Side Effects - Chemotherapy

Side Effects and Common Chemotherapy Drugs

• Chemotherapy is medication or combination of medications designed to kill cancer cells
• Every type of chemotherapy has side effects 
• Every cancer patient responds differently to the combination of chemotherapy drugs
• Depending on the type, dosage, and duration of the treatment, side effects can vary in intensity and duration
• What is very important to remember is that these side effects are temporary and gradually go away after the chemotherapy treatments end 

How or Why Chemotherapy Side Effects Occur

• Bone marrow activity (decreased, resulting in fewer red blood cells, white blood cells, and platelets)
  • Decreased white blood cells increase risk of infection
  • The body cannot make pus if you do not have white blood cells (WBC); however, you still would have an infectious process going on, just no pus as evidence
  • When WBCs return, they will develop pus
• Infection/Hemorrhage
  • Recent trends have occurred with antibiotics not being effective, germs resistant, increasing risk for patient to develop sepsis
  • History of frequent antibiotic prescriptions in past have created superbugs
• Bone marrow
  • All blood cells grow from stem cell
  • Chemotherapy harms stem cells, which impact bone marrow
  • Hemorrhage can be exacerbated by lack or decreased number of platelets and well as direct bleeding from blood vessel (erosion of tumor) 
  • Can be anemic as a result of blood loss or from not making enough red blood cells (RBCs) resulting in increased fatigue, altered cognition
  • The body needs RBCs to carry oxygen throughout the body
• Alopecia (hair loss)
  • Hair loss – usually grows back thicker, curlier and darker
• Nausea and Vomiting
• Bowel and Bladder 
  • Continuing concern with diarrhea, especially life-threatening if cannot get under control Protocol to take Lomotil, if not resolved in 24 hours, may need to be admitted for fluid and electrolyte management
• Neuropathy
  • Numbness and tingling, potential for burns, frostbite Use elbow to ascertain temperature
  • Difficult to perform Activities (or tasks) of Daily Living (ADLs)
    • Eating
    • Dressing
    • Getting into or out of a bed or chair
    • Taking a bath or shower
    • Using the toilet
    • Consider potential for foot drop, trouble walking, fall risk
• Renal (kidney)
  • Need increase of fluids to help your body cope with the chemicals
  • Example:  Cisplatin great for head and neck cancer, but very toxic on kidneys
  • Given with fluids before and after – at least 1000 ml before and after
• Photosensitivity
  • Skin Integrity or reactions
  • Many new drugs cause skin reactions
  • May show that the drug is working
  • Need to manage carefully to prevent skin infection
• Toxicity to the ear
  • Hearing
  • Balance problems
• Mucositis
  • Mouth, throat, stomach, and intestines
  • Mouth sores
  • Dry mouth
• Reproductive
  • May send women into early menopause
  • Sterility and fertility issues
  • Consider contraceptive issues
  • May give chemo in pregnancy though only after first trimester
    • NEVER the Antimetabolites at any time
  • With solid tumors, may have slightly more time (couple of weeks) to consult second opinion
  • Consider sperm banking or harvesting of eggs prior to procedure
• Biological Therapy
  • Treatment used to fight disease
  • Protects the body against the effects of chemotherapy

Some of the more common chemotherapy drugs and their side effects 

This section describes common drugs used in chemotherapy, their uses and their side effects.

