Chemotherapy Information for Patients Wellington Blood & Cancer Centre (WBCC) Radiation and Medical Oncology, Clinical Haematology
Contents What is chemotherapy? 3 Effects of chemotherapy 4 Other helpful information 11 Glossary of terms 12 Notes 13
What is chemotherapy? Chemotherapy is a term used to describe a range of drugs used in the treatment of cancer. The aim of chemotherapy treatment may be either to cure your cancer or to keep it under control. Chemotherapy drugs are usually given through a needle in your hand or arm, which goes directly into your bloodstream or sometimes as tablets. How does chemotherapy work? The chemotherapy you are given travels through the bloodstream affecting cancer cells throughout your body. The cancer cells are destroyed and normal cells grow to take their place. There are lots of different types of chemotherapy drugs. You are sometimes given two or three chemotherapy drugs at a time. Each of these drugs usually attacks the cancer cells in slightly different ways. This increases the anti-cancer effect. The drugs that you will receive will depend on the type of cancer you have and will be tailored to your needs by your consultant. Some drugs have been developed to help the body fight cancer itself. These are called biological therapies and tend to have different effects to conventional chemotherapy. This booklet does not discuss these. Information will be given to you specifically if these drugs make up part of your treatment. Some normal cells are temporarily affected by chemotherapy. Most common are the cells in your bone marrow, and the cells 3 CHEMOTHERAPY Radiation and Medical Oncology
lining your mouth and gut. Normal cells will regenerate before more chemotherapy is given. Some drugs will affect your hair follicles, and perhaps your fertility. Hair will grow back after chemotherapy is completed. Fertility may return, but you need to discuss this with your consultant. Effects of chemotherapy Bone Marrow The cells in your bone marrow are very important and produce your white blood cells, red blood cells and platelets. Approximately 7 to 14 days after chemotherapy is given, there are fewer white cells, red cells and platelets in your body (this is temporary). White cells are the body s infection fighters. A normal white cell count is between 3.0 and 11.0. The main type of white cell that fights infection is called a neutrophil. A low neutrophil count is called neutropenia. During the middle period after chemotherapy treatment (usually in the second week) your neutrophil count will be low and you will be more at risk of infections. You need a thermometer at home, and know how to use it. Don t shut yourself away, but do avoid people with an obvious infection, like the flu, measles, or chickenpox. By the third week after chemotherapy your bone marrow begins producing new neutrophils, and your ability to fight infection starts to come back to normal. Please watch your body carefully for signs of infection: If you feel unwell, check your temperature (normal is 36 37ºC). 4
If your temperature is 37.5 37.9ºC please ring your Community Cancer nurse for advice. If your temperature is 38ºC or more you must ring Ward 5 North or come to Emergency Department immediately. Do not take Paracetamol (Panadol/Panadeine) or Aspirin if you have a temperature (they reduce temperatures, which could delay you getting vital treatment started). You may have one of these other signs of infection, even without a high temperature, such as: Feeling shivery, cold, hot or shaking. Coughing, shortness of breath or coughing up coloured spit. Pain on passing urine ( wees ), passing urine often, smelly urine, or loin pain. Unusual vaginal discharge. An area of skin, or a sore, or cut that is red, painful, weepy or inflamed. Vomiting and/or diarrhoea that occurs approximately 7 14 days after chemotherapy. New, unexplained pain (e.g. sore throat or sore tooth). Unexplained tiredness or sleepiness. Red cells give blood its colour and takes oxygen around your body. A normal red cell or haemoglobin count is 120 for females and 130 for males. A low red cell count is called anaemia. When red cells are low, getting oxygen around 5 CHEMOTHERAPY Radiation and Medical Oncology
