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Coping with Chemotherapy Side Effects
edited by doctordee
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Chemotherapy and You. A Guide to Self-Help During Cancer Treatment
Publication #99-1136. Revised June 1999 This article has been edited. For the entire article, with graphics, go to this URL:

http://www.cancer.gov/cancerinfo/chemotherapy-and-you

What Causes Side Effects?
Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. This damage to normal cells causes side effects. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system. You may have none of these side effects or just a few.

The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. Before starting chemotherapy, your doctor will discuss the side effects that you are most likely to get with the drugs you will be receiving. Before starting the treatment, you will be asked to sign a consent form. You should be given all the facts about treatment including the drugs you will be given and their side effects before you sign the consent form.
How Long Do Side Effects Last?
Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over side effects depends on many things, including your overall health and the kind of chemotherapy you have been taking. Most people have no serious long-term problems from chemotherapy. However, on some occasions, chemotherapy can cause permanent changes or damage to the heart, lungs, nerves, kidneys, reproductive or other organs. And certain types of chemotherapy may have delayed effects, such as a second cancer, that show up many years later. Ask your doctor about the chances of any serious, long-term effects that can result from the treatment you are receiving (but remember to balance your concerns with the immediate threat of your cancer). Great progress has been made in preventing and treating some of chemotherapy's common as well as rare serious side effects.

Many new drugs and treatment methods destroy cancer more effectively while doing less harm to the body's healthy cells. The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment's ability to destroy cancer. Medicines can help prevent some side effects such as nausea. Sometimes people receiving chemotherapy become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor or nurse. They may be able to suggest ways to make side effects easier to deal with or reduce them. Below you will find suggestions for dealing with some of the more common side effects of chemotherapy.
Fatigue
Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It can be due to your disease, chemotherapy, radiation, surgery, low blood counts, lack of sleep, pain, stress, poor appetite, along with many other factors. Fatigue from cancer feels different from fatigue of everyday life. Fatigue caused by chemotherapy can appear suddenly. Patients with cancer have described it as a total lack of energy and have used words such as worn out, drained, and wiped out to describe their fatigue. And rest does not always relieve it. Not everyone feels the same kind of fatigue. You may not feel tired while someone else does or your fatigue may not last as long as someone else's does. It can last days, weeks, or months. But severe fatigue does go away gradually as the tumor responds to treatment.

Plan your day so that you have time to rest. Take short naps or breaks, rather than one long rest period. Save your energy for the most important things. Try easier or shorter versions of activities you enjoy. Take short walks or do light exercise if possible. You may find this helps with fatigue. Talk to your health care provider about ways to save your energy and treat your fatigue. Try activities such as meditation, prayer, yoga, guided imagery, visualization, etc. (See the section "Complementary Therapies.") You may find that these help with fatigue. Eat as well as you can and drink plenty of fluids. Eat small amounts at a time, if that is helpful.

Join a support group. Sharing your feelings with others can ease the burden of fatigue. You can learn how others deal with their fatigue. Your health care provider can put you in touch with a support group in your area. Limit the amount of caffeine and alcohol you drink. Allow others to do some things for you that you usually do. Keep a diary of how you feel each day. This will help you plan your daily activities. Report any changes in energy level to your doctor or nurse.
Nausea and Vomiting
Many patients fear that they will have nausea and vomiting while receiving chemotherapy. But new drugs have made these side effects far less common and, when they do occur, much less severe. These powerful antiemetic or antinausea drugs can prevent or lessen nausea and vomiting in most patients. Different drugs work for different people, and you may need more than one drug to get relief. Do not give up, but notify your doctor and nurse to find the drug or drugs that work best for you. Also, be sure to tell your doctor or nurse if you are very nauseated or have vomited for more than a few hours, or if your vomiting is so bad that you cannot keep liquids down. Dehydration is a risk factor for clotting, and some clots can kill.

What can I do if I have nausea and vomiting?

Drink liquids at least an hour before or after mealtime, instead of with your meals. Drink frequently and drink small amounts. Eat and drink slowly. Eat small meals throughout the day, instead of one, two, or three large meals. Eat foods cold or at room temperature so you won't be bothered by strong smells. Chew your food well for easier digestion. If nausea is a problem in the morning, try eating dry foods like cereal, toast, or crackers before getting up. (Do not try this if you have mouth or throat sores or are troubled by a lack of saliva.) Drink cool, clear, unsweetened fruit juices, such as apple or grape juice or light-colored sodas such as ginger ale that have lost their fizz and do not have caffeine. Suck on mints, or tart candies. (Do not use tart candies if you have mouth or throat sores.) Prepare and freeze meals in advance for days when you do not feel like cooking.