This table is from Morra and Potts (CHOICES, 4^th edition, Avon Books, 2003, pp. 260-287) and used with their permission

Excerpt of Table of Major Chemotherapy Drugs and Hormones
Name and Use	Common Side Effects	Occasional Side Effects
Aminoglutethimide (Cytrdren, Elitpen).  An aromatase inhibitor used in adrenal and prostate cancers. May be used as medical adrenalectomy in breast cancer. Given as a tablet.	Skin rash with fever, sluggishness and tiredness (usually goes away slowly 4 to 6 weeks after treatment is finished).	Dizziness, swelling of face, weight gain, leg cramps, fever, chills and sore throat, loss of appetite, mild nausea and vomiting, leg cramps.
Cyclophosphamide (Cytoxan, Neosar, and Endoxan) An alkylating agent used in lymphomas and Hodgkin’s disease, myeloma, neuroblastoma, retinoblastoma, sarcomas, Wilms’ tumor, cancers of the ovary, breast, prostate, head and neck, lung, bladder, cervix, stomach and uterus. Given IV or as a tablet.	Nausea, vomiting, loss of appetite, loss of hair.  [The patient] needs to drink extra liquids to prevent bladder problems. If [the patient] misses a dose, they should not double the next dose, but should talk with one’s doctor.	Blood in urine, pain when urinating, black tarry stools, fever, chills, nasal stuffiness and sore throat, cough and shortness of breath, dizziness, confusion, fast heartbeat, sterility (may be temporary), skin darkening, metallic taste during injection, blurred vision, cataract, second cancers (leukemia, bladder).
Doxorubicin (Adriamycin, Rubex, Adriamycin RDF, PFS or MDV) An antitumor antibiotic used in leukemias, lymphomas, Wilm’s tumor, neuroblastoma, multiple myelomas, sarcomas, cancers of the breast, ovary, bladder, thyroid, stomach, cervix, endometrium, liver, esophagus, head and neck, pancreas, prostate, testes and lung. Given IV.	Nausea and vomiting, red urine (usually lasts one or two days after each dose), hair loss, loss of appetite, heart problems.	Mouth sores, darkening of soles, palms or nails, may reactivate skin reactions from past radiation, fever, chills and sore throat, diarrhea, eye problems, fast or irregular heartbeat, shortness of breath, pain in joint, side or stomach, burning pain at injection site.
Fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex) An antimetabolite used in cancers of the stomach, colon, rectum, breast, pancreas, bladder, cervix, endometrium, esophagus, head and neck, liver, lung, ovary and skin. Usually given IV, except for skin, where a cream is used.	Nausea, mouth sores, diarrhea, skin darkening (sensitive to sun).	Mouth, tongue or lip sores, hair loss, skin rash or dryness, vomiting, poor muscle coordination, swelling of palms and soles, nail loss or brittle nails, eye irritation, increase of tears, blurred vision, headache, euphoria.
Methotrexate (Folex, Folex PFS, Mexate, Mexate-AQ, Abitrexate, Rheumatrex)  An antimetabolite used in choriocarcinoma, hydatiform mole, multiple myeloma, leukemia, lymphomas, sarcomas, cancers of the breast, head and neck, lung, bladder, brain, cervix, esophagus, kidney, ovary, prostate, stomach and testes. Given IV most commonly, in the muscle, or as a tablet.	Mild nausea and vomiting, diarrhea, mouth sores. [The patient] should not take more or less than the amount prescribed by the doctor. If a dose is missed, the next dose should not be doubled and the physician should be consulted. [The patient] may need to drink extra liquids to prevent kidney problems. [The patient] should not take aspirin or other medicine for swelling or pain without first checking with the physician. When very high doses are given, it is followed by the drug leucovorin calcium to counteract life-threatening side effects (called leucovorin rescue).	Loss of appetite, stomach pain, yellowing of eyes or skin, fever, chills and sore throat, cough, shortness of breath, blood in urine or dark urine, hair thinning, headache, dizziness, blurred vision, drowsiness or confusion, joint pain, skin rash, reddening of skin (sensitive to sun) anemia, flank pain, blurred vision, confusion, seizures.
Tamoxifen (Nolvadex, taxomifen citrate) An antiestrogen used in breast cancer. Given as a tablet.	Hot flashes, vaginal discharge. [The patient] should not take more or less than the amount prescribed by the physician. If [the patient] misses a dose, she should not take the missed dose at all and should not double the next dose; she should consult with her doctor. [The patient] should use birth control while taking tamoxifen, but she should not take birth control pills since they may change the effects of the tamoxifen. If she should become pregnant while taking tamoxifen, she should consult with her physician immediately.	Vaginal bleeding, dryness or itching, nausea, and vomiting, loss of appetite, irregular menstrual periods, hot flashes, endometriosis, bone and tumor pain, visual changes skin rash and itchiness, dizziness, loss of hair, depression, light-headedness, confusion, fluid retention, headache, anemia, swelling of legs, loss of appetite, blood clots, increased risk of uterine cancer.
Vincristine (Oncovin, Vincasar PFS, and leurocristine) A plant alkaloid used in leukemia, lymphomas, sarcomas, neuroblastoma, Wilms’ tumor, and melanoma, and multiple myeloma, cancers of the colon, rectum, brain, breast, cervix, ovary, lung and thyroid. Given IV.	Hair loss, numbness or tingling in hands or feet.	Pain in arms, legs, jaw or stomach, pain in testicles, mouth sores, fever, chills and sore throat, severe constipation, metallic taste, hoarseness, agitation, confusion, light-headedness, dizziness, drooping eyelids, jaw or joint pain, blurred or double vision, anemia, stomach cramps.

