Highlands Oncology Group, Fayetteville, Arkansas

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TREATMENT INFORMATION
INFO INDEX

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FOR OUR NEW CHEMOTHERAPY PATIENTS AND THEIR FAMILIES
The information in this packet has been assembled to help answer the many questions you may have regarding chemotherapy and its side effects. We at Highlands Oncology Group are proud to work as a team in an effort to make your experience as pleasant as possible. Enclosed in this booklet is information that will be helpful to you. By knowing about your chemotherapy, you can help us help you.

We cannot help you if we do not know what is happening to you. Please let us know when you do not feel well or if something is troubling you. We appreciate your communication. Many times there are simple measures that can be taken to help alleviate any problems you may be experiencing. Hopefully, this booklet will help with some questions or concerns that you may have. If not, please call us or tell us while you are in the clinic that you are having problems. Please do not assume that you must “live with it,” or that “it goes along with the treatment.”

During office hours, our switchboard operator will connect you directly to one of our nurses for any questions and concerns you may have. However, if a nurse is not available at that time, please leave a message on the answering machine explaining the situation. Your chart will be pulled and reviewed. You are important to us and we will try and call you back as soon as possible. However, please be patient on a return call. It may be a couple of hours before we can call you. If it is an emergency, please notify the switchboard operator so she can ensure that your call is answered.

After hours and on Sundays, please call the clinic at 479-587-1700 and speak with the answering service.  They will contact the oncologist that is on call for our clinic.  The Fayetteville office is open on Saturday between 8:00 a.m. and 2:00 p.m.  If you are having a problem during that time, you may call North Hills during those hours. The oncologist may be Dr. Beck, Dr. Bradford, Dr. Hayward, Dr. Oakhill, Dr. Travis or Dr. Rosenfeld. Do not worry if your doctor is not on call.  All the oncologists deal daily with oncology patients and their problems and they will be able to help you.

After hours EMERGENCY     (479) 587-1700

HOG at North Hills, Fayetteville   (479) 587-1700

HOG at 102, Bentonville   (479) 936-9900

TREATMENT INFORMATION INDEX
 
WHAT IS CHEMOTHERAPY?
    Chemotherapy is the use of drugs to destroy cancer cells.  Unlike surgery or radiation, which destroy cancer cells in one area of the body, chemotherapy is a “systemic” treatment that affects cancer cells anywhere they may be in the whole body “system.”

    Oncologists, or cancer doctors, study what has happened to many people with the same type of cancer to find out what has worked most successfully.  Chemotherapy often uses a combination of drugs, given in specific doses, in specific ways, at specific times, with the combination repeated several times.  Although you may have the same cancer as someone else, the chemotherapy treatment for your cancer may be different from theirs.  This is due to many reasons: sex, body weight and size, tumor type, stage of the cancer, your body’s tolerance, and other physical problems specific to you.
HOW DOES CHEMOTHERAPY WORK?
    Chemotherapy, called chemo for short, is a relatively new method of treating cancer.  Most cancer-fighting drugs in use today have been developed in the last four decades.

    Chemotherapy acts on cells that divide rapidly, which includes some tumor cells.  The drugs interfere with division of the cell, the cell's method of reproduction. If the cell is unable to reproduce, it will eventually die without another cell to replace it. The effect, then, is a decreased number of tumor cells.

    Unfortunately, chemotherapy also affects normal cells that divide rapidly.  Normal cells most affected by these drugs are cells of the: bone marrow, gastrointestinal tract, hair follicles, and some reproductive organs.  That is why side effects of chemotherapy may include low blood cell counts, mouth sores, diarrhea, hair loss, infertility, and other symptoms.

    More than one chemotherapy drug may be given at a time. Some chemotherapy drugs appear to have additional effects when combined.  The combination of drugs is given every three to four weeks.  There is enough time between cycles for the blood counts to recover.  Multiple cycles of the drugs are given to destroy more cancer cells.
HOW ARE THE MEDICINES GIVEN?
    Chemotherapy can be given in different ways. The four most common methods are intravenous, oral, intramuscular, and intrathecal. The method is based on the actual disease diagnosed and the agent's effectiveness.

    The intravenous (IV) route is a very common way of giving medicine directly into a vein. A small plastic needle is inserted into one of the veins in the lower arm. There is some discomfort during insertion because a needle stick is required to get into the vein. After that, administration of the medication is almost painless. Chemotherapy flows from a plastic bag through the needle and catheter into the blood stream. Sometimes a syringe is used to push the chemotherapy through the tubing.

    The oral method takes the form of a pill, capsule, or liquid taken by mouth. This is the easiest and most convenient method since it can be done at home.

    Intramuscular means an injection into the muscle. There is a slight pinch as the needle is placed into the muscle of the arm, thigh, or buttocks. However, the procedure lasts only a few seconds.

    Certain types of leukemia have a tendency to spread to the nervous system. To prevent this, doctors may perform a spinal tap and inject a chemotherapy drug into the spinal fluid to destroy any diseased cells. This is known as an intrathecal method of administration.
GUIDELINES FOR TREATMENT DAY
T O P
    We realize that this is a difficult day for you.  The following suggestions may help you get through it a little easier and may answer questions/concerns that you may have the day you come in for chemotherapy.

    Drink plenty of fluids the day before coming for your chemotherapy.  Plenty of fluids means to drink at least six to eight 8-ounce glasses of caffeine-free fluids.

    Eat a light breakfast on the morning of your treatment.  Do not eat any fried or greasy foods.

    Continue your regular medications unless otherwise instructed.  Ask the doctor if you are not sure of a particular medicine.

    Wear comfortable clothing.  Dress warmly if you are cold natured.  We try to have blankets available, but occasionally we run low.  You may want to bring your own blanket.

    Bring whatever you need to be comfortable for the time you will be in the clinic.  You may want to bring your lunch or a light snack, since we do not have food machines.  We provide sodas but if you have a favorite, and we do not have it, you may want to bring your own.

