Managing side effects
Increased risk of infection
A side effect of most chemotherapy treatment is a low white blood cell count. One of the types of white blood cell, called neutrophils, help fight infection. A low neutrophil count is called neutropenia. The lower your neutrophil count drops, the greater the risk of you developing an infection.
You may be given injection(s) of a drug called G-CSF (also called pegfilgrastim or Neulasta) under your skin on the day after your treatment, to boost your white cell count (your white cells help to fight infection). If required, this is administered from the second cycle of treatment onwards. You may need to have a blood test on Day 9 or 10 of your first cycle to see if your white cells have been affected by the treatment.
It is important to check your temperature if you are unwell. If you develop a fever of 38oC or higher, have shivers, shakes or feel unwell, you should call the rooms, the Patricia Ritchie Centre or, after hours, the McAuley Ward at the Mater Hospital or go to your nearest hospital emergency department. It is important to seek medical attention as soon as possible, even if it is the middle of the night, as infections can be life-threatening.
Nausea and vomiting
Some chemotherapy drugs may make you feel sick. These symptoms occur less frequently than they used to because of improvements in preventative medications, however it still relatively common and therefore knowing how to manage it is important. Anti-nausea medications (aka 'anti-emetics') are given before each chemotherapy treatment and may be continued for several days afterwards depending on your chemotherapy regimen.
The following drugs may be given with chemotherapy to prevent nausea:
Akynzeo (netupitant and palonosetron) or Aloxi (palonosetron)
Dexamethasone (may also be given for a few days after treatment)
Emend (aprepitant)
You will also be given tablets to take home for use as required in the days after chemotherapy. These may include:
Maxolon (metoclopramide) - take 1 tablets three times daily, half an hour prior to meals, as required
Nausicalm (cyclizine) - take 1/2 to 1 tablet three times daily as required
You may find it helpful to avoid cooking if you are feeling sick, and avoiding foods with strong smells or that are spicy, fatty or overly sweet. You should eat small meals more often, rather than three large meals.
If you continue to have nausea or vomiting despite taking these medications, or are unable to keep down adequate food or fluids, please contact the rooms, the Patricia Ritchie Centre or, after hours, the McAuley Ward at the Mater Hospital.
Fatigue
Feeling tired is common with chemotherapy. The best way of managing this is exercise! Exercise has been shown to reduce the severity of fatigue, enhance mood, reduce anxiety and aid restful sleep. You should aim to do 30 minutes of moderate intensity exercise five days of the week. It is fine to break this up into smaller amounts of time throughout the day, particularly if you have not exercised for a while. Sometimes you will feel too unwell to exercise, and that is okay - just resume exercise when you feel able. Even doing a little bit each day will make you feel better.
Diarrhoea
Diarrhoea can occur with chemotherapy, particularly with drugs such as fluorouracil, docetaxel, capecitabine and pemetrexed. This can usually be managed by ensuring you have adequate fluid intake and taking loperamide (Gastrostop or Imodium) or other anti-diarrhoeal medication as required.
If your diarrhoea is not controlled in spite of these medications, you are having difficulty maintaining adequate fluid intake, are feeling dizzy or lightheaded, or have abdominal pain or cramping, you should notify the rooms or the Patricia Ritchie Centre, or after hours, the McAuley Ward at the Mater Hospital.
Constipation
Constipation is relatively common with cancer treatment. Medications used to prevent nausea can cause constipation particularly in the days immediately after chemotherapy treatment. If you are prone to constipation it is recommended that you commence an aperient such as Coloxyl with Senna the day your chemotherapy starts and continue this for 3-4 days. It is also important to drink plenty of fluids and include high fibre foods in your diet to keep regular. Using prunes and pear juice may also assist in prevention of constipation. You should aim to have a bowel motion at least every two days. If necessary you can increase aperients to achieve this until such times as your bowel habit returns to normal:
Coloxyl with Senna - Take 1-2 tablets at night. If necessary, the tablets can be taken up to 3 times a day.