 

Common combinations of chemo drugs (cocktails)

Chemotherapy Drug Combinations
CMF:	cyclophosphamide (Cytoxan)+ methotrexate (Folex)+ fluorouracil (5-FU)
CAF:	cyclophosphamide  (Cytoxan) + doxorubicin (Adriamycin)+ fluorouracil (5-FU)
CA +/- tamoxifen:	cyclophosphamide (Cytoxan)+ doxorubicin (Adriamycin) +/- tamoxifen (Nolvaldex)
CMFVP:	cyclophosphamide (Cytoxan)+ methotrexate (Folex) + fluorouracil (5-FU) + vincristine (Oncovin) + prednisone (Sterecyt)

 

Chemo Side Effects

• Fatigue (Bone marrow activity; decreased, resulting in fewer red blood cells, white blood cells, and platelets)
• Infection/Hemorrhage
• Alopecia (hair loss)
• Nausea and Vomiting
• Bowel and Bladder
• Neuropathy
• Renal (kidney)
• Photosensitivity
• Skin Integrity
• Toxicity to the ear (hearing / balance Problems)
• Mucositis (mouth, throat, stomach, and intestines), mouth sores, dry mouth
• Reproductive
• Mood alteration
• Hepatic toxicity
• Cardiac and pulmonary

Most Common Chemo Side Effects

• Fatigue (feeling tired or lethargic) (see the branch on fatigue)
• Nausea and/or vomiting
• Lack of appetite
• Cognitive dysfunction (commonly referred to as "chemo brain")
• Diarrhea
• Constipation
• Body hair loss
  • Due to the effect of the drugs on the DNA of hair follicles
  • Patients may lose their head hair, eyebrows, eye lashes, underarms, etc.  

Less common side effects are:

