CancerNet from the National Cancer Institute
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CHEMOTHERAPY AND YOU
A Guide to Self-Help During Treatment
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Cancer Institute
Bethesda, Maryland 20892
NIH Publication No. 94-1136
June 16, 1994
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
ACKNOWLEDGMENTS
The National Cancer Institute is grateful to the numerous health
professionals and patients who contributed to the development and review of
this publication.
CONTENTS
ABOUT THIS BOOKLET
UNDERSTANDING CHEMOTHERAPY
What Is Chemotherapy?
How Does Chemotherapy Work?
What Can Chemotherapy Achieve?
Will Chemotherapy Be My Only Treatment for Cancer?
Which Drugs Will I Get?
Where Will I Get Chemotherapy?
How Often Will I Get Chemotherapy, and How Long Will I Get It?
How Will I Get Chemotherapy?
Does Chemotherapy Hurt?
Can I Take Other Medicines While I Am Getting Chemotherapy?
Will I Be Able To Work During Chemotherapy?
How Will I Know If My Chemotherapy Is Working?
COPING WITH SIDE EFFECTS
What Causes Side Effects?
How Long Do Side Effects Last?
Nausea and Vomiting
Hair Loss
Fatigue/Anemia
Infection
Blood Clotting Problems
Mouth, Gum, and Throat Problems
Diarrhea
Constipation
Nerve and Muscle Effects
Effects on Skin and Nails
Kidney and Bladder Effects
Flu-Like Syndrome
Fluid Retention
Sexual Effects: Physical and Psychological
EATING WELL DURING CHEMOTHERAPY
What If I Don't Feel Like Eating?
Can I Drink Alcoholic Beverages?
Should I Take Vitamin or Mineral Supplements?
TALKING WITH YOUR DOCTOR AND NURSE
CHEMOTHERAPY AND YOUR EMOTIONS
How Can I Get the Support I Need?
How Can I Make My Daily Life Easier?
How Can I Relieve Stress?
PAYING FOR CHEMOTHERAPY
A FINAL WORD
RESOURCES
National Cancer Institute
American Cancer Society
GLOSSARY
NOTES
ABOUT THIS BOOKLET
This booklet will help you, your family, and your friends understand
chemotherapy, the use of drugs to treat cancer. It will answer many of the
questions you may have about this method of cancer treatment. It will also
show you how you can help yourself during chemotherapy.
Taking care of yourself during chemotherapy is important for several
reasons. For one thing, it can lessen some of the physical side effects
you may have from your treatment. As you will see, some simple tips can
make a big difference in how you feel. But the benefits of self-help
aren't just physical; they're psychological, too. Knowing some ways to
take care of yourself can give your emotions a boost at a time when you may
be feeling that much of what's happening to you is out of your control.
This feeling can be easier to deal with when you discover how much you can
contribute to your own well-being, in partnership with your doctors and
nurses.
"Chemotherapy and You" will help you become an informed partner in
your care. Remember, though, it is only a guide. Self-help is never a
substitute for professional medical care. Be sure to ask your doctor and
nurse any questions you may have about chemotherapy, and tell them about
any side effects you may have.
You will find several helpful sections at the end of this booklet.
The section on Paying for Chemotherapy" gives you information about
insurance and other payment methods. The section called "Resources" tells
you how to get more information about cancer and how to find many services
available to cancer patients and their families. The "Glossary" explains
many terms related to cancer and chemotherapy. Additionally, you can get a
free series of fact sheets on anticancer drugs from the National Cancer
Institute.
UNDERSTANDING CHEMOTHERAPY
What Is Chemotherapy?
Chemotherapy is the use of drugs to treat cancer. The drugs often are
called "anticancer" drugs.
How Does Chemotherapy Work?
Normal cells grow and die in a controlled way. But cancer occurs when
cells become abnormal and keep dividing and forming more cells without
control or order. Anticancer drugs destroy cancer cells by stopping them
from growing or multiplying at one or more points n their life cycle.
Because some drugs work either together than along, chemotherapy often may
consist of ore than one drug. This is called combination chemotherapy.
In addition to chemotherapy, other methods sometimes are used to treat
cancer. For example, your doctor may recommend that you have surgery to
remove a tumor or to receive certain symptoms that may be caused by your
cancer. You also may receive radiation therapy to treat your cancer or its
symptoms. Sometimes, as described below, your doctor may suggest a
combination of chemotherapy, surgery, and/or radiation therapy.
Other types of drugs may be used to treat your cancer. These may
include certain drugs that can block the effect of hormones. Doctors may
also use biological therapy to boost the body's natural defenses against
cancer.
What Can Chemotherapy Achieve?
Depending on the type of cancer and its stage of development,
chemotherapy can be used:
-- To cure cancer.
-- To keep the cancer from spreading.
-- To slow the cancer's growth.
-- To kill cancer cells that may have spread to other parts of the
body from the original tumor.
-- To relieve symptoms that may be caused by the cancer.
Chemotherapy also can help people live more comfortably; this is known
as palliative care.
Will Chemotherapy Be My Only Treatment for Cancer?
Sometimes chemotherapy is the only therapy a patient receives. More
often, however, chemotherapy is used in addition to surgery and/or
radiation therapy; when it is used for this purpose it is called adjuvant
therapy. There are several reasons why chemotherapy may be given in
addition to other treatment methods. For instance, chemotherapy may be
used to shrink a tumor before surgery or radiation therapy. It also may be
used after surgery and/or radiation therapy to help destroy any cancer
cells that may remain.
Which Drugs Will I Get?
Your doctor decides which drug or drugs will work best for you. The
decision depends on what kind of cancer you have, where it is, the extent
of its growth, how it is affecting your normal body functions, and your
general health.
Your doctor also may suggest that you join a clinical trial for
chemotherapy, or you may want to bring up this option with your doctor.
Clinical trials are carefully designed research studies that test promising
new cancer treatments. Patients who take part in research may be the first
to benefit from improved treatment methods. These patients also can make
an important contribution to medical care because the results of the
studies may help many people. Patients participate in clinical trials only
if they choose to and are free to withdraw at any time.
To learn more about clinical trials, call the National Cancer
Institute's Cancer Information Service and ask for the booklet "What Are
Clinical Trials All About?" You also may want to ask about the video
"Patient to Patient: Cancer Clinical Trials and You." This videotape can
put to rest fears you may have about taking part in clinical trials. The
Cancer Information Service can be reached by dialing 1-800-4-CANCER (1-800-
422-6237).
Where Will I Get Chemotherapy?
You may get your chemotherapy at home, in your doctor's office, in a
clinic, in your hospital's outpatient department, or in a hospital. The
choice of where you get chemotherapy depends on which drug or drugs you are
getting, your hospital's policies, and your doctor's preferences. When
you first start chemotherapy, you may need to stay at the hospital for a
short time so that your doctor can watch the medicine's effects closely and
make any adjustments that are needed.