    Feel free to bring a book or your favorite cassette tape.  We have cassette tape players available.

    Have a family member or friend drive you to and from the clinic.  We usually have room for one person to stay with you while you are receiving your treatment.  You may need them to run an errand for you or simply keep you company during the time you will be at the clinic.

    When you get home, take it easy.  Relax for the rest of the day.  Eat lightly if you feel hungry.  Do not eat a lot of heavy, spicy, or greasy food.

    Remember to take your medicine to prevent nausea.  Take the nausea medication, whether your stomach feels upset or not, for the prescribed number of days.  This will prevent nausea that may occur days after the chemotherapy treatment.  If you are not sure, ask your nurse.  Usually you will only need to take this medication for a few days.

    Call us if you develop nausea, vomiting, or diarrhea that is not relieved by measures you are taking and the symptoms persist for more than 12 to 24 hours.  You could become dehydrated and this can be prevented.
NUTRITION DURING CHEMOTHERAPY
    Good nutrition is always important while receiving chemotherapy.  Adequate daily supplies of calories, protein, vitamins and minerals are needed to promote healing.  A good diet will help to promote healing and aid in minimizing side effects.
To promote good nutrition:

Drink two or more cups of milk daily. Cheese, cottage cheese, ice cream, or yogurt may be substituted.

Eat at least two 4-ounce servings of meat daily. Eggs, cheese, beans, or peanut butter may be substituted.

Eat at least two fruits daily. One should be a citrus fruit, such as: an orange, grapefruit, or tomato.

Eat at least two servings of vegetables daily. Include dark green vegetables or a dark yellow vegetable.

Eat at least four servings of grain or breads, such as: bread, cereal, oatmeal, rice, or pastas. Add butter liberally.

To increase calories and protein, eat nourishing snacks or add liquid supplements, such as: Instant Breakfast, Ensure, Sustacal, or Boost.

Drink eight to ten 8-ounce glasses of fluid a day. 		Other helpful hints:

Eat six to eight small meals rather than three regular meals a day. Don’t allow yourself to feel either “too empty” or “full.”

To avoid nausea: avoid greasy, fried, or spicy foods.

If cooking smells annoy you, substitute with cool foods, which have little aroma. If possible, have someone else prepare meals for you.

Eat slowly and chew food well.

Eat in a pleasant atmosphere or eat with friends and/or family to improve your appetite.

Enjoy dessert, as they provide needed calories and carbohydrates.

Snack between meals, including a bedtime snack.

Eat favorite foods when your appetite is poor.
PREVENTING WEIGHT LOSS
    During chemotherapy, increased amounts of protein and calories are needed to rebuild normal tissues that are affected by the chemotherapy.  You may find yourself losing weight even though you are eating nutritiously.  Now is not the time to lose weight.
To minimize weight loss and ensure good nutrition, you can:

Take advantage of “up times” when you feel well. You may want to prepare meals that you can freeze for the days when you will not feel like preparing a meal.

Concentrate on foods that are appealing and avoid foods that do not interest you during your chemotherapy.

Eat a big breakfast. Many people find they are able to eat larger amounts in the mornings. Eat smaller meals more often.

If meat does not taste right, cook chicken, turkey, or fish. You may like cold meat better. Other sources of protein are eggs, dairy products, peanut butter, and cheese.

Salty or tart foods, such as: orange juice, cranberry juice, pickles, lemon juice, and vinegar may enhance flavors.

Do not drink liquids at mealtimes. Limit non-nutritious beverages like coffee, sodas, and tea. 		To add calories to your diet, you can:

Use whole milk to cook with. It has 90 more calories per glass than skim milk.

Eat cream soups rather than clear soups.

Add whipping cream to pies, fruit, puddings, hot chocolate, Jell-O, and other desserts. It has 60 calories per tablespoon.

Eat nuts, dried fruits, candy, buttered popcorn, crackers, cheese, granola, milkshakes, ice cream, and popsicles made from juices. These are all good high-calorie snacks.

Add raisins, dates, chopped nuts, and/or brown sugar to hot or cold cereals for a snack.

Have a snack before bedtime every night. Try such foods as sandwiches, peanut butter or cheese with crackers, milkshakes, or hot chocolate.

Add butter or margarine to soups, vegetables, potatoes, cooked cereal, and rice. Add butter to hot bread and then add more when the bread has cooled.

Use Mayonnaise instead of salad dressing (ex. Miracle Whip).

Eat peanut butter on apples, bananas, celery, or even by itself. Put on sandwich with jelly.

Spread honey or jam on toast.

Canned fruit in heavy syrup has twice the calories of fresh fruit.

Use food supplements like Instant Breakfast, Sustacal, Ensure, or Boost to increase calories in addition to eating small frequent meals. Add them to milkshakes or puddings.
To add protein to your diet, you can:

Add skim milk powder to regular milk and/or add to hot or cold cereals, scrambled eggs, soups, gravies, ground meat, casseroles, desserts, or other baked products.

Use milk or half-and-half instead of water when making soup, cereals, instant cocoa, puddings, and canned soups.

Add diced or ground meat to soups and casseroles.

Add grated cheese or chunks of cheese to sauces, vegetables, soups, and casseroles.

Choose dessert recipes that contain eggs, such as: sponge and angel food cake, egg custard, and bread or rice pudding.