Wear loose-fitting clothes. Breathe deeply and slowly when you feel nauseated. Distract yourself by chatting with friends or family members, listening to music, or watching a movie or TV show. Use relaxation techniques. (See the section "Complementary Therapies.") Try to avoid odors that bother you, such as cooking smells, smoke, or perfume. Avoid sweet, fried, or fatty foods. Rest but do not lie flat for at least 2 hours after you finish a meal. Avoid eating for at least a few hours before treatment if nausea usually occurs during chemotherapy. Eat a light meal before treatment.

Nausea a day or two after the chemotherapy infusion is probably due to the chemotherapy agent, and might be managed best with Kytril, Zofran with or without Emend. Nausea 3 to 5 days after the chemotherapy agent might be due to the steroid in the chemo infusion. The steroid causes a gastritis. This nausea might respond better to bland food, antacids and/or metaclopramide [Reglan]. Nausea sometimes occurs as a result of constipation and blockage of the intestine by stool [fecal impaction]. Discuss this with your medical team.

You might want to check out a cancer nausea website. It is maintained by the manufacturer of Kytril but it seems fairly balanced on treatment options and background info.
Pain
Chemotherapy drugs can cause some side effects that are painful. The drugs can damage nerves, leading to burning, numbness, tingling or shooting pain, most often in the fingers or toes. Some drugs can also cause mouth sores, headaches, muscle pains, and stomach pains.

Not everyone with cancer or who receives chemotherapy experiences pain from the disease or its treatment. But if you do, it can be relieved. The first step to take is to talk with your doctor, nurse, and pharmacist about your pain. They need to know as many details about your pain as possible. You may want to describe your pain to your family and friends. They can help you talk to your caregivers about your pain, especially if you are too tired or in too much pain to talk to them yourself.

You need to tell your doctor, nurse, and pharmacist and family or friends

Where you feel pain. What it feels like: sharp, dull, throbbing, steady. How strong the pain feels. How long it lasts. What eases the pain, what makes the pain worse. What medicines you are taking for the pain and how much relief you get from them. Using a pain scale is helpful in describing how much pain you are feeling. Try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that is getting worse. A 10 means the pain is as bad as it can be. You may wish to use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure to let others know what pain scale you are using and use the same scale each time, for example, "My pain is 7 on a scale of 0 to 10." The goal of pain control is to prevent pain that can be prevented, and treat the pain that can't. To do this:

If you have persistent or chronic pain, take your pain medicine on a regular schedule (by the clock). Do not skip doses of your scheduled pain medicine. If you wait to take pain medicine until you feel pain, it is harder to control. Try using relaxation exercises at the same time you take medicine for the pain. This may help to lessen tension, reduce anxiety, and manage pain. Some people with chronic or persistent pain that is usually controlled by medicine can have breakthrough pain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. If you experience this pain, use a short-acting medicine ordered by your doctor. Don't wait for the pain to get worse. If you do, it may be harder to control. There are many different medicines and methods available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible.

If you are in pain and your doctor has no further suggestions, ask to see a pain specialist or have your doctor consult with a pain specialist. A pain specialist may be an oncologist, anesthesiologist, neurologist, neurosurgeon, other doctor, nurse, or pharmacist.
Hair Loss
Hair loss (alopecia) is a common side effect of chemotherapy, but not all drugs cause hair loss. Your doctor can tell you if hair loss might occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or fall out entirely. Hair loss can occur on all parts of the body, including the head, face, arms and legs, underarms, and pubic area. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. Sometimes, hair may grow back a different color or texture. Hair loss does not always happen right away. It may begin several weeks after the first treatment or after a few treatments. Many people say their head becomes sensitive before losing hair. Hair may fall out gradually or in clumps. Any hair that is still growing may become dull and dry.

How can I care for my scalp and hair during chemotherapy?

