Oral Chemotherapy. Cancer treatments are used to control and destroy these abnormally growing cells.

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1 Oral Chemotherapy Introduction Oral chemotherapy is a common treatment for a variety of cancers. It has proven to be safe and effective. Learning about the possible side effects of oral chemotherapy can help you better recognize and tolerate side effects, if they happen. This reference summary discusses oral chemotherapy. Oral chemotherapy is when chemo medications are given in pills or liquids that you can swallow. Anatomy The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Cancer happens when cells keep dividing and growing without the normal control. Cancer cells may also spread to different parts of the body through blood vessels and lymph channels. Cancer treatments are used to control and destroy these abnormally growing cells. Cancers in the body are given names depending on where the cancer originates. Cancer that begins in the lungs will always be called lung cancer even if it has spread to another place in the body such as the liver, bones or brain. The cause of a cancer in a patient cannot usually be specifically determined. Each cell contains hereditary or genetic materials called chromosomes. This genetic material controls the growth of the cell. Cancer always arises because of changes that happen in this genetic material. When the genetic material in a cell becomes abnormal, it loses its ability to control the growth of the cell. 1

2 These sudden changes in genetic material can happen for a variety of reasons. They may be inherited from parents, which is the case for some patients with breast cancer. If you have relatives with breast cancer or ovarian cancers make sure to discuss with your health care provider the possibility of genetic testing. Changes in genetic materials may also happen because of exposure to specific infections, drugs, tobacco or other factors. How Does Chemotherapy Work? Chemotherapy uses medications which target and destroy cells that are rapidly dividing. The chemo meds circulate through the entire body to stop the growth of cancer cells. Depending on your type of cancer and how advanced it is, chemotherapy can: Cure cancer. Chemo can destroy cancer cells and your health care provider will no longer detect them in your body. Control cancer. Chemo can keep cancer from spreading. Ease cancer symptoms. Chemo can shrink tumors that are causing pain or other symptoms. Cancer cells are more sensitive to chemotherapy than healthy cells because they divide more frequently. Healthy cells can also be affected by chemotherapy, especially the rapidly dividing cells of the: Skin. Hair. Lining of the stomach. Chemotherapy can also affect the cells of the: Intestines. Bladder. Bone marrow. 2

3 The side effects of chemotherapy are usually caused by its effects on healthy cells. Chemotherapy can be given many different ways. How chemotherapy is given may depend on the type of cancer you have, the medications being used, and your specific situation. This reference summary discusses oral chemotherapy. Oral chemotherapy is when chemo medications are given in pills or liquids that you can swallow. Taking Oral Chemotherapy Oral chemotherapy is as effective and safe as chemotherapy given through an IV for many types of cancer. Oral chemotherapy is typically taken at home. You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. You may receive 2 weeks of chemo followed by 1 week of rest. These 3 weeks make up one chemo cycle. Lab work is usually required prior to starting chemotherapy and at various times during your chemotherapy cycle. Follow your health care team s instructions about how to take your medication. Your health care team will work with you to design a schedule for you to take your medications. Stick to your medication schedule. Use of a pillbox and calendar may help you stay on schedule. Sometimes your health care provider may change your chemo schedule. This may be due to side effects you are having. If this happens your health care provider will explain what to do and when to start treatment again. People other than the patient must not touch the oral chemo pills. Patients should wash their hands prior to and immediately after touching the oral chemo medication. 3

4 Swallow chemo pills whole. Do not break or chew the medication unless specifically instructed to do so. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take an extra pill to catch up. If you miss several doses notify your health care provider. Keep a record if you are feeling poorly. Make sure that you update your health care team regularly about how you are feeling and any side effects you may have. Some side effects may affect how well the treatment works. Do not share your oral chemo medicine with anyone. Do not change your dose or stop taking this medicine without talking to your health care provider. Make sure to store the chemo medications out of reach of children or pets. Keep the medication in a cool dry place. Talk with your health care provider before taking any new prescription or over the counter medications, vitamins or herbal supplements. Some of these can affect how the chemo medication works. Tips for meeting with your health care provider or chemo nurse: Make a list of your questions before each appointment. Bring a family member or trusted friend to your appointments. Ask all your questions and take notes. Ask for printed information about your type of cancer and chemotherapy. Side Effects of Oral Chemotherapy There are many possible side effects to oral chemotherapy. Side effects are problems caused by the cancer treatment. This program discusses some of the general common side effects. Not all chemotherapy drugs cause all of the side effects discussed in this program. Also, some chemotherapy drugs can cause side effects that are not discussed in this program. 4

