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Learning about Chemotherapy What Can I Anticipate During Chemotherapy? Getting the Support You Need and Deserve
Manage Side Effects Eating Well During Chemotherapy Complementary Therapies
Learning about Chemotherapy

What Is Chemotherapy?
How Does Chemotherapy Work?
What Can Chemotherapy Do?
Is Chemotherapy Used With Other Treatments?

What Is Chemotherapy?
Chemotherapy is the treatment of cancer with drugs that can wipe out cancer cells. These drugs often are called "anticancer" drugs.

How Does Chemotherapy Work?
Normal cells grow and die in a controlled way. When cancer occurs, cells in your body that are not normal keep dividing and forming more cells without control. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying. Healthy cells can also be harmed, especially those that divide quickly. Harm to healthy cells is what causes side effects. These cells usually repair themselves in time after chemotherapy.

Because some drugs work better together than alone, often two or more drugs are given to you at the same time.
This is called combination chemotherapy.

What Can Chemotherapy Do?
Help cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells.
To control the cancer. This is done by keeping the cancer from spreading; slowing the cancer's growth; and killing cancer cells that may have spread to other parts of the body from the original site.
To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably.

Is Chemotherapy Used With Other Treatments?
Sometimes chemotherapy is the only treatment a patient receives. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy to:
Shrink a tumor before surgery or radiation therapy. This is called neo-adjuvant therapy.
Help destroy any cancer cells that may remain after surgery and/or radiation therapy. This is called adjuvant chemotherapy.
Make radiation therapy and biological therapy work better.
Help destroy cancer if it recurs or has spread to other parts of the body from the original site.

What Can I Expect During Chemotherapy?

Where Will I Get Chemotherapy?
How Often and For How Long Will I Get Chemotherapy?
How Is Chemotherapy Given?
How Will I Feel During Chemotherapy?
Can I Take Other Medicines While I Am Getting Chemotherapy?
How Will I Know If My Chemotherapy Is Working?

Some people with cancer want to know every detail about their condition and their treatment. Others prefer no information at all. The choice of how much information to seek out is yours, but there are questions that every person getting chemotherapy may ask.

This list is just a start. Always feel free to ask your health care team as many questions you want. If you do not understand their answers, keep asking until you do. Remember, there is no such thing as a "stupid" question, especially about cancer or your treatment. To make sure you get all the answers you want, you may find it helpful to draw up a list of questions before each doctor's appointment. Some people keep a "running list" and jot down each new question as it occurs to them. It may be helpful to take someone along for note taking.

Where Will I Get Chemotherapy?
Chemotherapy can be given in many different places: at home, a doctor's office, a clinic, a hospital's outpatient department, or as an "inpatient" in a hospital. The choice of where you get chemotherapy depends on which drug or drugs you are getting and your own and your doctor's wishes. Most patients receive their treatment as an "outpatient" and are not hospitalized. Sometimes, a patient starting chemotherapy may need to stay at the hospital for a short time so that the medicine's effects can be watched closely and any needed changes can be made.

How Often and For How Long Will I Get Chemotherapy?
How often and how long you get chemotherapy depends on:
The kind and stage of cancer you have.
The goals of the treatment.
The drugs that are used.
How your body responds to them.

You may get treatment every day, every week, or every month. Chemotherapy is often given in cycles that include treatment periods alternated with rest periods. Rest periods give your body a chance to build healthy new cells and regain its strength. Ask your doctor to tell you how long and how often you may expect to get treatment. Your treatment schedule is very important for the drugs to work right.

Sometimes, your doctor may need to delay a treatment based on the results of certain blood tests. (See the sections on Fatigue, Infection, and Anemia.) Your doctor will let you know what to do during this time and when to start your treatment again.

How Is Chemotherapy Given?
Chemotherapy can be given in several different ways: intravenously (through a vein), by mouth, through an injection (shot), or applied on the skin.

How Will I Feel During Chemotherapy?
Most people receiving chemotherapy find that they tire easily, but many feel well enough to continue to lead active lives. Each person and treatment is different, so it is not always possible to tell exactly how you will react. Your general state of health and extent of cancer you have, and the kind of drugs you are receiving can all affect how well you feel.