How Often Will I Get Chemotherapy, and How Long Will I Get It?
How often--and for how long--you get chemotherapy depends on the kind
of cancer you have, the goals of the treatment, the drugs that are used,
and how your body responds to them. You may get chemotherapy every day,
every week, or every month. Chemotherapy is often given in on-and-off
cycles that include rest periods so that your body has a chance to build
healthy new cells and regain its strength. Your doctor should be able to
estimate how long you will be getting chemotherapy.
Whatever schedule your doctor prescribes, it is very important to stay
with it. Otherwise, the anticancer drugs might not have their desired
effect. If you miss a treatment session or skip a dose of medication,
contact your doctor for instructions about what to do.
Sometimes, your doctor may delay a treatment based on the results of
certain blood tests. Your doctor will let you know what to do during this
time and when it's okay to start your treatment sessions again.
How Will I Get Chemotherapy?
Depending on the type of cancer you have and the drug or drugs you are
getting, your chemotherapy may be given in one or more of the following
ways:
-- Into a vein (intravenously, or IV). You will get the drug
through a thin needle inserted into a vein, usually on your hand
or lower arm. Another way to get IV chemotherapy is by means of
a catheter, a thin tube that is placed into a large vein in your
body and remains there as long as it is needed. This type of
catheter is known as a central venous catheter. Sometimes, a
central venous catheter is attached to a port, a small plastic or
metal container placed surgically under the skin.
-- By mouth (orally, or PO) in pill, capsule, or liquid form. You
will swallow the drug, just as you do many other medications.
-- Into a muscle (intramuscularly, or IM), under the skin
(subcutaneously, or SQ or SC), or directly into a cancerous area
in the skin (intralesionally, or IL). You will get an injection
with a needle.
-- Topically. The medication will be applied onto the skin.
Chemotherapy also may be delivered to specific areas of the body
using a catheter. Catheters may be placed into the spinal fluid, abdominal
cavity, bladder, or liver. Your doctor or nurse may use specific terms
when talking about certain types of catheters. For example, an intrathecal
(IT) catheter is used to deliver drugs into the spinal fluid.
Intracavitary (IC) catheters can be placed in the abdomen, pelvis, or
chest.
Two kinds of pumps--external and internal--may be used to control the
rate of delivery of chemotherapy. External pumps remain outside of the
body. Some are portable and allow a person to move around while the pump
is in use. Other external pumps are not portable and may restrict
activity. Internal pumps are placed surgically inside the body, usually
right under the skin. They contain a small reservoir (storage area) that
delivers the drugs into the catheter. Internal pumps allow people to go
about most of their daily activities.
Does Chemotherapy Hurt?
Getting chemotherapy by mouth, on the skin, or by injection generally
feels the same as taking other medications by these methods. Having an IV
usually feels like having blood drawn for a blood test. Some people feel a
coolness or other unusual sensation in the area of the injection when the
IV is started. Report these feelings to your doctor or nurse. Be sure
that you also report any pain, burning, or discomfort that occurs during or
after an IV treatment.
Many people have little or no trouble having the IV needle in their
hand or lower arm. However, if a person has a hard time for any reason, or
if it becomes difficult to insert the needle into a vein for each
treatment, it may be possible to use a central venous catheter or port.
This avoids repeated insertion of the needle into the vein.
Central venous catheters and ports cause no pain or discomfort if they
are properly placed and cared for, although a person usually is aware that
they are there. It is important to report any pain or discomfort with a
catheter or port to your doctor or nurse.
Can I Take Other Medicines While I Am Getting Chemotherapy?
Some medicines may interfere with the effects of your chemotherapy.
That is why you should take a list of all your medications to your doctor
before you start chemotherapy. Your list should include the name of each
drug, how often you take it, the reason you take it, and the dose.
Remember to include over-the-counter drugs such as laxatives, cold pills,
pain relievers, and vitamins. Your doctor will tell you if you should stop
taking any of these medications before you start chemotherapy. After your
treatments begin, be sure to check with your doctor before taking any new
medicines or stopping the ones you already are taking.
Will I Be Able To Work During Chemotherapy?
Most people are able to continue working while they are being treated
with anticancer drugs. It may be possible to schedule your treatments late
in the day or right before the weekend, so they interfere with work as
little as possible.
If your chemotherapy makes you very tired, you might want to think
about adjusting your work schedule for a while. Speak with your employer
about your needs and wishes at this time. You may be able to agree on a
part-time schedule, or perhaps you can do some of your work at home.
Under Federal and state laws, some employers may be required to allow
you to work a flexible schedule to meet your treatment needs. To find out
about your on-the-job protections, check with your local American Cancer
Society, a social worker, or your congressional or state representative.
The National Cancer Institute's publication "Facing Forward: A Guide for
Cancer Survivors" also has information on work-related concerns.
How Will I Know If My Chemotherapy Is Working?
Your doctor and nurse will use several methods to measure how well
your treatments are working. You will have frequent physical exams, blood
tests, scans, and x-rays. Don't hesitate to ask the doctor about the test
results and what they show about your progress.
While tests and exams can tell a lot about how chemotherapy is
working, side effects tell very little. (Side effects--such as nausea or
hair loss--occur because chemotherapy harms some normal cells as well as
cancer cells.) Sometimes people think that if they don't have side
effects, the drugs aren't working, or that, if they do have side effects,
the drugs are not working well. But side effects vary so much from person
to person, and from drug to drug, that having them or not having them
usually isn't a sign of whether the treatment is effective.
If you do have side effects, there is a lot you can do to help relieve
them. The next section of this booklet describes some of the most common
side effects of chemotherapy and gives you some hints for coping with them.
COPING WITH SIDE EFFECTS
If you have questions about side effects, you are not alone. Before
chemotherapy starts, most people are concerned about whether they will have
side effects and, if so, what they will be like. Once treatments begin,
people who have side effects want to know the best ways to cope with them.
This section will answer some of your questions.
If you are reading this section before you start chemotherapy, you may
feel overwhelmed by the wide range of side effects it describes. But
remember: Every person doesn't get every side effect, and some people get
few, if any. In addition, the severity of side effects varies greatly from
person to person. Whether you have a particular side effect, and how
severe it will be, depends on the kind of chemotherapy you get and how your
body reacts. Be sure to talk to your doctor and nurse about which side
effects are most likely to occur with your chemotherapy, how long they
might last, how serious they might be, and when you should seek medical
attention for them.
What Causes Side Effects?
