1-800-4-CANCER (1-800-422-6237)
■
■ Be gentle when you wash your hair. Use a mild shampoo, such as a baby shampoo.
Dry your hair by patting (not rubbing) it with a soft towel.
■
■ Do not use items that can hurt your scalp. These include:
• Straightening or curling irons
• Brush rollers or curlers
• Electric hair dryers
• Hair bands and clips
• Hairsprays
• Hair dyes
• Products to perm or relax your hair
After hair loss:
■
■ Protect your scalp. Your scalp may hurt during and after hair loss. Protect it by wearing a hat, turban, or scarf when you are
outside. Try to avoid places that are very hot or very cold. This includes tanning beds and outside in the sun or cold air. And
always apply sunscreen or sunblock to protect your scalp.
■
■ Stay warm. You may feel colder once you lose your hair. Wear a hat, turban, scarf, or wig to help you stay warm.
■
■ Sleep on a satin pillow case. Satin creates less friction than cotton when you sleep on it. Therefore, you may find satin pillow cases more comfortable.
■
■ Talk about your feelings. Many people feel angry, depressed, or embarrassed about hair loss. If you are very worried or
upset, you might want to talk about these feelings with a
doctor, nurse, family member, close friend, or someone who
has had hair loss caused by cancer treatment.
Ways to learn more
American Cancer Society
Offers a variety of services to people with cancer and their families, including referrals to low-cost wig banks.
Call:
1-800-ACS-2345 (1-800-227-2345)
TTY: 1-866-228-4327
Visit:
www.cancer.gov
29
Chemotherapy Side Effects and Ways to Manage Them
Infection
What it is and why it occurs
Some types of chemotherapy make it harder for your bone marrow to produce new white
blood cells. White blood cel s help your body fight infection. Therefore, it is important to
avoid infections, since chemotherapy decreases the number of your white blood cel s.
There are many types of white blood cel s. One type is called neutrophil. When your neutrophil count is low, it is called neutropenia. Your doctor or nurse may do blood tests to find out whether you have
neutropenia.
It is important to watch for signs of infection when you have
neutropenia. Check for fever at least once a day, or as often
as your doctor or nurse tel s you to. You may find it best to
use a digital thermometer. Call your doctor or nurse if your
temperature is 100.5°F or higher.
Call your doctor or nurse right away if you have a fever of
100.5°F or higher.
Ways to manage
■
■ Your doctor or nurse will check your white blood cell count throughout your treatment. If chemotherapy is likely to make your white blood cell count very low, you may get medicine to raise your white blood cell count and lower your risk of infection.
■■ Wash your hands often with soap and water. Be sure to
wash your hands before cooking and eating, and after you
use the bathroom, blow your nose, cough, sneeze, or touch
animals. Carry hand sanitizer for times when you are not near
soap and water.
■
■ Use sanitizing wipes to clean surfaces and items that
you touch. This includes public telephones, ATM machines,
doorknobs, and other common items.
■
■ Be gentle and thorough when you wipe yourself after a
bowel movement. Instead of toilet paper, use a baby wipe or squirt of water from a spray bottle to clean yourself. Let your
doctor or nurse know if your rectal area is sore or bleeds or if
you have hemorrhoids.
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1-800-4-CANCER (1-800-422-6237)
■
■ Stay away from people who are sick. This includes people with colds, flu, measles, or chicken pox. You also need to stay away from children who just had a “live virus”
vaccine for chicken pox or polio. Call your doctor, nurse, or local health department if you have any questions.
■
■ Stay away from crowds. Try not to be around a lot of people. For instance, plan to go shopping or to the movies when the stores and theaters are less crowded.
■■ Be careful not to cut or nick yourself. Do not cut or tear your nail cuticles. Use an electric shaver instead of a razor.
And be extra careful when using scissors, needles, or knives.
■
■ Watch for signs of infection around your catheter.
Signs include drainage, redness, swelling, or soreness. Let
your doctor or nurse know about any changes you notice
near your catheter.
■
■ Maintain good mouth care. Brush your teeth after meals and before you go to bed. Use a very soft toothbrush. You can make the bristles even softer by running hot water over them just before you brush. Use a mouth rinse that does not contain alcohol. Check with your
doctor or nurse before going to the dentist. (For more about taking care of your mouth, see
■■ Take good care of your skin. Do not squeeze or scratch pimples. Use lotion to soften and heal dry, cracked skin. Dry yourself after a bath or shower by gently patting (not rubbing) your skin. (For more information about taking care of your skin, see page 47.)