Use a mild shampoo. Use a soft hair brush. Use low heat when drying your hair. Have your hair cut short. A shorter style will make your hair look thicker and fuller. It also will make hair loss easier to manage if it occurs. Use a sun screen, sun block, hat, or scarf to protect your scalp from the sun if you lose hair on your head. Avoid brush rollers to set your hair. Avoid dying, perming, or relaxing your hair. Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or hair pieces. Others leave their head uncovered. Still others switch back and forth, depending on whether they are in public or at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.

If you choose to cover your head:

Get your wig or hairpiece before you lose a lot of hair. That way, you can match your current hair style and color. You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients. Someone may even come to your home to help you. You also can buy a wig or hair piece through a catalog or by phone. You may also consider borrowing a wig or hairpiece, rather than buying one. Check with the nurse or social work department at your hospital about resources for free wigs in your community.

Take your wig to your hairdresser or the shop where it was purchased for styling and cutting to frame your face. Some health insurance policies cover the cost of a hairpiece needed because of cancer treatment. It is also a tax-deductible expense. Be sure to check your policy and ask your doctor for a "prescription." Losing hair from your head, face, or body can be hard to accept.

Feeling angry or depressed is common and perfectly all right. At the same time, keep in mind that it is a temporary side effect. Talking about your feelings can help. If possible, share your thoughts with someone who has had a similar experience.
Anemia
Chemotherapy can reduce the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues do not get enough oxygen to do their work. This condition is called anemia. Anemia can make you feel short of breath, very weak, and tired. Call your doctor if you have any of these symptoms:

Fatigue (feeling very weak and tired). Dizziness or feeling faint. Shortness of breath. Feeling as if your heart is "pounding" or beating very fast. Your doctor will check your blood cell count often during your treatment. She or he may also prescribe a medicine that can boost the growth of your red blood cells. Discuss this with your doctor if you become anemic often. If your red count falls too low, you may need a blood transfusion or a medicine called erythropoietin to raise the number of red blood cells in your body. Things you can do if you are anemic (See the section "Fatigue")

Get plenty of rest. Sleep more at night and take naps during the day if you can. Limit your activities. Do only the things that are essential or most important to you. Ask for help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving. Eat a well-balanced diet. (See the section "Eating Well During Chemotherapy.") When sitting, get up slowly. When lying down, sit first and then stand. This will help prevent dizziness.
Central Nervous System Problems
Chemotherapy can interfere with certain functions in your central nervous system (brain) causing tiredness, confusion, and depression. These feelings will go away once the chemotherapy dose is lowered or you finish chemotherapy. Call your doctor if these symptoms occur.
Infection
Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the bone marrow, making it harder to make white blood cells (WBCs), the cells that fight many types of infections. Your doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors (CSF). Raising the white blood cell count greatly lowers the risk of serious infection. Most infections come from bacteria normally found on your skin and in your mouth, intestines and genital tract. Sometimes, the cause of an infection may not be known. Even if you take extra care, you still may get an infection. But there are some things you can do.
How can I help prevent infections?

Wash your hands often during the day. Be sure to wash them before you eat, after you use the bathroom, and after touching animals. Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories. (See the section "Constipation.")

Stay away from people who have illnesses you can catch, such as a cold, the flu, measles, or chicken pox. Try to avoid crowds. For example, go shopping or to the movies when the stores or theaters are least likely to be busy. Stay away from children who recently have received "live virus" vaccines such as chicken pox and oral polio, since they may be contagious to people with a low blood cell count. Call your doctor or local health department if you have any questions.

Do not cut or tear the cuticles of your nails. Be careful not to cut or nick yourself when using scissors, needles, or knives. Use an electric shaver instead of a razor to prevent breaks or cuts in your skin. Maintain good mouth care. (See the section "Mouth, Gum and Throat Problems.") Do not squeeze or scratch pimples. Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Do not rub too hard. Use lotion or oil to soften and heal your skin if it becomes dry and cracked. Clean cuts and scrapes right away and daily until healed with warm water, soap, and an antiseptic. Avoid contact with animal litter boxes and waste, bird cages, and fish tanks. Avoid standing water, for example, bird baths, flower vases, or humidifiers. Wear protective gloves when gardening or cleaning up after others, especially small children. Do not get any immunizations, such as flu or pneumonia shots, without checking with your doctor first. Do not eat raw fish, seafood, meat, or eggs.
Symptoms of Infection

Call your doctor right away if you have any of these symptoms:

Fever over 100 F or 38 C. Chills, especially shaking chills. Sweating. Loose bowel movements. Frequent urgency to urinate or a burning feeling when you urinate. A severe cough or sore throat. Unusual vaginal discharge or itching. Redness, swelling, or tenderness, especially around a wound, sore, ostomy, pimple, rectal area or catheter site. Sinus pain or pressure. Earaches, headaches, or stiff neck. Blisters on the lips or skin. Mouth sores.

