Chemotherapy: What To Do While In Treatment

Chemotherapy: While in treatment - the practical aspects of living with and through chemotherapy treatment DONE

Summary

While undergoing chemotherapy, consider the following guidelines:

  • Follow the treatment schedule.
    • Do not miss a scheduled chemotherapy session or test. If you have no choice but to miss an appointment, immediately contact the doctor who is supervising the treatment so he or she can decide what steps to take to limit the negative impact on your treatment.
    • Transportation is available if needed.
    • After treatment ends, follow-up appointments are scheduled for bood medical reason. Do your best not to miss them.
    • Medications
      • Take all drugs as directed.
        • If you have difficulty swallowing a drug, click here.
        • If you have difficulty taking a drug on schedule, click here.
        • To learn what to do if you miss a dose, click here.
      • Do not take any prescription drugs, over the counter drugs, vitamins or supplements without clearing it first with your doctor. They may affect your treatment.
      • If you have difficulty taking medications or doing whatever else you are supposed to do, or not do, because of another health condition - speak with both the doctor who is treating the other condition and your oncologist. They will likely have a solution to help you through.
      • Check with your doctor or pharmacist to find out whether any of the drugs you take, or any combination of drugs, create a hazard while driving. For instance, whether the drugs make you drowsy, or slow your response time.
    • Do not expect immediate results. Standard practice is to wait for 2 full cycles of treatment before looking for any response to it. This can take 2 to 3 months. Response is checked by repeating the tests that show the cancer.
    • Learn when to call your cancer doctor or nurse or go to the emergency room without delay. For example, If you have a fever over 100.5, call your doctor immediately - even if it is nighttime or a weekend. If there is a question, it is safer to call than to do nothing.
    • Chemotherapy is usually accompanied by side effects.
      • Side effects do not tell you whether the chemotherapy is working or not.
      • Most side effects can be minimized or eliminated entirely.
      • If your platelet count becomes low, take the necessary steps to help avoid problems.
      • To learn about side effects that often accompany a particular chemotherapy treatment, click here. For tips about dealing with side effects, click here.
      • Report all side effects to your doctor or nurse. For example, nausea, vomiting, mouth sores, difficulty swallowing, rashes, changes in your urine or stool, or fatigue. Side effects can either be minimized or eliminated all together.
    • Chemotherapy is often accompanied by low white blood cells. A low white blood cell count decreases your body's ability to fight infections.
      • Learn how to avoid unnecessary infections such as staying away from crowds and people with infectious diseases.
      • Watch for signs that indicate you have an infection. Call your doctor immediately if there are any signs of inection that you would normally treat on your own. For instance, fever over 99 degrees fahrenheit; white patches or painful areas in your mouth; pain, swelling or redness on your skin.
    • During the entire chemotherapy process, keep your intake of fluids high. Chemotherapy poisons are flushed out of your system through your kidneys and bladder. Fluids help keep the amount of toxins in your system reasonable.
    • Do not:
      • Start taking any new drugs or treatments, or otherwise change the drug schedule you were on before chemo started without speaking with your doctor first.
      • Take vitamins, minerals, herbs,antioxidants or other dietary supplements without first asking your doctor, nurse or dietitian whether it is okay. Some of these substances can be harmful. Some may reduce the effectiveness of the chemotherapy.
    • Do what you can to avoid unnecessary infections. For example, wash your hands often and avoid being close to anyone who is ill. Postpone teeth cleaning, other dental work or inoculations. To learn more, see: How To Lower Your Risk Of Infection
    • If medical personnel suggest or allow you take vitamins, minerals, herbs, antioxidants or other dietary supplements, do not take more than is recommended without first checking with medical personnel.
    • Be active. Research has found many positive effects of physical activity during treatment, including helping to reduce cancer-related fatigue and anxiety and improve mood,amother other positive benefits.
    • Practice wellness.
      • Pay special attention to what you consume, your hygiene, amount of activities and emotions. Exercise to the extent that you can and as permitted by your doctor.
      • Do what you can to avoid losing weight (unless you are excessively overweight). Weight loss can make fatigue or other side effects worse. Lack of food makes fatigue worse.
      • Do not ignore any other health conditions you have. Chemotherapy and side effects can take over your focus to the detriment of other health conditions.
    • It is best not to get pregnant during chemo.
    • Be open about your emotions. Make contact with someone going through the same thing you are. Consider joining a support group or at least talk with a buddy.
    • Keep family and friends in the loop. Lean on them for support and assistance. Your doctor will let you know if you are in a situation in which you may have to stay away from people for awhile - including family and friends.