Movicol sachets – Mix 1 sachet in 125 – 250mLs of water. A maximum of 8 sachets per day can be taken.
N.B. Osmolax or Clearlax are equivalent alternatives to Movicol
I recommend avoiding lactulose as it tends to increase abdominal bloating and cause flatulence.
If your bowels have not opened after three days, you should try using one glycerine and one Dulcolax suppository inserted in the rectum. If this still does not work, contact the rooms or the Patricia Ritchie Centre for further advice.
Mucositis and dry mouth
Chemotherapy commonly causes a sore mouth, mouth ulcers and altered sense of taste. To prevent this:
- use sodium bicarbonate mouthwash four times daily (dissolve 1 teaspoon of bicarbonate soda in a glass of water)
- avoid mouthwashes containing alcohol containing
- use a soft toothbrush and floss your teeth gently every day.
If you develop mouth ulcers or a sore mouth try the following for symptomatic relief:
- suck on ice blocks
- avoid hot, spicy or rough food
- suck on frozen pineapple pieces (fresh pineapple rather than tinned) which have soothing and anti fungal properties
- gargle soluble paracetamol (max 1-2 tablets four times daily)
- Difflam mouth spray
- gargle soluble aspirin (1 tablet three times daily)
- for ulcers, Bonjela or SM33 or Kenalog in Orabase - apply small amount directly to ulcer
You may need an anti fungal if you have oral thrush (often with white coating on tongue). You can use Nilstat antifungal drops (swish 1mL around your mouth for one minute, then swallow) or Fungilin lozenges. If these do not work after 3-4 days, fluconazole tablets (150mg single dose tablet) can be used.
For treatment of dry mouth
- sip water or sugarless drinks often
- use a mouthwash at least 4 times a day
- chew sugarless gum or suck on sugarless lollies to stimulate saliva flow
- avoid caffeine, alcohol and tobacco, as these can dry out the mouth
- apply lip balm regularly
- Biotene Oral Balance Moisturising Gel and/or Aquae mouth spray may be helpful as required
A side effect of most chemotherapy treatment is a low white blood cell count. One of the types of white blood cell, called neutrophils, help fight infection. A low neutrophil count is called neutropenia. The lower your neutrophil count drops, the greater the risk of you developing an infection.
You may be given injection(s) of a drug called G-CSF (also called pegfilgrastim or Neulasta) under your skin on the day after your treatment, to boost your white cell count (your white cells help to fight infection). If required, this is administered from the second cycle of treatment onwards. You may need to have a blood test on Day 9 or 10 of your first cycle to see if your white cells have been affected by the treatment.
It is important to check your temperature if you are unwell. If you develop a fever of 38oC or higher, have shivers, shakes or feel unwell, you should call the rooms, the Patricia Ritchie Centre or, after hours, the McAuley Ward at the Mater Hospital or go to your nearest hospital emergency department. It is important to seek medical attention as soon as possible, even if it is the middle of the night, as infections can be life-threatening.
Nausea and vomiting
Some chemotherapy drugs may make you feel sick. These symptoms occur less frequently than they used to because of improvements in preventative medications, however it still relatively common and therefore knowing how to manage it is important. Anti-nausea medications (aka 'anti-emetics') are given before each chemotherapy treatment and may be continued for several days afterwards depending on your chemotherapy regimen.
The following drugs may be given with chemotherapy to prevent nausea:
Akynzeo (netupitant and palonosetron) or Aloxi (palonosetron)
Dexamethasone (may also be given for a few days after treatment)
Emend (aprepitant)
You will also be given tablets to take home for use as required in the days after chemotherapy. These may include:
Maxolon (metoclopramide) - take 1 tablets three times daily, half an hour prior to meals, as required
Nausicalm (cyclizine) - take 1/2 to 1 tablet three times daily as required
You may find it helpful to avoid cooking if you are feeling sick, and avoiding foods with strong smells or that are spicy, fatty or overly sweet. You should eat small meals more often, rather than three large meals.