Report any signs of infection to your doctor right away, even if it is in the middle of the night. This is especially important when your white blood cell count is low. If you have a fever, do not take aspirin, acetaminophen, or any other medicine to bring your temperature down without checking with your doctor first.
Blood Clotting Problems
Anticancer drugs can affect the bone marrow's ability to make platelets, the blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even without an injury. Call your doctor if you have any of these symptoms: unexpected bruising. small, red spots under the skin. reddish or pinkish urine. black or bloody bowel movements. bleeding from your gums or nose. vaginal bleeding that is new or lasts longer than a regular period. headaches or changes in vision. warm to hot feeling of an arm or leg. Your doctor will check your platelet count often while you are having chemotherapy. If your platelet count falls too low, the doctor may give you a platelet transfusion to build up the count. There are also medicines called colony stimulating factors that help increase your platelets.

How to help prevent problems if your platelet count is low

Check with your doctor or nurse before taking any vitamins, herbal remedies, including all over-the-counter medicines. Many of these products contain aspirin, which can affect platelets. Before drinking any alcoholic beverages, check with your doctor. Use a very soft toothbrush to clean your teeth. When cleaning your nose blow gently into a soft tissue. Take extra care not to cut or nick yourself when using scissors, needles, knives, or tools. Be careful not to burn yourself when ironing or cooking. Avoid contact sports and other activities that might result in injury. Ask your doctor if you should avoid sexual activity. Use an electric shaver instead of a razor.

How to help prevent problems if your blood is clotting too much.

Clotting [thromboembolism] is one of the most common causes of death in cancer patients. Among the thrombotic complications in patients with cancer are disseminated intravascular coagulation [DIC], pulmonary embolism, stroke, and heart attack. Clearly, these complications arise as tumor cells interact with almost all components of the hemostatic system including platelets. Please see Dehydration and Clotting on this website, for more information.
Mouth, Gum, and Throat Problems
Good oral care is important during cancer treatment. Some anticancer drugs can cause sores in the mouth and throat, a condition called stomatitis or mucositis. Anticancer drugs also can make these tissues dry and irritated or cause them to bleed. Patients who have not been eating well since beginning chemotherapy are more likely to get mouth sores. In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Every step should be taken to prevent infections, because they can be hard to fight during chemotherapy and can lead to serious problems.
How can I keep my mouth, gums, and throat healthy?

Talk to your doctor about seeing your dentist at least several weeks before you start chemotherapy. You may need to have your teeth cleaned and to take care of any problems such as cavities, gum abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay. Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch. Brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special toothbrush and/or toothpaste if your gums are very sensitive. Rinse with warm salt water after meals and before bedtime. Rinse your toothbrush well after each use and store it in a dry place. Avoid mouthwashes that contain any amount of alcohol. Ask your doctor or nurse to suggest a mild or medicated mouthwash that you might use. For example, mouthwash with sodium bicarbonate (baking soda) is non-irritating. If you develop sores in your mouth, tell your doctor or nurse. You may need medicine to treat the sores. If the sores are painful or keep you from eating, you can try these ideas:
How can I cope with mouth sores?

Ask your doctor if there is anything you can apply directly to the sores or to prescribe a medicine you can use to ease the pain. Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat. Eat soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, yogurt, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat. Avoid irritating, acidic foods and juices, such as tomato and citrus (orange, grapefruit, and lemon); spicy or salty foods; and rough or coarse foods such as raw vegetables, granola, popcorn, and toast.

Mouth sores can be so severe that nutrition and hydration are affected. For a further discussion of mouth sores, their cause and treatment, and the magic mouthwash recipe, Go To the Diet Page on this website.
How can I cope with mouth dryness?