Add peanut butter to sauces, and/or use on crackers, waffles, hot breads, or muffins.
FULL-LIQUID DIET
T O P
    You may follow a full-liquid diet when your body can digest all liquids but can't handle solid food yet.  Your doctor may recommend this diet after surgery or when you can't chew and swallow food.  All liquids served at room or body temperature are part of this diet.  This diet can include most of the recommended food groups.  Extra milk has been included to ensure adequate protein.  When planned properly, this diet can be used for long periods.  In these instances, your doctor may prescribe a commercial supplement and/or certain vitamins.  However, you should only take these if your doctor recommends them.
Type of Food Highlands Oncology Group Allowed Items Highlands Oncology Group Excluded Items Highlands Oncology Group
Beverages
 		Cereal beverages, coffee, tea, fruit drinks: strained lemonade, limeade or fruit punches, water None
Breads, Cereals, Flours Refined or strained cooked cereal Breads and cereals in solid form
Cheeses
 		Cheese soup All others
Desserts Plain gelatin desserts, junket, soft or bakes custards, sherbets, plain cornstarch pudding, fresh or frozen yogurt, ice milk, smooth ice cream All others
Eggs Pasteurized eggnog All Others
Fats Butter, cream, oils, margarine All Others
Fruits, Fruit Juices All juices and nectars, thin fruit purees All Others
Meat, Poultry, Legumes Small amounts of strained meat in broth or gelatin All Others
Milk Chocolate, buttermilk, skim and whole milk, ice milk, milkshakes, plain yogurt Yogurt and milk products with pieces of fruit and all others
Potatoes, Rice, Pasta Potatoes pureed in soup All Others
Soup Bouillon, broth, clear cream soups, any strained or blenderized soup All Others
Sweets Honey, jelly, syrups in small amounts All Others
Vegetable Tomato puree for cream soups, tomato, vegetable juices All Others
Miscellaneous Flavoring extracts, salt All Others
CLEAR-LIQUID DIET
T O P
    Clear-liquid diets are useful if the body can't handle the softest foods or heavy or thick liquids.  Patients usually follow this type of diet after surgery or before stomach or bowel surgery.  Patients with severe nausea and vomiting may also have this diet.  A clear-liquid diet often lasts 1 to 2 days or until you can drink or eat other beverages and foods.  It cannot meet the suggested daily servings, but it helps ensure that your body doesn't lose too much fluid as you recover and become ready for a regular diet.
Type of Food Highlands Oncology Group Allowed Items Highlands Oncology Group Excluded Items Highlands Oncology Group
Beverages
 		Milk, milk drinks, and cereal beverages, coffee, tea, fruit-flavored drinks, strained lemonade, limeade, and fruit punches Milk, milk drinks, and all others
Breads, Cereals, Flours None All
Cheeses
 		None All
Desserts Plain gelatin desserts, fruit ices without milk or pieces of fruit, popsicles All others
Eggs None All
Fats None All
Fruits, Fruit Juices Apple, cranberry and grape juice, strained citrus juices if tolerated All Others
Meat, Poultry, Legumes None All
Milk None All
Potatoes, Rice, Pasts None All
Soup Bouillon, clear fat-free broths, consommé All Others
Sweets Honey, jelly, syrups, plain sugar, candy in small amounts All Others
Vegetable Strained vegetable broth All Others
Miscellaneous Salt All Others
MOST COMMON SIDE EFFECTS OF CHEMOTHERAPY
    Unfortunately, there are side effects when you receive chemotherapy. The following are the most common side effects. You may experience some of them, but not necessarily all of them. Just because they are listed, does not mean it will happen to you.

Sometimes you may feel that you are having a side effect (for instance, nausea) when in fact you may be experiencing another symptom (such as pain) which causes the side effect. (Did we confuse you with that comment?) If you have any questions about side effects that the following does not answer for you, please call.
ALLERGIC REACTION
T O P
    Every drug causes an allergic reaction in some people.  The body reacts strongly to get rid of this “foreign” substance.  However, some chemotherapy drugs may cause: hives or other rashes, general body swelling, shortness of breath, wheezing, anxiety, and/or low blood pressure in many patients within a few minutes of being given.  Other allergic reactions may appear as high fever and chills (without infection) within a few hours or days later.

With quick treatment, the immediate hypersensitivity reactions usually get better within minutes or hours.  The slower appearing reactions often take several days to improve.  Your chemotherapy may be given more slowly or an anti-allergy medication may be added with your next dose, should you experience an allergic reaction.

If you should have an allergic reaction, you need to:

  • Notify your nurse or doctor IMMEDIATELY should you suddenly have trouble breathing or notice intense itching while you are receiving a chemotherapy drug.
  • For itching, take a lukewarm bath with ¼ cup baking soda added.
  • Take an antihistamine (anti-allergy) medicine if ordered by your doctor, and apply lotions or creams as prescribed.
  • Your doctor may order an intraveneous or intramuscular injection to reverse severe chills.
APPETITE CHANGES
    Foods and liquids may taste different to you, because in addition to the cancer cells being destroyed, normal cells are also destroyed.  Chemotherapy attacks rapidly dividing cells, which include the cells lining your mouth, stomach, and intestines.  Also, you may not be as active, which may decrease your appetite.  Although you may have temporarily lost your appetite, it is important to eat as nutritiously as possible to help your body recover from the effects of the chemotherapy.

A decreased appetite may become worse during the first few days after chemotherapy is given, but should improve prior to the next dose of chemotherapy.  It may not return to normal until a few weeks after your final chemotherapy treatment.  Also, when you increase your activity, your appetite will improve.

To help with appetite changes, you need to:

  • Eat small frequent snacks (six per day) that include foods you best tolerate. Eat even if you are not hungry.
  • Eat high-protein foods, for example: milk, eggs, cheese, peanut butter, and nuts.  Meat products may taste bitter.  Plastic rather than metal utensils may reduce the bitter taste.  If you need more salt to make meat more tasty, and you are not on a salt-restricted diet, you may be able to enjoy cured meats, such as: ham, bacon, sausage, and corned beef, or you may want to try marinating meats in soy sauce.  Meats can even be marinated in sweet fruit juices or sweet wines and cooked with fruit over them to improve their taste.
  • Eat a high-calorie diet (e.g. cream, butter, margarine, sugar, syrup, jelly) if you are not overweight or a diabetic. Some ingredients may perk up your appetite. Try and use more of them.  For example, if you normally use 1 tsp of sugar, use 3-4 tsp of sugar.  Also, increase use of spices and seasonings.
  • Excellent sources of nutrition can be added to your cooking and baking, such as nonfat dry milk and pasteurized liquid eggs or egg substitutes.
  • Add nutritional value to beverages by using light cream for milk.  Add 1-2 spoonfuls of ice cream to milk beverages.  Add 1-3 tbsp of nonfat dry milk to each glass of milk.
  • Take advantage of frozen dinners.
  • Use high-protein, high-calorie sandwich fillings.  These may include: eggs, chicken, turkey, or tuna salad with mayonnaise, or peanut butter with bananas, bacon, or jelly.
  • Dilute condensed cream soups with 1 cup of milk instead of water and add extra nonfat dry milk or undiluted evaporated milk.
  • Add raisins, nuts, or dates to muffins, rolls, and cereal.  Add grated cheese to biscuits.
  • Vary odors and textures (consistency) of foods from meal to meal to increase your appetite.
  • Drink acidic beverages, such as lemonade, because they may increase your appetite.
  • Serve foods attractively and eat with someone whenever possible.  Socializing may increase your appetite.
  • Serve with gravy or add salad dressing to vegetables or meat to increase ease of swallowing.
  • Keep food out of sight except when eating.  Seeing food may decrease your appetite.
  • Brush your teeth after meals.
  • Exercise 10–15 minutes before eating.
  • Plan your meals in advance so if you do not feel like cooking, it is ready to eat.
  • If odors are decreasing your appetite, have someone else prepare your meals, if possible.
  • Perform muscle relaxation or other stress reduction techniques before meals to reduce tension before eating,
  • Eat when you are hungry, even if it is not time to eat.
  • Limit fluids when eating in order to save room for solid food.
  • Keep easy-to-prepare snacks on hand, such as peanut butter, cheese, or crackers.
  • Eat dessert to add calories and nutrition, such as ice cream and pudding.
  • Blender drinks with fruit, yogurt, milk, or extra dry milk can be easy to drink with a decreased appetite.
  • Have on hand nutritional supplements (Ensure, Instant Breakfast, Boost) which can be purchased at any grocery store.
  • Notify your doctor or nurse if a significant weight lose is noted.

    To help prevent or decrease nausea, should it occur:
  • Drink carbonated beverages (Remember, these are not nutritious and should not be your only source of liquids.)
  • Eat tart foods, such as pickles or lemons.
  • After sleeping, eat crackers before becoming active.
ANEMIA (LOW RED BLOOD CELL COUNT)
T O P
    Anemia means too few red blood cells (RBCs).  RBCs deliver oxygen to the body.  These cells are made in the bone marrow of the large bones in the body and then travel through the bloodstream.  Chemotherapy drugs affect both cancer cells and normal cells when the cells are in the process of dividing.  Chemotherapy drugs do most of their damage to the cells that divide most often, including cancer cells and the immature RBCs in your bone marrow.  If you lose too many RBCs, you will develop anemia and may become tired more quickly than before.  You may become dizzy when first standing, feel light-headed, become upset easily, feel chilly, or be short of breath.

    Anemia caused by chemotherapy is temporary.  If anemia develops, it will not occur immediately after chemotherapy.  It may occur after two or more months of chemotherapy.  It takes that long because it takes 8-10 days for a RBC to mature in the bone marrow.  It then takes the RBC 120 days to travel through the bloodstream and die.  The RBCs already finished growing and in your bone marrow at the time of your chemotherapy will continue to live out their normal life span. As these cells die, however, there may not be enough new RBCs to replace them.  Although you will be making more RBCs, your body may not be making enough to keep up with the demand.  As a result, you may need a blood transfusion.  Blood tests will be performed periodically to check for anemia.

To help build up your RBCs, you need to:

  • Rest as much as necessary to save you energy during this stage.
  • Eat green leafy vegetables, liver, and lean cooked red meats.
  • Take iron pills if prescribed.  Taking iron with a source of vitamin C, like orange juice, will help your body absorb more iron.
  • Sit before standing and stand a minute before walking if you are experiencing dizziness.
  • Do important activities first so you will have enough energy.
  • Your doctor may prescribe a series of injections such as Epogen, Procrit.  These injections will stimulate your bone marrow to produce RBCs more quickly than it could do otherwise.  The injections are given in the arm with a very small needle.
BLEEDING (LOW PLATELET COUNT)
T O P
    Platelets are cells that form blood clots to stop bleeding.  They are produced in the bone marrow of long bones and then travel through the bloodstream.  Chemotherapy affects cells as they divide, which means it kills not only cancer cells but also healthy cells that normally divide often, such as platelets in the bone marrow.  Your body has many extra platelets, but if the number becomes very low, you may bleed longer after an injury or may begin bleeding during activities (such as brushing your teeth) that otherwise would not cause you problems.  On the other hand, you may not have any bleeding.  Blood tests will be performed periodically to determine your platelet count.

    Your platelet count may fall 8 to 14 days after chemotherapy.  Because platelets normally live such a short time, the bone marrow makes huge numbers of replacements and it usually replenishes the supply within 2 weeks.  Your chemotherapy will not be given again until your platelet count is within a safe range.  You may be given a platelet transfusion if your platelet count is very low or you are having heavy bleeding.