■
■ Clean cuts right away. Use warm water, soap, and an antiseptic to clean your cuts. Do this every day until your cut has a scab over it.
■■ Be careful around animals. Do not clean your cat’s litter box, pick up dog waste, or clean bird cages or fish tanks. Be sure to wash your hands after touching pets and other animals.
■
■ Do not get a flu shot or other type of vaccine without first asking your doctor or nurse. Some vaccines contain a live virus, which you should not be exposed to.
■
■ Keep hot foods hot and cold foods cold. Do not leave leftovers sitting out. Put them in the refrigerator as soon as you are done eating.
■
■ Wash raw vegetables and fruits well before eating them.
■
■ Do not eat raw or undercooked fish, seafood, meat,
chicken, or eggs. These may have bacteria that can cause
infection.
■
■ Do not have food or drinks that are moldy, spoiled, or
past the freshness date.
www.cancer.gov
31
Do not take drugs that reduce fever without first talking
with your doctor or nurse.
■
■ Call your doctor right away (even on the weekend or
in the middle of the night) if you think you have an
infection. Be sure you know how to reach your doctor
after office hours and on weekends. Call if you have a fever
of 100.5°F or higher, or when you have chil s or sweats.
Do not take aspirin, acetaminophen (such as Tylenol®),
ibuprofen products, or any other drugs that reduce fever
without first talking with your doctor or nurse. Other signs of infection include:
• Redness
• Headache
• Swel ing
• Stiff neck
• Rash
• Bloody or cloudy urine
• Chills
• Painful or frequent need
• Cough
to urinate
• Earache
• Sinus pain or pressure
Be sure you know how to reach your doctor or nurse
after office hours and on weekends.
Write the number to call in an emergency here:
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1-800-4-CANCER (1-800-422-6237)
Chemotherapy Side Effects and Ways to Manage Them
Infertility
What it is and why it occurs
Some types of chemotherapy can cause infertility. For a woman, this means that you may not be able to get pregnant. For a man, this means you may not be able to get a woman pregnant.
In women, chemotherapy may damage the ovaries. This damage can lower the number of healthy eggs in the ovaries. It can also lower the hormones produced by them. The drop in hormones can lead to early menopause. Early menopause and fewer healthy eggs can cause infertility.
In men, chemotherapy may damage sperm cel s, which grow and divide quickly. Infertility may occur because chemotherapy can lower the number of sperm, make sperm less able to move, or cause other types of damage.
Whether or not you become infertile depends on the type of chemotherapy you get, your age, and whether you have other health problems. Infertility can last the rest of your life.
Before treatment starts, tell your doctor or nurse if you want to have children in the future.
Ways to manage
For WOMEN, talk with your doctor or nurse about:
■
■ Whether you want to have children. Before you start
chemotherapy, let your doctor or nurse know if you might
want to get pregnant in the future. He or she may talk with
you about ways to preserve your eggs to use after treatment
ends or refer you to a fertility specialist.
■
■ Birth control. It is very important that you do not get pregnant while getting chemotherapy. These drugs can hurt the fetus, especial y in the first 3 months of pregnancy. If you have not yet gone through menopause, talk with your doctor or nurse about birth control and ways to keep from getting pregnant.
■
■ Pregnancy. If you still have menstrual periods, your doctor or nurse may ask you to have a pregnancy test before you start chemotherapy. If you are pregnant, your doctor or nurse will talk with you about other treatment options.
Chemotherapy can cause birth defects. Do not get pregnant
while you are getting treatment.
www.cancer.gov
33
Talk with your doctor or nurse about saving your sperm before
you start treatment, if you want to father children in the future.
For MEN, talk with your doctor or nurse about:
■
■ Whether you want to have children. Before you start
chemotherapy, let your doctor or nurse know if you might
want to father children in the future. He or she may talk
with you about ways to preserve your sperm to use in the
future or refer you to a fertility specialist.
■
■ Birth control. It is very important that your spouse or partner does not get pregnant while you are getting chemotherapy. Chemotherapy can damage your sperm and cause birth defects.
Chemotherapy may damage sperm and cause birth defects.
Make sure that your spouse or partner does not get pregnant
while you are in treatment.
Ways to learn more
American Cancer Society
Offers a variety of services to people with cancer and their families.