You may want to have someone available to drive you to and from treatment if, for example, you are taking medicine for nausea or vomiting that could make you tired. You may also feel especially tired from the chemotherapy as early as one day after a treatment and for several days. It may help to schedule your treatment when you can take off the day of and the day after your treatment. If you have young children, you may want to schedule the treatment when you have someone to help at home the day of and at least the day after your treatment. 

Can I Take Other Medicines While I Am Getting Chemotherapy?
Some medicines may interfere or react with the effects of your chemotherapy. Give your doctor a list of all the medicines you take before you start treatment. Include:
the name of each drug
the dosage
the reason you take it
how often you take it

Note: Tell your doctor about all over-the-counter remedies, including vitamins, laxatives, medicines for allergies, indigestion, and colds, aspirin, ibuprofen, or other pain relievers, and any mineral or herbal supplements. Your doctor can tell you if you should stop taking any of these remedies or increase them before you start chemo. After your treatments begin, be sure to check with your doctor before taking any new medicines or stopping the ones you are already taking.

How Will I Know If My Chemotherapy Is Working?
Your doctor and nurse will use several ways to see how well your treatments are working. You may have physical exams and tests often. Always feel free to ask your doctor about the test results and what they show about your progress.

Manage with Side Effects

What Causes Side Effects?
How Long Do Side Effects Last?
Nausea and Vomiting
Hair Loss
Central Nervous System Problems
Symptoms of Infection
Mouth, Gum, and Throat Problems
Effects on Skin and Nails
Radiation Recall
Kidney and Bladder Effects
Flu-Like Symptoms
Fluid Retention

What Causes Side Effects?
 The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.

You may have none of these side effects or just a few. The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. 

How Long Do Side Effects Last?
Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over side effects depends on many things, including your overall health and the kind of chemotherapy you have been taking.

Most people have no serious long-term problems from chemotherapy. However, on some occasions, chemotherapy can cause permanent changes or damage to the heart, lungs, nerves, kidneys, reproductive or other organs.

The side effects of chemotherapy can be rotten, but they must be measured against the treatment's ability to destroy cancer. Medicines can help prevent some side effects such as nausea. Sometimes people receiving chemotherapy become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor or nurse. They may be able to suggest ways to make side effects easier to deal with or reduce them.

Below you will find suggestions for dealing with some of the more common side effects of chemotherapy.

Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It can be due to your disease, chemotherapy, radiation, surgery, low blood counts, lack of sleep, pain, stress, poor appetite, along with many other factors.

Fatigue from cancer feels different from fatigue of everyday life. Fatigue caused by chemotherapy can appear suddenly. Patients with cancer have described it as a total lack of energy and have used words such as worn out, drained, and wiped out to describe their fatigue. And rest does not always relieve it. Not everyone feels the same kind of fatigue. You may not feel tired while someone else does or your fatigue may not last as long as someone else's does. It can last days, weeks, or months. But severe fatigue does go away gradually as the tumor responds to treatment.

How can I cope with fatigue?
Plan your day so that you have time to rest.
Take short naps or breaks, rather than one long rest period.
Save your energy for the most important things.
Try easier or shorter versions of activities you enjoy.
Take short walks or do light exercise if possible. You may find this helps with fatigue.
Talk to your health care provider about ways to save your energy and treat your fatigue.
Try activities such as meditation, prayer, yoga, guided imagery, visualization, etc. You may find that these help with fatigue.
Eat as well as you can and drink plenty of fluids. Eat small amounts at a time, if that is helpful. (It helped me.)
Join a support group. Sharing your feelings with others can ease the burden of fatigue. You can learn how others deal with their fatigue. Your health care provider can put you in touch with a support group in your area.
Allow others to do some things for you that you usually do.
I know that this is hard but let them do things for you.
It's their way of helping.
Keep a diary of how you feel each day. This will help you plan your daily activities.
Report any big changes in energy level to your doctor or nurse.

Nausea and Vomiting
Many patients fear that they will have nausea and vomiting while receiving chemotherapy. But new drugs have made these side effects far less common and, when they do occur, much less severe. These powerful antiemetic or antinausea drugs can prevent or lessen nausea and vomiting in most patients. Different drugs work for different people, and you may need more than one drug to get relief. Do not give up. Continue to work with your doctor and nurse to find the drug or drugs that work best for you. Also, be sure to tell your doctor or nurse if you are very nauseated or have vomited for more than a day, or if your vomiting is so bad that you cannot keep liquids down.

