Chemotherapy Education
To our patients. Welcome to the Regional West Health Services. You may have concerns, anxiety, or fear about beginning chemotherapy. Our staff is well-trained, experienced, and will take the time to help you understand your chemotherapy treatment. Please let us know about any questions or concerns you may have so we can provide you with a positive treatment experience. There are many different diseases with many types of treatments, therefore you will see variations in the amount of time you and others will spend in our area. Treatment times range from 15 minutes to six to eight hours. In order to accommodate patients, we schedule according to length of infusion time along with our patient’s unique schedule needs. We will do our best to give you your desired time of appointment but sometimes this can be difficult. In order to help avoid nausea, please eat a light meal prior to arriving for your chemotherapy treatment. Meals are not provided in the chemotherapy room although you may bring lunch, snacks, or make arrangements for lunch to be brought if you are here over the lunch hour. There is a microwave and refrigerator available for you to use. We have coffee, hot tea, juice, crackers, and granola bars available as well. We ask everyone to be courteous toward other patients and visitors, as well as mindful of their right to privacy. Feel free to bring in quiet personal items to help pass the time such as books, magazines, Kindles or other e-readers, knitting, ipads, or ipods (with headphones). Please avoid wearing any fragrances due to the sensitivities of your fellow patients. We ask that children and pregnant women avoid the chemotherapy room in order to reduce any unnecessary exposure. With prior arrangements, a short tour may be arranged for your young or pregnant loved one(s). There is a restroom for visitors and a separate restroom for chemotherapy patients. If you have any questions, please talk to our chemotherapy nurses. We are here to help you have a positive experience during your chemotherapy. A follow-up phone call from a chemotherapy nurse is likely the day after your first chemotherapy treatment. Please provide us with a phone number where you are most likely to be reached.
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Table of contents. Letter To Patients
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Nausea And Vomiting
4
Appetite Changes
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Infection Risks
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Fatigue 10 Memory Changes
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Mouth And Throat
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Blood Counts
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Hair Loss
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Nerve Changes
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Fertility Changes
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Sexual Changes
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Diarrhea 18 Constipation 19 Resources 20
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What are nausea and vomiting?
Nausea is when you feel sick to your stomach, like you are going to throw up. Vomiting is when you actually throw up. Nausea, queasiness, or vomiting can occur two to four hours after treatment. Not all chemotherapy drugs cause nausea and vomiting. Your nurse will let you know if you are at risk for nausea and vomiting.
Follow these tips to feel better On days you get treatment. ▪ If you feel sick before treatment, talk with your nurse about ways to relax, or your doctor may prescribe a medicine that will help you relax before treatment. ▪
▪
Some people feel better if they eat a light meal before treatment. Others may feel better if they don’t eat. You will learn what is best for you. Wait at least one hour after you treatment before you try to eat.
Take your anti-nausea medicine. ▪ Talk with your doctor or nurse to make sure you are taking your medicines correctly. ▪
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It may be very important for you to take your medicine as prescribed even on days you feel well.
Your doctor will provide a prescription for nausea medicine for you at home. Your doctor and nurse will instruct you on how and when to take your nausea medicines at home. If you are taking Prednisone or Decadron (dexamethasone), make sure you take this medication with food. Call your doctor or your chemotherapy nurse if your nausea medicine is not working for you or if you experience vomiting for more than six hours.
Stay away from some foods. ▪ Greasy, fried, salty, sweet, or spicy foods can increase your nausea. Eat less of these foods if they make you feel sick. Have enough to eat and drink. ▪ If you find it hard to drink full glasses of water, try small sips frequently throughout the day. ▪
You may feel better eating five or six small frequent meals rather than three big meals.
Your nurse will provide you with a booklet on nutritional tips during chemotherapy, and we can contact our dietician for assistance.