Ask your doctor if you should use an artificial saliva product to moisten your mouth. Drink plenty of liquids. Ask your doctor if you can suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum. (Sorbitol, a sugar substitute that is in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.) Moisten dry foods with butter, margarine, gravy, sauces, or broth. Dunk crisp, dry foods in mild liquids. Eat soft and pureed foods. Use lip balm or petroleum jelly if your lips become dry. Carry a water bottle with you to sip from often.
Diarrhea
When chemotherapy affects the cells lining the intestine, it can cause diarrhea (watery or loose stools). If you have diarrhea that continues for more than 24 hours, or if you have pain and cramping along with the diarrhea, call your doctor. In severe cases, the doctor may prescribe a medicine to control the diarrhea. If diarrhea persists, you may need intravenous (IV) fluids to replace the water and nutrients you have lost. Often these fluids are given as an outpatient and do not require hospitalization. Do not take any over-the-counter medicines for diarrhea without asking your doctor.

How can I help control diarrhea?

Drink plenty of fluids. This will help replace those you have lost through diarrhea. Mild, clear liquids, such as water, clear broth, sports drinks such as Gatorade, or ginger ale, are best. If these drinks make you more thirsty or nauseous, try diluting them with water. Drink slowly and make sure drinks are at room temperature. Let carbonated drinks lose their fizz before you drink them. Eat small amounts of food throughout the day instead of three large meals. Unless your doctor has told you otherwise, eat potassium-rich foods. Diarrhea can cause you to lose this important mineral. Bananas, oranges, potatoes, and peach and apricot nectars are good sources of potassium.

Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. A clear liquid diet does not provide all the nutrients you need, so do not follow one for more than 3 to 5 days. Eat low-fiber foods. Low-fiber foods include white bread, white rice or noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins, cottage cheese, yogurt without seeds, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken, or turkey without the skin, and fish.

Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit. Avoid hot or very cold liquids, which can make diarrhea worse. Avoid coffee, tea with caffeine, alcohol, and sweets. Stay away from fried, greasy, or highly spiced foods, too. They are irritating and can cause diarrhea and cramping. Avoid milk and milk products, including ice cream, if they make your diarrhea worse.
Constipation
Some anticancer medicines, pain medicines, and other medicines can cause constipation. It can also occur if you are less active or if your diet lacks enough fluid or fiber. If you have not had a bowel movement for more than a day or two, call your doctor, who may suggest taking a laxative or stool softener. Do not take these measures without checking with your doctor, especially if your white blood cell count or platelets are low.

What can I do about constipation?

Drink plenty of fluids to help loosen the bowels. If you do not have mouth sores, try warm and hot fluids, including water, which work especially well. Check with your doctor to see if you can increase the fiber in your diet (there are certain kinds of cancer and certain side effects you may have for which a high-fiber diet is not recommended). High fiber foods include bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn. Get some exercise every day. Go for a walk or you may want to try a more structured exercise program. Talk to your doctor about the amount and type of exercise that is right for you.

For more information about constipation, Go To the Diet Page on this website.
Nerve and Muscle Effects
Sometimes anticancer drugs can cause problems with your body's nerves. One example of a condition affecting the nervous system is peripheral neuropathy, where you feel a tingling, burning, weakness, or numbness or pain in the hands and/or feet. Some drugs can also affect the muscles, making them weak, tired, or sore. Sometimes, these nerve and muscle side effects, though annoying, may not be serious. In other cases, nerve and muscle symptoms may be serious and need medical attention. Be sure to report any nerve or muscle symptoms to your doctor. Most of the time, these symptoms will get better; however, it may take up to a year after your treatment ends.

Some nerve and muscle-related symptoms include: tingling, burning, weakness, or numbness in the hands and/or feet. Pain when walking, or weak, sore, tired or achy muscles. Loss of balance, clumsiness, difficulty picking up objects and buttoning clothing, shaking or trembling. Other walking problems. Jaw pain, hearing loss, stomach pain, constipation .

How can I cope with nerve and muscle problems?

If your fingers are numb, be very careful when grasping objects that are sharp, hot, or otherwise dangerous. If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs, and using bath mats in the bathtub or shower. Always wear shoes with rubber soles (if possible). Ask your doctor for pain medicine.
Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy, such as redness, rashes, itching, peeling, dryness, acne, and increased sensitivity to the sun. Certain anticancer drugs, when given intravenously, may cause the skin all along the vein to darken, especially in people who have very dark skin. Some people use makeup to cover the area, but this can take a lot of time if several veins are affected. The darkened areas will fade a few months after treatment ends. Your nails may also become darkened, yellow, brittle, or cracked. They also may develop vertical lines or bands.