5 Some common side effects from chemo are: Fatigue. Nausea. Vomiting. Decreased blood cell counts. Platelets Other common side effects from chemo include: Hair loss. Mouth sores. Skin rashes. Pain. You may have a lot of side effects, some or none at all. This depends on the type of chemo you get and how your body reacts to the chemo. Before you start taking chemotherapy, talk with your health care provider about which side effects to expect. Sometimes, chemo causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys or reproductive organs. Some types of chemo may cause a second cancer years later. Effects on Blood One of the most important side effects of chemotherapy is its effect on the blood cells. Blood has 3 important components: Red blood cells, or RBCs. White blood cells, or WBCs. Platelets. Normally, blood cells are among the most rapidly dividing cells in the body. This means blood cells are the most sensitive to chemotherapy. RBCs carry oxygen from the lungs to the rest of the body. WBCs fight infections. Platelets are important because they help the blood clot and prevent uncontrolled bleeding. Red Blood Cells White Blood Cells Platelets 5

6 Chemotherapeutic agents may decrease the levels of these blood components. This decrease is usually temporary. When the RBCs decrease significantly, a condition known as anemia happens. This makes patients feel very tired and sometimes short of breath. A blood transfusion may be necessary at this stage. Call your health care provider if: Your level of fatigue changes or you are not able to do your usual activities. You feel dizzy or like you are going to faint. You feel short of breath. It feels like your heart is pounding or beating very fast. When the WBCs decrease significantly, a condition known as neutropenia happens. This condition may make it difficult for patients to fight infections. Call your health care provider or nurse right away if you have a fever of F or higher, or if you are feeling sick and experiencing chills. When the platelets decrease significantly, a condition known as thrombocytopenia happens. Patients who have this condition may bleed a little longer from minor cuts. If their platelet count is low enough they may also develop internal bleeding inside their brain, intestines or urinary bladder. Low blood cell counts can sometimes be treated with blood cell transfusions or medications. Even though health care providers check blood counts regularly, patients must watch for symptoms of these side effects. To help in the treatment and prevention of potentially life-threatening complications, if any of the following symptoms happen, patients should contact their health care provider. Increased tiredness, fatigue, shortness of breath, or chest pain may indicate anemia. 6

7 The following are signs of infection that may be caused by neutropenia, or low count of white blood cells: Fever. Chills. Cough. Sore throat. Other signs of infection include: Skin or mouth sores. Burning during urination. Severe diarrhea (more than 3 liquid stools in a day). Contact a health care provider or go to the ER immediately for a fever. Easy bruising is a sign of thrombocytopenia, or a low platelet count. Contact a health care provider or go to the ER immediately if you have any of the following signs of thrombocytopenia: Bleeding from the skin that does not stop after applying pressure for 10 minutes. Blood in the urine or stools. Severe headache. Patients can help prevent some of these side effects. To decrease the chances of infections, good oral and body hygiene are essential. Patients should also stay away from people with colds or other infections. Patients should also avoid activities that may increase the chance of bleeding, such as the use of razors, nail clippers or flossing teeth. Brushing teeth regularly is okay with a soft bristle toothbrush. Patients with dentures should make sure their dentures fit properly. 7

8 Patients should avoid straining while having a bowel movement. This can cause hemorrhoids and bleeding. A stool softener may be required to help prevent straining during a bowel movement. If you have an elevated temperature greater than 100.5ºF, you should call your health care provider. This may help in the early detection of infections. Hair Loss Hair loss is another side effect of chemotherapy. This is also known as alopecia. Cells in the hair follicles are responsible for hair growth and maintenance. Because these cells divide rapidly, they are affected by chemotherapy drugs. Not all chemotherapy leads to hair loss. Some chemo drugs will only cause thinning of the hair. Hair loss may affect the scalp, face and the rest of the body. The rate of hair loss may be rapid. Hair loss is usually temporary. When new hair grows, it may have a different color, texture or length. Even though hair loss cannot be prevented, patients may prepare for it. Some patients choose a wig or a hairpiece. Other patients decide to keep their head bare, or cover it with a bandana or hat. The exposed scalp may be more sensitive than usual to sunlight. Patients should keep it covered when outdoors. Nausea and Vomiting Some chemotherapeutic agents can lead to significant nausea and vomiting. Nausea is when you feel sick to your stomach, like you are going to throw up. Patients should make sure to tell their health care provider if they experience such side effects. Effective anti-nausea and anti-vomiting medications are available. Let your health care provider know if your medicine for nausea and vomiting is not working. Drinking clear liquids before chemotherapy helps some patients decrease nausea. 8