Foods and drinks that may be easy on your stomach: Soups Clear broth, such as chicken, beef, or vegetable Drinks Clear soda, such as Ginger-ale or 7-up Cranberry or grape juice, may need to increase dilution Drinks such as Pedialyte® or Gatorade® Tea (avoid hot) Water Main Meals/Snacks Chicken, broiled or baked Cream of Wheat® or Cream of Rice®cereal Crackers, or pretzels, or noodles Potatoes, boiled without skin White rice White toast Fruits and Sweets Bananas Canned fruit, unsweetened such as applesauce, peaches, and pears Gelatin (Jell-O®),Popsicles and sherbet Yogurt (plain or vanilla)
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What are appetite changes?
Common changes in appetite from chemotherapy, usually include feeling less hungry and finding that some foods may taste different. If you are having problems, let your doctor or nurse know so we can contact our dietician to visit with you. Talk to your provider before taking any vitamins or herbs.
Helpful tips to make eating easier Set meal times or routines Eat a little, even if you’re not hungry. ▪
Try eating five or six small meals each day, instead of three large meals.
▪
Try new or different foods to keep your interest in food.
▪
Eat with friends or family.
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Choose healthy nutritious foods like those listed on page 5.
▪
Experiment with different seasonings.
▪
If food tastes like metal, try using plastic utensils.
Activity or exercise Exercise or activity may increase your appetite.
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If you can, take a short walk each day.
▪
Discuss with your doctor or nurse about exercise that can help you.
Drink plenty of liquids It is important that you get enough to drink, though try not to fill up on liquids before you eat a meal. ▪
Try drinking milkshakes or soups.
▪
Keep track of what your eating and drinking each day. Discuss this with your doctor or nurse to make sure you are eating and drinking enough.
It is important to eat well to help you stay strong. Your doctor will be monitoring your weight.
Place this list on your refrigerator: These foods and drinks are high in calories and protein Soups Cream soups Soups with lentils or beans (black, kidney, pinto, and red) Drinks Some instant breakfast drinks Milkshakes (add fruit) Milk (whole) Fruit smoothies (add ice-cream) Main meals Chicken Lentils or beans (kidney, black, pinto, and red) Eggs Nuts, seeds, and wheat germ Fish Cottage cheese or other cheeses Sweets Custard Ice Cream Muffins Puddings Yogurt (plain or vanilla). Try not to use low-fat or fat-free Extras Butter, oils, or margarine added to foods Cream cheese or sour cream (add to potatoes) Drink replacements (Ensure速 or Boost速) Powdered milk added to foods
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How do I lower my risk of an infection? Steps to lower your chances of getting an infection? Wash your hands well ▪ Wash your hands well with soap and water. Have your family and friends wash their hands too. ▪ Always wash your hands:
– Before you cook or eat. – After you use the bathroom. – After being in a public place.
▪ Use hand sanitizer when you can’t find soap and
water.
Try to stay away from germs ▪ Stay away from people who are sick or have a cold. ▪ Wash all raw vegetables and fruits. ▪ If you handle raw meats, wash your hands well after.
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▪ Avoid gardening. If you must garden, wear gloves and
always wash your hands with soap and water afterward.
▪ Have someone else clean up after your pet. ▪ Check with your doctor before having dental work. ▪ Try to stay away from people who have just had a
chicken pox, polio, or measles vaccine.
Try not to injure your skin ▪ Use an electric shaver, not a razor. ▪ After using the bathroom, clean yourself gently and
let your doctor or nurse know if you have any rectal bleeding or sores.
▪ Don’t squeeze pimples.
Call your doctor or nurse immediately if you have ▪ A fever that is 100.5° F or higher. Monitor your temperature at least twice a day, in the morning and evening. ▪ Chills. ▪ Sore throat or cough. ▪ Bad sinus pain (headache). ▪ Stiff or sore neck. ▪ Bloody or cloudy urine. ▪ Swelling or redness anywhere. ▪ Burning during urination. ▪ If you think you are sick, check with your doctor or nurse before you take any medicine.
This includes aspirin, acetaminophen (Tylenol®), or ibuprofen (such as Advil®).
▪ Check with your doctor or nurse before you receive any vaccine.
If you have any other signs or changes that don’t seem normal to you, don’t wait. Call your doctor or nurse right away.