    Your cancer care team will measure how well your treatments are working by doing certain tests. This will include physical exams, blood tests, bone marrow biopsies, scans, and x-rays.


    • Ask if you can take lab tests ahead of time so you can review the results with your doctor at your appointment.
    • Ask your doctor about the test results and what they show about your progress.

    Expect that your healthcare providers will take safety precautions. Chemo drugs can be harmful in unintended situations.

    Consider other matters common to all cancer treatments, such as how to pay for treatment, how to deal with work, and whether and how to travel. Those subjects, as well as how to deal with emotional changes, are covered in Survivorship A to Z's document: In Treatment.

    For additional information, see:

    NOTE: If you are feeing too sick to read or write, get access to television or to streaming videos. If you do not have a television, you can watch on a computer through an internet connection. A funny movie or t.v. show can be good for your mood.

    Coping Tips For Daily Life During Chemotherapy

    Here are some tips to help during chemotherapy:

    Do not expect immediate results.

    • Standard practice is to wait two full cycles before looking for any response to chemotherapy. This can take 2 to 3 months.
    • Response is checked by repeating the same tests that originally diagnosed the cancer.

    Prepare in case of hair loss.

    Many of the drugs used in chemotherapy can cause temporary hair loss. If the chemotherapy you use could cause this effect, consider purchasing a wig now that matches your hair color., or at least clipping enough hair that it can be matched later if desired. For information about wigs, including low cost or free ones, click here.

    Before each chemotherapy treatment

    • Eat. It is often difficult to eat after the treatment.
    • Drink plenty of water.
    • Take something to snack on in case you have to wait for the treatment.
    • Patients have reported that sucking on ice chips or popsicles immediately before chemo or when the solution first enters your veins helps to eliminate mouth sores.

    Spread the word among your friends that cooking may be difficult for you. Home cooked meals provided by friends have been said to have the taste of love in them.

    Check everything you consume other than food with your doctor.

    • Do not take vitamins, minerals, herbs, antioxidants or other dietary supplements without first asking your doctor, nurse or dietitian whether it is okay. Some of these substances can be harmful when mixed with chemotherapy. Some may reduce the effectiveness of the chemotherapy.
    • If medical personnel suggest or allow you to take vitamins, minerals, herbs, antioxidants or other dietary supplements, do not take more than is recommended without first checking with medical personnel.

    Pamper yourself.

    • Take a hot bath, with or without bubbles.
    • Get a massage.
    • Go to a movie.

    Use stress reducing techniques.

    Survivorship A to Z provides information about stress reducing techniques. See "To Learn More".

    Consider getting a pet.

    A pet does not have to be a dog or a cat to have beneficial emotional and physical effects. For information, including how to have a pet in an apartment which prohibits pets, click here.

    Get emotional support.

    Eat nutritiously. See: Chemotherapy and Nutrition

    The following content is provided by the American Cancer Society

    Try to keep your treatment goals in mind.

    This will help you keep a positive attitude on days when the going gets rough.

    Learn as much as you want to know about your disease and its treatment.

    This can lessen your fear of the unknown and increase your feeling of control.

    Keep a journal or diary while you're being treated.

    A record of your activities and thoughts can help you understand the feelings you have as you go through treatment. It can also help you highlight questions you need to ask your doctor or nurse. You can also use your journal to record side effects. This will help you when you talk about them with your doctor and nurse. You can also write down the steps you take to cope with side effects and how well those steps work. That way, you'll know which methods worked best for you in case you have the same side effects again.

    Take it easy.

    You may not have as much energy as usual, so try to get as much rest as you can. Let the "small stuff" slide, and only do the things that are most important to you.

    Try new hobbies and learn new skills.

    Exercise if you can and if your doctor approves.

    Using your body can make you feel better about yourself, help you get rid of tension or anger, and build your appetite.

    Side Effects: What To Expect And What To Do About Them

    There are different side effects which accompany different chemotherapies. Each side effect can either be eliminated or at least reduced in severity.

    To learn about possible side effects from various drugs, see American Cancer Society's www.cancer.org/ACS::guide_to_cancer_drugs_to_cancer_drugs Feel free to do additional research on your own. If you do additional research, be cautious about the source of information as well as the date of the report.Treatments are continually being refined and improved. (For information about how to do medical research, click here.)

    For information about a variety of side effects and how to deal with them, click here.