9 To prevent nausea try having bland, easy to digest foods and drinks that do not upset your stomach. These foods can include: Plain crackers. Toast. Gelatin. Clear broth. Clear, carbonated beverages that have lost their fizz. Other foods that may not upset your stomach include: Noodles. Boiled potatoes without skins. Applesauce. Peaches. Sherbet, sorbet and yogurt. Eat small meals and snacks instead of three large meals a day. Do not lay down right after eating. Avoid eating fatty and fried foods and stay away from foods and drinks that have a strong smell. Have foods or drinks that are warm or cool, avoid hot or cold food. Appetite may also decrease during chemotherapy. Unfortunately, food may also not taste as good for chemotherapy patients. But patients should maintain a regular calorie intake even if it means eating smaller portions of food more frequently. Sore Throat The cells lining the inside of the mouth and throat divide rapidly. They are also continuously exposed to infections from the food we eat. Chemotherapy can cause inflammation and infections inside the mouth. This condition, known as stomatitis, makes swallowing difficult and painful. Keeping good oral hygiene and frequently checking the inside of the mouth for problems, such as bleeding areas or white patches, can help decrease the chance of infections. This also helps detect infections early before they become a problem. 9

10 Rinsing the mouth frequently with warm water mixed with salt is helpful. Avoiding carbonated drinks and acidic, spicy or hot foods, is helpful. Keeping the inside of the mouth moist by sucking on hard candy or ice chips can also be helpful. Diarrhea Because the cells lining the intestines and colon divide constantly, they can be affected by chemotherapy. This can cause diarrhea. Increasing fluid intake usually keeps the patient hydrated. Foods that are difficult to digest should be avoided during cases of diarrhea. These foods include milk products, vegetables of the cabbage and broccoli family and spicy food. Clear liquids are usually okay. If diarrhea becomes bloody or if there are more than three bowel movements over and above the usual number of bowel movements a day, the patient should call the health care provider. This can be a symptom of internal bleeding or infection and may require immediate medical attention. Constipation Constipation is sometimes caused by chemotherapy. Maintaining a high fiber diet and increasing the amount of fluids you drink can help decrease this side effect. If constipation becomes a significant problem, a health care provider may recommend or prescribe stool softeners. This helps decrease the chances of hemorrhoid formation and bleeding. Effects on the Skin and Nails Because the cells lining the skin divide fairly rapidly, they are susceptible to chemotherapy. Chemotherapy can cause the skin to become red, dry and itchy. Your skin may begin to peel and you may develop a skin rash which may worsen with sun exposure. Report skin rashes to your health care provider or nurse for further evaluation. If you develop a skin rash avoid using acne skin products even if the rash looks like acne. 10

11 If you have swelling, redness, or pain in the palms of your hands or soles of your feet and it interferes with normal activity call your health care provider or chemo nurse immediately. Use moisturizing lotions to prevent skin dryness. Patients should avoid exposure to the sun and tanning booths. Sunscreen should be used whenever patients leave the house because they can still sunburn on cloudy days. Your nails may become dark, turn yellow or become brittle and cracked. Sometimes your nails may loosen and fall off, but new ones will grow back in. Fertility and Sexuality Men wishing to father children may consider sperm banking prior to the start of chemotherapy. Chemotherapy may affect sperm count and viability. Because chemotherapy may be very toxic to unborn children, women of a childbearing age should take birth control measures during chemotherapy. Some women may have changes in their menstrual cycle because of chemotherapy, which could result in a total absence of their menstrual periods. They should still take precautions against becoming pregnant. Chemotherapy could also cause dryness of the vagina and increased pain with sexual intercourse. A lubricating, water-soluble jelly such as K-Y Jelly can help decrease symptoms. Other Possible Side Effects Besides the most common side effects of chemotherapy, other side effects can happen. These side effects depend on the type of cancer, the type of chemotherapy treatment and the patient s medical condition. For example, some chemotherapy drugs may adversely affect the heart, lungs or nerves. In such cases your health care provider will monitor these vital organs. Summary Chemotherapy is the careful use of medications to treat cancer. Oral chemotherapy is when chemo medications are given in pills or liquids that you can swallow. 11

12 Follow your medication schedule and keep a record of how you are feeling. Attend all scheduled appointments and don t be afraid to ask questions. Keep a record of when you took your chemo meds and your side effects. Bring these records as well as questions you want to discuss. If you write your questions prior to the appointment, you may be less likely to forget them. Make sure to keep your health care provider updated about your oral chemotherapy progress. Remember to report your side effects and any missed chemo doses. Some of the side effects that you should tell your healthcare team about include: Fever of F or higher. Nausea and vomiting. Diarrhea or constipation. Numbness in your hands or feet. Dizziness. Other serious side effects include: Mouth sores. Skin changes. Severe fatigue. Shortness of breath while walking. If you have any questions, or you do not feel well, make sure to contact your health care team. If you develop a fever or have chills and cannot get a hold of your health care team, go to the emergency room. Side effects can happen and may be uncomfortable. But, knowing about these side effects can make chemotherapy a more tolerable journey. Taking your oral chemotherapy medicine on time, and the way the medicine was prescribed by your health care provider can improve the chance of the medication working. Sometimes the cost of oral chemotherapy can be expensive. Talk to your health care provider if you cannot afford your oral chemotherapy medicine. 12