Number to call if you think you are sick: 308.630.2100
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What is fatigue?
Cancer-related fatigue is one of the most common symptoms in people with cancer. Cancer-related fatigue can cause you to feel tired, weak, and low on energy all the time. Any activity such as making a meal or showering can make you feel exhausted. However, it affects everyone differently.
If you are experiencing fatigue be sure and talk to your doctor or nurse about it. Ask your health care providers what you can do to help relieve the symptoms.
It is normal to feel fatigued or extremely tired the first few days after a chemotherapy treatment. Usually the feeling of fatigue improves before your next chemotherapy cycle.
Tips when you feel tired or weak Save your energy. ▪ Choose one or a few of the most important things you need to get done each day. Ask for help. ▪ When family or friends offer to help you, let them. They can help with grocery shopping, house cleaning, or meals. Balance activity with your rest. ▪ Take short rest periods or naps during the day. Less than one hour is best. ▪ Try to sleep at least eight hours every night. ▪ Research has shown that a short walk or exercise each
day can improve your fatigue symptoms.
▪ Try to eat foods high in protein and calories during this
time.
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Call your doctor or nurse immediately if ▪ You feel dizzy or faint ▪ You are short of breath ▪ Your heart is beating fast
Questions? Call us at 308.630.2100
What are memory changes?
You may experience difficulty with concentration and memory during your chemotherapy treatment. This is not uncommon, and is sometimes referred to as “chemo-brain” or “chemo-fog.”
You might notice these changes
Helpful Tips
▪ Memory lapses.
▪ Get organized.
▪ Short attention span.
▪ Keep a journal.
▪ Difficulty focusing on a task.
▪ Take notes during your health care visits.
▪ Planning or organizing.
▪ Keep a to-do list. Use a grocery list when you shop.
▪ Trouble remembering dates or names.
▪ Do things that need the most thinking each day
▪ Slow thinking. ▪ Fogginess. ▪ Difficulty doing more than one thing at a time.
In most cases these symptoms are just temporary and begin to resolve after treatment is completed. These changes may be caused from stress or from a medicine you are taking. Keep your doctor informed. You or a family member should let your doctor or nurse know if you notice you are ▪ Confused. ▪ Very sad or depressed. ▪ Finding it very difficult to think or remember things. ▪ Having difficulty sleeping.
when you feel the best.
▪ Get extra rest. ▪ Write down things you need to remember. ▪ Use a calendar to write down important dates or
information.
▪ Use a pill box, calendar, or note pad to keep track of
your medications.
▪ If you need help keeping track of your medications,
let your doctor or nurse know.
▪ Ask for help if you are having difficulties with these
symptoms.
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What are mouth and throat changes?
You may experience some mouth dryness, tenderness, or sores. Unfortunately, chemotherapy can damage healthy cells while it is destroying cancer cells. Mouth sores can occur when chemotherapy damages the lining of the mouth.
Not all chemotherapy drugs cause mouth sores. Your doctor or nurse will let you know if your treatment will cause sores. Tenderness or sores may occur two days to two weeks after chemotherapy
Keep your mouth and lips moist. ▪ Use lip balm or lip moisturizer. ▪ Sip on water. ▪ Suck on ice chips.
If you do develop mouth sores or have trouble eating or swallowing, let your doctor or nurse know. Your provider will prescribe a medicated mouth rinse to help relieve symptoms. You may not be able to prevent mouth sores. However, the following tips may help: ▪ If possible, have a dental checkup before you start
chemotherapy.
▪ Keep your mouth clean and exam your mouth daily
for swelling, redness, white patches, or bleeding.
▪ Brush your teeth and tongue after each meal and
before bedtime using a soft toothbrush.
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▪ Rinse your mouth with salt and baking soda using
the recipe below:
Use this mixture four times a day: ¼ tsp baking soda ¼ tsp salt 1 cup warm water Take small sips and swish and spit ▪ Replace your toothbrush often. ▪ Floss your teeth at least once a day if you can
tolerate it, and if it doesn’t cause bleeding.