• Skin
  • Common changes to the skin include:
    • Itching
    • Redness
    • Drying or peeling
    • Acne
    • Sun sensitivity
    • Brittle nails
    • Blackened nails
    • Shingles
  • How to manage skin changes
    • Check with your provider about what types of lotions to use or avoid. Many patients automatically want to use lotions with aloe, but for some types of skin reactions, you may need to avoid lotions that contain aloe. The same is true for lotions that contain lanolin
    • You need to use very mild soaps, lotions and skin creams
    • Dont use perfumes, colognes, after shaves or perfumed deodorants
    • Dont shave your arms or legs until you are done with your chemo
    • Use sunscreen even if you are only going out for a short walk.
    • Wear a wide-brimmed hats to help protect you from the sun
    • Wear long-sleeved cotton shirts and pants to protect you from the sun and reduce the rubbing of the material against your skin (avoid wearing heavy jeans)
    • Wear soft cotton socks in your sandals or shoes to avoid irritation to your feet and ankles (especially if you are diabetic)
    • Wear plastic gloves when washing dishes, cleaning fish or game or gardening. Be extra careful with knives when cleaning fish or game or cutting vegetables to avoid cutting your skin. You are more likely to get infections throughout your chemo
    • Use corn starch as a dusting powder on itchy skin. Avoid making a poultice of corn starch and water on your skin. It is likely to take skin off when you remove the poultice. Avoid using a tobacco poultice for the same reason.
• Brittle or blackened nails
  • Avoid using nail polish to hide the blackened finger and toe nails. This blackening will disappear after chemo ends.
  • For nails that become brittle, cracked, peeling or develop vertical lines or bands, you can
    • Use nail strengtheners
    • Add 1-2 servings of gelatins (like Jell-o) to your daily diet.
    • You can also drink a gelatin liquid (like Knox orange flavored liquid gelatin) to help strengthen your nails.
    • Wear gloves whenever you are doing dishes, cleaning fish or game or working in the garden to avoid additional damage to your nails and skin.
• Headaches
  • Let your provider know you are having headaches.
  • They may tell you to use an over-the-counter headache tablet, other than aspirin, like you normally do, or ask you to try another. Aspirin is not recommended because of the blood thinning reactions and its harshness on the stomach lining that is probably already sensitive
• Muscle aches
  • Let your provider know where you ache. The provider may have you take an over-the-counter anti-inflammatory drug or a prescription. Sometimes gentle massage is recommended for these aches.
• Burning or painful sensation during urination
  • Be sure to tell the provider so that you can be checked for a bladder infection. If that is the cause, they will give you some medication to cure the infection.
• Discolored urine (pee)
  • Sometimes this discoloration is related to a bladder infection and the provider will test you and then give you medication to control the infection
  • Sometimes the discoloration is caused by the type of chemo drugs you are using and is nothing you need to worry about. It may be red, orange, bright yellow or blue-green. It may also smell like medicine. The color of your pee will go back to normal after you are done with your chemo.
• Vaginal infections (itching, burning, redness, smelly, white or heavy discharge from your vagina; if you have these symptoms, see your provider so that you can receive the correct type of ointment to control the infection)
  • The changes in your tissues from the chemo may make you more likely to get vaginal infections
  • Wear cotton underwear
  • Avoid wearing nylon panty hose
  • Avoid wearing jeans or tight slacks or pants
  • Avoid using Vaseline in or around your vagina (it may make you more likely to get an infection because it is not water-based)
• Changes in the mouth and throat
  • Chemo can cause sores or ulcers in the mouth and the lining of the mouth to become sore and tender. These ulcers can be very painful
  • While you are doing chemo, your white blood cells that help fight infection, are reduced. The most common infection is called thrush or candidiasis).
    • This is a fungus infection in the mouth.
    • It looks like white patches or a white coating on the tongue and lining of the mouth.
    • It can also be in the vagina.
    • It needs to be treated by anti-fungal medication
    • It can take several days before you notice relief
• Dry Mouth
  • This means your have very little saliva
  • You may have trouble swallowing because you need saliva to swallow easily
  • Drink a lot of water and mild juices, like apple or carrot juice.
• Sore or bleeding gums
  • You may only notice this when you brush your teeth or when you eat
  • Occasionally, they bleed when you are not brushing your teeth or eating
  • Avoid hard, sugary, or acid foods or drinks (like vinegar dressing on your salads)
• Changes in your tastes and smells
  • A side effect of some chemo drugs is the change in your senses.
  • A metallic taste sometimes occurs and makes food and drinks that you frequently enjoy, suddenly taste badly. Rinse your mouth with small sips of 7-up® in between bites of food to see it that helps you.
• How to manage changes in your mouth
  • Sores in your mouth can easily become infected, so you need to treat them as soon as they appear
  • Drink a lot of water or herbal teas (about 12 glasses)
  • Try herbal teas (especially ginger teas)
  • Eat soft, bland foods like gelatin, cottage cheese, pastas, mashed potatoes, milkshakes, bananas applesauce, oatmeal, puddings
  • Avoid alcoholic drinks
  • Avoid acidic drinks like orange or grapefruit juice
  • Avoid hot spices, garlic, onion, vinegar and salty foods
  • Use a very soft toothbrush or use a gentle toothpaste or baking soda and water on a Q-tip to gently rub against your gums
  • Use baking soda and water rather than commercial toothpaste if the toothpaste is too irritating or if it contains abrasives.
  • Use a sensitive toothpaste (like Sensodyne®)
  • Gentle rinse your mouth with baking soda and water (and spit out the solution after youve gargled or swished the solution around)
  • Ask your provider if there is a mouthwash that you should use to reduce the irritation and sores in your mouth and throat
  • Avoid Mouthwashes with a lot of salt or alcohol
  • Use numbing medications like those that are used for teething children (do not use tobacco paste or chew)
  • Use a lip balm to keep your lips from chapping
• Tingling, burning sensation in hands or feet
  • You need to tell your doctor about this. It may mean that your nerves are being damaged by the chemo and the provider may change the medications.
• Fever
  • If your fever is over 100°, call the provider. A fever that high is probably due to some infection.
• Chills
  • If you find yourself shivering or shaking and you cannot stay warm, call the provider. This is probably due to some infection.
• Fluid retention
  • Some of the chemo drugs cause you to retain fluid.
  • Check with your provide and keep track of changes in your weight.
  • Providers usually do not want you to take a diuretic to get rid of the excess fluids while you are on chemo.
  • They may tell you to avoid foods or drinks with a lot of sodium (like tomato juice) in them.
• Blood clotting problems
  • These may be aches in your calves or feet.
  • Most providers will change your chemo drugs to avoid these types of problems.

