamines such as diphenhydramine (for example, Bendadryl®) may help to relieve the itching. Other Side Effects of Chemotherapy: Skin, Hair and Nails © 2001, 2012 The University of Texas MD Anderson Cancer Center, 07/19/12 Patient Education Office Page 1 of 2 • • A bath with mild soap such as Dove®, Tone®, Basis®, Lubriderm Body Bar®, Lowila®, Oilatum®, or Emulave® may be soothing. Wear loose fitting clothing. Hair Loss or Thinning Hair loss (known as alopecia) can occur on all parts of the body including the head, face, arms, legs, underarms and pubic areas. It may involve only mild thinning or complete loss of hair. Hair loss is usually temporary. It does not normally happen right away. It can start anywhere from 7 to 21 days after treatment begins. If you lose hair, it will almost always grow back after you have completed treatment; however, it may grow back a different color or texture than what you had before. If you experience hair loss, keep your scalp clean and moisturized to prevent skin breaks. Use sunscreen, sun block, a hat, scarf, or wig to protect your scalp from the sun. You may want to use a soft head covering such as a scarf or wig until your hair grows back. Some health insurance policies will pay for the cost of a wig during chemotherapy treatment. MD Anderson’s Beauty and Barber Shop provide shampoos, shaves, wigs, scarves and hats at no cost to patients. Call 713-792-6039 for more information. Other suggestions include: • Protect your hair from added stress by using mild shampoos and soft hair brushes. Also, avoid using heat appliances, such as blow dryers, curling irons, and hot rollers. If you must use heat appliances, use the lowest setting. Pat your hair dry. • Consider a shorter hairstyle. Shorter styles often appear thicker and fuller than most other styles, and will make hair loss easier to manage if it occurs. • If you decide to cover your head with a wig, plan to buy your wig before you lose a lot of hair. That way, you can more closely match your original style and color. Effects on Nails Changes in your fingernails or toenails may occur while you are receiving treatment. Your nails may become darkened, and/or develop white streaks or ridges. They may become brittle, dry and cracked, and lift up from the nail bed. Changes such as these are temporary, and will take time to grow out. It is important, however, that you protect your hands and feet if these changes occur; if not, your chance of developing infections may increase and nail loss could occur. • Do not cut your nails; instead, gently file them. • Do not get professional manicures or pedicures. • Use lotions and creams to keep your nails and cuticles healthy. • Wear gloves while working around the house or yard to protect your hands. • Do not use any nail-strengthening products, as they may cause irritation to your skin or nails. • Remove artificial nails. These tend to be a good breeding area for fungal infection and can lead to serious treatment-related problems. • Tell your doctor about any redness, pain or other changes that occur around your cuticles or if your nail problems do not respond to your efforts. Other Side Effects of Chemotherapy: Skin, Hair and Nails © 2001, 2012 The University of Texas MD Anderson Cancer Center, 07/19/12 Patient Education Office Page 2 of 2 Nutrition A Pathfinder The Learning Center provides materials for information and convenience only. They are not to be substituted for medical advice. Medical information is often controversial and continually changes. Please talk to your doctor about your specific concerns. The Learning Center provides a wide range of materials, and each location has different resources. Please call ahead to learn which location has the resources you need. To learn more or ask questions, please call, email or visit The Learning Center. Levit Family Learning Center Mays Clinic Floor 2, near The Tree Sculpture, Room ACB2.1120 Monday – Friday, 9 a.m.-4 p.m. 713-563-8010 http://www.mdanderson.org/tlc Email: email@example.com Theodore N. Law Learning Center Main Building Floor 4, near Elevator A, Room R4.1100 Monday – Friday, 9 a.m.-4 p.m. 713-745-8063 Pamphlets Cooking Smart. American Cancer Society. 2009. Eating Hints for Cancer Patients: Before, During and After Treatment. National Cancer Institute. 2009. The New American Plate Series. American Institute for Cancer Research. 2010. Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families. American Cancer Society. 2008. Nutrition of the Cancer Patient. American Institute for Cancer Research. 2007. Staying Lean for Cancer Prevention. American Institute for Cancer Research. 2008. Periodicals American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity. American Cancer Society. American Institute for Cancer Research Newsletter. American Institute for Cancer Research. Nutrition: A Pathfinder © 2000, 2013 The University of Texas MD Anderson Cancer Center, Revised 01/03/13 Patient Education Office Page 1 of 5 Environmental Nutrition. Environmental Nutrition. Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. American Cancer Society. Tufts Health and Nutrition Letter. Tufts Media. Books ACSM’s Guide to Exercise and Cancer Survivorship. Irwin M. QZ 266 A187 2012. Anticancer: A New Way of Life. Servan-Schreiber D. QZ 200 S378 2009. American Cancer Society Complete Guide to Nutrition for Cancer Survivors: Eating Well, Staying Well During and After Cancer. Grant B. QZ 266 A512 2010. American Dietetic Association Complete Food and Nutrition Guide. Duyff R. QU 145 D988a 2012. The Anti-Cancer Cookbook. J Greer. WB 405 G816a 2008. *Bowe’s & Church’s Food Values of Portions Commonly Used. Pennington J. QU 145 P414b 2005. The Cancer-Fighting Kitchen: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery. Katz R. WB 405 K19c 2009. Cancer Nutrition Center Handbook: An Essential Guide for Cancer Patients and Their Families. Katzin C. WB 405 K19e 2011. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. Campbell T. QT 235 C191c 2005. Eating Well Through Cancer: Easy Recipes & Recommendations During & After Treatment. Clegg H. WB 405 C624e 2006. The Essential Cancer Treatment Nutrition Guide and Cookbook: Includes 150 Healthy & Delicious Recipes. Lamantia J. WB 405 L214e 2012. Everything Cancer-Fighting Cookbook. Katzin C. QZ 266 K19c 2011. Food Matters: A Guide to Conscious Eating With More Than 75 Recipes. Bittman M. QU 145 B625f 2009. *Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund, American Institute for Cancer Research. Ref QZ 266 F686 2007. *Foods That Harm, Foods That Heal: An A-Z Guide to Safe and Healthy Eating. Reader’s Digest Association. QU 145 F686 2004. Foods to Fight Cancer. Beliveau R, et al. QZ 200 B431f 2007. Forks Over Knives: The Plant-Based Way to Health. Stone G. WB 405 F721 2011. Goes Down Easy: Recipes to Help You Cope With the Challenge of Eating During Cancer Treatment. Mecklinger E. WB 405 M487g 2006. How to Cook Everything Vegetarian: Simple Meatless Meals for Great Food. Bittman M. WB 405 B624h 2007. In Defense of Food: An Eater’s Manifesto. Pollan M. QU 145 P771i 2008. *Integrating Therapeutic and Complementary Nutrition. Marian M, et al. QU 145 I608 2007. *Indicates reference only (unavailable for check out) Nutrition: A Pathfinder © 2000, 2013 The University of Texas MD Anderson Cancer Center, Revised 01/03/13 Patient Education Office Page 2 of 5 *The Mediterranean Diet: A Clinician’s Guide for Patient Care. Zacharias E. QU 145 Z16m 2012. *Modern Nutrition in Health and Disease. Shils M. QU 145 M689 2006. The New Mayo Clinic Cookbook. Hensrud D, Nelson J. WB 405 N5322 2012. *Nutrient-Drug Interactions. Meckling KA. QV 38 N976 2007. Nutrition and Cancer: Practical Tips and Tasty Recipes for Survivors. Luthringer K. WB 405 L973n 2011. *Nutrition in the Prevention and Treatment of Disease. Coulston A. QU 145 N9789 2008. *Nutritional Issues in Cancer Care. Kogut V, Luthringer S. QU 145 N9774 2005. *Nutritional Management of Cancer Treatment Effects. Kumar N. QZ 266 K96n 2012. *Nutritional Oncology. Heber D. QZ 266 N9763 2006. One Bite at a Time: Nourishing Recipes for Cancer Survivors and Their Friends. Katz R. WB 405 K19o 2008. The 150 Healthiest Foods on Earth: The Surprising, Unbiased Truth About What You Should Eat and Why. Bowden J. QU 145 B785t 2007. *Present Knowledge in Nutrition. 10th ed. Erdman J, MacDonald I, eds. 2012. QU 145 P933 2012. The Survivor’s Handbook: Eating Right for Cancer Survival. Barnard N. QU 145 B259s 2006. The Top 100 Immunity Boosters. Haigh C. QU 145 H149t 2005. Veganomicon: The Ultimate Vegan Cookbook. Moskowitz IC, Romero TH. WB 405 M911v 2007. *Vegetarian Nutrition. Sabetel J. Ref QU 145 V422 2001. What to Eat. Nestle M. QU 145 N468w 2006. What To Eat During Cancer Treatment: 100 Great-Tasting, Family-Friendly Recipes to Help You Cope. Besser J. WB 405 W555 2009. Audio The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. Campbell T. QT 235 C191c 2005. Superfoods Audio Collection. Pratt S. QU 145 P917sa 2006 CD. Video Dr. Andrew Weil’s Guide to Eating Well. Weil A. QU 145 DVD 3850 2007. Eating Right for Cancer Survival. Barnard N. QZ 266 DVD 4073. Evidence-Based Nutrition in Cancer Care: Current Evidence and Controversies. Abrams D. QZ 266 DVD 4059 2009. Food for the Fight: Guidelines for Healthy Nutrition During and After Cancer Treatment. American Institute for Cancer Research. QZ 200 DVD 4014 2008. Forks Over Knives. Fulkerson L. WB 405 DVD 4155 2011. Healthy Body, Healthy Mind: Nutrition and Exercise. Krichmar P. QU 145 DVD 1229 2006. *Indicates reference only (unavailable for check out) Nutrition: A Pathfinder © 2000, 2013 The University of Texas MD Anderson Cancer Center, Revised 01/03/13 Patient Education Office Page 3 of 5 Nutrition and Cancer. The University of Texas MD Anderson Cancer Center. QZ 200 DVD 1228 2005. Websites The University of Texas MD Anderson Cancer Center, Department of Clinical Nutrition http://www.mdanderson.org/education-and-research/departments-programs-andlabs/departments-and-divisions/clinical-nutrition/index.html The Department of Clinical Nutrition’s website gives information for the public and cancer patients. The site includes links to Complementary Therapies. The link to Education gives information on side effects, recipes and nutrition for cancer patients. The American Dietetic Association Home Page http://www.eatright.org/ The home page of the nation’s largest organization of food and nutrition professionals gives objective food and nutrition information for optimal nutrition, health and well-being. Although partially restricted to ADA members, consumers may search for healthy lifestyle tips and use online tools, brochures, reading lists and links to other nutrition resources. American Cancer Society http://www.cancer.org/ This comprehensive cancer site gives nutrition information for the cancer patient. Use the search bar and type “nutrition” to find information. Topics include nutrition for the cancer patient and cancer survivor, nutrition during and after treatment, handling side effects and much more. Search “cooking smart” to find general information and tips on healthy cooking. American Institute for Cancer Research http://aicr.org AICR fosters research on diet and cancer prevention and educates the public about the results. This site contains valuable research-based information. Subscribe to a free e-newsletter and weekly healthy recipes. Access the Nutrition Hotline online or by telephone where you can submit questions to an AICR registered dietitian. Center for Disease Control and Prevention - Fruits and Veggies Matter http://www.fruitsandveggiesmatter.gov http://www.fruitsandveggiesmorematters.org These sites feature information about the National Fruit & Vegetable Program. The goal is to promote health through increased consumption of fruits and vegetables. Fruits & Veggies – More Matters is a national public health initiative created to encourage Americans to eat more fruits and vegetables. The sites offer meal planning