What can I do if I have nausea and vomiting?
Drink liquids at least an hour before or after mealtime, instead of with your meals. Drink frequently and drink small amounts.
Eat and drink slowly.
Eat small meals throughout the day, instead of one, two, or three large meals.
Eat foods cold or at room temperature so you won't be bothered by strong smells.
Chew your food well for easier digestion.
If nausea is a problem in the morning, try eating dry foods like cereal, toast, or crackers before getting up. (Do not try this if you have mouth or throat sores or are troubled by a lack of saliva.)
Drink cool, clear, unsweetened fruit juices, such as apple or grape juice or light-colored sodas such as ginger ale that have lost their fizz and do not have caffeine.
(To take out the fizz add one teaspoon of sugar to the fizzy drink and stir.)
Suck on mints, or candies. (Do not use tart candies if you have mouth or throat sores.)
Prepare and freeze meals in advance for days when you do not feel like cooking.
Wear loose-fitting clothes.
Breathe deeply and slowly when you feel nauseated.
Distract yourself by chatting with friends or family members, listening to music, or watching a movie or TV show.
Use relaxation techniques.
Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
Avoid eating for at least a few hours before treatment if nausea usually occurs during chemotherapy.
Eat a light meal before treatment if you can.

Chemotherapy drugs can cause some side effects that are painful. The drugs can damage nerves, leading to burning, numbness, tingling or shooting pain, most often in the fingers or toes. Some drugs can also cause mouth sores, headaches, muscle pains, and stomach pains.

Not everyone with cancer or who receives chemotherapy experiences pain from the disease or its treatment. But if you do, it can be relieved. The first step to take is to talk with your health care team about your pain. They need to know as many details about your pain as possible. You may want to describe your pain to your family and friends. They can help you talk to your caregivers about your pain, especially if you are too tired or in too much pain to talk to them yourself.

Hair Loss
Hair loss (alopecia) is a common side effect of chemotherapy, but not all drugs cause hair loss. Your doctor can tell you if hair loss might occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or fall out entirely. Hair loss can occur on all parts of the body, including the head, face, arms and legs, underarms, and pubic area. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. Sometimes, hair may grow back a different color or texture (My hair grew back thicker). 

Hair loss does not always happen right away. It may begin several weeks after the first treatment or after a few treatments. Many people say their head becomes sensitive before losing hair. Hair may fall out gradually or in clumps. Any hair that is still growing may become dull and dry.

How can I care for my scalp and hair during chemo?
Use a mild shampoo.
Use a soft hair brush.
Use low heat when drying your hair.
Have your hair cut short. A shorter style will make your hair look thicker and fuller. It also will make hair loss easier to manage if it occurs.
Use a sun screen, sun block, hat, or scarf to protect your scalp from the sun if you lose hair on your head.
Avoid brush rollers to set your hair.
Avoid dying, perming, or relaxing your hair.

Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or hair pieces. Others leave their head uncovered. Still others switch back and forth, depending on whether they are in public or at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.

If you choose to cover your head:
Get your wig or hairpiece before you lose a lot of hair. That way, you can match your current hair style and color. You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients. Someone may even come to your home to help you. You also can buy a wig or hair piece through a catalog, internet or by phone.
You may also consider borrowing a wig or hairpiece, rather than buying one. Check with the nurse or social work department at your hospital about resources for free wigs in your community.
Take your wig to your hairdresser or the shop where it was purchased for styling and cutting to frame your face.
Some health insurance policies cover the cost of a hairpiece needed because of cancer treatment. It is also a tax-deductible expense. Be sure to check your policy and ask your doctor for a "prescription."

Losing hair from your head, face, or body can be hard to accept. Feeling angry or depressed is common and perfectly all right. At the same time, keep in mind that it is a temporary side effect. Talking about your feelings can help. If possible, share your thoughts with someone who has had a similar experience.
See Tips for You for the Look Good Feel Better program in your area.

Chemotherapy can reduce the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues do not get enough oxygen to do their work. This condition is called anemia. Anemia can make you feel short of breath, very weak, and tired. Call your doctor if you have any of these symptoms:
Fatigue (feeling very weak and tired).
Dizziness or feeling faint.
Shortness of breath.
Feeling as if your heart is "pounding" or beating very fast.