▪ Avoid mouthwashes that contain alcohol. ▪ Avoid foods or drinks that are carbonated, spicy,
hot, or contain citrus.
▪ Drink plenty of fluids and avoid alcohol. ▪ Eat soft bland foods.
What blood counts do we monitor? White Blood Cell Count (WBC) Normal 5000-10,000/mm Neutrophils 40-60% Low White Blood Cell Count Neutropenia Remember, your white blood cells fight infection. It is very important that you follow the instructions provided to prevent infection. Your provider will let you know if your WBC is low and what precautions you should take. Your provider may start you on a medication called Neulasta to keep your WBCs from dropping too low. You may receive this 24 hours after chemotherapy treatment or may be ordered if your WBCs are dropping too low. Red Blood Cell Count Normal (Hgb) Male 14-18 g/dl Female 12-16 g/dl Low Red Blood Cell Count (RBC): Anemia Hemoglobin carries your oxygen. Anemia can make you feel very tired or weak. Your provider will be monitoring your RBC count closely. Notify your provider if you have any of these symptoms ▪ Dizziness or feeling faint ▪ Shortness of breath
▪ Very weak and tired
▪ Your heart is beating fast
Platelet Count Normal 150,000-400,000/mm³ Low Platelet Count You could be at risk for bleeding. Platelets are cells that help stop bleeding by binding to the site of a wound or injury. It is important to watch and report any signs of bleeding, such as: ▪ Blood in your urine or stool.
▪ If your gums start bleeding with brushing.
▪ If you have an unusual nose bleed that is difficult to
stop.
▪ Increased and unusual bruising.
Protect yourself ▪ Use an electric shaver, not a razor. ▪ Be careful when using sharp objects. ▪ Wear shoes all the time. ▪ Blow your nose gently. ▪ Tell your provider if you have had bowel movements or are constipated. ▪ Don’t use dental floss or toothpicks.
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What is hair loss?
Chemotherapy can harm the cells that make hair. This means that hair on your head and anywhere on your body may fall out.
Will I lose my hair? Not everyone loses their hair. Only certain chemotherapy drugs cause your hair to fall out. When will I lose my hair? Your hair may start to fall out Two to three weeks after chemotherapy begins. What you can do before your hair falls out: ▪ Treat ▪ Cut
your hair gently.
your hair short.
▪ Shave ▪ Get
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your head with an electric razor.
a wig.
Regional West’s Cancer Treatment Center offers wigs at no charge from “Emma’s Closet” Call the Cancer Treatment Center at 308.630.1438
What are nerve changes?
Some chemotherapy drugs can cause nerve changes. You may experience numbness, tingling, burning, pain, or weakness in different parts of your body. It usually starts in your hands or feet. This is called “peripheral neuropathy”. Your provider will discuss with you if you are at risk for nerve changes and what you should expect.
We will monitor you for nerve changes as you go through treatment. We ask you to report changes to us as you go through treatment. You should notify your provider if you notice any of these changes:
Hearing Problems ▪ Hearing loss or a change in your hearing. Stomach Problems ▪ Constipation or hard stools. ▪ Stomach pain.
Pain ▪ Tingling, burning, or numbness in your hands or feet. ▪ Pain when you walk.
Movement Changes ▪ Falling. ▪ Losing your balance or feeling dizzy. ▪ Numbness in hands or feet. ▪ Sore, tired or achy muscles. ▪ Trouble picking things up. ▪ Shaking or trembling.
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Fertility and sexual changes in women?
If you are planning on having children, it is very important that you talk to your provider before you start chemotherapy. Ask what birth control methods you and your partner can use prior to chemotherapy. Chemotherapy can harm an unborn baby (fetus). Don’t get pregnant during treatment.
Sexual changes you may notice. This will depend on your age, the type of chemotherapy you will have, and the type of cancer you have. It will also depend on other existing health issues. You may experience these sexual side effects during treatment: ▪ Vaginal dryness or itchiness. ▪ Hot flashes. ▪ A change in your periods. ▪ Stress, fatigue, and little or no interest in sex. ▪ Painful intercourse. ▪ Your partner’s interest in sex may change.