assistance, recipes, a fruit and vegetable nutrition database and links to additional nutrition resources. National Cancer Institute The following are links to the “Nutrition in Cancer Care (PDQ®)” found on the NCI website. This document is available in patient and health professional versions. The health professional Nutrition: A Pathfinder © 2000, 2013 The University of Texas MD Anderson Cancer Center, Revised 01/03/13 Patient Education Office Page 4 of 5 version gives references with links to PubMed. These documents are also available in Spanish by using the “En español” tab. Patient Version http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/patient Health Professional Version http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/HealthProfessional Nutrition.gov http://www.nutrition.gov This site gives access to food and nutrition information from across the federal government. It is a gateway to reliable information on nutrition, healthy eating, physical activity and food safety for consumers. Specialized nutrition information is provided about infants, children, teens, women, men and seniors. Find practical information on healthy eating, dietary supplements, fitness and food safety. Nutrition Data http://www.nutritiondata.com In addition to tools like the Daily Needs Calculator and the Nutrient Search Tool, Nutrition Data gives a complete nutrient analysis for any food or recipe and helps you select foods that best match your dietary needs. Nutrition: A Pathfinder © 2000, 2013 The University of Texas MD Anderson Cancer Center, Revised 01/03/13 Patient Education Office Page 5 of 5 Food Safety Tips When patients have cancer treatments, their immunity may be compromised. This means they can more easily get infections. Proper food handling and food preparation methods should reduce the risk of food-related infections. Wash hands with warm soapy water for 20 seconds before preparing, cooking or eating food. Wear clean clothes during food handling. Clean counter tops by washing with hot soapy water and rinsing thoroughly. Sanitize with a solution containing chlorine bleach. (1 part bleach to 10 parts water). Use separate cutting boards for raw vegetables/fruits and raw meats. Cleanse each board thoroughly between cutting each food item. Use clean utensils and knives. Use a clean knife every time you cut a different food. Never use the same spoon for tasting food as you are using to stir the food. Place raw meat and poultry packages in plastic bags before putting them in the shopping cart with other fresh foods. Refrigerate foods promptly after shopping or cooking. Cover foods on refrigerator shelves. Cold foods should be stored at or below 40o F. Suggested storage times for refrigerated foods: Raw fish and seafood – 1 to 2 days Raw meat, chicken, or turkey – 2 to 3 days Leftovers – 3 to 4 days Luncheon meats – 4 to 7 days Milk – 5 days Raw fruits and vegetables – 7 days Eggs – 7 to 14 days Do not store raw meat, poultry or fish in direct contact with prepared foods. Always place cooked foods above raw foods in the refrigerator to prevent contamination. Thaw meat and poultry in the refrigerator, not at room temperature. Cover thawing meats and place them on bottom shelf separate from other foods. Wash all fruits and vegetables thoroughly before cutting. Use a vegetable brush designed for this purpose. Eat fully cooked meats, poultry, fish, and eggs. Meat should be cooked to 160o F and poultry to 180o F. Avoid eating dishes that contain raw eggs or fish, such as Caesar salad dressing, sushi, raw cookie dough and cake batter, hollandaise sauce, and homemade eggnog or ice cream. Do not purchase foods from shared bins in grocery stores or from street vendors. Food Safety Tips © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 10/03/12 Patient Education Office Page 1 of 2 Avoid open salad bars at restaurants. Consume only pasteurized milk, cheeses, yogurts and juices. Observe expiration dates on foods. Throw away any food which looks rotten, slimy or molded. Maintain and check the temperatures for your refrigerator and freezer, about every 6 months: Refrigerator – 20 to 40 degrees Fahrenheit Freezer – 0 degrees Fahrenheit or lower If drinking water from a private well is approved by your doctor, then your drinking water needs to be tested annually. Contact the health department or local water department in your area, to find out how to test it. Food Safety Tips © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 10/03/12 Patient Education Office Page 2 of 2 Side Effect Management: Nutrition Related Tips Side effects are different for every patient and can be managed. Common ones include: nausea and vomiting, loss of appetite, changes in taste and smell, fatigue, weight loss, mouth sores, diarrhea and constipation. By following the tips below, you can take an active role in your care. Nausea and Vomiting Medicines work well to control nausea and vomiting, but making changes in your diet can also be helpful. Foods Eat small amounts of food six to eight times per day to help keep something in your stomach. Snack on dry foods between meals such as crackers, toast, cereal or breadsticks. Try not to eat your favorite foods when you have nausea or vomiting. Later, you may associate these foods with nausea. Avoid greasy or spicy foods and foods with strong smells. Cold and bland foods may be more appealing because they tend to have fewer odors. Try lemon drops, mints, ginger candy and tart foods (such as pickles and lemons) which are helpful for some patients. Fluids Drink 8 to 10 cups (1 cup = 8 ounces) of fluids per day or discuss your needs with your dietitian. Try clear soups, flavored gelatin, lemonade, popsicles, mint or ginger tea and ice chips made of any kind of liquid. Drink fluids between meals instead of with meals. Drink fluids from a cup with a lid and sip through a straw if smells are triggering nausea. Additional Tips Take nausea medicine 30 minutes before meals. Keep your head elevated by 30 degrees or