Your doctor will check your blood cell count often during your treatment. She or he may also prescribe a medicine that can boost the growth of your red blood cells. Discuss this with your doctor if you become anemic often. If your red count falls too low, you may need a blood transfusion or medicine  to raise the number of red blood cells in your body.
Get plenty of rest. Sleep more at night and take naps during the day.
Limit your activities. Do only the things that are essential or most important to you.
Ask for help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving.
Eat a well-balanced diet. 
When sitting, get up slowly. When lying down, sit first and then stand. This will help prevent dizziness.

Central Nervous System Problems
Chemotherapy can interfere with certain functions in your central nervous system (brain) causing tiredness, confusion, and depression. These feelings will go away once the chemotherapy dose is lowered or you finish chemotherapy. Call your doctor if these symptoms occur.

Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the bone marrow, making it harder to make white blood cells (WBCs), the cells that fight many types of infections. Your doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors (CSF). Raising the white blood cell count greatly lowers the risk of serious infection.

Most infections come from bacteria normally found on your skin and in your mouth, intestines and genital tract. Sometimes, the cause of an infection may not be known. Even if you take extra care, you still may get an infection. 

Report any signs of infection to your doctor right away, even if it is in the middle of the night. This is especially important when your white blood cell count is low. If you have a fever, do not take aspirin, acetaminophen, or any other medicine to bring your temperature down without checking with your doctor first.
Anticancer drugs can affect the bone marrow's ability to make platelets, the blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even without an injury.

Call your doctor if you have any of these symptoms:
unexpected bruising.
small, red spots under the skin.
reddish or pinkish urine.
black or bloody bowel movements.
bleeding from your gums or nose.
vaginal bleeding that is new or lasts longer than a regular period.
headaches or changes in vision.
warm to hot feeling of an arm or leg.

Your doctor will check your platelet count often while you are having chemotherapy. If your platelet count falls too low, the doctor may give you a platelet transfusion to build up the count. There are also medicines called colony stimulating factors that help increase your platelets.

Mouth, Gum, and Throat Problems
Good oral care is important during cancer treatment. Some anticancer drugs can cause sores in the mouth and throat, a condition called stomatitis or mucositis. Anticancer drugs also can make these tissues dry and irritated or cause them to bleed. Patients who have not been eating well since beginning chemotherapy are more likely to get mouth sores.

In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Every step should be taken to prevent infections, because they can be hard to fight during chemotherapy and can lead to serious problems.

How can I keep my mouth, gums, and throat healthy?
Talk to your doctor about seeing your dentist at least several weeks before you start chemotherapy. You may need to have your teeth cleaned and to take care of any problems such as cavities, gum abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay.
Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch. Brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special toothbrush and/or toothpaste if your gums are very sensitive. Rinse with warm salt water after meals and before bedtime.
Rinse your toothbrush well after each use and store it in a dry place.
Avoid mouthwashes that contain any amount of alcohol. Ask your doctor or nurse to suggest a mild or medicated mouthwash that you might use. For example, mouthwash with sodium bicarbonate (baking soda) is non-irritating.

If you develop sores in your mouth, tell your doctor or nurse. You may need medicine to treat the sores. If the sores are painful or keep you from eating, you can try these ideas:

How can I cope with mouth sores?
Ask your doctor if there is anything you can apply directly to the sores or to prescribe a medicine you can use to ease the pain.
Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat.
Eat soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, yogurt, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat.
Avoid irritating, acidic foods and juices, such as tomato and citrus (orange, grapefruit, and lemon); spicy or salty foods; and rough or coarse foods such as raw vegetables, granola, popcorn, and toast.

How can I cope with mouth dryness?
Ask your doctor if you should use an artificial saliva product to moisten your mouth.
Drink plenty of liquids.
Ask your doctor if you can suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum. (Sorbitol, a sugar substitute that is in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)
Moisten dry foods with butter, margarine, gravy, sauces, or broth.
Dunk crisp, dry foods in mild liquids.
Eat soft and pureed foods.
Use lip balm or petroleum jelly if your lips become dry.
Carry a water bottle with you to sip from often.

When chemotherapy affects the cells lining the intestine, it can cause diarrhea (watery or loose stools). If you have diarrhea that continues for more than 24 hours, or if you have pain and cramping along with the diarrhea, call your doctor. In severe cases, the doctor may prescribe a medicine to control the diarrhea. If diarrhea persists, you may need intravenous (IV) fluids to replace the water and nutrients you have lost. Often these fluids are given as an outpatient and do not require hospitalization. Do not take any over-the-counter medicines for diarrhea without asking your doctor.