If you have been told that your platelet count is low, you need to:
  • Watch for unexplained bruises.
  • Be careful not to bump or cut yourself.  If you bleed, apply pressure over the area for 5 to 10 minutes with a bandage or clean piece of cloth.  Applying an ice pack over the area once the bleeding has stopped will prevent further bleeding under the skin.
  • Avoid strenuous activity, lifting heavy objects, and bending over from the waist.
  • Brush your teeth gently with a soft toothbrush.  If bleeding occurs when flossing, stop and do not floss again for a few days.  Check with your doctor before any dental work is done.
  • If you need an injection, notify the nurse or doctor about your platelet count.
  • If you need to have blood drawn or be given an injection, put pressure on the needle site for 5 minutes afterwards.
  • Do not use aspirin or products that contain aspirin (salicylic acid, such as Advil or Aleve). Check the labels of over-the-counter medications to be sure they do not contain salicylic acid. If you are unsure, ask the pharmacist or your doctor.
  • Avoid blowing your nose too hard, coughing too harshly, or staining too much with a bowel movement.
  • Take any prescribed steroid medications with milk, food, or an antacid (like Maalox).
  • Avoid drinking alcoholic beverages, as they can decrease blood clotting.
  • Eat protein-rich foods and beverages.
  • Drink eight to ten 8-ounce glasses of fluid a day to keep the intestinal lining in good condition and avoid constipation.
  • Avoid coarse fruits and vegetables because they may cause your gums to bleed when chewing.
  • Call your nurse or doctor if you notice blood in your vomit, urine, stools, or sputum.
  • Call your nurse or doctor if bleeding continues after you have applied pressure for 15 minutes.
  • Go to the nearest emergency room if you have a major injury or are bleeding spontaneously. Explain to the emergency room doctor about your chemotherapy and low platelet count.
BREATHING PROBLEMS
T O P
    A few chemotherapy drugs can cause temporary breathing problems. You may notice becoming short of breath when walking or climbing stairs.

If lung tissue damage occurs during chemotherapy, your drug will be discontinued and another drug will be prescribed for your disease. Lung tissue can regenerate itself in time (weeks) if damage from chemotherapy has not been prolonged or severe.

To help you breath easier, you should:

  • Stop smoking!!
  • Practice deep breathing every four hours while awake. Deep breathing expands the lung tissue and reduces the side effects of therapy. To deep breathe, take three deep breaths through your nose, hold your breath for 5 seconds, and then cough deeply, using you stomach (abdominal) muscles before you exhale. If you are prone to fracture bones, you may not want to cough.
  • Rest as much as necessary to conserve your energy.
  • Sit up in a chair or rest your head in bed against several pillows.
  • Eat easy-to-chew and easy-to-swallow foods if shortness of breath interferes with eating normal foods.
  • Call the nurse or doctor if you experience continued unrelieved shortness of breath or an increase in shortness of breath occurs.
CONSTIPATION
    Chemotherapy may slow down the nerve messages to your intestine resulting in constipation. A person does not have to have a stool every day. As long as a person is not having difficulty passing a stool, he is not constipated. Constipation is present when there is difficulty passing a stool. Constipation is temporary and is relieved when you finish chemotherapy. Usually, within a week after chemotherapy, your bowel habits will return to normal.

To help with constipation, you should:

  • Eat high-fiber foods that include whole-grain cereal, bran, raw fruits, dates, prunes, vegetables, dried fruits, and raisins. Add bran to your diet. If you have trouble eating raw fruits and vegetables (and your white blood count is not low), try grating them.
  • Avoid cheese products and refined grain products.
  • Eat fruits, such as: oranges, peaches, pears, and prunes.
  • Drink eight to ten 8-ounce glasses of fluid a day.
  • Respond immediately to the urge to have a bowel movement.
  • Exercise if you are able. Walk every day even if for a short time period. If you cannot walk or exercise, contract and relax different muscles. This can even be done in bed.
  • After checking with your doctor, take a stool softener such as Colace or Surfak.
  • Check with your nurse or doctor prior to taking a laxative or enema.
  • Notify your nurse or doctor if you do not have a bowel movement in 3-4 days.
DEPRESSION
T O P
    Depression related to your chemotherapy is more than feeling “blue” or “down” from time to time. It is having a depressed mood and a loss of interest or pleasure in many activities. Depression may be associated with a marked decrease in daily activities, difficulty sleeping or sleeping too much, feelings of hopelessness or worthlessness, diminished ability to think or concentrate, and recurrent thoughts of death. Depression is a medical condition that is treatable.

To assist with depression, you need to:

  • Talk to family members, your nurse, and/or your doctor concerning your symptoms. Do activities that give you pleasure. Spend time with those who love and care about you. Ask your doctor about prescription medication until your depression improves. If your symptoms are not relieved, talk with your doctor about seeking professional help to assist you with coping mechanisms to deal with the cancer and the stress you are under.
DIARRHEA
    Diarrhea means loose (and sometimes more frequent) bowel movements, due to damaged cells lining the digestive tract.  Because chemotherapy targets cells that rapidly divide, which includes the cells of the intestinal wall, diarrhea may occur.  How severe the diarrhea is varies from person to person.  Some abdominal cramping may also occur. Diarrhea caused by chemotherapy is usually temporary.  The cell lining in your mouth, stomach, and intestines will grow back.

To help diarrhea, you should:

  • Check with your nurse or doctor about taking an over-the-counter medication such as Kaopectate, Pepto-Bismol, or Imodium A.D.
  • Drink eight to ten 8-ounce glasses of fluid a day.  This will replace lost fluids, not cause more diarrhea. Avoid hot or cold fluids since they may increase cramping.
  • If diarrhea continues or becomes severe, take a liquid diet such as Gatorade and Ginger Ale.
  • Avoid food that contains fat.  Avoid food that contains roughage and bulk. Avoid milk and milk products.
  • Avoid drinking beverages while eating food.  Allow carbonated beverages to lose their fizz before drinking them.
  • Eat foods high in potassium, such as: bananas, apricots without the skin, baked potatoes without the skin, broccoli, halibut, asparagus, saltwater fish, or mushrooms.
  • Keep track of the number of bowel movements you have in a day to assess for possible dehydration.  The signs and symptoms of dehydration are: dryness of skin and mouth, decreased urine volume, and sunken eyes.  If these symptoms occur, call your nurse or doctor.
  • Soaking in a warm bath or taking a sitz bath for 20 minutes two times a day may soothe the anal area.  Clean the area with warm water very gently, but thoroughly, after each bowel movement and then patting dry may also help soothe the area.  Unscented wipes or hemorrhoid wipes like Tucks may help.  Lastly, applying a non-prescription ointment that contains lidocaine (like Desitin or A and D ointment) will help soothe the anal are.
  • Notify your nurse or doctor if you are taking 5FU or Camptosar and you have more than 2 liquid stools a day.
  • Notify your nurse or doctor if your diarrhea becomes severe (more than 5 liquid stools in a day) and non-prescription drugs are not effective.
  • Notify your nurse or doctor if you become light-headed, develop a temperature over 100.4, or are unable to urinate for over 3 hours.