sit up for at least 30 minutes after eating. Eat in a well-ventilated area or outside to avoid strong smells. Ask a friend or family member to prepare your meals for you. Side Effect Management: Nutrition Related Tips ÂŠ The University of Texas MD Anderson Cancer Center, 01/26/11 Patient Education Office Page 1 of 4 Loss of Appetite Try these suggestions to help maintain weight and keep energy levels up: Eat every two to three hours and choose foods and fluids that are high in calories and protein. Avoid fried or greasy foods. Keep snacks available like: peanut butter and crackers, cheese and crackers, high protein smoothies, granola bars, nuts and liquid nutrition supplements. Take advantage of hunger. Eat your largest meal when you are most hungry. Light exercise like walking, before a meal may help increase your appetite. Changes in Taste and Smell Practice good mouth care. Brush your teeth and tongue after every meal. Rinsing your mouth with a baking soda solution before eating may help. To make the solution, mix 1/4 teaspoon of baking soda in 4 ounces of water. To decrease the smell of foods, eat foods cold or at room temperature. For soups or fluids, try using a cup with a lid and sip through a straw. If you have a metallic taste in your mouth, try using plastic utensils and avoid canned food. For salty or bitter tastes, try adding honey, agave nectar, maple syrup or jam to foods. For sweet tastes, increase salty and tart flavors with lemon wedges, citrus fruits, vinegar, pickled foods or salt (avoid these if you have a sore mouth or throat). Try adding seasonings to your food such as basil, oregano, mint, rosemary, tarragon, onion, garlic, barbeque sauce, chili powder, ketchup or mustard to make foods taste better. Marinate and cook meat in sweet juices, sauces, fruits, acidic dressings or wines. If you are unable to eat meats due to taste changes, make sure to include plenty of other protein sources in your diet. Foods high in protein include fish, eggs, beans, nuts, soymilk, tofu, milk, cheese, yogurt and peanut butter. To clear your taste buds or remove a taste from your mouth, try these: sugar-free gum and peppermints, pickles, lemons or lemon drops, lemon or lime sorbet or frozen fresh fruits, such as grapes, melon or oranges. Fatigue Drink 8 to 10 cups (1 cup = 8 ounces) of fluids per day or discuss your needs with your dietitian. Eat a well balanced diet that includes fruits, vegetables, whole grains and quality protein sources. Let friends and family prepare meals or bring them to you. Buy ready-to-eat pre-portioned meals or make high protein smoothies. On days that you feel rested, cook extra food and freeze it. Eat small, frequent meals instead of larger meals and keep snacks handy. Keep naps short to prevent skipping a meal. Light activity and walking can give you more energy and improve your appetite. Side Effect Management: Nutrition Related Tips ÂŠ The University of Texas MD Anderson Cancer Center, 01/26/11 Patient Education Office Page 2 of 4 Weight loss Adding calories and protein to your diet can help slow or stop weight loss. Healthy, High-Calorie Food and Beverage Choices Honey and jam Dried fruit and fruit juices Olive, canola and almond oil Avocado Instant breakfast drinks and powders* Liquid nutritional supplements like Boost® or Ensure® High-Protein Foods Beans and legumes Cooked meats, poultry and fish Eggs Milk, yogurt and cottage cheese* Meat alternatives from vegetable protein (veggie burgers) Soy milk and tofu Nuts and nut butters like peanut butter *These products may contain lactose. If you are lactose intolerant, consider using lactose-free milk, soy milk and lactose-free cheese. Mouth Sores Choose soft, moist foods. Avoid rough-textured, acidic, tart and spicy foods that may cause irritation. Cut foods into small bites. Puree foods in a blender by adding liquids such as milk or broth. Drink through a straw to help push the food beyond painful areas. Avoid extremely hot foods and extremely cold foods. Try drinking fluids and eating foods that are at room temperature. Drink 8 to 10 cups (1 cup = 8 ounces) of fluids per day or discuss your needs with your dietitian. Practice good mouth care. Brush your teeth and tongue after every meal. Rinsing your mouth with a baking soda solution before eating may help. To make the solution, mix 1/4 teaspoon of baking soda in 4 ounces of water. Side Effect Management: Nutrition Related Tips © The University of Texas MD Anderson Cancer Center, 01/26/11 Patient Education Office Page 3 of 4 Diarrhea Drink 8 to 10 cups (1 cup = 8 ounces) of fluids per day or discuss your needs with your dietitian. Drink the majority of your fluids between meals rather than with meals. Sodium and potassium (electrolytes) are lost when you have diarrhea. Eat salted crackers, pretzels or broth to replace sodium. Consume potatoes (without skin), bananas and juices such as carrot, orange and papaya to replace potassium. Include electrolyte drinks such as G2® (Gatorade® product), Pedialyte® and mixing equal parts of Gatorade® or Powerade® with equal part water. Eat small frequent meals. Limit high-fiber foods such as dried peas and beans, seeds, whole grains and high-fiber fruits and vegetables or those with thick peels and skins. Limit high-fat foods such as fried food, greasy food, rich desserts (pies, cakes and cookies) and excessive amounts of butter, oil and cream. Avoid alcohol, caffeine, spicy foods and hot fluids (including soup) which cause food to move more quickly though the intestines. Limit or avoid dairy products if they make diarrhea worse. Constipation Fiber Intake Fiber helps bowel movements by making stools softer and easier to pass. Gradually increasing fiber in your diet will help decrease gas, bloating and abdominal cramps. Eat dry cereals with more than 4 grams of fiber per serving, such as Raisin Bran®, All Bran®, ® ® Shredded Wheat or Fiber One . Eat whole grains such as brown rice, barley, quinoa, oats and 100% whole grain breads instead of white