Call:
1-800-ACS-2345 (1-800-227-2345)
TTY: 1-866-228-4327
Visit:
fertileHOPE
A LIVESTRONG initiative dedicated to providing reproductive information, support, and hope to cancer patients and survivors whose medical treatments present the risk of infertility.
Call:
1-866-965-7205
Visit:
34
1-800-4-CANCER (1-800-422-6237)
Chemotherapy Side Effects and Ways to Manage Them
Mouth and Throat Changes
What they are and why they occur
Some types of chemotherapy harm fast-growing cel s, such as those that line your mouth, throat, and lips. This can affect your teeth, gums, the lining of your mouth, and the glands that make saliva. Most mouth problems go away a few days after chemotherapy is over.
Mouth and throat problems may include:
■
■ Dry mouth (having little or no saliva)
■
■ Changes in taste and smell (such as when food tastes like metal or chalk, has no taste, or does not taste or smell like it used to)
■
■ Infections of your gums, teeth, or tongue
■
■ Increased sensitivity to hot or cold foods
■
■ Mouth sores
■
■ Trouble eating when your mouth gets very sore
Ways to manage
■
■ Visit a dentist at least 2 weeks before starting
chemotherapy. It is important to have your mouth as healthy as possible. This means getting all your dental work done before
chemotherapy starts. If you cannot go to the dentist before
chemotherapy starts, ask your doctor or nurse when it is safe to
go. Be sure to tell your dentist that you have cancer and about
your treatment plan.
■
■ Check your mouth and tongue every day. This way, you
can see or feel problems (such as mouth sores, white spots, or
infections) as soon as they start. Inform your doctor or nurse
about these problems right away.
Visit your dentist at least 2 weeks before starting chemotherapy.
■
■ Keep your mouth moist. You can keep your mouth moist by
sipping water throughout the day, sucking on ice chips or sugar-
free hard candy, or chewing sugar-free gum. Ask your doctor or
nurse about saliva substitutes if your mouth is always dry.
www.cancer.gov
35
■
■ Clean your mouth, teeth, gums, and tongue.
• Brush your teeth, gums, and tongue after each meal and at
bedtime.
• Use an extra-soft toothbrush. You can make the bristles even
softer by rinsing your toothbrush in hot water before you
brush.
• If brushing is painful, try cleaning your teeth with cotton
swabs or Toothettes®.
• Use a fluoride toothpaste or special fluoride gel that your
dentist prescribes.
• Do not use mouthwash that has alcohol. Instead, rinse your
mouth 3 to 4 times a day with a solution of 1/4 teaspoon
baking soda and 1/8 teaspoon salt in 1 cup of warm water.
Follow this with a plain water rinse.
• Gently floss your teeth every day. If your gums bleed or hurt, avoid those areas but floss your other teeth. Ask your doctor
or nurse about flossing if your platelet count is low. (See the
section called “Bleeding” on page 20 for more information on platelets.)
• If you wear dentures, make sure they fit well and keep them
clean. Also, limit the length of time that you wear them.
■
■ Be careful what you eat when your mouth is sore.
• Choose foods that are moist, soft, and easy to chew or swallow. These include cooked cereals, mashed potatoes, and scrambled eggs.
• Use a blender to puree cooked foods so that they are easier to eat. To help avoid infection, be sure to wash all blender parts before and after using them. If possible, it is best to wash them in a dishwasher.
• Take small bites of food, chew slowly, and sip liquids while you eat.
• Soften food with gravy, sauces, broth, yogurt, or other liquids.
• Eat foods that are cool or at room temperature. You may find that warm and hot foods hurt your mouth or throat.
• Suck on ice chips or popsicles. These can relieve mouth pain.
• Ask your dietitian for ideas of foods that are easy to eat. For ideas of soft foods that
are easy on a sore mouth, see page 57.
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1-800-4-CANCER (1-800-422-6237)
Call your doctor, nurse, or dentist if your mouth hurts a lot.
Your doctor or dentist may prescribe medicine for pain or to
keep your mouth moist. Make sure to give your dentist the phone
number of your doctor and nurse.
■
■ Stay away from things that can hurt, scrape, or burn your mouth, such as:
• Sharp or crunchy foods, such as crackers and potato or corn chips
• Spicy foods, such as hot sauce, curry dishes, salsa, and chili
• Citrus fruits or juices such as orange, lemon, and grapefruit
• Food and drinks that have a lot of sugar, such as candy or soda
• Beer, wine, and other types of alcohol
• Toothpicks or other sharp objects
• Tobacco products, including cigarettes, pipes, cigars, and chewing tobacco Do not use tobacco or drink alcohol if your mouth is sore.