How can I help control diarrhea?
Drink plenty of fluids. This will help replace those you have lost through diarrhea. Mild, clear liquids, such as water, clear broth, sports drinks such as Gatorade, or ginger ale, are best. If these drinks make you more thirsty or nauseous, try diluting them with water. Drink slowly and make sure drinks are at room temperature. Let carbonated drinks lose their fizz before you drink them.
Eat small amounts of food throughout the day instead of three large meals.
Unless your doctor has told you otherwise, eat potassium-rich foods. Diarrhea can cause you to lose this important mineral. Bananas, oranges, potatoes, and peach and apricot nectars are good sources of potassium.
Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. A clear liquid diet does not provide all the nutrients you need, so do not follow one for more than 3 to 5 days.
Eat low-fiber foods. Low-fiber foods include white bread, white rice or noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins, cottage cheese, yogurt without seeds, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken, or turkey without the skin, and fish.
Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit.
Avoid hot or very cold liquids, which can make diarrhea worse.
Avoid coffee, tea with caffeine, alcohol, and sweets. Stay away from fried, greasy, or highly spiced foods, too. They are irritating and can cause diarrhea and cramping.
Avoid milk and milk products, including ice cream, if they make your diarrhea worse.

Some anticancer medicines, pain medicines, and other medicines can cause constipation. It can also occur if you are less active or if your diet lacks enough fluid or fiber. If you have not had a bowel movement for more than a day or two, call your doctor, who may suggest taking a laxative or stool softener. Do not take these measures without checking with your doctor, especially if your white blood cell count or platelets are low.

What can I do about constipation?
Drink plenty of fluids to help loosen the bowels. If you do not have mouth sores, try warm and hot fluids, including water, which work especially well.
Check with your doctor to see if you can increase the fiber in your diet (there are certain kinds of cancer and certain side effects you may have for which a high-fiber diet is not recommended). High fiber foods include bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.
Get some exercise every day. Go for a walk or you may want to try a more structured exercise program. Talk to your doctor about the amount and type of exercise that is right for you.

Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy, such as redness, rashes, itching, peeling, dryness, acne, and increased sensitivity to the sun. Certain anticancer drugs, when given intravenously, may cause the skin all along the vein to darken, especially in people who have very dark skin. Some people use makeup to cover the area, but this can take a lot of time if several veins are affected. The darkened areas will fade a few months after treatment ends.

Your nails may also become darkened, yellow, brittle, or cracked. They also may develop vertical lines or bands.

Some symptoms may mean you are having an allergic reaction that may need to be treated at once. Call your doctor or nurse right away if:
you develop sudden or severe itching.
your skin breaks out in a rash or hives.
you have wheezing or any other trouble breathing.

How can I cope with skin and nail problems?

Try to keep your face clean and dry.
Ask your doctor or nurse if you can use over-the-counter medicated creams or soaps.

Itching and dryness
Apply corn starch as you would a dusting powder.
To help avoid dryness, take quick showers or sponge baths. Do not take long, hot baths. Use a moisturizing soap.
Apply cream and lotion while your skin is still moist.
Avoid perfume, cologne, or aftershave lotion that contains alcohol.
Use a colloid oatmeal bath or diphenhydramine (Benadryl) for generalized pruritis (hives).

Nail problems
You can buy nail-strengthening products in a drug store. Be aware that these products may bother your skin and nails.
Protect your nails by wearing gloves when washing dishes, gardening, or doing other work around the house.
Be sure to let your doctor know if you have redness, pain, or changes around the cuticles.

Sunlight sensitivity
Avoid direct sunlight as much as possible, especially between 10 a.m. and 4 p.m. when the sun's rays are the strongest.
Use a sun screen lotion with a skin protection factor (SPF) of 15 or higher to protect against sun damage. A product such as zinc oxide, sold over the counter, can block the sun's rays completely.
Use a lip balm with a sun protection factor.
Wear long-sleeve cotton shirts, pants and hats with a wide brim (particularly if you are having hair loss), to block the sun.
Even people with dark skin need to protect themselves from the sun during chemotherapy.