Fertility Issues Discuss fertility options with your physician before you start treatment if you want to have children. You may need to be referred to a fertility specialist.
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Tips for hot flashes: ▪ Wear layered clothing. ▪ Decrease caffeine intake. ▪ Keep a fan nearby. ▪ Ask your provider if you need help; there are
medications that may help.
Tips for vaginal dryness: ▪ Over-the-counter lubricants. ▪ Check with your provider for prescription options.
You should know: Your body excretes chemotherapy through urine, stool, and body fluids for at least two days after your chemotherapy treatment. You may want to refrain from sex during this time. If you have sex, you and your partner should use protection.
Fertility and sexual changes in men?
If you are still hoping to have children, talk with your doctor before treatment starts to see what sexual changes or changes to your fertility you may have. Changes may depend on the type of chemotherapy and the type of cancer you have.
Fertility Issues â–Ş It may be difficult for you to have an erection. â–Ş You may feel too tired or stressed to have sex.
Managing Side Effects Talk with your doctor or nurse about how to manage these side effects and changes. Discuss with your doctor how long these changes will last. Protect your Partner Always use a condom at least 48 hours after chemotherapy because some chemotherapy may be in your semen. Check with your chemotherapy nurse to know how long you should take precautions. Not all drugs are the same.
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What is Diarrhea?
If you have bowel movements that are soft, loose, or watery, you may have diarrhea.
Call your doctor’s office if you have ▪ A fever of 100.5° F or higher. ▪ Diarrhea and cramps for more than one day. ▪ Dizziness.
Try these things to feel better. ▪ Eat five or six small meals each day rather than three big meals. ▪ Try foods like bananas, applesauce, white rice, and
white toast.
Make sure you drink enough liquids. ▪ It is important to replace fluids by drinking more liquid. ▪ If you are experiencing diarrhea you should drink
eight to 12 cups each day.
▪ Clear broth, gelatin, and drinks like Pedialyte® are
good choices.
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If you have diarrhea, stay away from these foods. ▪ Dairy products such as milk, cheese, and sour cream. ▪ Spicy, greasy, or fried foods. ▪ Foods that cause gas, such as broccoli and cabbage. ▪ Foods high in fiber, such as whole-wheat breads,
granola, and bran cereals.
▪ Raw fruits or vegetables. ▪ Caffeine drinks, beer, or wine.
You may try some Imodium® over the counter if you are having diarrhea. Follow the instructions on the label
What is Constipation?
Constipation occurs when you are having fewer bowel movements than normal and ones that are painful or hard to pass.
Things that can help prevent constipation. ▪ Eat whole-grain breads and cereals. ▪ Eat several servings of fruits and vegetables a day. ▪ Eat nuts, granola, or popcorn.
Let your doctor or nurse know if you have not had a bowel movement in two days or if you have pain in your rectal area. You may need a stool softener or a mild laxative. Let your doctor or nurse know. Drinking plenty of liquids and moderate exercise can help. ▪ Drinking warm liquids may help, such as coffee or tea. ▪ Walking or riding an exercise bike for 15 to 30
minutes a day.
If you need help, let us know. We will contact our dietician to visit with you and help.
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What are some resources?
Resources as you go through treatment There are many websites that you can visit. These are just a few we recommend National Cancer Institute Cancer Information Service and clinical trial information
Cancer Patient Resource Online www.patientresource.com
Phone 1.800.422.6237
LIVESTRONG.org Online www.livestrong.org
Online www.cancer.gov Chat Online www.gov/help American Cancer Society Online: www.cancer.org Cancer.Net Patient information from the American Society of Clinical Oncology (ASCO) Online www.cancer.net
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National Coalition for Cancer Survivorship Online www.canceradvocacy.org
If you need assistance, ask your provider or nurse.
308.630.2100 Vince Bjorling, MD
Becci Bowman, APRN-C, AOCNP, ACHPN, DNP
Clinton Merrill, MD
Susan Schoeneman, APRN‑C, AOCNP
Regine Leconte, MD
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