your body is harder. You may feel more tired, look pale, and might get a little dizzy or short of breath when moving around. If this is a problem, please call your doctor, Community Cancer Nurse, the WBCC, or Ward 5 North. The red cells are not usually affected as much as the white cell count, but sometimes after a few chemotherapy cycles you may need a blood transfusion. When chemotherapy is completed, your bone marrow will produce normal amounts of red cells again. Platelets help clot the blood when you cut or bruise yourself. A normal platelet count is between 150 and 450. A low platelet count is called thrombocytopenia. In the 7 14 day period after chemotherapy you may find that you bruise and bleed more easily. You need to watch your body for any unusual bleeding. This may include: Blood in your urine your urine may be rose (pink) coloured. Blood in your bowel movements red, or black tarry bowel movements. Unusual or unexplained bruising. Blood in your vomit (bright red, or black & looking like coffee grounds). A bleeding nose that doesn t stop after applying ice and pressure for 15 20 minutes. Bleeding from a cut that does not stop after applying pressure for 15 20 minutes. The platelet count will return to normal once your bone marrow recovers from the chemotherapy. 6
If you have any of these signs of bleeding, infection, or if you feel generally unwell, please contact Ward 5 North, your Community Cancer Nurse, or the WBCC Day Ward immediately. (See back page for phone numbers) DO NOT DELAY IN GETTING TREATMENT You need to have a blood test in the morning of the day before each chemotherapy, to check your blood cell counts are at a safe level. If your counts are not satisfactory your chemotherapy may need to be delayed (this will not disadvantage your treatment). Feeling Sick (Nausea) Not everyone feels sick (has nausea) after they have had chemotherapy, and some chemotherapy drugs do not cause sickness. Nausea can mean different things to different people, such as a lack of appetite, a churning feeling in your stomach, or food smells putting you off eating. It is most likely you will be prescribed anti-sickness medications to take. Please get your prescription filled at a chemist on the way home after having chemotherapy. Your doctor or nurse will explain how to take these medications, and a chart for you to follow can be written. At home if you are not sure what to take, please phone your Community Cancer Nurse, the WBCC, or Ward 5 North for help. It is important that you take the medications that are prescribed. You may be prescribed Ondansetron (Zofran), a 12 hour anti-sickness medication. One tablet is taken twice daily, for six doses. This often causes constipation, and sometimes headaches. 7 CHEMOTHERAPY Radiation and Medical Oncology
Another anti-sickness pill you might be prescribed is Aprepitant. This is usually 80mg daily. Specific instructions will be given to you. You may also be prescribed Dexamethasone, a steroid, which helps with controlling nausea and vomiting. This is prescribed for three days as well. Dexamethasone can irritate your stomach; it must be taken in the morning, with food at breakfast time. Another anti-sickness medication is Metoclopramide (Maxolon, or Metamide). It works best if taken 30 minutes before eating meals, and you may need to take it regularly for 3 to 5 days. This can cause agitation/restlessness in some people, which you must report. While these drugs work well for most people, some people respond better to other drug(s). Changes may be needed to your medication doses, or another medication prescribed. If you are troubled with nausea and/or vomiting and are unable to take your anti-sickness medications, or you continue to be nauseated and/or vomiting while taking your anti-sickness medications, or if you are having other problems with these drugs, you must contact your Community Cancer Nurse, the WBCC Day Ward, or Ward 5 North. Please do not delay with phoning, as there is a system in place to help you. Mouth 8 The cells in your mouth grow rapidly, and are sensitive to the effects of chemotherapy. Your mouth may become ulcerated, sore or infected. To care for your mouth and help prevent problems, we recommend you do this mouth care 4 times a day (after meals and before bed)