Radiation Recall
Some people who have had radiation therapy develop "radiation recall" during their chemotherapy. During or shortly after certain anticancer drugs are given, the skin over an area that had received radiation turns red — a shade anywhere from light to very bright. The skin may blister and peel. This reaction may last hours or even days. Report radiation recall reactions to your doctor or nurse. You can soothe the itching and burning by:
Placing a cool, wet compress over the affected area.
Wearing soft, non-irritating fabrics. Often find cotton underwear is most comfortable.

Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or permanent damage to the bladder or kidneys. If you are taking one or more of these drugs, your doctor may ask you to collect a 24-hour urine sample. A blood sample may also be obtained before you begin chemotherapy to check your kidney function. Some anticancer drugs cause the urine to change color (orange, red, green, or yellow) or take on a strong or medicine-like odor for 24-72 hours. Check with your doctor to see if the drugs you are taking may have any of these effects.

Always drink plenty of fluids to ensure good urine flow and help prevent problems. This is very important if you are taking drugs that affect the kidney and bladder. Water, juice, soft drinks, broth, ice cream, soup, popsicles, and gelatin are all considered fluids.

Tell your doctor if you have any of these symptoms:
Pain or burning when you urinate (pass your water).
Frequent urination.
Not being able to urinate.
A feeling that you must urinate right away ("urgency").
Reddish or bloody urine.
Chills, especially shaking chills.

Flu-Like Symptoms
Some people feel as though they have the flu for a few hours to a few days after chemotherapy. This may be especially true if you are receiving chemotherapy in combination with biological therapy. Flu-like symptoms — muscle and joint aches, headache, tiredness, nausea, slight fever (usually <100ˇF), chills, and poor appetite — may last from 1 to 3 days. An infection or the cancer itself can also cause these symptoms. Check with your doctor if you have flu-like symptoms.

Fluid Retention
Your body may retain fluid when you are having chemotherapy. This may be due to hormonal changes from your therapy, to the drugs themselves, or to your cancer. Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen. You may need to avoid table salt and foods that have a lot of salt. If the problem is severe, your doctor may prescribe a diuretic, medicine to help your body get rid of excess fluids.

Eating Well During Chemotherapy

What If I Don't Like Eating?
Can I Drink Alcoholic Beverages?
Can I Take Extra Vitamins and Minerals?

It is very important to eat well while you are getting chemotherapy. Eating well during chemotherapy means choosing a balanced diet that contains all the nutrients the body needs. Eating well also means having a diet high enough in calories to keep your weight up and high enough in protein to rebuild tissues that cancer treatment may harm. People who eat well can cope with side effects and fight infection better. Also, their bodies can rebuild healthy tissues faster.

What If I Don't Feel Like Eating?
On some days you may feel you just cannot eat. You can lose your appetite if you feel depressed or tired. Or, side effects such as nausea or mouth and throat problems may make it difficult or painful to eat  In some cases, if you cannot eat for a long period of time, your doctor may recommend that you be given nutrition intravenously until you are able to eat again.

When a poor appetite is the problem, try these ideas:
Eat frequent, small meals or snacks whenever you want, perhaps four to six times a day. You do not have to eat three regular meals each day.
Keep snacks within easy reach, so you can have something whenever you feel like it.
Even if you do not want to eat solid foods, try to drink beverages during the day. Juice, soup, and other fluids like these can give you important calories and nutrients.
Vary your diet by trying new foods and recipes.
When possible, take a walk before meals; this may make you feel hungrier.
Try changing your mealtime routine. For example, eat in a different location.
Eat with friends or family members. When eating alone, listen to the radio or watch TV.
Ask your doctor or nurse about nutrition supplements.
Speak with your dietician about your specific nutrition needs.

Can I Drink Alcoholic Beverages?
Small amounts of alcohol can help you relax and increase your appetite. On the other hand, alcohol may interfere with how some drugs work and/or worsen their side effects. For this reason, some people must drink less alcohol or avoid alcohol completely during chemotherapy. Ask your doctor if and how much beer, wine, or other alcoholic beverages you can drink during treatment.

Can I Take Extra Vitamins and Minerals?
You can usually get all the vitamins and minerals you need by eating a healthy diet. Talk to your doctor, nurse, registered dietician, or a pharmacist before taking any vitamin or mineral supplements. Too much of some vitamins and minerals can be just as dangerous as too little. Find out what is recommended for you.


Getting the Support You Need And Deserve

How Can I Get Support?
How Can I Make My Daily Life More Enjoyable?