rice and potatoes. Add wheat germ or bran to cereal, yogurt, salads, casseroles or baked products. Add more beans and legumes in your diet. Eat at least five servings of fruits and vegetables daily. Choose snacks such as raw fruits and vegetables, nuts, seeds or popcorn. Adequate Fluid Intake Drink 8 to 10 cups (1 cup = 8 ounces) of fluids per day, or discuss your needs with your dietitian. Drink the majority of your fluids between meals rather than with meals. Drink warm prune juice or other warm drinks which cause foods to move more quickly through the intestines. Exercise Regular moderate exercise (as tolerated), such as walking, can strengthen and stimulate the muscles that help move food and stool through the digestive system. For more information or to schedule a nutrition consultation, please call the Department of Clinical Nutrition at 713-563-5167. Side Effect Management: Nutrition Related Tips © The University of Texas MD Anderson Cancer Center, 01/26/11 Patient Education Office Page 4 of 4 Coping and Assistance During Chemotherapy People affected by the diagnosis and treatment of cancer often find this to be a trying time. There are a number of people here at MD Anderson to help. I’m feeling angry or afraid about my cancer and chemotherapy. What can I do? Cancer treatment causes major changes in your life. It is not unusual to feel fearful, angry or depressed during treatment. Tell your doctor or nurse about any mood swings or emotional changes. Talking with someone about how you feel can help. Cancer survivors say that it is a mistake to try to go through the cancer experience alone. Maintain close friendships with people who are caring and supportive. You will need all your emotional strength to fight cancer. For this reason, you need friends who will let you be yourself - friends with whom you can relax. Counseling can also help. Sometimes it is easier to talk to someone outside of your circle of friends or family. Social work counselors are available to provide individual or family counseling to help you cope with the impact and changes that result from a diagnosis of cancer. Another option to consider is a support group. Support groups offer a chance to share concerns and tips with others who are going through the same experience in a safe, private setting. Your social work counselor can give you information about local support groups near you. Contact your social worker counselor at 713-792-6195. How do I talk with my children about what I am going through? Many patients have children and teenagers who may need help coping with a parent’s cancer and treatment. In addition, some parents may wonder about the best way to talk about their diagnosis and treatment with their children and teens. Accurate information and good communication among family members can contribute to improved coping in children, teens and the family as a whole. The KIWI program (Kids Inquire, We Inform) aims to teach coping strategies to parents and their children, as well as facilitate communication among family members. To learn more about KIWI, contact your social work counselor at 713-792-6195. Coping and Assistance During Chemotherapy © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/20/12 Patient Education Office Page 1 of 4 I cannot afford treatment. The bills keep piling up. Is help available? The financial impact of cancer treatment can add to the overall stress and anxiety of the cancer experience. Social work counselors are available to assess your unique situation and look for any available resources at MD Anderson or in the community that can help with a variety of needs. Often, the hardest part is building up enough courage to just ask for help. It’s important to remember that the resources available are in place for people who are going through the exact situation you and your family might be experiencing. I cannot make it to all of my appointments with work, transportation issues and needing child care. What should I do? We understand that life gets busy with work, family and other obligations. However, it is important for your treatment that you make it to all of your appointments. Resources are available to help you overcome some of the issues you may face. Talk with your patient service coordinator (PSC) about scheduling your appointments at times that work best for you. This may not be possible for all appointments, but it can help with some. If transportation to and from your appointment is a problem, talk with your social work counselor. You may qualify for a transportation assistance program in the community. If child care is needed, MD Anderson has two Child Visitation Rooms. They offer free short-term child care for children ages 2 months to 12 years. Toys, movies and video games are available. For more information, call 713-745-0577. I am a friend or family member of a patient having chemotherapy. Helping to care for them can be overwhelming. What can I do? Being the caregiver for someone undergoing chemotherapy can be difficult and exhausting. Rely on your support system to help as much as you can. Often people want to help, but do not know what to do. Be specific when asking for help and support. Have a list ready when someone offers to help or when you see an opportunity to ask. Your task list may contain items like run errands, prepare meals, do housework, pay bills, take your loved one to an appointment or care for children after school. Take time to care for yourself to avoid care giving fatigue. Your own rest and taking time to enjoy things for yourself isn’t selfish. It is necessary. You are not alone in how you feel. There are services and support available at MD Anderson to help caregivers cope with their loved one’s treatment. The Department of Social Work provides counseling and support to family members and other caregivers of patients. For more information, call 713-792-6195. There is also a support group for caregivers, called “Caregivers: I’ve Got Feelings, Too.” To learn more about