Foods to avoid when diarrhea occurs:
Milk and milk products
Dried beans and peas
Corn, popcorn
Olives, pickles
Seeds in bread, roll, crackers
Cloudy juices
Pumpkin, squash, figs
Potato chips, snack chips
Meat with tough connective tissue
Raw vegetables with tough skin or seeds
Fruit with tough skins, dried fruit, berries
Chunky peanut butter
Coarse cereals (bran, shredded wheat, granola, Coconut wheat germ)
Breads made with nuts or dried fruit
Sweets containing nuts, coconut, fruits
FATIGUE
T O P
    Chemotherapy destroys normal cells in addition to cancer cells, which may cause you to feel tired. It is common for people to decrease their physical activity, change their diet, and not sleep as well during chemotherapy.  These changes can increase fatigue.  You may feel tired and have little energy, even after rest.  ou may find it hard to concentrate, or feel sleepy or irritable.

Fatigue tends to go in cycles and can be worse after chemotherapy is given and then get better before the next dose.  However, it can increase with each chemotherapy cycle.  Fatigue is temporary and your energy will eventually return after chemotherapy is over.

To help with fatigue, you can:

  • Plan around your chemotherapy cycle and use the most energy at a specific time.
  • Plan a special treat for yourself once in each cycle, during the time you feel best (usually the week before your next chemotherapy cycle).
  • Pace your activities when you feel fatigue.
  • Take naps. Sit or lie down when you can.  Take frequent rest periods.
  • Exercise regularly, especially walking.  Exercise helps the body rid itself of substances that can cause fatigue and helps you sleep better, eat better and cope with stress better.  Do not overdo and do not exercise the day after treatment.
  • Eat frequent nutritious meals.  Drink 8-10 8-ounce glasses of fluid a day.
  • Pick activities that mean the most to you and concentrate on them.  Let other people help you.
  • Say NO to other people’s extra demands on your energy.
  • Learn the signs that mean you are becoming tired and take a break then.
  • Distract yourself from treatment with music, reading, art, visiting with friends- any activity that you enjoy.
FEVER, CHILLS
    Fever, often accompanied by chills, can be caused by chemotherapy and is a reaction of your body to the drugs. Several hours after you have chemotherapy, your temperature may rise. Otherwise, you should not have a fever.

If you have a fever:

  • Keep a thermometer at home to check your temperature.  If your temperature is over 100.4, call your nurse or doctor for directions of what to do.
  • Drink 8-10 8-ounce glasses of fluid a day.
  • Take Tylenol every four hours (After checking with your doctor).  DO NOT take aspirin as it can cause bleeding.
  • Take tepid (lukewarm) sponge baths to reduce fever and promote comfort.
HAIR THINNING OR LOSS
T O P
    Chemotherapy attacks both cancer cells and normal cells when they are in the process of dividing.  Thus, it does most of its damage to cells that divide frequently, which include hair follicles.  Depending on which chemotherapy drugs you receive and their doses, some, or all, of your hair may fall out.  This includes hair on you scalp, eyebrows, eyelashes, facial, and pubic hair.

Your hair may start to grow again in 3 to 4 months even if you are still receiving chemotherapy. It may look different from pre-chemotherapy hair.  The change may last about two years and then may return to its original appearance.

To help with thinning hair:

  • Use a soft bristle brush to remove tangles.  Avoid over-combing.  Do not use brush rollers when setting your hair.  Use low heat when drying your hair.
  • If you have long hair, you may want to cut it shorter.  Short hair is emotionally easier to deal with if and when your hair starts to thin.  Short hair also hides thinning hair better.
  • Avoid bleaching, teasing, curlers, permanent, and hairspray, because these make the hair brittle, causing it to fall out sooner.
  • You may want to wear a cotton turban or scarf at night to catch loose hair.
  • You may want to buy a wig, cotton scarves, turbans, hats, and false eyelashes.  If you plan to wear a wig that looks like your own hair, visit a supplier and wig stylist before you lose your hair for a better match of color and style. This may be the time when you can experiment with that new color and style you always thought of wearing but didn’t have the nerve to try. (Some insurance companies may pay for a wig.  Check your policy.  There are also some local organizations that provide free wigs, such as the Northwest Arkansas Cancer Support Home.)
  • Talk to your nurse or doctor about any feelings or questions you have about changes in your appearance.  Also, local cancer support groups can offer you not only emotional support but practical information about how to cope with hair loss.
HEARING CHANGES
    Some chemotherapy may cause ringing or other noises in your ears, decrease your ability to hear high tones, or occasionally cause deafness.  It is rare for deafness to be permanent.

If a ringing sensation occurs, your drug may be discontinued and another drug prescribed.

If you should experience ringing sensations, you should:

Notify your nurse or doctor.
INFECTION (LOW WHITE BLOOD CELL COUNT)
T O P
    White blood cells (WBCs) are produced in the bone marrow of the body’s large bones and help protect the body from infection.  WBCs have very short lives, only a few hours of traveling through the bloodstream after they leave the bone marrow.  Chemotherapy attacks cells as they divide, which means it not only kills cancer cells, but also healthy cells. This means chemotherapy also attacks WBCs.  If the number of WBCs drops too low, you will have an increased chance for infection.

Signs and symptoms of infections are: sore throat, cough, nasal congestion, a burning feeling when urinating, shaking chills, burning (pain) at the anus, pain, redness, swelling, warmth at the site of an injury to the skin, and fever.