Severe side effects

• There are severe enough to call your provider:
  • A lot of patients dont want to bother the providers in between their chemo treatments and try to ignore serious side effects. But it is very important that your providers know what you are going through.
  • Write down your symptoms or side effects
  • Keep track of the day and times of your chemo treatments
  • The time of day that the side effects occurred
  • What types of side effects did you have
  • How long they lasted
  • How severe they were
  • How the side effect interfered with your daily activities
  • What were you doing when the side effect occurred
  • How did you try to deal with it.

• Changes in your body temperature
  • Fever over 100°
  • Shaking chills
  • Sweating a lot
• Changes in your skin
  • Any kind of bleeding or bruising
  • Swelling, pain or red irritation around the area where the IV (intravenous tube) was inserted
  • Swelling or redness of the eyelids, hands or feet
  • Redness or swelling around a sore, pimple or boil
  • Pins and needles in your hands and feet
  • Numbness or no feeling in your fingers or toes, hands or feet
• Changes in your breathing or throat
  • Inability to catch your breath (call your provider)
  • Gasping for air (call your provider)
  • Choking feeling (call your provider)
  • Spastic coughing (call your provider)
  • Sore throat (call your provider if you have difficulty swallowing for more than a day)
• Changes in your bowel movements
  • Severe diarrhea (if you have diarrhea more than four times in a day, call your provider)
  • Severe constipation (no bowel movement for more than 3 days, call your provider)
• Changes in your urine (pee)
  • Reddish or brownish or darkened color (for more than 3 trips to the bathroom, call your provider)
  • Pain or burning when you pee (call your provider)
  • Urgent need to pee (if this occurs over a period of 2 hours, call your provider)
  • Peeing often throughout the day or night (call your provider)
• Changes in your vision or eyesight
  • Blurred or double vision (call your provider)
  • A lot of swelling and tearing (call your provider)
  • Very dry eyes (easily irritated; use saline eye drops; if the saline drops do not help, call your provider))
  • Cataracts (clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images; call your provider to have him/her check your eyes)
  • Problems with your retina (detached retina which must be treated immediately by a provider or can result in blindness in that eye)
  • Glaucoma (a build-up of fluid pressure in the eyes causing damage to the optic nerve that can result in limited vision or blindness; call your provider to have him/her check your eyes)
• You also need to share with your provider if the side effects are getting worse or less of a problems

