WhatisChemotherapy?

PMH
Chemotherapyisawayoftreatingcancerwiththeuseofmedications.Today,thereare manydifferenttypesofmedicationsthatcanbeusedtocureortocontrolthegrowth, multiplicationandspreadofcancercells.Yourcourseoftreatmentmayincludea combinationofanumberofmedications. Othertreatmentmethodsincludesurgery,radiationtherapy,oracombinationofthesewith chemotherapy.Thetypeofchemotherapymedicationsyouwillreceivedependsonthetype ofcancer,thepartofyourbodywherethecanceris,andtheconditionofyourhealth.

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HowisChemotherapygiven?
Thechemotherapymedicationsareeithertakenorally(bymouth)orinjectedwitha needleintoabloodvessel.Thispamphletdealswithchemotherapygivenbyinjection fromthispoint. Themedicationsthatyouareprescribedarebasedonthetypeofcancerthatyouhave. Medicationsusedtotreatyoumaybedifferentfromthoseusedtotreatotherpatients.The sideeffectsyouexperiencemaybedifferentfromotherpatients.Thisoftenhastodowith thetypeofcancerfightingmedicationsusedaswellasthedosage. WherewillmyChemotherapybegiven? MostchemotherapyisgivenattheChemoDayCarelocatedatLevel2ofPrincess MargaretHospital. WhatdoIneedtodotoprepare? Whenyoufirstvisitthehospitalyouwillreceiveablueplasticregistrationcard.Youmust bringthisbluecardandyourOHIPcardeverytimeyouvisitthehospitalforfollowup checksorfortreatmentappointments. (Pleaseremember:checkwithyourdoctorornursewhetheryouneedabloodtestbefore eachchemotherapytreatment).
Thisinformationistobeusedforinformationalpurposesonlyandisnotintendedasa substituteforprofessionalmedicaladvice,diagnosisortreatment.Pleaseconsultyour healthcareproviderforadviceaboutaspecificmedicalcondition.Asinglecopyofthese materialsmaybereprintedfornoncommercialpersonaluseonly. 2008UniversityHealthNetwork.Allrightsreserved. Author:JanStewart,JackSeki,RoyLeeandSophieKim Created:08/2008 Form:D5194

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AfteryoucheckinattheChemoDayCareUnitfortreatment: Ifyouhadabloodtest,thenursewillchecktheresultsofyourbloodtesttoseeifyour bodyishealthyenoughfortreatment.Ifso,thepharmacywillprepareyourmedications. Ifyoudidnothaveabloodtest,youwillbeaskedtowaitwhilethepharmacyprepares yourmedications. Thewholeprocessmaytakefrom1to2hours.Youcanbringfoodandreadingmaterials withyou.Thewaittimeforeachchemotherapytreatmentdependsonthetypeand numberofmedications,andthenumberofpatientsscheduledfortreatmentforthatday. Afriend(s)orafamilymember(s)canalsoaccompanyyou.Duringthetimewhenyou receivechemotherapytreatment,oneortwofamilymember(s)/friend(s)canaccompany youintheChemoDayCareunit.

IsitPainful?
Chemotherapyisnormallynotpainful. Mostpatientsdonotexperienceanydiscomfortwhenchemotherapymedicationsare givenintravenously.Ifyouexperienceanypain,itchiness,scorchingorneedlepain whilethedrugisadministerintravenously,youshouldinformyourChemoDayCare nurseimmediately.