this support group, call 713-794-4700. The Anderson Network, a network of cancer survivors, provides support to current patients and their caregivers. To find out more about their caregiver support programs, call toll free 800-345-6324. Coping and Assistance During Chemotherapy © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/20/12 Patient Education Office Page 2 of 4 I’m feeling overwhelmed and stressed. What resources are available to help me relax? Relaxation and coping resources, such as books, CDs, videos and classes are available to you in several MD Anderson locations: Department of Social Work The Department of Social Work has licensed social work counselors who can provide a variety of coping, relaxation and self-hypnosis interventions to help patients with stress reduction, pain management, and lowering anxiety during various medical treatments and procedures. For more information, call 713-792-6195. Integrative Medicine Center The Integrative Medicine Center aims to work collaboratively with your primary oncology team to build an integrative care plan. Services include an integrative medicine consultation, dietary counseling, oncology massage and acupuncture. Group classes, such as yoga, tai chi and meditation are available at no charge. For more information, call 713-794-4700. Patient and Family Library The Patient/Family Library offers books (including foreign language books), magazines, newspapers, puzzles, audiobooks and CD players for patients and family members to check out. Main Building, Floor 1, near The Aquarium, Room R1.2212 713-792-1080 The Learning Center The Learning Center provides the latest information on cancer care, support, prevention and general health and wellness issues. Helpful staff and volunteers guide customer information searches and help visitors locate the information they need. Locations include: • Law Learning Center Main Building, Floor 4, near Elevator A, Room R4.1100 – 713-745-8063 • Levit Learning Center Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120 – 713-563-8010 • Holden Foundation Learning Center Jesse H. Jones Rotary House International, Floor 1 – 713-745-0007 Some samples of resources available in The Learning Center include: Books Cancer is a Word, Not a Sentence. Buckman, R., 2007. Chicken Soup For the Soul: The Cancer Book: 101 Stories of Courage, Support and Love, Canfield, J., 2009. Chill Out: 100 Creative Ways to Relax. Craze, R., 2001. Relaxation and Stress Reduction Workbook. Davis, M., 2008. Cancer Fear and Stress Relief Program: Relieve Fear and Stress During Cancer Treatment and Recovery. Murray, S., 2006. Coping and Assistance During Chemotherapy © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/20/12 Patient Education Office Page 3 of 4 What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope. Silver, J., 2009. Face to Face With Cancer: Comfort and Practical Advice for Sufferers and Carers. Stroud, M., 2004. Living With Cancer: A Practical Guide. Visel, D., 2006. CDs Inner Peace: Soothing Music for Body, Mind & Soul. Halpern, S., 2005. Optimizing Chemotherapy. Miller, E., 2008 Relax Into Healing Deep, Healing Sleep. Hopps, N., 2001. Self Healing with Guided Imagery. Weil, A., Rossman, M., 2003 Your Present: A Half Hour of Peace. Mantell, S., 2000 Drops of Nectar. Rea, S., 2003. Meditations for Difficult Times. Siegel, B., 2004. Videos Visions For Cancer Recovery: A Health Meditation and Guided Visualization. Hallman, M., 2004. Relaxation and Breathing for Meditation. Lesky, A., 2003. The Garden of Now: Mindfulness Meditation and Stress Reduction for Beginners. Turesky, D., 2010 MDA-TV Selected videotapes are also available for viewing through MDA-TV, an in-house cable television system within MD Anderson Cancer Center. A current listing of these videotapes can be found in the “Patient Education Guide.” Look under the "Mind Body” subtitle for a listing of relaxation and coping videos. If you do not have this pamphlet, ask your health care professional for a copy. Also available through MDA-TV is a Relaxation Channel on Channel 20. Coping and Assistance During Chemotherapy © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/20/12 Patient Education Office Page 4 of 4 Outside Organizational Resources American Brain Tumor Association 800-886-2282 http://www.abta.org/care-treatment/support-resources/ A national organization that provides a listing of support groups, a pen-pal program, a newsletter, and a list of clinical studies for brain tumors. American Cancer Society 800-ACS-2345 (800-227-2345) http://www.cancer.org Not-for-profit organization that supports cancer research. ACS offers patients and their families many services including educational programs, support groups, and free booklets. Can Care of Houston, Inc. 713-461-0028 or 888-461-0028 http://www.cancare.org Cancer Support Network made up of cancer survivors and family members of cancer survivors. CancerCare 800-813-HOPE (800-813-4673) http://www.cancercare.org A national, nonprofit social service agency that provides free emotional support, information, and practical help to people with cancer and their loved ones. Offers online teleconferences, referrals to support services, and other services. Cancer Information Service 800-4-CANCER (800-422-6237) Nationwide hot line provides information on cancer detection, diagnosis, treatment (including clinical trials), rehabilitation, and prevention. Provides information on counseling, home care services, hospice, and screening programs nationwide. Caregiver.Com http://www.caregiver.com firstname.lastname@example.org Includes topic specific newsletters and online discussions for caregivers. Caregiver.com produces Today's Caregiver magazine, the first national magazine dedicated to caregivers. Outside Organizational Resources ÂŠ 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 1 of 3 Colon Cancer Alliance http://www.ccalliance.org The Colon Cancer Alliance has information, support and resources for people with colorectal