Because cancer cells grow and divide rapidly, anticancer drugs are
made to kill fast-growing cells. But certain normal, healthy cells also
multiply quickly, and chemotherapy can affect these cells, too. When it
does, side effects may result. The fast-growing, normal cells most likely
to be affected are blood cells forming in the bone marrow and cells in the
digestive tract, reproductive system, and hair follicles. Anticancer drugs
can also damage cells of the heart, kidney, bladder, lungs, and nervous
system. The most common side effects of chemotherapy include nausea and
vomiting, hair loss, and fatigue. Other common side effects include an
increased chance of bleeding, getting an infection, or developing anemia.
These side effects result from changes in blood cells during chemotherapy.
How Long Do Side Effects Last?
Most normal cells recover quickly when chemotherapy is over, so most
side effects gradually disappear after treatment ends, and the healthy
cells have a chance to grow normally. The time it takes to get over some
side effects and regain energy varies from person to person. How soon you
will feel better depends on many factors, including your overall health and
the kinds of drugs you have been taking.
While many side effects go away fairly rapidly, certain ones may take
months or years to disappear completely. Sometimes, the side effects can
last a lifetime, as when chemotherapy causes permanent damage to the heart,
lungs, kidneys, or reproductive organs. And certain types of chemotherapy
occasionally may cause delayed effects, such as a second cancer, that show
up many years later.
It is important to remember that many people have no long-term
problems due to chemotherapy. It also is reassuring to know that doctors
are making great progress in preventing some of chemotherapy's more serious
side effects. For instance they are using many new drugs and techniques
that increase chemotherapy's powerful effects on cancer cells while
decreasing its harmful effects on the body's healthy cells.
The side effects of chemotherapy can be unpleasant, but they must be
measured against the treatment's ability to destroy cancer. People getting
chemotherapy sometimes 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. It may be that your medication or the
treatment schedule can be changed. Or your doctor may be able to suggest
ways to reduce side effects or make them easier to tolerate. Remember
though, your doctor will not ask you to continue treatments unless the
expected benefits outweigh any problems you might have.
On the pages that follow, you will find suggestions for dealing with
some of the more common side effects of chemotherapy.
Nausea and Vomiting
Chemotherapy can cause nausea and vomiting by affecting the stomach,
the area of the brain that controls vomiting, or both. This reaction to
chemotherapy varies from person to person and from drug to drug. For
example, some people never vomit or feel nauseous. Others feel mildly
nauseated most of the time, while some become severely nauseated for a
limited time during or after a treatment. Their symptoms may start soon
after a treatment or hours later. They may feel sick for a few hours or
for about a day. Be sure to tell your doctor or nurse if you are very
nauseated and/or have vomited for more than a day or if your nausea is so
bad that you cannot even keep liquids down.
Nausea and vomiting can almost always be controlled or at least
lessened. If you experience this side effect, your doctor can choose from
a range of drugs known as antiemetics, which help curb nausea and vomiting.
Different drugs work for different people, and it may be necessary to use
more than one drug to get relief. Don't give up. Continue to work with
your doctor and nurse to find the drug or drugs that work best for you.
You can also try the following ideas:
-- Avoid big meals so your stomach won't feel too full. Eat small
meals throughout the day, instead of one, two, or three large
meals.
-- Drink liquids at least an hour before or after mealtime, instead
of with your meals.
-- Eat and drink slowly.
-- Stay away from sweet, fried, or fatty foods.
-- 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. (Don't try this if
you have mouth or throat sores or if you 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.
-- Suck on ice cubes, mints, or tart candies. (Don't use tart
candies if you have mouth or throat sores.)
-- Try to avoid odors that bother you, such as cooking smells,
smoke, or perfume.
-- Prepare and freeze meals in advance for days when you don't feel
like cooking.
-- Rest in a chair after eating, but don't lie flat for at least 2
hours after you've finished your meal.
-- 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.
-- Avoid eating for at least a few hours before treatment if nausea
usually occurs during chemotherapy.
Hair Loss
Hair loss (alopecia) is a common side effect of chemotherapy, but it
doesn't always happen. Your doctor can tell you whether hair loss is
likely to occur with the drug or drugs you are taking. When hair loss does
occur, the hair may become thinner or may fall out entirely. 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. In some
cases, hair may grow back in a different color or texture.
Hair loss can occur on all parts of the body, not just the head.
Facial hair, arm and leg hair, underarm hair, and pubic hair all may be
affected.
Hair loss usually doesn't happen right away; more often, it begins
after a few treatments. At that point, hair may fall out gradually or in
clumps. Any hair that is still growing may become dull and dry.
To care for your scalp and hair during chemotherapy:
-- Use mild shampoos.
-- Use soft hair brushes.
-- Use low heat when drying your hair.
-- Don't use brush rollers to set your hair.
-- Don't dye your hair or get a permanent.
-- Have your hair cut short. A shorter style will make your hair
look thicker and fuller. It will also make hair loss easier to
manage if it occurs.
-- Use a sunscreen, sunblock, hat, or scarf to protect your scalp
from the sun if you lose a lot of the hair on your head.Some
people who lose all or most of their hair choose to wear turbans,
scarves, caps, wigs, or hairpieces. 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.
Here are some tips 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 natural color and current hair style if
you wish. You may be able to buy a wig or hairpiece at a
specialty ship just for cancer patients. Someone even may come
to your home to help you. You also can buy a wig or hairpiece
through a catalog or by phone. Call the American Cancer Society
for more information.
-- Consider borrowing a wig or hairpiece, rather than buying one.
Check with the local chapter of the American Cancer Society or
with the social work department at your hospital.
-- Remember that a hairpiece needed because of cancer treatment is a
tax-deductible expense and may be at least partially covered by
your health insurance. Be sure to check your policy.
Losing hair from your head, face, or body can be hard to accept. It's
common--and perfectly all right--to feel angry or depressed about this
loss. Talking about your feelings can help.
Fatigue/Anemia
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 don't get enough oxygen to do their work.
This condition is called anemia.
Anemia can make you feel very weak and tired. Other symptoms of
anemia include dizziness, chills, or shortness of breath. Be sure to
report any of these symptoms to your doctor.
Your doctor will check your blood cell count often during your
treatment. If your red count falls too low, you may need a blood
transfusion to increase the number of red blood cells in your body.
Here are some things you can do to help yourself feel better if you
develop anemia:
-- Get plenty of rest. Sleep more at night and take naps during the
day if you can.
-- Limit your activities: Do only the things that are most
important to you.
-- Don't be afraid to get 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 or lying down, get up slowly. This will help
prevent dizziness.
Infection
Chemotherapy can make you more likely to get infections. This happens
because most anticancer drugs affect the bone marrow and decrease its
ability to produce white blood cells, the cells that fight many types of
infections. An infection can begin in almost any part of your body
including your mouth, skin, lungs, urinary tract, rectum, and reproductive
tract.