While most of these problems are not serious and you can take care of them yourself, a few need immediate attention. Certain drugs given intravenously (IV) can cause serious and permanent tissue damage if they leak out of the vein. Tell your doctor or nurse right away if you feel any burning or pain when you are getting IV drugs. These symptoms do not always mean there is a problem, but they must always be checked at once. Don't hesitate to call your doctor about even the less serious symptoms.

Some symptoms may mean you are having an allergic reaction that may need to be treated at once. Call your doctor or nurse right away if: you develop sudden or severe itching OR your skin breaks out in a rash or hives OR you have wheezing or any other trouble breathing.

How can I cope with skin and nail problems?

Acne

Try to keep your face clean and dry. Ask your doctor or nurse if you can use over-the-counter medicated creams or soaps.

Itching and dryness

Apply corn starch as you would a dusting powder. To help avoid dryness, take quick showers or sponge baths. Do not take long, hot baths. Use a moisturizing soap. Apply cream and lotion while your skin is still moist. Avoid perfume, cologne, or aftershave lotion that contains alcohol. Use a colloid oatmeal bath or diphenhydramine for generalized pruritis.

Nail problems

You can buy nail-strengthening products in a drug store. Be aware that these products may bother your skin and nails. Protect your nails by wearing gloves when washing dishes, gardening, or doing other work around the house. Be sure to let your doctor know if you have redness, pain, or changes around the cuticles.

Sunlight sensitivity

Avoid direct sunlight as much as possible, especially between 10 a.m. and 4 p.m. when the sun's rays are the strongest. Use a sun screen lotion with a skin protection factor (SPF) of 15 or higher to protect against sun damage. A product such as zinc oxide, sold over the counter, can block the sun's rays completely. Use a lip balm with a sun protection factor. Wear long-sleeve cotton shirts, pants and hats with a wide brim (particularly if you are having hair loss), to block the sun. Even people with dark skin need to protect themselves from the sun during chemotherapy.
Radiation Recall
Some people who have had radiation therapy develop "radiation recall" during their chemotherapy. During or shortly after certain anticancer drugs are given, the skin over an area that had received radiation turns red; a shade anywhere from light to very bright. The skin may blister and peel. This reaction may last hours or even days. Report radiation recall reactions to your doctor or nurse. You can soothe the itching and burning by: Placing a cool, wet compress over the affected area. Wearing soft, non-irritating fabrics. Women who have radiation for breast cancer following lumpectomy often find cotton bras the most comfortable.
Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or permanent damage to the bladder or kidneys. If you are taking one or more of these drugs, your doctor may ask you to collect a 24-hour urine sample. A blood sample may also be obtained before you begin chemotherapy to check your kidney function. Some anticancer drugs cause the urine to change color (orange, red, green, or yellow) or take on a strong or medicine-like odor for 24-72 hours. Check with your doctor to see if the drugs you are taking may have any of these effects. Always drink plenty of fluids to ensure good urine flow and help prevent problems. This is very important if you are taking drugs that affect the kidney and bladder. Water, juice, soft drinks, broth, ice cream, soup, popsicles, and gelatin are all considered fluids.

Tell your doctor if you have any of these symptoms:

Pain or burning when you urinate (pass your water). Frequent urination. Not being able to urinate. A feeling that you must urinate right away ("urgency"). Reddish or bloody urine. Fever. Chills, especially shaking chills.
Flu-Like Symptoms
Some people feel as though they have the flu for a few hours to a few days after chemotherapy. This may be especially true if you are receiving chemotherapy in combination with biological therapy. Flu-like symptoms; muscle and joint aches, headache, tiredness, nausea, slight fever (usually less than 100 degrees F.), chills, and poor appetite; may last from 1 to 3 days. An infection or the cancer itself can also cause these symptoms. Check with your doctor if you have flu-like symptoms.
Fluid Retention
Your body may retain fluid when you are having chemotherapy. This may be due to hormonal changes from your therapy, to the drugs themselves, or to your cancer. Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen. You may need to avoid table salt and foods that have a lot of salt. If the problem is severe, your doctor may prescribe a diuretic, medicine to help your body get rid of excess fluids.
Effects on Sexual Organs
Chemotherapy may, but does not always, affect sexual organs and functioning in both men and women. The side effects that might occur depend on the drugs used and the person's age and general health.