Chemotherapy, like cancer, can bring major changes to a person's life. While it can help cure your cancer, it can sometimes affect overall health, cause stress, disrupt day-to-day schedules, and strain personal relationships. It is no wonder, then, that some people feel tearful, anxious, angry, or depressed at some point during their chemotherapy.

These emotions can be perfectly normal, but they can also be disturbing. Fortunately, there are ways to deal with these emotional side effects, just as there are ways to cope with the physical side effects of chemotherapy.

How Can I Get Support?
You can draw on many sources of support. Here are some of the most important: Doctors, nurses, and other health professionals. If you have questions or worries about your cancer treatment, talk with members of your health care team. Tell them if you are feeling anxious or depressed, or if you are experiencing other emotional or physical changes.

Counseling professionals. There are many kinds of counselors who can help you express, understand, and cope with your feelings. If you are depressed, you should consider seeking professional help. Feeling hopeless, worthless, guilty, or that life is not worth living are signs of depression. Depending on your preferences and needs, you may want to talk with a psychiatrist, psychologist, social worker, sex therapist, or member of the clergy. There are also medicines that can be used to treat depression. Many cancer centers have "psycho-oncology" programs with psychiatrists, psychologists, and social workers trained to work with cancer patients. Your doctor, nurse, or social worker may be able to suggest who to contact.

Friends and family members. Talking with friends or family members can help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can. However, you may need to help them help you. At a time when you might expect that others will rush to your aid, you may have to make the first move.

Asking friends and family for help. Many people do not understand cancer, and may withdraw from you because they are afraid of your illness and not know what to do to help you. Others may worry that they will upset you by saying "the wrong thing." You can help by being open in talking with others about your illness, your treatment, your needs, and your feelings. By talking openly, you can correct mistaken ideas about cancer. You can also let people know that there is no single "right" thing to say, as long as their caring comes through loud and clear. Once people know they can talk with you honestly, they may be more willing and able to open up and lend their support. Accepting help may be hard. When you allow others to help, you make them feel less helpless. In a sense, you are helping others deal with your illness.

Support groups. Support groups are made up of people who are going or have gone through the same kinds of experiences as you. Many people with cancer find they can share thoughts and feelings with group members that they do not feel comfortable sharing with anyone else. Support groups also can serve as an important source of practical information about living with cancer. Some studies suggest that not only can support groups help with how you are feeling emotionally, but may also help you recover physically from your cancer.

Support can also be found in one-to-one programs that put you in touch with another person very similar to you in age, sex, type of cancer, and so forth. In some programs, this person comes to visit you. In others, a "hotline" puts you in touch with someone you can talk with on the telephone. Later, you may want to help others who are going through the same experience you did.

Sources for information about support programs, counseling advice, financial assistance, transportation to and from treatment, and information about cancer include neighborhood organizations, local health care providers, and your hospital, clinic, or medical center where you are being treated. At public libraries and patient libraries at hospitals, a librarian can help you find books and articles through a literature search.

How Can I Make My Daily Life More Enjoyable?
Share your feelings with friends and family.
Watch funny movies.
Listen to music.
Try new hobbies and learn new skills.
Exercise, if you can.
Do things that interest you.
Just go for it!

Complementary Therapies

Massage Therapy
Meditation and Prayer
Muscle Tension and Release
Physical Exercise
Rhythmic Breathing

Many people with cancer are exploring complementary therapies. These methods focus on the mind, body, and spirit. They do not take the place of medical therapies, but add to them. They can reduce stress, lessen side effects from cancer and cancer treatments, and enhance well-being. And they can help you feel more in control; it is something you can do for yourself.

A few of the therapies available are described here. Many more therapies exist such as art therapy, humor, journaling, reiki, music therapy, pet therapy and others. You may want to check with your doctor before using these techniques, especially if you have lung problems. A social worker, psychologist, or nurse may be able to help you with these therapies. You may also want to read books, listen to audiotapes, and watch videotapes about these techniques.

With training in biofeedback, you can control body functions such as heart rate, blood pressure, and muscle tension. A machine will sense when your body shows signs of tension and lets you know in some way such as making a sound or flashing a light. The machine also gives you feedback when you relax your body. Eventually, you can control your relaxation responses without having to depend on feedback from the machine. Your doctor, nurse, or social worker can refer you to someone trained in teaching biofeedback.