Your doctor will check your blood cell count often while you are
getting chemotherapy. Your doctor also may add colony stimulating factors
to your treatment to keep your blood count from getting too far below
normal. In spite of these extra steps, however, your white blood cell
count still may drop. If this happens, your doctor may postpone your next
treatment or give you a lower dose of drugs for a while.
When your white count is lower than normal, it is very important to
try to prevent infections by taking the following steps:
-- Wash your hands often during the day. Be sure to wash them extra
well before you eat and before and after you use the bathroom.
-- Clean your rectal area gently but thoroughly after each bowel
movement. Ask your doctor or nurse for advice if the area
becomes irritated or if you have hemorrhoids. Also, check with
your doctor before using enemas or suppositories.
-- Stay away from people who have diseases you can catch, such as a
cold, the flu, measles, or chickenpox. Also try to avoid crowds.
-- Stay away from children who recently have received immunizations,
such as vaccines for polio, measles, mumps and rubella (German
measles).
-- Don't cut or tear the cuticles of your nails.
-- Be careful not to cut or nick yourself when using scissors,
needles, or knives.
-- Use an electric shaver instead of a razor to prevent breaks or
cuts in your skin.
-- Use a soft toothbrush that won't hurt your gums.
-- Don't squeeze or scratch pimples.
-- Take a warm (not hot) bath, shower, or sponge bath every day.
Pat your skin dry using a light touch. Don't rub.
-- Use lotion or oil to soften and heal your skin if it becomes dry
and cracked.
-- Clean cuts and scrapes right away with warm water, soap, and an
antiseptic.
-- Wear protective gloves when gardening or cleaning up after
animals and others, especially small children.
-- Do not get any immunization shots without checking first with
your doctor to see if it's all right.
Most infections come from the bacteria normally found on the skin and
in the intestines and genital tract. In some cases, the cause of an
infection may not be known. When your white blood cell count is low, your
body may not be able to fight off infections. So, even if you take extra
care, you still may get an infection.
Be alert to the signs that you might have an infection and check your
body regularly for its signs, paying special attention to your eyes, nose,
mouth, and genital and rectal areas. The symptoms of infection include:
-- Fever over 100 degrees F.
-- Chills.
-- Sweating.
-- Loose bowels (this can also be a side effect of chemotherapy).
-- A burning feeling when you urinate.
-- A severe cough or sore throat.
-- Unusual vaginal discharge or itching.
-- Redness or swelling, especially around a wound, sore, pimple, or
intravenous catheter sites.
Report any signs of infection to your doctor right away. This is
especially important when your white blood cell count is low. If you have
a fever, don't use aspirin, acetaminophen, or any other medicine to bring
your temperature down without first checking with your doctor.
Blood Clotting Problem
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 from a minor injury.
Be sure to let your doctor know if you have unexplained bruising,
small red spots under the skin, reddish or pinkish urine, or black or
bloody bowel movements. Also report any bleeding from your gums or nose.
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 transfusion to build up the count.
Here are some ways to avoid problems if your platelet count is low:
-- Don't take any medicine without first checking with your doctor
or nurse. This includes aspirin or aspirin-free pain relievers,
including acetaminophen, ibuprofen, and any other medicines you
can buy without a prescription. These drugs may affect platelet
function.
-- Don't drink any alcoholic beverages unless your doctor says it's
all right.
-- Use a very soft toothbrush to clean your teeth.
-- Clean your nose by blowing gently into a soft tissue.
-- Take care not to cut or nick yourself when using scissors,
needles, knives, or tools.
-- Be careful not to burn yourself when ironing or cooking. Use a
padded glove when you reach into the oven.
-- Avoid contact sports and other activities that might result in
injury.
Mouth, Gum, and Throat Problems
Good oral care is important during cancer treatment. Anticancer drugs
can cause sores in the mouth and throat. They can also make these tissues
dry and irritated or cause them to bleed. In addition to being painful,
mouth sores can become infected by the many germs that live in the mouth.
Because infections can be hard to fight during chemotherapy and can lead to
serious problems, it's important to take every possible step to prevent
them.
Here are some suggestions for keeping your mouth, gums, and throat
healthy:
-- If possible, see your dentist before you start chemotherapy to
have your teeth cleaned and to take care of any problems such as
cavities, 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 tooth 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 type of toothbrush and/or toothpaste if your gums are
very sensitive.
-- Rinse your toothbrush well after each use and store it in a
dry place.
-- Avoid commercial mouthwashes that contain a large amount of salt
or alcohol. Ask you doctor or nurse about a mild mouthwash that
you might use.
If you develop sores in your mouth, be sure to contact your doctor or
nurse because you may need medical treatment for the sores. If the sores
are painful or keep you from eating, you also can try these ideas:
-- Ask your doctor if there is anything you can apply directly to
the sores. You also may ask your doctor 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.
-- Choose soft, soothing foods, such as ice cream, milkshakes, baby
food, soft fruits (bananas and applesauce), mashed potatoes,
cooked cereals, soft-boiled or scrambled eggs, 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, such as tomatoes, citrus fruit,
and fruit juice (orange, grapefruit, and lemon); spicy or salty
foods; and rough, coarse, or dry foods such as raw vegetables,
granola, and toast.
If mouth dryness bothers you or makes it hard for you to eat, try
these tips:
-- Ask your doctor if you should use an artificial saliva product to
moisten your mouth.
-- Drink plenty of liquids.
-- Suck on ice cubes, popsicles, or sugarless hard candy. You can
also chew sugarless gum.
-- Moisten dry foods with butter, margarine, gravy, sauces, or
broth.
-- Dunk crisp, dry foods in mild liquids.
-- Eat soft and pureed foods like those listed above.
-- Use lip balm if your lips become dry.
Diarrhea
When chemotherapy affects the cells lining the intestine, the result
can be diarrhea (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 an
antidiarrheal medicine. However, you should not take any over-the-counter
antidiarrheal medicines without asking your doctor first.
You can also try these ideas to help control diarrhea:
-- Eat smaller amounts of food, but eat more often.
-- 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. Eat low-fiber foods, instead. Low-fiber foods include
white bread, white rice or noodles, creamed cereals, ripe
bananas, canned or cooked fruit without skins, cottage cheese,
yogurt, eggs, mashed or baked potatoes without the skin, pureed
vegetables, chicken or turkey without the skin, and fish.
-- Avoid coffee, tea, alcohol, and sweets. Stay away from fried,
greasy, or highly spiced foods, too. They are all irritating and
can cause diarrhea and cramping.
-- Avoid milk and milk products if they make your diarrhea worse.