Your WBC count may fall 8 to 12 days after chemotherapy.  Your bone marrow will continue to make new WBCs, although the demand may temporarily outweigh the supply.

Your doctor and nurse will know when your WBCs will reach their lowest point in the bloodstream (which is called the nadir) after chemotherapy is given.  If your WBC is too low, your next chemotherapy dose may be postponed (or your dose decreased) until the number of WBCs return to a safer range.  Blood tests will be performed periodically to determine your WBC.  The doctor may prescribe injections of a “colony-stimulating factor” like Neupogen, or G- CSF, to help the WBCs recover more quickly.

If you have been told your WBC is low, you need to:

  • Use excellent hygiene daily.  Wash your hands frequently: before and after meals, after using the restroom, etc.
  • Stay away from people with colds.  Stay away from crowds.  This may mean not going to church, shopping, or any other activity that involves several people being present.
  • If you think you may have a fever, take your temperature.  If it is above 100.4, call your nurse or doctor.
  • Use antiseptic mouthwashes that DO NOT contain alcohol.
  • Drink eight to ten 8-ounce glasses of fluid a day.
  • Always wear shoes to prevent cuts to your feet.
  • Wear gloves when working in the garden, wear rubber gloves when washing dishes, and use protective port holders when cooking.
  • If you do cut yourself, wash immediately with soap and water and apply an antibiotic cream.
  • Avoid sunburn.  Wear sunscreen and avoid the sun when possible.
  • Use an electric razor to avoid accidentally cutting the skin.
  • Take several deep breaths often when awake to keep lungs well expanded and decrease risk of lung infection.
INJECTION SITE SYMPTOMS
    Chemotherapy given through the vein (intravenous, IV) is irritating and can cause a variety of symptoms in the injection area and along the vein.  You may feel burning, stinging, warmth, redness, pain, or swelling in the area.

If you experience any of the above symptoms, you need to:

Notify the nurse or doctor.
MOUTH SORES
T O P
    You may experience a sore irritated mouth or difficulty swallowing, due to damage to the layers of cells lining the mouth or esophagus (the tube that leads from the mouth to the stomach). Chemotherapy attacks rapidly dividing cells, which includes the mouth and esophagus.

Mouth sores caused by chemotherapy are temporary and usually occur 5 to 14 days after chemotherapy.  The cellular lining in the mouth and throat will grow back and will heal completely when chemotherapy is completed.

To help with mouth sores:

  • Drink plenty of liquids.  Keep your mouth moist.
  • Brush your teeth with a soft toothbrush. Perform oral hygiene four times a day (within 30 minutes of eating and at bedtime).  For severe mouth sores, you may want to perform oral hygiene hourly.
  • If you have dentures, clean after every meal to remove irritating food particles and to help prevent infection.  Do not use gum-like grips with your dentures.
  • Avoid very hot or very cold temperatures in food as they may cause irritation.
  • Avoid commercial mouthwashes that contain alcohol or a lot of salt.
  • Stop smoking!!
  • If severe and unrelieved by home remedies, notify your nurse or doctor.
ADVICE FOR FRIENDS AND FAMILY OF THOSE WITH CANCER
    A diagnosis of cancer can create awkward tensions between friends and family.  If someone you know has cancer, you may already find that your conversations with him or her are strained. You may even find yourself not calling or visiting your friend or family member, not because you do not care, but because you do not know how to be helpful.  Like hundreds of others, you feel caught in a dilemma.  You want to reach out to your friend or family, but you are afraid of making matters worse by doing the wrong thing, such as mentioning the word “cancer.”

    These feelings are normal.  Sadly, however, friends and family sometimes drift apart during a cancer crisis.  he following suggestions are made in an effort to prevent discomfort and be more helpful to you – the friend and family member.

  • Say or do something, anything.  The risk of hurting your friend or family member by saying the wrong thing is much less of a danger than the risk of hurting them by saying nothing.   Silence may convey the impression that you do not care.
  • Make a symbolic effort to help.  If you find it hard to get started, think of the old saying, “Say it with flowers.”  Say it with vegetables from your garden, freshly baked cookies, or a card to let them know you are thinking of them.
  • Regarding conversations, it is usually best to confront the fact of cancer directly, saying for example, “I am so sorry to learn about your cancer.”  This gives him or her the choice of either talking about their cancer or not.
  • Follow your friend’s lead after you have mentioned the cancer.  If he or she changes the subject, this does not mean you have said the wrong thing.  On the contrary, you may find that your friend will talk about it at a later date.
  • If your friend does talk about the cancer, be a good listener.  Share your own feelings honestly.  Do not be afraid to cry.  Tears show you care.
  • Do not talk about people you know who have cancer and have died.  It is depressing!
  • Do not make everything better by offering false cheer or false hope. You are not expected to “fix” the cancer.  Just being present is appreciated.
  • Do not offer advice on how your friend should bear up under adversity.  People deal with illness in different ways.  Your way of dealing with illness may not be theirs.
  • Make specific offers of help like: “Can I go to the grocery store for you?” or “Can I pick up the kids?”  People do not tend to ask for help if you simply say, “Call if you need anything.”
  • Do not stop offering help even if you are told that no help is needed.  Wait a while and ask again.

    Cancer patients and their families want to see tangible signs of concern from their friends and other family members.  They need to be certain that, despite the rapid changes taking place in their life, your friendship is one thing that will remain constant.
DO'S AND DON'TS
T O P
(Little things that make a big difference.)

DO make a list of your current medications, doses, and how you are taking these medications. Add any new over-the-counter medications that you are taking.  Carry this list with you at all times. This list will be helpful for any health care professional that may need to care for you.

DO keep copies of our phone numbers in convenient locations at your home.  This will make it easier for you to pick up the phone and call us.  Ask for extra copies if you need them.