    Chemotherapy And Nutrition

    Good nutrition is extremely important during treatment. People who eat well cope with side effects better and fight infection more easily. In addition, their bodies can rebuild healthy tissues faster.

    Eating well during chemotherapy means choosing a balanced diet that contains all the nutrients your body needs, including foods from each of the following food groups: fruits and vegetables; poultry, fish, and meat; cereals and breads; and dairy products. You should consume enough calories to keep your weight up and, most importantly, enough protein to build and repair skin, hair, muscles and organs.

    • Eat a balanced diet.
      • For information about nutrition, click here.
      • If you need meals delivered to your home, contact the American Cancer Society to find out if there is an organization that delivers in your area. Call 800.ACS.2345. If not, friends and family, or a local religious organization may be able to help.
      • For information about financial help buying food (formerly "food stamps"), click here.
    • Eat as much as you can to help keep your weight up.
      • For information about weight gain and loss, including how to dress without spending a lot of money as your weight changes, click here.
    • It may be easier to eat small, frequent meals during the day instead of three large meals.
    • To help keep up your weight during treatment, consider:
      • Supplementing food with a nutrition drink such as Ensure or by putting a protein powder in your food.
      • Increasing your intake of fattening foods unless fattening foods are not a good idea because of other aspects of your health situation.
    • Do not eat any raw foods or foods containing raw eggs during treatment.
    • Buy, store and cook foods properly.
    • Ask your doctor what you should be adding to your diet to make up for nutrients the drugs may remove.
    • Small amounts of alcohol can help increase your appetite. Since alcohol can interact negatively with some drugs, ask your doctor before proceeding.
    • Marijuana can also help with appetite in the states in which it is legal for medical purposes. If marijuana for medical purposes is not allowed in your state, synthetic marijuana may have the same effect. Check with your health care team. (For information about medical marijuana, click here.)

    You may also need to drink extra amounts of fluid to protect your bladder and kidneys during your treatment.

    For the American Cancer Society's nutrition tips for managing side effects of treatment, see: www.cancer.org/docroot/ESN/content/ESN_3_2x_Nutrition_During_Treatment_Part_II_Managing_Side_Effects.asp?sitearea=ESN

    Ed note: For eating tips, National Cancer Institute has a publication Eating Hints for Cancer Patients Before, During and After Treatment available for free online at: www.cancer.gov/cancerinfo/eatinghints or call for a copy: 800.4.CANCER

    Tips To Make The Process Of Getting Chemotherapy Easier

    In General

    • It generally takes at least several hours for a chemotherapy treatment ("infusion").
    • Most treatment centers have television available. Many centers have individual televisions for each patient.
    • Consider taking something with you to keep yourself occupied. For instance, a book, music player or a hobby such as knitting.
    • Treatment centers may be cold. In case the center doesn't have enough blankets, take a blanket or throw with you for at least the first session.
    • Also consider taking a thermos of liquid and snacks in case you get hungry.
    • If possible, bring someone to keep you company and to help with driving home in case you don't feel well.

    If the lymph nodes in your underarm have been removed

    • Make sure the IV is not inserted on the side where the nodes have been removed to avoid causing swelling and possible infection.
    • Avoid having blood drawn or blood pressure taken on that side.

    Permanent Access

      Chemotherapy involves inserting a needle into a vein for every treatment. Instead of individual sticks, you can choose a more permanent access, such as a Hickman line or portocath.

      • The Hickman line is a thin silicone tube inserted into a large vein, that exits through the chest wall.
      • The portocath (also known as a "port")is completely inserted under the skin and so requires minimal care.
      • Both a port and catheter:
        • Are inserted under the skin during a minor outpatient surgical procedure.
        • Can be left in for months or even years.
        • Are removed after the end of treatment.
      • While a port or catheter is implanted, precautions to avoid infection are necessary. Follow the guidelines the doctor gives you carefully.

      Daily And Work Life

      Being in chemotherapy treatment doesn't mean changing your everyday normal life. There are some aspects that will need to be adapted, but generally being in chemotherapy does not mean turning your whole life around.

      Your daily and work lives will be better it you maintain a positive attitude. It's easy to focus on the side effects of chemotherapy instead of the good that the drugs are doing you. We're not suggesting that you become a pollyanna. The glass is half full as well as help empty. To learn more about how to have a positive attitude (without being a pollyanna),, click here.

      When it comes to work, do as much as you can comfortably tolerate. In addition to the financial benefits (including health insurance if you have it through an employer), experience indicates that it helps to keep busy and keep your mind off of the treatment.