Remove any dentures or partial plates, cleaning these as usual. Clean your teeth with a soft (child s) toothbrush and toothpaste. Rinse and gargle your mouth thoroughly with mouthwash, and spit out the rinse (leave any dentures or plates out). Mouthwash is made up of equal amounts of table salt and baking soda (from the kitchen), mixed together & kept in a jar with a screw-top lid. Dissolve ¼ to ½ a teaspoonful of this mixture in a glass of warm water for your mouthwash. Use a lip balm to keep your lips moist and supple. Check your mouth in the mirror once a day. If your mouth has any of the following problems, contact your Community Cancer Nurse, or the WBCC Day Ward, or Ward 5 North: - Ulcers - Any white spots or patches on your tongue or the inside of your mouth - Bleeding, from gums or lips - Cold sores There are various products and mouth rinses available that will help to treat any problems you may have with your mouth. Your doctor or nurse will be able to help you with these. Hair Loss Not all chemotherapy drugs cause hair loss (alopecia), and the hair loss is not permanent. Your doctor or nurse will tell you if the drugs you are having are likely to cause hair loss. 9 CHEMOTHERAPY Radiation and Medical Oncology
If your chemotherapy does cause hair loss, your hair will usually begin falling out in the third week after your first dose of chemotherapy, and usually will be gone completely soon after the second dose. Some people get a tender or tingling scalp before their hair starts to fall out. Your hair will start to regrow about six weeks after your last chemotherapy treatment. You are entitled to a benefit for a wig. The Ministry of Health can pay this directly to the hairdresser. We have a list of wig experts your nurse will pass this information on to you. Constipation Some chemotherapy drugs, and/or the anti-sickness drug Ondansetron, may cause you to get constipated. Constipation can mean small hard bowel movements, or not being regular, or no bowel movement for 2 3 days. This can make you feel sick, and can give you pains in your stomach. Please try to avoid becoming constipated by drinking plenty of fluids (2000 mls per day), taking mild exercise and eating a high fibre diet. Other helpful remedies are Kiwi Crush, and a herbal laxative Alpine tea bags (the supermarkets stock these). Your GP could prescribe laxative tablets if needed. Please contact your Community Cancer Nurse, WBCC or Ward 5 North if you have not had a bowel motion for 2 days or if you think you may be constipated. Diarrhoea Some chemotherapy drugs may cause you to have diarrhoea. It is important that you have a high fluid intake to ensure that you don t become dehydrated. If you are having diarrhoea (loose sloppy bowel motions/poos) or are having difficulty 10
maintaining a good fluid intake you need to contact your doctor at the hospital. Other Helpful Information Drinking For the first 4 to 5 days after chemotherapy, try to drink at least 2 litres of fluid per day to flush out residual chemotherapy. This seems like a lot of fluid remember soup, jelly and ice blocks count as fluid. It is a good idea to bring a drink bottle with you to your appointment so you have something to drink for the journey and if you have to wait when you arrive. With these extra fluids you will need to pass urine regularly. While your urine has chemotherapy in it (for up to 7 days afterwards), please avoid splashes around the toilet and seat, and use the full toilet flush option. Eating Eat small nutritious meals often. Snack regularly during the day rather than eating 3 full meals a day, particularly if you have some nausea. Try to include two or three pieces of fruit, or another high fibre food in your diet. Meal substitutes such as Complan may be helpful if you don t feel like cooking. The Cancer Society has a book called Eating Well which is written for people having chemotherapy, and is full of very helpful information. There is a dietician available to advise you if you have any questions or problems. Ask your Community Cancer Nurse or the WBCC Day Ward nurse, or Ward 5 North to make a referral for you. 11 CHEMOTHERAPY Radiation and Medical Oncology
Chemotherapy and Body Waste Chemotherapy stays in your body for hours and even days, and most is passed out of the body in urine and bowel motions. If you vomit after taking the chemotherapy, the vomit may also contain some of the chemotherapy. Please use the toilet as normal but flush the toilet using a full flush (not a half flush) with the lid down. Use disposable gloves (available from supermarkets) and old cloths to clean up any spills, for example; vomit, urine or loose bowel motions. Empty containers into the toilet by pouring it close to the water with the aim of avoiding splashing. If a bedpan, urinal or commode is used wear disposable gloves when emptying. Rinse the container with water after each use. Wash it with soap and water at least once a day (use the laundry sink or bath NOT the kitchen sink when doing this). Place used disposable gloves/cloths in a double plastic bag and put in the rubbish bin. If you use stoma or urine bags when disposing of them put in a double plastic bag and put in the rubbish bin. Always wash your hands. Laundry Wear disposable gloves to handle soiled laundry. Soiled linen or clothes should be kept in a plastic bag if unable to be washed immediately. 12