SideEffects
WhataretheSideEffects? Beforeyouundergochemotherapy,adoctor,anurseorapharmacistwilltellyouabout themedication(s)andtheirPOTENTIALsideeffects.Chemotherapymedicationsaffect normalcells,aswellascancercells.Normalcellsthataremostlikelyaffectedinclude thoseinthebonemarrow,gastrointestinaltract,reproductivesystem,andinhair follicles. Thesideeffectsareusuallytemporary,andveryfewpatientsexperienceallsideeffects listedinthisinformationpamphlet.Somepatientsmaynotexperienceanysideeffects. Everyoneisdifferentandwillresponddifferentlytotheirmedications. 1.EffectsontheBoneMarrow Chemotherapymedicationsmayaffectbloodcellsredbloodcells,whitebloodcellsand plateletsproducedbythebonemarrow.Thesebloodcellsusuallyrecoverbythenext chemotherapytreatmentcycle. Consequently,inmostcases,abloodtestisrequiredbeforeeach chemotherapytreatment.
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(A) EffectonREDBLOODCELLS Redbloodcellscarryoxygentovariouspartsofourbody.Whenyourredbloodcell countistoolow(commonlyknownas"anemia"),youwillfeeltired,dizzy,andshortof breath. Ifthishappens,youshouldinformyourdoctorimmediately.Increasingtheiron consumptioninyourdietandgettingmorerestwillhelptoimproveanemicconditions. Ifneeded,youmaybegivenabloodtransfusion. (Thedietitianinthehospitalcanansweryourquestionsconcerningyourdiet). (B) EffectonWHITEBLOODCELLS Whitebloodcellshelpyourbodyfightinfections.Ifyourwhitebloodcellcountislow, youarevulnerabletoinfection.Youshouldavoidcontactwithpeoplewhosufferfrom infection,includingcommoncoldsandinfluenza. Thefollowingmethodswillalsohelpyouavoidinfection: 1. Washhandsfrequently 2. Avoiduseofhardtoothbrushesordentalfloss.Ifyouneedtocleanandwashyour gums,doitgently 3. Whenshaving,useanelectricshaverandnotarazororblade 4. Useunscentedlotionoroiltomoisturizeyourskin 5. Avoidcuttingorscrapingyourskin,ifthishappensyoushouldwashandclean theaffectedareaimmediatelywithwarmwaterandsoap 6. Aftereachbowelmovement,cleanyourrectalareagentlyandthoroughly.Ifthere isirritationintheareainformyourdoctorimmediately Reportanyofthefollowingtoyourdoctorimmediately: 1. 2. 3. 4. 5. 6.
o o Afeverover38 C(or100.5 F)thatlastsfor24hoursorlonger Feelingextremelycoldand/orshivering Severepaininthethroatormouth Burningsensationandpainwhenurinating Persistentcoughingandfeelingofcongestioninthechest Yellowishfluidleakingfromtheearoreye

(C) EffectonPLATELETS Plateletshelpformclotstostopbleeding.Ifyourplateletcountislow,youmaybleedor bruisemoreeasilythanusual.Trytoavoidbumping,cuttingorscrapingyourself.Take extracautionwhenblowingyournoseorcleaningyourgums.Ifyounoticebleeding, bruisesorredspotsinyourskin,informyourdoctorimmediately.Also,informyou doctorimmediatelyifyougumsbleed,ifthereisbloodinyoururine orvomit,orifyourstoolisblack.

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DonottakeanymedicationsthatcontainAspirinoribuprofen.Beforeyouundergoany surgeryordentaltreatment,youshouldfirstconsultyouroncologist.