-- Unless your doctor has told you otherwise, eat more potassium-
rich foods because diarrhea can cause you to lose this important
mineral. Bananas, oranges, potatoes, and peach and apricot
nectars are good sources of potassium.
-- Drink plenty of fluids to replace those you have lost through
diarrhea. Mild, clear liquids, such as apple juice, water, weak
tea, clear broth, or ginger ale are best. Drink them slowly, and
make sure they are at room temperature. Let carbonated drinks
lose their fizz before you drink them.
-- If your diarrhea is severe, it is important to let your doctor
know. Ask your doctor if you should try a clear liquid diet to
give your bowels time to rest. As you feel better, you gradually
can add the low-fiber foods listed above. A clear liquid diet
doesn't provide all the nutrients you need, so don't follow one
for more than 3 to 5 days.
-- If your diarrhea is very severe, you may need to get intravenous
fluids to replace the water and nutrients you have lost.
Constipation
Some people who get chemotherapy become constipated because of the
drugs they are taking. Others may become constipated because they are less
active or less nourished than usual. Tell your doctor if you have not had
a bowel movement for more than a day or two. You may need to take a
laxative or stool softener or use an enema, but don't use these remedies
unless you have checked with your doctor, especially if your white blood
cell count is low.
You also can try these ideas to deal with constipation:
-- Drink plenty of fluids to help loosen the bowels. Warm and hot
fluids work especially well.
-- Eat a lot of high-fiber foods. High-fiber foods include bran,
whole-wheat breads and cereals, raw or cooked vegetables, fresh
and dried fruit, nuts, and popcorn.
-- Get some exercise. Simply getting out for a walk can help, as
can a more structured exercise program. Be sure to check with
your doctor before becoming more active.
Nerve and Muscle Effects
Your nervous system affects just about all your body's organs and
tissues. So it's not surprising that when chemotherapy affects the cells
of the nervous system--as the drugs sometimes do--a wide range of side
effects can result. For example, certain drugs can cause peripheral
neuropathy, a condition that may make you feel a tingling, burning,
weakness, or numbness in the hands and/or feet. Other nerve-related
symptoms include loss of balance, clumsiness, difficulty picking up objects
and buttoning clothing, walking problems, jaw pain, hearing loss, stomach
pain, and constipation. In addition to affecting the nerves, certain
anticancer drugs also can affect the muscles and make them weak, tired, or
sore.
In some cases, nerve and muscle effects--though annoying--may not be
serious. In other cases, nerve and muscle symptoms may indicate serious
problems that need medical attention. Be sure to report any suspected
nerve or muscle symptoms to your doctor.
Caution and common sense can help you deal with nerve and muscle
problems. For example, if your fingers become numb, be very careful when
grasping objects that are sharp, hot, or otherwise dangerous. If your
sense of balance or muscle strength is affected, avoid falls by moving
carefully, using handrails when going up or down stairs and using bathmats
in the bathtub or shower. Do not wear slippery shoes.
Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy.
Possible side effects include redness, itching, peeling, dryness, and acne.
Your nails may become brittle, darkened, or cracked. They also may develop
vertical lines or bands.
You will be able to take care of most of these problems yourself. If
you develop acne, try to keep your face clean and dry and use over-the-
counter medicated creams or soaps. For itching, apply cornstarch as you
would a dusting powder. To help avoid dryness, take quick showers or
sponge baths rather than long, hot baths. Apply cream and lotion while
your skin is still moist and avoid perfume, cologne, or aftershave lotion
that contains alcohol. You can strengthen your nails with the remedies
sold for this purpose, but be alert to signs of a worsening problem because
these products can be irritating to some people. Protect your nails by
wearing gloves when washing dishes, gardening, or performing other work
around the house. Get further advice from your doctor if these skin and
nail problems don't respond to your efforts. Be sure to let your doctor
know if you have redness, pain, or changes around the cuticles.
Certain anticancer drugs, when given intravenously, may produce a
fairly dramatic darkening of the skin all along the vein. Some people use
makeup to cover the area, but this can become difficult and time-consuming
if several veins are affected, which sometimes happens. The darkened areas
usually will fade on their own a few months after treatment ends.
Exposure to the sun may increase the effects some anticancer drugs
have on your skin. Check with your doctor or nurse about using a sunscreen
lotion with a skin protection factor of 15 to protect against the sun's
effects. They may even suggest that you avoid being in direct sunlight or
that you use a product, such as zinc oxide, that blocks the sun's rays
completely. Long-sleeve cotton shirts, hats, and pants also will block the
sun.
Some people who have had radiation therapy develop "radiation recall"
during their chemotherapy. During or shortly after anticancer drugs are
given, the skin over the area that was treated with radiation turns red--a
shade anywhere from light to very bright--and may itch or burn. This
reaction may last hours or even days. You can soothe the itching and
burning by putting a cool, wet compress over the affected area. Radiation
recall reactions should be reported to your doctor or nurse.
Most skin problems are not serious, but a few demand immediate
attention. For example, certain drugs given intravenously can cause
serious and permanent tissue damage if they leak out of the vein. Tell
your doctor or nurse right away if you feel any burning or pain when you
are getting IV drugs. These symptoms don't always mean there's a problem
but they always must be checked out at once.
You also should let your doctor or nurse know right away if you
develop sudden or severe itching, if your skin breaks out in a rash or
hives, or if you have wheezing or any other trouble breathing. These
symptoms may mean you are having an allergic reaction that may need to be
treated at once.
Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or
permanent damage to the kidneys. Be sure to ask your doctor if your
anticancer drugs are among the ones that have this effect, and notify the
doctor if you have any symptoms that might indicate a problem. Signs to
watch for include:
-- Pain or burning when you urinate.
-- Frequent urination.
-- A feeling that you must urinate right away ("urgency").
-- Reddish or bloody urine.
-- Fever.
-- Chills.
In general, it's a good idea to drink plenty of fluids to ensure good
urine flow and help prevent problems; this is especially important if your
drugs are among those that affect the kidney and bladder. Water, juice,
coffee, tea, soup, soft drinks, broth, ice cream, soup, popsicles, and
gelatin are all considered fluids. Your doctor will let you know if you
must increase your fluid intake.
You also should be aware that some anticancer drugs cause the urine to
change color (orange, red, or yellow) or to take on a strong or medicine-
like odor. The color and odor of semen may be affected, as well. Check
with your doctor to see if the drugs you are taking have this effect.
Flu-Like Syndrome
Some people report feeling as though they have the flu a few hours to
a few days after chemotherapy. Flu-like symptoms--muscle aches, headache,
tiredness, nausea, slight fever, chills, and poor appetite--may last from 1
to 3 days. These symptoms also can be caused by an infection or by the
cancer itself, so it's important to 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 effects of 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 with a high sodium content. If the
problem is severe, your doctor may prescribe diuretics, medicine to help
your body get rid of excess fluids. However, don't take any over-the-
counter diuretics without asking your doctor first.