Soiled items should be washed separately from other laundry for two complete cycles. Use normal detergent and warm/hot water. Put used disposable gloves in a double plastic bag and put in the rubbish bin, then wash your hands. Prednisone / Dexamethasone You may be taking Prednisone or Dexamethasone as part of your chemotherapy. Take the tablet(s) once a day, every day that you have been instructed to do so. The tablet(s) must be taken with food at breakfast time (they can irritate your stomach lining if taken on an empty stomach). If you develop heartburn, indigestion or reflux please notify your doctor, Community Cancer Nurse or the WBCC nurses. Sexual Activity There is no reason why you should not have sexual intercourse during your chemotherapy treatment. You are advised to use a condom to avoid your partner being exposed to chemotherapy, as chemotherapy is present in all body fluids for up to 7 days afterwards. It is important to be gentle to prevent any abrasions that may be a site for bleeding or infection. For women, there may be some vaginal dryness due to your treatment. To prevent any abrasions you may need to use some lubrication such as Johnson s KY Jelly or Astroglide. Please discuss contraception with your hospital doctor, as chemotherapy does not protect you against pregnancy. If you are taking the oral contraceptive, it may not be as effective as usual due to the chemotherapy drugs you are taking. 13 CHEMOTHERAPY Radiation and Medical Oncology
Menstruation You may not menstruate while on chemotherapy. This often returns to normal in the months after your treatment has been completed. Some chemotherapy regimens may cause your periods to cease altogether and not return. Your doctor will be able to give you information about the effects of your treatment on your menstrual cycle. Skin Care Your skin will be more sensitive to the sun during chemotherapy and for a year afterwards. Please avoid the sun if possible, or use sun block, long sleeves and sunhat. Avoiding the sun on your head is especially important if you have hair loss or thinning. Summary There may seem to be a lot of problems associated with chemotherapy, but be assured that it is unlikely that you will experience all of these. We believe you should know what to look for, and how to encourage the healing process in your body. Show this booklet to your support person so that they also have an understanding of your treatment. It is sometimes a good idea to have a notebook or the patient handheld record to write down any problems or questions you might have over this time. You can then discuss these with your doctor or nurse next time you see them. Please be prepared for delays when you come in for treatment due to waiting time to see Doctors, delays in chemotherapy preparation and availability of space in the Day Ward. 14
Glossary of terms Anemia: low red cells in the blood. Red cells move oxygen around the body which helps your internal organs to work effectively. Red cells give you energy. Neutropenia: low neutrophils in the blood. Neutrophils help fight infection. Thrombocytopenia: low platelets stops your blood from clotting effectively making you bruise or bleed more easily. 15 CHEMOTHERAPY Radiation and Medical Oncology
Contact Numbers C&C DHB / Kenepuru Community Cancer Nurses 8.00am 4.30pm Monday to Friday (04) 385 5821 If you want them urgently ask for the nurse to be paged. Kapiti Community Cancer Nurse (04) 903 0224 If you want her urgently ask for the nurse to be paged. After hours for any area of C&C DHB (04) 385-5999 and ask for the on call cancer nurse. Hutt Valley Community Cancer Nurse 8.30am 5.00pm Monday to Friday (04) 570 9148 Leave a message on the answer phone, or ask to be put through to their cellphone. Hutt Valley After hours and weekends Ring Ward 5 North. Wellington Blood & Cancer Centre (WBCC) Day Ward 8am 4.30pm Monday to Friday (04) 806 2044 (After hours: ring Ward 5 North) Ward 5 North (anytime, day or night) (04) 806 0418 16
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Contact details: Level 3 North, Wellington Hospital Ph 04 8060 761, Fax 04 8060 323. Mon-Fri 8am-4.30pm