If you continue to have nausea or vomiting despite taking these medications, or are unable to keep down adequate food or fluids, please contact the rooms, the Patricia Ritchie Centre or, after hours, the McAuley Ward at the Mater Hospital.
Fatigue
Feeling tired is common with chemotherapy. The best way of managing this is exercise! Exercise has been shown to reduce the severity of fatigue, enhance mood, reduce anxiety and aid restful sleep. You should aim to do 30 minutes of moderate intensity exercise five days of the week. It is fine to break this up into smaller amounts of time throughout the day, particularly if you have not exercised for a while. Sometimes you will feel too unwell to exercise, and that is okay - just resume exercise when you feel able. Even doing a little bit each day will make you feel better.
Diarrhoea
Diarrhoea can occur with chemotherapy, particularly with drugs such as fluorouracil, docetaxel, capecitabine and pemetrexed. This can usually be managed by ensuring you have adequate fluid intake and taking loperamide (Gastrostop or Imodium) or other anti-diarrhoeal medication as required.
If your diarrhoea is not controlled in spite of these medications, you are having difficulty maintaining adequate fluid intake, are feeling dizzy or lightheaded, or have abdominal pain or cramping, you should notify the rooms or the Patricia Ritchie Centre, or after hours, the McAuley Ward at the Mater Hospital.
Constipation
Constipation is relatively common with cancer treatment. Medications used to prevent nausea can cause constipation particularly in the days immediately after chemotherapy treatment. If you are prone to constipation it is recommended that you commence an aperient such as Coloxyl with Senna the day your chemotherapy starts and continue this for 3-4 days. It is also important to drink plenty of fluids and include high fibre foods in your diet to keep regular. Using prunes and pear juice may also assist in prevention of constipation. You should aim to have a bowel motion at least every two days. If necessary you can increase aperients to achieve this until such times as your bowel habit returns to normal:
Coloxyl with Senna - Take 1-2 tablets at night. If necessary, the tablets can be taken up to 3 times a day.
Movicol sachets – Mix 1 sachet in 125 – 250mLs of water. A maximum of 8 sachets per day can be taken.
N.B. Osmolax or Clearlax are equivalent alternatives to Movicol
I recommend avoiding lactulose as it tends to increase abdominal bloating and cause flatulence.
If your bowels have not opened after three days, you should try using one glycerine and one Dulcolax suppository inserted in the rectum. If this still does not work, contact the rooms or the Patricia Ritchie Centre for further advice.
Mucositis and dry mouth
Chemotherapy commonly causes a sore mouth, mouth ulcers and altered sense of taste. To prevent this:
- use sodium bicarbonate mouthwash four times daily (dissolve 1 teaspoon of bicarbonate soda in a glass of water)
- avoid mouthwashes containing alcohol containing
- use a soft toothbrush and floss your teeth gently every day.
If you develop mouth ulcers or a sore mouth try the following for symptomatic relief:
- suck on ice blocks
- avoid hot, spicy or rough food
- suck on frozen pineapple pieces (fresh pineapple rather than tinned) which have soothing and anti fungal properties
- gargle soluble paracetamol (max 1-2 tablets four times daily)
- Difflam mouth spray
- gargle soluble aspirin (1 tablet three times daily)
- for ulcers, Bonjela or SM33 or Kenalog in Orabase - apply small amount directly to ulcer
You may need an anti fungal if you have oral thrush (often with white coating on tongue). You can use Nilstat antifungal drops (swish 1mL around your mouth for one minute, then swallow) or Fungilin lozenges. If these do not work after 3-4 days, fluconazole tablets (150mg single dose tablet) can be used.
For treatment of dry mouth
- sip water or sugarless drinks often
- use a mouthwash at least 4 times a day
- chew sugarless gum or suck on sugarless lollies to stimulate saliva flow
- avoid caffeine, alcohol and tobacco, as these can dry out the mouth
- apply lip balm regularly
- Biotene Oral Balance Moisturising Gel and/or Aquae mouth spray may be helpful as required