Sexual Effects: Physical and Psychological
Chemotherapy may--but does not always--affect sexual organs and
functioning in both men and women. The side effects that might occur
depend on the drugs used and the person's age and general health.
Men
Chemotherapy drugs may lower the number of sperm cells, reduce their
ability to move, or cause other abnormalities. These changes can result in
infertility, which may be temporary or permanent. Infertility affects a
man's ability to father a child but does not affect his ability to have
sexual intercourse.
Because permanent sterility may occur, it's important to discuss this
issue with your doctor before you begin chemotherapy. If you wish, you
might consider sperm banking, a procedure that freezes sperm for future
use.
Men undergoing chemotherapy should use an effective means of birth
control with their partners during treatment because of the harmful effects
of the drugs on chromosomes. Ask your doctor when you can stop using birth
control for this purpose.
Women
Anticancer drugs can damage the ovaries and reduce the amount of
hormones they produce. As a result, some women find that their menstrual
periods become irregular or stop completely while they are having
chemotherapy.
The hormonal effects of chemotherapy also may cause menopause-like
symptoms such as hot flashes and itching, burning, or dryness of vaginal
tissues. These tissue changes can make intercourse uncomfortable, but the
symptoms often can be relieved by using a water-based vaginal lubricant.
The tissue changes also can make a woman more likely to get vaginal
infections. To help prevent infection, avoid oil-based lubricants such as
petroleum jelly, wear cotton underwear and pantyhose with a ventilated
cotton lining, and don't wear tight slacks or shorts. Your doctor also may
prescribe a vaginal cream or suppository to reduce the chances of
infection. If infection does occur, it should be treated right away.
Damage to the ovaries may result in infertility, the inability to
become pregnant. In some cases, the infertility is a temporary condition;
in other cases, it may be permanent. Whether infertility occurs, and how
long it lasts, depends on many factors, including the type of drug, the
dosage given, and the woman's age.
Although pregnancy may be possible during chemotherapy, it still is
not advisable because some anticancer drugs may cause birth defects.
Doctors advise women of childbearing age--from the teens through the end of
menopause--to use birth control throughout their treatment.
If a woman is pregnant when her cancer is discovered, it may be
possible to delay chemotherapy until after the baby is born. For a woman
who needs treatment sooner, the doctor may suggest starting chemotherapy
after the 12th week of pregnancy, when the fetus is beyond the stage of
greatest risk. In some cases, termination of the pregnancy may be
considered.
Sexuality
Sexual feelings and attitudes vary among people during chemotherapy.
Some people find that they feel closer than ever to their partners and have
an increased desire for sexual activity. Others experience little or no
change in their sexual desire and energy level. Still others find that
their sexual interest declines because of the physical and emotional
stresses of having cancer and getting chemotherapy. These stresses may
include worries about changes in appearance; anxiety about health, family,
or finances; or side effects, including fatigue and hormonal changes.
A partner's concerns or fears can also affect the sexual relationship.
Some may worry that physical intimacy will harm the person who has cancer;
others may fear that they might "catch" the cancer or be affected by the
drugs. Many of these issues can be cleared up by talking about
misunderstandings. Both you and your partner should feel free to discuss
sexual concerns with your doctor, nurse, or other counselor who can give
you the information and the reassurance you need.
You and your partner also should try to share your feelings with one
another. If it's difficult for you to talk to each other about sex, or
cancer, or both, you may want to speak to a counselor who can help you
communicate more openly. People who can help include psychiatrists,
psychologists, social workers, marriage counselors, sex therapists, and
members of the clergy.
If you were comfortable with and enjoyed sexual relations before
starting therapy, chances are you will still find pleasure in physical
intimacy during your treatment. You may discover, however, that intimacy
takes on a new meaning and character. Hugging, touching, holding, and
cuddling may become more important, while sexual intercourse may become
less important. Remember that what was true before you started
chemotherapy remains true now: There is no one "right" way to express your
sexuality. It's up to you and your partner to determine together what is
pleasurable and satisfying to you both.
The American Cancer Society has two free booklets on sexuality that
may be helpful--one for women and one for men. Contact your local unit or
the national office for copies.
EATING WELL DURING CHEMOTHERAPY
It is very important to eat as well as you can while you are
undergoing treatment. People who eat well can cope with side effects
better and are able to fight infection more easily. In addition, their
bodies can rebuild healthy tissues faster.
Eating well during chemotherapy means choosing a balanced diet that
contains all the nutrients the body needs. A good way to do this is to eat
foods from each of the following food groups: fruits and vegetables;
poultry, fish, and meat; cereals and breads; and dairy products. Eating
well also means having a diet high enough in calories to keep your weight
up and, most important, high enough in protein to build and repair skin,
hair, muscles, and organs.
You may also need to drink extra amounts of fluid to protect your
bladder and kidneys during your treatment.
What If I Don't Feel Like Eating?
Even when you know it's important to eat well, there may be days when
you feel you just can't. This may happen because side effects such as
nausea or mouth and throat problems make it difficult or painful to eat.
You also can lose your appetite if you feel depressed or tired. If this is
the case, be sure to read the sections in this booklet on your particular
discomforts. They will give you tips that can make it easier for you to
eat.
When a poor appetite is the problem, try these hints:
-- Eat small meals or snacks whenever you want. You don't have to
eat three regular meals each day.
-- Vary your diet and try new foods and recipes.
-- When possible, take a walk before meals; this makes you feel
hungrier.
-- Try changing your mealtime routine. For example, eat by
candlelight or in a different location.
-- Eat with friends or family members. When eating alone, listen to
the radio or watch TV.
-- If you live alone, you might want to arrange for "Meals on
Wheels" or a similar program to bring food to you. Ask your
doctor, nurse, local American Cancer Society office, or the
Cancer Information Service about these programs, which are
provided in many communities.
The National Cancer Institute's booklet "Eating Hints" provides more
tips about how to make eating easier and more enjoyable. It also gives
many ideas about how to eat well and increase your protein and calorie
intake during cancer treatment. For a free copy of "Eating Hints," call
the Cancer Information Service at 1-800-4-CANCER.
Can I Drink Alcoholic Beverages?
Small amounts of alcohol can help you relax and increase your
appetite. On the other hand, alcohol may interact with some drugs to
reduce their effectiveness or worsen their side effects. For this reason,
some people must drink less alcohol or avoid alcohol completely during
chemotherapy. Be sure to ask your doctor if it's okay for you to drink
beer, wine, or other alcoholic beverages.
Should I Take Vitamin or Mineral Supplements?