Medicine Wheel:  The Mind and Chemo Side Effects

• Cognitive Dysfunction (also commonly called "chemo brain") 
• Also known as "chemo brain" or "brain fog"
• Refers to problems with your memory while you are taking chemo and for several months or years later
• Signs/symptoms
• Memory loss
• Trouble paying attention; making decisions
• Difficulty with activities of daily living
• Make silly mistakes
• Difficulty writing
• Trouble making decisions

•  

Medicine Wheel:  Emotions and Chemo Side Effects

• Emotional effects can have a tremendous impact on the success of their chemotherapy treatment
• It’s important to address emotional side effects as soon as they come up
• Emotional distress is not something people can "will" themselves out of, or talk themselves out of
• Emotions distress is a natural result of a significant life-altering issue such as a cancer diagnosis; undergoing chemo makes this issue impossible to ignore
• Examples of emotions
  • Fear, anxiety or stress 
  • Depression   
  • Hopelessness
  • Denial
  • Mood swings
  • Irritability
  • Insomnia
• Strategies to address the emotions
  • Stay active
  • Keep up your hope; Never give up
  • Remember that you can get through this
• Try to vary the chemotherapy experience to make it more comfortable for you
  • For example one woman said that it was very helpful when her grandchildren occasionally accompanied her to her chemotherapy sessions
    • The children brought toys and played near her feet during the treatments
    • Seeing the children play helped her keep focused on why she was completing the chemotherapy sessions ... to continue to see her grandchildren play and grow
  • Ask different family members, friends, or healers to come visit during the sessions
  • Ask a tribal story teller to come visit and share traditional stories with the patient of strength, courage and/or battles with unusual enemies / contestants / or rivals
  • If the chemo room has a VCR or DVD player, bring in your favorite happy or cute movies or tapes
  • If you are feeling okay during the chemo (some days are good and some days are harder), bring your beadwork or basket weaving or other arts and crafts to work on
    • You may need an extra trash can if your craft has a lot of waste (like carving)
    • Check the room and make certain you have a table to set your tools on
    • If not, bring a light, portable table or TV tray
  • If you are having a hard day, put the sewing or artwork away for another day to avoid sending sick or bad feelings or spirits into the artwork
• It has been helpful for a lot of AI/AN survivors to have a good support system
  • This may be your family and friends
  • It may be a local Native support group or circle for cancer patients in your community
  • Sometimes you just want to be left alone. Tell others when you need time alone with your thoughts or prayers

Medicine Wheel:  The Spirit and Chemo Side Effects

• Almost all AI/AN patients get help from spiritual practices and beliefs during their chemo
• When you go in for your chemotherapy, Bring your token or other traditional spiritual articles to help you pray and stay healthy