Ways to learn more
National Oral Health Information Clearinghouse
A service of the National Institutes of Dental and Craniofacial Research that provides oral health information for special care patients.
• Call: 1-866-232-4528
• Visit: http://www.nidcr.nih.gov
• E-mail: nidcrinfo@mail.nih.gov
Smokefree.gov
Provides resources including information on quitlines, a step-by-step cessation guide, and publications to help you or someone you care about quit smoking.
• Call: 1-877-44U-QUIT (1-877-448-7848)
• Visit: http://www.smokefree.gov
www.cancer.gov
37
Chemotherapy Side Effects and Ways to Manage Them
Nausea and Vomiting
What they are and why they occur
Some types of chemotherapy can cause nausea, vomiting, or both. Nausea is when you feel sick to your stomach, like you are going to throw up. Vomiting is when you throw up.
You may also have dry heaves, which is when your body tries to vomit even though your stomach is empty.
Nausea and vomiting can occur while you are getting chemotherapy, right after, or many hours or days later. You will most likely feel better on the days you do not get chemotherapy.
New drugs can help prevent nausea and vomiting. These are called antiemetic or
antinausea drugs. You may need to take these drugs 1 hour before each chemotherapy treatment and for a few days after. How long you take them after chemotherapy will depend on the type of chemotherapy you are getting and how you react to it. If one antinausea drug does not work well for you, your doctor can prescribe a different one. You may need to take more than one type of drug to help with nausea. Acupuncture may also help. Talk with your doctor or nurse about treatments to control nausea and vomiting caused by chemotherapy.
Ways to manage
■
■ Prevent nausea. One way to prevent vomiting is to prevent nausea. Try having bland, easy-to-digest foods and drinks that do not upset your stomach. These include plain
crackers, toast, and gelatin. To learn more, see the list of foods and drinks that are easy
■■ Plan when it’s best for you to eat and drink. Some people feel better when they eat a light meal or snack before chemotherapy. Others feel better when they have chemotherapy on an empty stomach (nothing to eat or drink for 2 to 3 hours before treatment). After treatment, wait at least 1 hour before you eat or drink.
■
■ Eat small meals and snacks. Instead of 3 large meals each day, you might feel better if you eat 5 or 6 small meals and snacks. Do not drink a lot before or during meals. Also, do not lie down right after you eat.
■
■ Have foods and drinks that are warm or cool (not hot or cold). Give hot foods and drinks time to cool down, or make them colder by adding ice. You can warm up cold foods by taking them out of the refrigerator 1 hour before you eat or warming them slightly in a microwave. Drink cola or ginger ale that is warm and has lost its fizz.
Eat 5 or 6 small meals and snacks each day instead of 3 large ones.
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1-800-4-CANCER (1-800-422-6237)
■
■ Stay away from foods and drinks with strong smells.
These include coffee, fish, onions, garlic, and foods that
are cooking.
■
■ Try small bites of popsicles or fruit ices. You may also find sucking on ice chips helpful.
■
■ Suck on sugar-free mints or tart candies. But do not use tart candies if you have mouth or throat sores.
■
■ Relax before treatment. You may feel less nausea if you relax before each chemotherapy treatment. Meditate, do
deep breathing exercises, or imagine scenes or experiences
that make you feel peaceful. You can also do quiet hobbies
such as reading, listening to music, or knitting.
■■ When you feel like vomiting, breathe deeply and
slowly or get fresh air. You might also distract yourself by chatting with friends or family, listening to music, or
watching a movie or TV.
■
■ Talk with your doctor or nurse. Your doctor can
give you drugs to help prevent nausea during and after
chemotherapy. Be sure to take these drugs as ordered and
let your doctor or nurse know if they do not work. You
might also ask your doctor or nurse about acupuncture,
which can help relieve nausea and vomiting caused by
cancer treatment.
Tell your doctor or nurse if you vomit for more than 1 day
or right after you drink.
Let your doctor or nurse know if your medicine for nausea
is not working.
To learn more about dealing with nausea and vomiting during cancer treatment read Eating Hints: Before, During, and After Cancer Treatment, a book from NCI. You can get a free copy at http://www.cancer.gov/publications or by calling 1-800-4-CANCER (1-800-422-6237).
www.cancer.gov
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