Men

Infertility

Chemotherapy drugs may lower the number of sperm cells and reduce their ability to move. These changes can result in infertility, which may be temporary or permanent. Infertility affects a man's ability to father a child, but not a man's ability to have sexual intercourse. Other possible effects of these drugs are problems with getting or keeping an erection and damage to the chromosomes, which could lead to birth defects.

What You Can Do

Before starting treatment, talk to your doctor about the possibility of sperm banking, a procedure that freezes sperm for future use if infertility may be a problem. Ask about the cost of sperm banking. Use birth control with your partner during treatment. Ask your doctor how long you need to use birth control. Use a condom during sexual intercourse for the first 48 hours after the last dose of chemotherapy because some of the chemotherapy may end up in the sperm. Ask your doctor if the chemotherapy will likely affect your ability to father a child. If so, will the effects be temporary or permanent?

Women

Effects on the ovaries

Anticancer drugs can affect the ovaries and reduce the amount of hormones they produce. Some women find that their menstrual periods become irregular or stop completely while having chemotherapy. Related side effects may be temporary or permanent.

Infertility

Damage to the ovaries may result in infertility, the inability to become pregnant. The infertility can be either temporary or permanent. Whether infertility occurs, and how long it lasts, depends on many factors, including the type of drug, the dosage given, and the woman's age.

Menopause

A woman's age and the drugs and dosages used will determine whether she experiences menopause while on chemotherapy. Chemotherapy may also cause menopause-like symptoms such as hot flashes and dry vaginal tissues. These tissue changes can make intercourse uncomfortable and can make a woman more prone to bladder and/or vaginal infections. Any infection should be treated right away. (See "Infection.") Menopause may be temporary or permanent.

Help for hot flashes

Dress in layers. Avoid caffeine and alcohol. Exercise. Try meditation or other relaxation methods.

Relieving vaginal symptoms and preventing infection

Use a water or mineral oil-based vaginal lubricant at the time of intercourse. There are products that can be used to stop vaginal dryness. Ask your pharmacist about vaginal gels that can be applied to the vagina. Avoid using petroleum jelly, which is difficult for the body to get rid of and increases the risk of infection. Wear cotton underwear and pantyhose with a ventilated cotton lining. Avoid wearing tight slacks or shorts. Ask your doctor about prescribing a vaginal cream or suppository to reduce the chances of infection. Ask your doctor about using a vaginal dilator if painful intercourse continues.

Pregnancy

Although pregnancy may be possible during chemotherapy, it still is not advisable because some anticancer drugs may cause birth defects. Doctors advise women of childbearing age, from the teens through the end of menopause, to use some method of birth control throughout their treatment, such as condoms, spermicidal agents, diaphragms or birth control pills. Birth control pills may not be appropriate for some women, such as those with breast cancer. Ask your doctor about these contraceptive options. If a woman is pregnant when her cancer is discovered, it may be possible to delay chemotherapy until after the baby is born. For a woman who needs treatment sooner, the possible effects of chemotherapy on the fetus need to be evaluated.

Feelings About Sexuality

Sexual feelings and attitudes vary among people during chemotherapy. Some people find that they feel closer than ever to their partners and have an increased desire for sexual activity. Others experience little or no change in their sexual desire and energy level. Still others find that their sexual interest declines because of the physical and emotional stresses of having cancer and getting chemotherapy. These stresses may include: worries about changes in appearance. anxiety about health, family, or finances. side effects of treatment, including fatigue, and hormonal changes. A partner's concerns or fears also can affect the sexual relationship. Some may worry that physical intimacy will harm the person who has cancer. Others may fear that they might "catch" the cancer or be affected by the drugs.

Both you and your partner should feel free to discuss sexual concerns with your doctor, nurse, social worker, or other counselor who can give you the information and the reassurance you need. You and your partner also should try to share your feelings with each other.

If talking to each other about sex, cancer, or both, is hard, you may want to speak to a counselor who can help you talk more openly. People who can help include psychiatrists, psychologists, social workers, marriage counselors, sex therapists, and members of the clergy. If you were comfortable with and enjoyed sexual relations before starting chemotherapy, chances are you will still find pleasure in physical intimacy during your treatment. You may discover, however, that intimacy changes during treatment. Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important. Remember that what was true before you started chemotherapy remains true now: There is no one "right" way to express your sexuality. You and your partner should decide together what gives both of you pleasure.


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