After Hours Emergency (479) 587-1700
HOG at North Hills, Fayetteville (479) 587-1700
HOG at 102, Bentonville (479) 936-9900

DO leave messages on answer machines, especially if we are unable to pick up the phone when you call.  This will at least make contact with us and avoid any unnecessary delays.  Your phone calls will be returned.  Remember to use the after hours emergency phone number that is listed on our business card if you need to speak with a physician for an emergency.

DO keep a thermometer in your home and use it if you feel that you are running an elevated temperature.  Know what your temperature is prior to calling us. It will help us make a decision on your plan of care if you are ill.  Normal temperatures range from 96 to 99.5 degrees.  Please call if your temperature is 100.4 or more.

DO take your medications as prescribed.  If they are prescribed on an "as needed" basis, take them if you need them.  If they are prescribed on a "scheduled" basis, take them at the times that have been outlined for you.

Some medications are time-released.  Please do not take any more or any less than have been prescribed.  These are meant to keep a constant level of the medication in your blood.  Let us know if you think you need more or less of the medication.

DO take your anti-nausea medication as it has been prescribed.  If you are currently receiving chemotherapy treatments, be sure to take the medicine on the days you are receiving the treatments.   Take it for at least a day following completion of your treatment.  If you have unmanageable nausea or vomiting, contact the clinic and let us know.  We will make an adjustment with your medicine to help.  It is easier to prevent nausea and vomiting than it is to stop it.

DO wear clothes that are comfortable with loose or short sleeves when you come for chemotherapy.   If you are warm natured or cold natured, try to wear clothes that will keep you comfortable while you receive your treatment.

If you have a subclavian or port, try to wear a shirt or blouse, which opens down the front or has a big neck.  This will keep you from having to undress.

DO remember to drink plenty of fluids.  Drink eight to ten 8-ounce glasses of fluid a day.

DO try and remain positive (although at times it is hard to do). This is a difficult time for you, your family, and your friends.  Your health may be reflected by your attitude.  A positive attitude may help you feel better in the long run.

DON'T suffer through side effects such as nausea, vomiting, diarrhea, constipation, or pain while you are at home.  Many times all it takes is just a phone call to find out that there is something that we can do to help you.

DON'T wait until the office opens to try to obtain help.  One of the five oncologists is on call at all times when the office is closed.  If you are experiencing a problem and need help, call the emergency/after hours number.  Many times you can be evaluated in a more timely manner before the problem becomes worse if you seek help when the clinic is closed.

DON'T take aspirin or Ibuprofen products without asking.  Pepto-Bismal and Alka-Seltzer are examples of products that contain aspirin.  These drugs may make you more likely to bleed, as can chemotherapy.

Last, but not least, DON'T hesitate to ask questions.  You've heard it before - no question is a stupid question.  A little question and a little answer can relieve a lot of anxiety.
RESOURCES FOR MORE INFORMATION
The American Cancer Society – Voluntary organization that offers a variety of services to patients and their families.  Supports research, provides educational materials, and conducts educational programs.
Telephone: 1-800-ACS-2345
(1-800-227-2345) Local address: 614 East Emma Street, Springdale, AR 72764
Local telephone: 1-479-872-1161
Website: www.cancer.org

“Been There” – Local network of cancer survivors.  Provides an outlet for you to express all the emotions and concerns you may be experiencing.
Telephone: 1-800-513-1555
Local telephone: 1-479-855-9211


Cancer Care, Inc. – Offers counseling, support groups, financial assistance for non-medical expenses, home visits by trained volunteers, and referrals to services such as housekeeping, nursing care, and health aides.
Telephone: 1-800-813 HOPE
(1-800-813-4673)
Website: www.cancercareinc.org

Cancer Information Resource Line Telephone: 1-479-361-5813

Cancer Network of Northwest Arkansas – Offers spring and fall classes (dates vary) that meet weekly for six weeks to discuss topics such as “I Have Cancer,” “Cancer and My Family,” “Ten Rights and Privileges of a Cancer Patient,” and “Six Things Every Cancer Patient Should Know and Do.”  Time is allowed to meet other cancer patients and family members.
Address: First Baptist Church of Springdale, 1709 Johnson Road, Springdale, AR 72764
Telephone: 1-479-751-4523

Cancer Support Home – Open Monday to Friday 9:00 a.m. to 4:00 p.m.  Open to all cancer patients, friends, and family members who desire a place to meet and participate in a variety of supportive activities.  Anyone seeking assistance in fighting for recovery with renewed hope and energy will find that their needs may be met at the support home.  All services are free of charge.
Address: 1101 North Woolsey Avenue, Fayetteville, AR 72703
Telephone: 1-800-416-8707
Local telephone: 1-479-521-8024
FAX: 1-479-521-8041


The National Cancer Institute (NCI) – Coordinates the government’s cancer research program. Telephone: 1-800-4-CANCER (Information Service)
Website: rex.nci.nih.gov

For additional resources, please refer to the additional handouts enclosed, or contact our social worker, Christina Raichart, at (479) 587-1700 ext. 134.
BIBLIGRAPHY
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Board of Regents of the University of Wisconsin. Nutrition Care for you…Cancer Therapy. University Hospital and Clinics, Madison, WI. 1990.

Cailan, D.B. “You Can Help When Your Friend Has Cancer.” Cancer Family Care, General Office, Cincinnati, OH.

Ireland Cancer Center, University Hospitals of Cleveland, Cleveland , OH.

North Florida Regional Medical Center, Gainsville, FL

Northeast Regional Cancer Center, Humble, TX

School of Nursing, University of California. Managing the Side Effects of Chemotherapy & Radiation Therapy, 3rd edition. Regents. 1996.

Page, Sherry, RN, BSN, OCN Radiation Oncology, Allison Cancer Center, Midland, TX

U.S. Department of Health and Human Services. Chemotherapy and You: A guide to Self-Help During Treatment. National Cancer Institute. 1992.
T O P
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Highlands Oncology Group
All Rights Reserved.