cancer. Crisis Hot Line 713-228-1505 (English) or 713-526-8088 (Spanish) A 24-hour confidential telephone counseling service for emotional or stress-related problems. Staffed by trained volunteers. Disability Info – Federal Government http://www.disabilityinfo.gov A federal government website designed to provide people with disabilities access to the information they need quickly and easily. Fertile Hope: A LIVESTRONG Initiative 866-965-7205 http://www.fertilehope.org A national, nonprofit organization dedicated to providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility. Hospice Foundation of America 800-854-3402 http://www.hospicefoundation.org Provides information on terminal illness, death and the process of grief and bereavement. Lance Armstrong Foundation http://www.livestrong.org The Lance Armstrong Foundation’s LIVESTRONG website covers survivorship topics on the physical, emotional and practical issues of cancer. Leukemia & Lymphoma Society 800-955-4572 http://www.lls.org Provides information for patients with lymphoma or leukemia, including support groups and financial assistance. lungcancer.org http://www.lungcancer.org This site offers general information on all aspects of lung cancer for patients and caregivers. It also contains a section that addresses the latest clinical trials, teleconferences, meetings and other resources. A unique aspect of this website is “Ask the Expert” where you can e-mail questions to an oncology nurse, and a response is given within 48 hours. Outside Organizational Resources © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 2 of 3 National Coalition for Cancer Survivorship 888-650-9127 http://www.canceradvocacy.org/ Answers questions and directs callers to local groups and individuals. Offers information on legal issues and discrimination. Patient Advocate Foundation 800-532-5274 http://www.patientadvocate.org Serves as a liaison between patients and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters relating to a patient's condition. Susan G. Komen for the Cure 877-GO-KOMEN (877-465-6636) http://www.komen.org A helpline staffed by trained volunteers to provide breast health and breast cancer information. United Ostomy Associations of America 800-826-0826 http://www.uoaa.org An association dedicated to complete rehabilitation of all "ostomates". United Way Help Line Houston Dial 2-1-1 Trained volunteers provide 24-hour telephone counseling and referral to appropriate agencies/services. Us-Too International, Inc. 800-808-7866 http://www.ustoo.com/ Support for patients with prostate cancer. Visiting Nurse Association of America 800-426-2547 http://www.vnaa.org Provides information on all aspects of home health care. Additional Resources Websites and other resources are available on specific cancer sites. The MD Anderson Learning Center creates pathfinders for specific cancer types and subjects. Pathfinders contain references to available print, video and online resources. To find a pathfinder for your type of cancer, visit The Learning Center website at www.mdanderson.org/TLC. Outside Organizational Resources ÂŠ 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 3 of 3 Appearance Information for Patients on Chemotherapy If you are undergoing chemotherapy, there has never been a more important time to give yourself some special care - including special care for your appearance. When you look your best, you feel better; and when you feel better, it may be easier to cope with cancer and chemotherapy. Resources to Help You in Caring for Your Appearance During Chemotherapy Treatment Volunteer Beauty and Barber Shop Located in the Main Building, Floor 6, near Elevator F, Room G6.3253. Staffed by a licensed cosmetologist, this shop offers a selection of free wigs, hats, scarves, turbans and bandanas for women and free caps, hats and bandanas for men. If men are interested in hair pieces, referrals can be made. Shampoos, haircuts, shaves and scalp treatments also are available. Shop hours are 8:00 a.m. to 5:00 p.m. Monday through Friday. All services are offered on a first come, first served basis. No appointment is necessary. Head-wrapping demonstrations using scarves and hats are given every Thursday from 11 a.m. to 1 p.m. For more information or to register call 713-792-6039. The "Look Good...Feel Better" program The “Look Good…Feel Better” program is a free program to help women undergoing cancer treatment learn to cope with the appearance-related side effects of treatment. It is held the first Thursday of the month from 11:30 a.m. to 1 p.m. For more information or to register call 713792-6039. Videotapes The following videotape can be viewed on any MD Anderson “on-demand.” “Scarves - A Fashionable Alternative” A former model who was treated for breast cancer demonstrates dozens of ways to cover hair loss using scarves, and how to coordinate clothes and accessories for a total look. Appearances Appearances, a retail shop, offers specialized products and services such as breast prostheses, head coverings, sun protective clothing, clothing to accommodate mastectomy and reconstructive surgery patients, cosmetics and motivational materials. It is open weekdays from 9 a.m. to 5 p.m. and located in the Mays Clinic on Floor 2 near The Tree Sculpture in Room ACB2.1502. Appearance Information for Patients on Chemotherapy © 1997, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/20/12 Patient Education Office Page 1 of 1 Resources at MD Anderson Cancer Center Anderson Network 713-792-2553 or (800-345-6324) A group of current and former cancer patients who are ready to reach out with understanding, resources, support and hope. You can call and talk with a cancer survivor with the same diagnosis and treatment and learn of other support programs available for you. You can also visit our Anderson Network volunteers at one of the two Hospitality Center locations: • Main Building, Floor 2, near The Sundial or call at 713-794-1055, or • Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1002 