      • If you experience nausea, time your infusion at the health care center so that the days on which you are likely to be nauseous are days off. For most people, this means getting infused on a Friday afternoon so there is the weekend to recover.
      • Time off:
        • You may need to take time off work if the side effects make you unable to work.
        • During the two days when you receive constant 5-FU through a chemo port, it can be dangerous to work. For example, if something hits the bottle or dislodges the line. People won't necessarily know you are being infused during that period of time, because the bottle generally comes in a fanny pack which can be anything. Perhaps you can get an accommodation at work that allows you to work at home during those two days.
        • If you need to take time off from work, your oncologist or health care center can write a note for you explaining the situation.
          • To learn about your rights at work, click here.
          • To learn about accommodations, click here.
          • To learn about working at home, click here.
        • If you need to take time off from work, your health care center can write a note for you explaining the situation.
      • During the rest of the time:
        • Fatigue or chemo brain may affect your ability to work. If so, learn about how to work around them by clicking here for fatigue and here for chemo brain.
        • If you need an accommodation, learn about your rights, and about how to ask/negotiate for one. For intance, if you have diarrhea, it would be helpful to work close to a bathroom.

      For additional information about work, see:

      Weight Loss Or Gain During Chemotherapy

      Chemotherapy may be accompanied by either weight loss or weight gain.

      Weight loss is frequently caused by nausea leading to a lack of appetite. The reasons for weight gain are not clear. There is speculation weight gain may be caused by intense food cravings that develop despite the nausea.

      There are techniques for dealing with weight change. For instance, thrift shops are a good source of inexpensive clothing for the temporarily thinner or heavier you. See the document noted in "To Learn More."

      Before And During The Actual Infusion

      Before You Start

      • Consider bringing a friend for at least the first few sessions. It will help relieve the anxiety (though there is no pain and the process is not as difficult as you may think).
      • Take things to keep yourself occupied. Consider books, knitting, video games, or a lap top you can work on. Most infusion centers have free wi-fi available.
      • Wear warm clothes or bring something that will warm you such as a small blanket.
      • Take protein snacks with you. If your time at the infusion center could go through meal time, take food for the meal "just in case."

      At The Infusion Center Where You Receive Chemotherapy

      • The drug may feel cold as it enters the vein. This feeling rarely lasts more than a few seconds.
      • If you start to feel queasy during the treatment, mention it at once. It can likely be relieved by infusing the drug more slowly.
      • Nausea can be controlled by over the counter remedies such as Maalox, Pepcid, Nexium or Prevacid.
      • Let the doctor or nurse know right away if you develop sudden or severe itching, if your skin breaks out in a rash or hives, or if you are wheezing or have any other trouble breathing.These symptoms may mean you are having an allergic reaction that needs immediate attention. Also let them know if you feel pain, burning, coolness or anything unusual while you are getting chemotherapy.

      Exercise During Chemotherapy Treatment

      Aim for exercise which would be considered moderately intense exercise. To help determine a moderately intense exercise program, consider the following possibilities:

      • Exercise that allows you to talk, but not sing.
      • Use the Borg Scale of perceived exertion which uses numbers associated with words to describe how you feel during exercise. For information about the Borg Scale, go to http://www.hsph.harvard.edu. Type "Borg scale" into the search box.
      • Exercise within a training zone determined by your heart rate. The training zone shows a low end and a higher end. If your heart rate is below the range, increase your exercise intensity. For example, swing your arms, speed up, walk up hill. If your heart rate if above the range, slow down. You can calculate your training zone by using the following formula:
        • Maximum heart rate = 220 minus your age
        • (Maximum heart rate) less (Resting heart rate) x . 5 + (Resting heart rate) = low end of training zone
        • (Maximum heart rate) less (Resting heart rate) x .7 +(Resting heart rate) = higher end of training zone

      Ideally, try to accumulate 150 minutes of exercise each week. Schedule the time into each day. If it's easier, brak your exercise sessions into three ten minute sessions a day.

      To increase the odds that you will find the time and will to exercise, consider the following tips:

      • Think of exercise as an essential part of your treatment and then of your recovery.
      • Ask for support from the people around you.
      • Create a reasonable exercise schedule.
      • Consider exercising with a buddy.

      NOTE: Before starting any exercise program, check with your medical team to determin:

      • Whether there are days when you shouldn't exercise or exercise at a lower intensity.
      • Whether the exercise you are considering is OK.