How to reduce chemo side effects or cope with them-- During your Chemo

• What is it like?
  • When you go in for a chemo appointment, there are usually fairly comfortable chairs around the room, a television and/or radio and reading lamps
  • There are usually other people in the same room all receiving chemo
  • The providers connect the bottle of chemo drugs to the patient through an IV (intravenous tube) so that the medicine goes directly into the blood stream
  • Chemo “sessions” may be as short at 1 hour one day a week, or can be 9 hours three times a week
  • Different types of drugs are used to treat different stages of cancer
  • The length of each session and type of drugs used for chemotherapy depend on the stage of cancer and type of cancer cell (e.g., histologic grade and stage)
  • This means the person sitting next to you may also be a breast cancer patient, but may be receiving totally different medications within their chemo cocktail
• Plan to have someone take you to and from your appointment
  • Sometimes you feel a little nervous and other times feel sick
    • Have a bucket in the car/truck in case you suddenly need to throw up
    • It is safer to have someone take you
    • Most people want this help to be from a family member or close friend
  • A lot of times the family or friend stays with you during your treatment. But if your chemo is supposed to be for several hours, they may leave and then return when you are done to take you home
  • If a family member or close friend is not available to do this, ask the Community Health Representative (CHR) or Community Health Aide (CHA) to help you with this
  • If the CHR or CHA cannot do this, let the hospital or clinic know that you need help getting to the appointments. Most will have a way to get you help getting to your appointment (like a taxi voucher)
• Bring food or drink that your stomach can handle
  • This is really important if your chemo sessions are long or especially if you also are diabetic
  • Foods and drinks usually taste differently during the weeks that you are having chemo (some taste metallic and others just taste strange)
  • Only you will know which foods or drinks ones you can handle
  • Only you will know ahich foods and drinks give you an upset stomach
  • If you are diabetic, this is very important for you to have a healthy snack or drink to control your blood sugar
    • Chemo is stressful for most people
    • Stress affects your blood sugar level
    • Make certain you remind the nurses in the chemo room that you are diabetic.
• Bring a thermos of warm water or herbal tea close by so that you are getting warm liquids
• Bring extra water and blankets in the car/truck
  • Sometimes you will suddenly thirsty or feel chilled going or returning from chemo and you may want to have some water or put a blanket on you
• If you have lymphedema, bring a pillow or blanket to raise and rest your arm upon to help reduce the swelling
  • Bring a blanket with you into the chemo room
    • During chemo, cold medication is slowly dripped into your blood stream through an IV (intravenous tube)
    • A lot of patients feel “cold” after a short while (30 minutes or an hour)
    • Ask your healer, minister or priest to bless your Indian blankets (for spiritual strength and physical warmth)

How to reduce chemo side effects or cope with them-- After Your Chemo

• Sudden illness
  • Pack a bucket in the truck / car, in case you suddenly need to vomit during the drive home
  • There may be very little warning
  • The embarrassment following vomiting is a little less if the substance can be contained in the bucket rather than throughout the truck / car
  • The bucket can also be emptied outside rather than remaining in the vehicle for the entire ride home
  • Bring a gallon bottle of water to rinse out the bucket before it is returned to the inside of the vehicle
• Have a place set up for you to lie down during the drive home
  • You may suddenly feel tired and need to lie down
  • Have a couple of pillows and blanket in the car for you to use
  • Have a small pillow if you have lymphedema (caused by having some lymph nodes removed during surgery)
  • You need to keep your arm elevated to prevent swelling
  • You may want to ask your traditional Indian healer, minister or priest to bless your pillow for some additional spiritual strength

General Supportive Care throughout Chemotherapy

• The side effects from chemo will lessen after your treatment is over
• Few side effects are permanent
  • These may be damage to your:
    • Heart
    • Lungs
    • Nerves
    • Kidneys
    • Other organs
  • If you have any of these types of problems, you need to make certain you have regular medical appointments to check on these organs and body systems (like a heart check-up every year)
• If you are diabetic, these organs and body systems also may be damaged by your diabetes
  • Your diabetic doctor needs to be told by you that you have received chemo
  • You need to have your diabetes doctor and cancer (oncologist) doctor talk to one another about controlling permanent damage to these organs
• Remember that everyone reacts differently to chemo
  • You may do fine with your first round of chemo and have a hard time during your second round of chemo.
• When you are having side effects, you need to tell your providers
  • Typically, they can help you
  • They may change the drugs you are receiving or the dosage of the drugs to lessen the side effects
  • They cannot do this unless you let the providers know what problems you are having
• Let family and friends help you and your family with
  • Meals
  • Household chores
  • Writing monthly bills