or call at 713-563-8299 Appearances 713-563-8200 Appearances, a retail shop, offers specialized products and services such as breast prostheses, head coverings, sun protective clothing, clothing to accommodate mastectomy and reconstructive surgery patients, cosmetics and motivational materials. It is located in the Mays Clinic, Floor 2, near The Tree Sculpture in Room ACB2.1502. Beauty/Barber Shop 713-792-6039 The Beauty/Barber Shop offers patients shampoos, haircuts, shaves, as well as wigs, scarves and hats to all current MD Anderson patients. Services are provided by Volunteer Services at no charge. Appointments are not necessary. The shop is located in the Main Building, Floor 6, near Elevator F in Room G6.3253. Chaplaincy 713-792-7184 The Department of Chaplaincy and Pastoral Education offers pastoral care and spiritual support to all patients, family members and staff through regular chapel services, intercessory prayers, and sacramental ministry. Meditation/Prayer Rooms are located throughout the campus and a Muslim Prayer Room is located in the Main Building on Floor 3 near Elevator E. You can visit the Chapel at the following locations: • Main Building, Floor 1, near The Café Corner in Room R1.2800 • Mays Clinic, Floor 2, near The Tree Sculpture in Room ACB2.1035 Resources at MD Anderson Cancer Center © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 1 of 3 Cyber Center 713-795-2830 The Cyber Center provides a well-equipped business office with fax services; computer workstations with Internet access; a printer and copier; and TV/VCRs and movies for checkout. Long distance calls and faxes require a calling or credit card. Other services are free. The Cyber Center is located in the Main Building, Floor 4, near Elevator D in Room B4.4317a. Emergency Center In case of an emergency, please call 911, or go to the nearest emergency center. MD Anderson’s Emergency Center is open 24 hours a day, every day. From Holcombe Boulevard, turn at Entrance Marker 3. The entrance is on Bates Street near Garage 2. From inside the Main Building, go to Floor 1, near The Fountain, Room P1.3100. For non-emergencies during business hours, please call your care center. Ethics Consultation Service 713-792-8775 MD Anderson's Ethics Consultation Service helps patients, families and health professionals make difficult decisions about medical treatments and patient care. These decisions may involve moral values, religious beliefs, or professional duties and guidelines. The Learning Center The Learning Center provides the latest information about health, cancer and cancer prevention. Helpful staff and volunteers guide customer information searches and help visitors locate the information they need. The Learning Center also provides access to and information on, helpful websites, medical journals, books, videos and other resources. Computers, printers, copier and fax machine are available for personal business. The Learning Center locations include: • Law Learning Center Main Building, Floor 4, near Elevator A, Room R4.1100, 713-745-8063 • Levit Learning Center Mays Clinic, Floor 2, near The Tree Sculpture, Room ACB2.1120, 713-563-8010 Patient/Family Center 713-745-8000 The Patient/Family Center has a homelike atmosphere with comfortable sofas and recliners that provides a place to rest and relax between appointments. Volunteers offer assistance and answer questions about appointment schedules, directions, lodging and other needs. Private phones also are available. It is located in the Main Building, Floor 2, near Elevator A in Room R2.1200 Patient/Family Library 713-792-1080 The Patient/Family Library offers books (including foreign language books), magazines, newspapers, puzzles, games, audiobooks and CD players for patients and family members to check out. It is located in the Main Building, Floor 1, near the Aquarium in Room R1.2212. Resources at MD Anderson Cancer Center © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 2 of 3 Pharmacy MD Anderson has three outpatient retail pharmacies to serve you. The pharmacy locations include: • Main Building, Floor 2, near Elevator C, 713-792-6125 • Main Building, Floor 10, near Elevator B, 713-745-7180 • Mays Clinic, Floor 2, near The Tree Sculpture, 713-563-8222 Integrative Medicine Center 713-794-4700 The Integrative Medicine Center aims to work collaboratively with you primary oncology team to build an integrative care plan. Services include an integrative medicine consultation, dietary counseling, oncology massage and acupuncture. Group classes, such as yoga, tai chi and meditation are available at no charge. You can visit the Integrative Medicine Center at their two locations: • Main Building, Floor 1, outside of the Aquarium main entrance • Mays Clinic, Floor 2, near The Tree Sculpture in Room ACB2.1041 Release of Medical Information Office 713-792-6710 The Release of Medical Information Office is where you can obtain copies of your medical records. You must provide a signed Authorization for Release of Information form, available at the office. • Main Building, Floor 3, near Elevator D in Room B3.4362 • Mays Clinic, Floor 2, near the Tree Sculpture in Room ACB2.1613 Social Work 713-792-6195 Social Work provides free short-term individual and group counseling and information on support groups, community resources (i.e. housing), advance directives (Medical Power of Attorney, Living Wills), and other special programs. The Department of Social Work is located at the following locations: • Main Building, Floor 2, near The Park in Room B2.4759 • Mays Clinic, Floor 2, near The Tree Sculpture in Room ACB2.2135 Resources at MD Anderson Cancer Center © 2001, 2012 The University of Texas MD Anderson Cancer Center, Revised 08/03/12 Patient Education Office Page 3 of 3 Chemotherapy Notes __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Chemotherapy Notes ÂŠ 2002, 2012 The University of Texas MD Anderson Cancer Center, Reviewed 08/20/12 Patient Education Office Page 1 of 1