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1 CHEMOTHERAPY CHEMOTHERAPY In this section you will learn about: What is chemotherapy Understanding your blood work Your first chemotherapy treatment Paying for your medicine Complementary and alternative therapies

2 Treating cancer with chemotherapy What is chemotherapy? Chemotherapy is a type of treatment that uses drugs to destroy, slow down, or stop the growth of cancer cells. Other types of treatments that use drugs to target cancer cells include hormonal drug therapy, biological therapy, and targeted therapy. The type of treatment you have depends on many factors, including your type of cancer. Chemotherapy is sometimes used after surgery or radiation to target cells that were too small to see or were not destroyed. Chemotherapy might also be used before surgery or radiation to shrink the size of the tumour. How is chemotherapy given? Through a vein (Intravenous or IV ), or By mouth (oral) Is chemotherapy painful? It does not hurt to get chemotherapy. If you a feel burning sensation or see redness or swelling in the area of the needle, tell your chemotherapy nurse right away. After you are home, if you feel pain, see redness or swelling in the arm where you received chemotherapy, call the Triage Nursing Line (See the contact page at the front of this binder). Can I take other medicines while I am on chemotherapy? Chemotherapy teaching class Ask a member of your healthcare team about attending a class to prepare for your chemotherapy. Some medicines and natural health products (including vitamins, minerals and herbal supplements) can affect the chemotherapy drugs you are taking. It is important to bring a list or the drugs themselves (in the original containers) to your appointments. Your doctor or nurse will ask you questions about your medicines and let you know if it is safe to continue taking them. 48

3 Why does chemotherapy lead to side effects? Chemotherapy does not only damage cancer cells it also damages some healthy cells. It is important to remember that everyone reacts differently to chemotherapy. See the section called Side Effects for more information on why chemotherapy may cause side effects and how to manage them. Please read over the When to call for help page at the front of this binder for a list of times when you should get help. Understanding your blood work Before each treatment, blood work will be done to measure your blood counts. Your treatment may be delayed if you have a low blood count. These blood counts are measuring your: White blood cells Red blood cells Platelets Your white blood cells are important to fight off infections in your body. Red blood cells carry oxygen to all parts of your body. Platelets help to make your blood clot if you are bleeding and help wounds heal. Some treatments can affect how many white blood cells, red blood cells and platelets your body is making. Some people can have blood work done at an outside lab. Talk to your healthcare team to see if this is possible for you. 49

4 What if I have a low white blood count? Low white blood cell counts make the body more open to infection. It is called neutropenia. While you are having chemotherapy, infections while on chemotherapy can happen very quickly and make people very sick. Your risk of infection is greatest 5 to 14 days after each treatment. Watch for signs of infection, including: A fever you have a temperature of 38 C (100.4 F) or higher Chills or shakes Areas of redness or tenderness Pain, burning, frequent urge to urinate Feeling unwell, like a flu Cough or sore throat What you can do: Wash your hands often with plain soap and water or hand sanitizer. Take your temperature daily or when you are feeling unwell. Avoid people who are sick. Do not take ASA (Aspirin, acetylsalicylic acid) without speaking to your oncologist. If a doctor has advised you to take ASA to prevent heart disease or stroke, please talk to your oncologist before starting treatment. Do not use ASA for headache, fever, or occasional aches and pains; use acetaminophen (Tylenol ) instead. 50

5 Fever If you have a temperature of 38 C (100.4 F) or higher: Monday to Friday 8:30 a.m. to 4:00 p.m., call (519) , press 3 to call the Triage Nursing Line. After hours, holidays, and on weekends call your family doctor or go to your nearest Emergency Department. Tell staff that you are receiving chemotherapy and that you have a fever. Show them your fever card. DO NOT take acetaminophen (e.g., Tylenol ) for your fever until you speak with a doctor or nurse. FEVER CARD This may be an oncologic EMERGENCY Having a fever is a medical emergency. Have a good thermometer that you can read and understand. What if I have a low red blood count? When you don t have enough red blood cells to carry oxygen around your body, your tissues cannot do their jobs properly. Having low red blood cell counts is called anemia. When your red blood cell count is low you may: Feel tired Feel short of breath with activity Feel dizzy or light headed Have a headache Have chest pain What you can do: Rest in between activities Plan healthy meals and eat food high in protein Get up slowly so that you do not get dizzy 51

6 What if I have a low platelet count? Normally, if you cut yourself, the platelets in your blood make the bleeding stop by forming a clot. If your platelet count is low you may have: Bruises or small purple spots on your body Bleeding that will not stop Blood in your urine or stool (or black stool) What you can do: Use a soft toothbrush. Check with your oncologist before dental work. Prevent constipation. Do not use suppositories or enemas. Avoid ASA (such as Aspirin ) and ASA containing products. Use an electric shaver instead of a razor blade. To stop the bleeding, apply pressure and hold for 5-10 minutes or until the bleeding stops. If you can t stop the bleeding you must go to your local Emergency Department. Make sure you have a driver. Your first chemotherapy treatment Check-in at the chemotherapy reception desk, located on level 2. You will be given a pager. When it is time for your appointment, your pager will vibrate and lash. A nurse will come to greet you outside of the chemotherapy suite. 52

7 You will be asked to wash your hands at the sanitizing station and reminded that this is a scent-free environment. Artificial scents can make some people in the chemotherapy suite feel more nauseous. You will be offered a bed or a comfortable lazy-boy chair, depending on what is available. It is a good idea to dress in layers, because the chemotherapy suite is kept at a cool temperature. Feel free to bring in your own blanket. We have a portable DVD player if you would like to watch a movie. You are welcome to bring in your own DVD or choose one from our selection of movies. Can I bring someone with me into the chemotherapy suite? Yes, you can bring one person with you into the chemotherapy suite. Children under the age of 16 are not allowed in the chemotherapy suite, since it is not safe for them. You will never be alone. There will always be a nurse watching you while you get your treatment. Lunch and snacks You may bring food with you to your treatments. Family or friends can also bring food in for you when you are getting treatment. Driving On your treatment days, please find someone to drive you to LRCP, or your local chemotherapy clinic. Some of the medicines might make you drowsy. If no one is able to drive you to LRCP, contact the Canadian Cancer Society if you would like a volunteer driver to help you. See the contact page to find the phone number. 53

8 Paying for your medicine Most medicines given in the chemotherapy suite are covered by OHIP. You have to pay for chemotherapy and other medicines that you take at home. There is a drug access facilitator who can help you understand your options. For more information on paying for your medicines and how the drug access facilitator can help, please go to the tab called Finances. Complementary and alternative therapies A complementary therapy is any type of therapy or product that is not considered a typical treatment for cancer. Complementary therapies are sometimes used together with conventional treatments. Alternative therapies are used instead of conventional treatments. Vitamin, mineral and herbal supplements are one of the most common types of complementary or alternative therapies. If you are interested in or using complementary and alternative therapies, it is important to talk about this with your healthcare team. Recommended resources Visit the Patient & Family Library to get a free copy of the Canadian Cancer Society s booklets: Chemotherapy and Other Drug Therapies: A guide for people with cancer Complementary Therapies: A guide for people with cancer 54

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