2.EffectsontheDigestiveTract
(A) Irritation/SoresinMouth Somechemotherapymedicationsmaycauseyourmouthtobecomedry,or uncomfortable,orevensoreandpainful.Informyourdoctorifyouexperienceanyof thesesymptoms. Thefollowingmayhelpyoucope: 1. Maintainyouroralhygieneasmuchaspossibleuntilthesoresdisappear.You canrinseyourmouthwithasolutionmadefromateaspoonfulofbakingsoda mixedinaglassofwater.Rinseyourmouthaftermeals.Donotswallowthe solution. 2. Donotuseacommercialmouthwash,mostcommercialmouthwashescontain alcohol,whichwillcauseyourmouthtobecomeverydry 3. Uselipbalmtoreducedrynessinthelips 4. Ifyouareprescribedmedicalrinse,pleasefollowthedoctor'sinstructions 5. Useaspongytoothbrushandnotabrushwithtoughbristles.Drinkwithastraw, asthiswillmakeiteasierforyoutoswallow (B) Nauseaandvomiting: Somechemotherapymedicationsmaycausenauseaand/orvomiting.Yourdoctormay prescribemedicationstopreventnauseaandvomiting. Youcantrythefollowingmethods,untilyoufindtheonethatismosteffectiveforyou: 1. Eatdrytoastorbiscuitstoreducediscomfortinthestomach 2. Avoiddrinkingwaterwhileeatinginstead,drinkanhourbeforeoraftereating. Betweenmealsyoucandrinksomelightsodas,suchasgingeraleandotherpops 3. Ifthesmellofcookinginthekitchenbothersyou,stayawayifpossible 4. Somefoodssuchasmeatorpoultrywillgodownbetterwheneatencoldrather thathot 5. Eatfoodthatcanbedigestedeasily,suchasfoodwithreducedfatorfortified starch 6. Eatslowly,andrestaftereatingtoallowfoodtodigestbetter 7. Drinksmallamountsofliquidsfrequently,suchasicecubes,popsicles,water, juices,gingerale,tea,jelly,andclearsoup.Theycanbedigestedeasily.When thenauseafeelingsubsides,youcangraduallyeatsolidfood 8. Eatsmallquantitiesoffoodmorefrequently(ratherthanafewlargermeals) (C)LossofAppetite
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Alossofappetiteisofconcerntous,asitisdifficulttoovercome.Itmayrequireyouto experimentwithmanytypesoffoods.Ourdietitianswelcomequestionsfromyouatany time.Youcanmakearrangementstoseeonethroughyourdoctorornurse. (D)Constipation Constipationisacommonsideeffectasaresultofchemotherapymedications,painkillers andantivomitingmedication.Youcanaskyourdoctor,nurseorpharmacisttofindout intowhichmedicationiscausingyourconstipation. Thefollowingsuggestionsmayhelptopreventconstipation: 1. Trytoeatfoodthatincreasesbowelmovements,suchasbran,wholegrainsor plumjuice 2. Eatmorefruitsandvegetables 3. Drinkplentyoffluids6to8cupsdailyifyouarenotrestrictedtotheamountof fluidallowed 4. Dolightexercisesfrequently,suchaswalking,ifpossible 5. Ifconstipationpersistsforoverthreedays,informyourdoctorassoonas possible,asyoumayneedtotakesomeformofalaxative 6. Ifyouhavestomachpain,nauseaandvomitingalongwithconstipation,inform yourdoctorimmediately (E)Diarrhea Ifyouhavediarrheaanditcontinuesformorethan24hours,orifyouhavepainsand crampsinthestomach,informyourdoctorimmediately.Inseverecasesyourdoctorcan prescribemedicationtostopit.Thefollowingaresomewaysthatwillhelpyoucopewith diarrhea: 1. 2. 3. 4. 5. 6. 7. 8. Itisbettertoeatfoodwhenitiswarm,ratherthanwhenitishotorcold Trytodrinkbeveragesonlybetweenmeals Eatsmallquantitiesoffoodfrequently,andtrytorelaxwhenyouareeating Avoidfoodthatwillproducegases,suchascabbage,broccoli,beans,sweet potato,carbonateddrinks,etc Avoidfoodwithhighfibresuchasuncookedfruitsandvegetables,wholegrains, bran,nuts,etc Keepyourrectalareaclean,andwipetheareagentlyafterbowelmovements Ifdiarrheacontinuesforover24hours,informyourdoctorimmediately Avoideatingdairyproducts.

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3.EffectsontheReproductiveSystem
Manychemotherapymedicationshavesomeeffectonthereproductivesystemofmen andwomen.However,thesemedicationsnormallydonothaveaneffectononessex life. Forwomen,chemotherapymedicationscancauseirregularperiods,abnormalbleeding, andsymptomsofmenopause,butpregnancyisstillpossible.Aschemotherapy medicationscanaffecttheunbornbaby,thereisaperiodoftimeduringandafter chemotherapywhenpregnancyisnotrecommended.Wehopethatyouwilldiscuss contraceptionmethodsandyourmenstrualperiodswithyournurseordoctor.Please continuetocheckyourbreastandnipplemonthly,andundergoadetailedbreast examinationonceayear. Formen,somechemotherapymedicationswillcausealowerspermcount.Speaktoyour doctorornurseofanyquestionsorconcernsyoumayhave.Althoughyourspermcount maybenormal,wedonotknowifmedicationwillhaveanyeffectonanunbornbaby. Werecommendthatpatientstakecontraceptivemeasuresduringandafterchemotherapy. Aftercompletingchemotherapytreatment,yourspermcountshouldreturntonormal,but forsomepatientsthisdoesnothappen.Ifyouhaveanyquestions,pleaseconsultyour doctor. Familyplanningshouldbedelayeduntil afterthecompletionofchemotherapytreatment. Askyourdoctoraboutcontraceptionmethods.