There is no single answer to this question, but one thing is clear:
No diet or nutritional plan can "cure" cancer, and taking vitamin and
mineral supplements should never be considered a substitute for medical
care. You should not take any supplements without your doctor's knowledge
and consent.
TALKING WITH YOUR DOCTOR AND NURSE
Some people with cancer want to know every detail about their
condition and their treatment. Others prefer only general information.
The choice of how much information to seek is yours, but there are
questions that every person getting chemotherapy should ask. These
include:
-- Why do I need chemotherapy?
-- What are the benefits of chemotherapy?
-- What are the risks of chemotherapy?
-- What drug or drugs will I be taking?
-- How will the drugs be given?
-- Where will I get my treatments?
-- How long will my treatment last?
-- What are the possible side effects?
-- Are there any side effects that I should report right away?
-- Are there any other possible treatment methods for my type of
cancer?
This list is just a start. You always should feel free to ask your
doctor, nurse, and pharmacist as many questions as you want. If you don't
understand their answers, keep asking until you do. Remember, when it
comes to cancer and cancer treatment there is no such thing as a "stupid"
question. To make sure you get all the answers you want, you may find it
helpful to draw up a list of questions before your appointment. Some
people even keep a "running list" and jot down each new question as it
occurs to them.
To help remember your doctor's answers, you may want to take notes
during your appointment. Don't feel shy about asking your doctor to slow
down when you need more time to write. You may also ask if you can use a
tape recorder during your visit. That way, you can review your
conversation later as many times as you wish. Some doctors like this idea
and others don't, so be sure to check before you try it. Another way to
help you remember is to bring a friend or family member to sit with you
while you talk to your doctor. This person can help you understand what
your doctor says during your visit and help refresh your memory afterward.
CHEMOTHERAPY AND YOUR EMOTIONS
Chemotherapy can bring major changes to a person's life. It can
affect overall health, threaten a sense of well-being, disrupt day-to-day
schedules, and put a strain on personal relationships. No wonder, then,
that many people feel fearful, anxious, angry, or depressed at some point
during their chemotherapy.
These emotions are perfectly normal and understandable, but they also
can be disturbing. Fortunately, there are ways to cope with these
emotional "side effects," just as there are ways to cope with the physical
side effects of chemotherapy.
How Can I Get the Support I Need?
There are many sources of support you can draw on. Here are some of
the most important:
-- Doctors and nurses. If you have questions or worries about your
cancer treatment, talk with members of your health care team.
-- Counseling professionals. There are many kinds of counselors who
can help you express, understand, and cope with the emotions
cancer treatment can cause. Depending on your preferences and
needs, you might want to talk with a psychiatrist, psychologist,
social worker, sex therapist, or member of the clergy.
-- 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. You may find,
though, that you'll 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.
Many people do not understand cancer, and they may withdraw from
you because they're afraid of your illness. Others may worry
that they will upset you by saying "the wrong thing."
You can help relieve these fears 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's no
single "right" thing to say, so 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.
The National Cancer Institute's booklet "Taking Time" offers
useful advice to help cancer patients and their families and
friends communicate with one another.
-- Support groups. Support groups are made up of people who are
going through the same kinds of experiences as you. Many people
with cancer find they can share thoughts and feelings with group
members that they don't feel comfortable sharing with anyone
else. Support groups also can serve as an important source of
practical information about living with cancer.
Support can also be found in one-to-one programs that put you in touch
with another person very similar to you in terms of 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.
Sources for information about support programs include your hospital's
social work department, the local office of your American Cancer Society,
and the National Cancer Institute's Cancer Information Service.
How Can I Make My Daily Life Easier?
Here are some tips to help you while you are getting chemotherapy:
-- Try to keep your treatment goals in mind. This will help you
keep a positive attitude on days when the going gets rough.
-- Remember that eating well is very important. Your body needs
food to rebuild tissues and regain strength.
-- Learn as much as you want to know about your disease and its
treatment. This can lessen your fear of the unknown and increase
your feeling of control.
-- Keep a journal or diary while you're in treatment. A record of
your activities and thoughts can help you understand the feelings
you have as you go through treatment, and highlight questions you
need to ask your doctor or nurse. You also can use your journal
to record the steps you take to cope with side effects, and how
well those steps work. That way, you'll know which methods
worked best for you in case you have the same side effects again.
-- Set realistic goals and don't be too hard on yourself. You may
not have as much energy as usual, so try to get as much rest as
you can, let the "small stuff" slide, and only do the things that
are most important to you.
-- Try new hobbies and learn new skills. Exercise if you can.
Using your body can make you feel better about yourself, help you
get rid of tension or anger, and build your appetite. Ask your
doctor or nurse about a safe and practical exercise program.
How Can I Relieve Stress?
You can use a number of methods to cope with the stresses of cancer
and its treatment. The techniques described here can help you relax. Try
some of these methods to find the one (or ones) that work best for you.
You may want to check with your doctor before using these techniques,
especially is you have lung problems.
-- 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.
-- Rhythmic breathing. Get into 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.
-- Biofeedback. 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
will let you know in some way such as making a sound or flashing
a light. The machine will also give you feedback when you relax
your body. Eventually, you will be able to control your
relaxation responses without having to depend on feedback from
the machine. Your doctor or nurse can refer you to someone
trained in teaching biofeedback.
-- Imagery. 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; don't 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."
If you choose to use imagery as a relaxation technique, please be
sure to read the caution in the following section.
-- Visualization. Visualization is a method that 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.
Visualization and imagery may help to relieve stress and to
increase your sense of self-control. But it is very important to
remember that they can never take the place of the medical care
your doctor prescribes to treat your cancer.
-- Hypnosis. Hypnosis puts you in a trance-like state that can
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 or nurse to
refer you to someone trained in the technique.
-- Distraction. You use distraction any time an activity takes your
mind off your worries or discomforts. Try 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. You may be surprised how comfortably the time passes.
PAYING FOR CHEMOTHERAPY
The cost of chemotherapy varies with the kinds and dose of drugs used,
how long and how often they are given, and whether you get them at home, in
a clinic or office, or in the hospital. Most health insurance policies
(including Medicare Part B, which helps pay for doctors' bills and many
other medical services) cover at least part of the cost of many kinds of
chemotherapy.
Sometimes, however, an insurer may not pay for the use of certain
drugs for certain kinds of cancers--at least not at first. If your insurer
denies payment for your treatment, don't give up. Most people do get
payment eventually.
Teamwork with your doctor and the office staff is important. Be sure
to let them know if you have been denied payment. They can consult with
your insurer and help answer any questions your insurer may have. They
also can consult with the company that makes the drug or drugs you are
taking. Often, these companies can provide information or other services
that will help you get payment.
In some states, Medicaid (which makes health care services available
for people with financial need) may help pay for certain treatments.