Distraction is the use of an activity to take your mind off your worries or discomforts. Talking with friends or relatives, watching TV, listening to the radio, reading, going to the movies, or working with your hands by doing needlework or puzzles, building models, or painting are all ways to distract yourself. Many cancer centers now have music or creative art therapists who can be very helpful to you while you are getting treatment for your cancer. Ask your nurse or social work department about possible resources in your area.

Hypnosis puts you in a deeply-relaxed state that can help reduce discomfort and anxiety. You can be hypnotized by a qualified person, or you can learn how to hypnotize yourself. If you are interested in learning more, ask your doctor, nurse, or social worker to refer you to someone trained in the technique.

Imagery is a way of daydreaming that uses all your senses. It is usually done with your eyes closed. To begin, breathe slowly and feel yourself relax. Imagine a ball of healing energy-- perhaps a white light--forming somewhere in your body. When you can "see" the ball of energy, imagine that as you breathe in you can blow the ball to any part of the body where you feel pain, tension, or discomfort such as nausea. When you breathe out, picture the air moving the ball away from your body, taking with it any painful or uncomfortable feelings. (Be sure to breathe naturally; do not blow.) Continue to picture the ball moving toward you and away from you each time you breathe in and out. You may see the ball getting bigger and bigger as it takes away more and more tension and discomfort. To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say to yourself, "I feel alert and relaxed."

Massage Therapy
The idea that touch can heal is an old one. The first written records of massage date back 3,000 years ago to China. Massage therapy involves touch and different methods of stroking and kneading the muscles of the body. A licensed massage therapist should do the therapy. Talk to your doctor before beginning this therapy.

Meditation and Prayer
Meditation is a relaxation technique that allows you to focus your energy and your thoughts on something very specific. This is especially helpful when your mind and body are stressed from cancer treatment. For example, you may want to repeat a word (over and over), or look at an object, such as a picture. Another form of meditation is allowing your thoughts, feelings, and images to flow through your mind. For patients who believe in a higher spiritual power, prayer can provide strength, comfort and inspiration throughout the cancer experience. Whether you pray alone, with family and friends, or as a member of a religious community, prayer may help. A member of the clergy or your spiritual advisor can help you incorporate prayer into your daily life.

Muscle Tension and Release
Lie down in a quiet room. Take a slow, deep breath. As you breathe in, tense a particular muscle or group of muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, or stiffen your arms or legs. Hold your breath and keep your muscles tense for a second or two. Then breathe out, release the tension, and let your body relax completely. Repeat the process with another muscle or muscle group. You also can try a variation of this method, called "progressive relaxation." Start with the toes of one foot and, working upward, progressively tense and relax all the muscles of one leg. Next, do the same with the other leg. Then tense and relax the rest of the muscle groups in your body, including those in your scalp. Remember to hold your breath while tensing your muscles and to breathe out when releasing the tension.

Physical Exercise
Exercise can help lessen pain, strengthen weak muscles, restore balance, and decrease depression and fatigue. After getting approval from your doctor, you may want to begin by walking 5-10 minutes twice a day and later increasing your activity.

Rhythmic Breathing
Get in a comfortable position and relax all your muscles. If you keep your eyes open, focus on a distant object. If you close your eyes, imagine a peaceful scene or simply clear your mind and focus on your breathing.

Breathe in and out slowly and comfortably through your nose. If you like, you can keep the rhythm steady by saying to yourself, "In, one two; out, one two." Feel yourself relax and go limp each time you breathe out.

You can do this technique for just a few seconds or for up to 10 minutes. End your rhythmic breathing by counting slowly and silently to three.

Visualization is similar to imagery. With visualization, you create an inner picture that represents your fight against cancer. Some people getting chemotherapy use images of rockets blasting away their cancer cells or of knights in armor battling their cancer cells. Others create an image of their white blood cells or their drugs attacking the cancer cells.

All you need is a quiet, comfortable place and some time each day to practice breathing, stretching, and meditation. To learn about yoga you may want to take a class and review books, audiotapes, or videotapes on yoga. Ask your social worker, psychologist, or psychiatrist about yoga classes in your area.


I hope that this information will help you understand how chemotherapy is used to treat cancer. Knowing what to expect when going for your chemo treatments, may help you not feel as anxious. Remember to talk with your health care team whenever you have questions.  There are never stupid questions.
If it makes you feel better Ask.


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