4.EffectsontheHair
Somechemotherapymedicationsmaycausethinningofhairoreventotalhairloss.Your scalpwillbecomebrittle,andthehairthatcontinuestogrowwillbecomeweak,loseits lusterandbecomedry.Inadditiontothehairontheheadandface,chemotherapymay causeyoutoloseotherbodyhair.Hairlossmayoccurafewdaysorafewweeksafter chemotherapy.Atfirstyouwillnoticethatyouarelosingmorehairthanusualafteryou brush,comborwashyourhair.Askyourdoctor,nurseorapharmacistabouttheeffect ofyourtreatmentonyourhair. Youmightconsidercuttingyourhairshortpriortothestartofyourtreatmentifyouhave longhairsothatthechangeisnottoodrastic.Ifyouchoosetocoveryourhead,youcan useaturbanorscarf.Youcanalsoorderawigbeforeundergoingchemotherapyor duringtheearlystagesofchemotherapy.Ifyouhaveaprivatedrugplan checkwithyour insurancewhetherthewigiscovered.Youwillneedaprescriptionforreimbursement. Itmaybedifficulttoacceptyourhairlossanditmaytakesomeemotionaladjustment. Youmaybecomeangry,orfeeldepressed,andtheseemotionsarenormal.Youmayfeel

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betterafterventingthem.Rememberthatafterthechemotherapytreatmentiscompleted, yourhairwillgrowbackagain.Thenewhairmaygrowbackslightlydifferentincolour and/ortexture.

5.EffectsonyourEmotions
Withadiagnosisofcancerandtheprospectofchemotherapytreatmentitiscommonto gothroughaseriesofemotionssuchasfear,worry,depression,anger,etc. Whenyoustartyourchemotherapytreatment,youmayhavetochangeyourlifestyle.You mayneedtoadjustyourdailyactivitiesaccordingtotimerequiredforchemotherapyand forthewholetreatmentprocedure.Yourhealthwillalsobeaffectedbyreactionsto chemotherapy,andthesechangesare,ofcourse,notwelcomed.Donothesitatetoexpress yourfeelingstoyourdoctor,nurseorpharmacist. Pleaserememberthatyouarenotalone.Whileundergoingchemotherapy,youwill wonderhowyourbodywillreact,whetherthemedicationwillbeeffective,andhowyou candealwithfeelingsofdepressionandworries.Youdonothavetofacethese difficultiesalone.Talktoyourdoctor,nurseorpharmacist. PhoneyourDoctorifanyoftheseoccur: 1. 2. 3. 4. 5. 6. 7. 8. Seriousvomitingcontinuesforover24hoursafterchemotherapy Diarrheacontinueforover24hours Skinbleedseasilyorbruisesappearwithoutcause o o Fever,bodytemperatureabove38 C(or100.5 F)ifyouexperienceshivering,or ifyouarefeelingcold Dizziness,extremetirednessorshortnessofbreath Sputumthatisyellow,greenorrustycolour Throatormouthispainful Burningsensationwhenurinating,bloodintheurineorreducedamountofurine

ImportantPhoneNumbers
HospitalMainLine:(416)9462000 Doctor:_______________________________ Nurse:________________________________ ChemoDayCare:_______________________ Others:________________________________
Acknowledgements: CentenaryHealthCentreSite,OncologyClinic,RougeValleyHealthSystem TerryCheng,MSW KarenLock,RN DonnaMcCullough,NurseManager Dr.LillianSiu,MedicalOncologist
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