Patient Guide to Chemotherapy - Part 3

Nausea and Vomiting

It is possible that you may feel nauseated or vomit following your treatment. It is not a side effect of every drug. Some drugs cause a greater reaction than others. If your chemotherapy contains drugs that cause nausea and vomiting, you will be given medication aimed at preventing this both before and after your chemotherapy. Do not wait for nausea and vomiting to occur; take the medication for nausea regularly, as prescribed, as a preventive measure.

If nausea persists, you may repeat this medication following directions on the bottle. There may be times when you will be asked to take this medication before coming to the clinic.

If this medication does not help, please inform your doctor so that the dose can be adjusted to suit you better. Ice cold wash cloths applied to your neck may help bring relief. Nausea does not usually last longer than 24 hours following your treatment; if it does please inform your doctor or a nurse.

Eat only when you feel you can, but try to avoid a heavy meal immediately before or after your treatment. Try cool foods without a strong aroma such as diluted juices, gingerale, Popsicles®, gelatin desserts, custards, dry cereals, crackers, toast or plain cookies. When you eat, drink fluids first, then eat light non-greasy low fat foods that are not spiced or fried. Try to avoid cooking aromas. After eating, relax in an upright position to ease digestion. Avoid lying down for at least two hours.

Rather than eating your regular three meals a day, try to eat more frequently, in small amounts (6 - 8 times a day). Eat slowly and chew your food well. Have 8- 10 cups of fluid to prevent dehydration. Try diluted juices, fruit drinks, weak tea and gingerale. For further suggestions about your diet, contact the dietitian.

You may find that you will need someone to drive you home. If medication is given to reduce nausea it may make you sleepy.

Loss of Appetite (Anorexia)

If you feel nauseated you will not feel much like eating. There are a few steps you can take which might help improve your appetite. Try to take your medication for nausea one hour before eating and rinse your mouth and gums well before eating.

Maintaining your weight is important. Make an effort to eat regularly even if it's only a few bites. Eat small meals often (about 6-8 times daily). Some foods may be easier to eat than others. Try cereals and cream soups (throughout the day). Keep a variety of nutritious snack foods on hand such as cheese, crackers, muffins, nuts and puddings.

Be flexible. If you aren't hungry at dinnertime make breakfast or lunch or a mid- morning snack your main meal. Take advantage of time-saving appliances like blenders or microwaves. Use ready-to-eat, easily prepared food, freezing meals ahead of time whenever possible. Check with your doctor to determine if a glass of wine or beer can be used to improve your appetite. A further contributing factor to anorexia is the altered taste and heightened sense of smell that many patients on chemotherapy experience. Although no specific treatment exists, it is at least temporary and resolved completely once chemotherapy is stopped.

If you are at all worried about your food intake or about your weight, please speak to your doctor or nurse who may refer you to a clinical dietitian.

Diarrhea

Diarrhea is a less common reaction to chemotherapy, but if it occurs, you can take steps to look after yourself. Drink plenty of fluids to replace lost fluids. Try diluted fruit juices and non-carbonated fruit drinks. Diarrhea can be minimized by eating small meals throughout the day. Non-irritating foods such as chicken, fish, eggs, white bread, canned vegetables, bananas, applesauce or low fibre cereals are some suggestions. Avoid fatty and fried foods, rich sauces, caffeine, alcohol, smoking and chocolate. Try to drink your liquids slowly. Be careful with extremely hot or cold foods. Keep your activity to a minimum after meals. For detailed dietary suggestions, contact the dietitian.

Call your doctor if diarrhea persists as medication may be ordered for you to be taken 2 or 3 times daily. If you are sore around the rectal area, Vaseline or K-Y Jelly can be used to relieve the discomfort. If receiving radiation to this area consult your doctor before applying anything.

Constipation

Some medications can cause constipation. This is almost universal if you need to use pain relieving medications of the opioid class (eg. codeine, Tylenol #3®, Percocet®, Percodan®, morphine, Dilaudid®). Laxatives should be used routinely. Check with your nurse. Adding high-fibre foods like whole grain cereals, bran breads, fruits and vegetables, dried beans, peas and even popcorn can also help prevent constipation. Drink plenty of liquids in combination with the above high-fibre foods. Tea, hot lemon, water and juices such as prune juice may also be effective.

A daily routine of exercise such as walking will help considerably. If constipation persists bring it to the attention of your doctor or nurse.

Reproductive System Changes

Chemotherapy may cause changes in your reproductive system. Women who are still menstruating may have irregular periods or stop menstruating. You may experience hot flashes. These changes may be permanent or temporary. After treatment you may remain fertile and can still become pregnant although some patients, particularly those nearing menopause, may not.

You should discuss these matters, including birth control, with your doctor. If pregnancy occurs while on chemotherapy, there is a strong possibility of harmful effects on the fetus as a result of the chemotherapy drugs. Pregnancy at this time should not be considered.

In men, chemotherapy often decreases the number of sperm cells produced. Although sterility is common during therapy, sexual function is generally not changed. In some men the sterility may be permanent. You may want to consider sperm banking before beginning treatment. Please discuss this further with your doctor.

Other common side effects of chemotherapy such as tiredness or a decrease in your sense of well-being may lessen your ability or desire for sexual relations. Usually this condition is not a lasting one. Relationships can often be strengthened during times of stress. You and your partner can give considerable comfort and encouragement to one another.

Hair Loss

Not all chemotherapy drugs cause hair loss, but some do. Hair follicles like most other rapidly growing hair cells (eg. nails, bone marrow and lining of the gut) are rapidly growing cells and are affected by chemotherapy drugs. You may experience partial or even complete hair loss not only from the scalp but also of body hair.

Hair loss may occur about 1 to 2 weeks after your first treatment. This, however, is a temporary loss and your hair will grow again when treatment is stopped. Occasionally, hair will even start to grow again after 3-6 months of chemotherapy. This does not imply your chemotherapy is no longer effective. When your hair regrows there is the chance that it may be a slightly different color and texture from your original hair.

Avoid having a perm if you are on a drug which may cause hair loss, as this weakens the hair.

If you have long hair, you may wish to style it shorter so that when it begins to fall out it will not pull and tangle as much. You may wish to consider visiting a wig shop prior to hair loss so that your own colour and style may be matched. Wigs are available at the Institute for you to borrow if you do not wish to purchase one. Ask at the Volunteer Office on the main floor about this service, or call 432-8334 at the CCI.

After hair loss, wash your scalp gently with mild soap and water. Protect your scalp from direct sun as sunburn is a possibility. Some women choose to wear colourful scarves and men often wear caps.