Contact the office that handles social services in your city or county to
find out whether you are eligible for Medicaid and whether your
chemotherapy is a covered expense.
If you need help paying for treatments, contact your hospital's social
service office, the Cancer Information Service, or the local office of the
American Cancer Society. They may be able to direct you to other sources
of help. Another possibility is the Leukemia Society of America; to find a
chapter near you, check the white pages of your local telephone book.
A FINAL WORD
The National Cancer Institute hopes "Chemotherapy and You" helps you
and your family, whether you are waiting to begin chemotherapy or already
have begun your treatment. Discuss the information in this booklet with
your doctor and nurse, and take good care of yourself during your
chemotherapy. By working together, you, your family, and your health care
providers will make the strongest possible team in your fight against
cancer.
RESOURCES
Information about cancer is available from many sources, including the
ones listed below. You may want to check for additional information at
your local library or bookstore and from support groups in your community.
Cancer Information Service
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer
Institute, is a nationwide telephone service for cancer patients and their
families and friends, the public and health care professionals. The staff
can answer any questions in English or Spanish and can send free National
Cancer Institute booklets about cancer. They also know about local
resources and services. One toll-free number, 1-800-4-CANCER (1-800-422-
6237), connects callers with the office that serves their area.
PDQ
People who have cancer, those who care about them, and doctors need
up-to-date and accurate information about cancer treatment. To meet these
needs, PDQ was developed by NCI. PDQ contains an up-to-date list of
clinical trials all over the country. The Cancer Information Service, at
1-800-4-CANCER, can provide PDQ information to doctors, patients, and the
public.
American Cancer Society
1599 Clifton road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a
national office (at the above address) and local units all over the
country. To obtain further information about services and activities in
local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-
227-2345), or the number listed under American Cancer Society in the white
pages of the telephone book.
Other Booklets
National Cancer Institute printed materials, including the booklets
listed blow, are available from the Cancer Information Service free of
charge by calling 1-800-4-CANCER.
-- "Advanced Cancer: Living Each Day"
-- "Eating Hints: Recipes and Tips for Better Nutrition During
Cancer Treatment"
-- "Facing Forward: A Guide for Cancer Survivors"
-- "Questions and Answers About Pain Control" (also available from
the American Cancer Society)
-- "Radiation Therapy and You: A Guide to Self-Help During
Treatment"
-- "Taking Time: Support for People With Cancer and the People Who
Care About Them"
-- "What Are Clinical Trials All About?"
-- "What You Need To Know About Cancer." A series of booklets about
different types of cancer.
-- "When Cancer Recurs: Meeting the Challenge Again"
GLOSSARY
This glossary reviews the meaning of some words used in "Chemotherapy
and You." It also explains some words related to chemotherapy that are not
mentioned in this booklet but that you may hear from your doctor or nurse.
Adjuvant therapy: Anticancer drugs or hormones given after surgery and/or
radiation to help prevent the cancer from coming back.
Alopecia: Hair loss.
Anemia: Having too few red blood cells. Symptoms of anemia include
feeling tired, weak, and short of breath.
Anorexia: Poor appetite.
Antiemetic: A medicine that prevents or controls nausea and vomiting.
Benign: A term used to describe a tumor that is not cancerous.
Biological therapy: Treatment to stimulate or restore the ability of the
immune system to fight infection and disease. Also called immunotherapy.
Blood count: The number of red blood cells, white blood cells, and
platelets in a sample of blood. This is also called the complete blood
count (CBC).
Bone marrow: The inner, spongy tissue of bones where red blood cells,
white blood cells.
Cancer: A general name for more than 100 diseases in which abnormal cells
grow out of control; a malignant tumor.
Catheter: A thin flexible tube through which fluids can enter or leave the
body.
Central venous catheter: A special thin, flexible tube placed in a large
vein. It remains there for as long as it is needed to deliver and withdraw
fluids.
Chemotherapy: The use of drugs to treat cancer.
Chromosomes: Threadlike bodies found in the nucleus, or center part, of a
cell that carry the information of heredity.
Clinical Trials: Medical research studies conducted with volunteers. Each
study is designed to answer scientific questions and to find better ways to
prevent or treat cancer.
Colony-stimulating factors: Substances that stimulate the producation of
blood cells. Treatment with colony-stimulating factors (CSF) can help the
blood-forming tissue recover from the effects of chemotherapy and radiation
therapy. These include granulocyte colony-stimulating factors (G-CSF) and
granulocyte-macrophage colony-stimulating factors (GM-CSF).
Combination chemotherapy: The use of more than one drug to treat cancer.
Diuretics: Drugs that help the body get rid of excess water and salt.
Gastrointestinal: Having to do with the digestive tract, which includes
the mouth, esophagus, stomach, and intestines.
Hormones: Natural substances released by an organ that can influence the
function of other organs in the body.
Infusion: Slow and/or prolonged intravenous delivery of a drug or fluids.
Injection: Using a syringe and needle to push fluids or drugs into the
body; often called a "shot."
Intra-arterial (IA): Into an artery.
Intracavitary (IC): Into a cavity, or space, specifically the abdomen,
pelvis, or the chest.
Intralesional (IL): Into the cancerous area in the skin.
Intramuscular (IM): Into a muscle.
Intrathecal (IT): Into the spinal fluid.
Intravenous (IV): Into a vein.
Malignant: Used to describe a cancerous tumor.
Metastasis: When cancer cells break away from their original site and
spread to other parts of the body.
Palliative care: Treatment to relieve, rather than cure, symptoms caused
by cancer. Palliative care can help people live more comfortably.
Peripheral neuropathy: A condition of the nervous system that usually
begins in the hands and/or feet with symptoms of numbness, tingling,
burning and/or weakness. Can be caused by certain anticancer drugs.
Per os (PO): By mouth, orally.
Platelets: Special blood cells that help stop bleeding.
Port: A small plastic or metal container surgically placed under the skin
and attached to a central venous catheter inside the body. Blood and
fluids can enter or leave the body through the port using a special needle.
Radiation therapy: Cancer treatment with radiation (high-energy rays).
Red blood cells: Cells that supply oxygen to tissues throughout the body.
Remission: The disappearance of signs and symptoms of disease.
Stomatitis: Sores on the inside lining of the mouth.
Subcutaneous (SQ or SC): Under the skin.
Tumor: An abnormal growth of cells or tissues. Tumors may be benign (non-
cancerous) or malignant (cancerous).
White blood cells: The blood cells that fight infection.
The NCI is the U.S. Government's main agency for cancer research and
information about cancer. The NCI's publications are free. They may be
copied or reproduced without written permission.
National Cancer Institute
NIH Publication No. 94-1136
Revised July 1993
Date Last Modified: 08/94