Getting Started: A Chemotherapy Education Program

Designed to alleviate your fears and to provide you with the tools, resources and confidence to ask

questions, solve problems, and express your needs.

Getting Started: An OverviewThe content of this program

• Focuses on systemic therapies.• Reviews the definition of cancer, which drugs

will be given and why, and how chemotherapy works.

• Discusses, in general, expectations and possible side effects and management strategies for potential chemotherapy side effects.

• Outlines symptoms for which to call your Oncologist’s Office.

What is Cancer?• An abnormal growth of cells

- The immune system usually recognizes abnormal cells and can either repair them or force them into apoptosis (cell death).

- If abnormal cell growth goes undetected, cell overgrowth is allowed to occur.

• Benign tumor- Confined growth that does not spread

elsewhere

• Malignant tumor- Cells may remain in one area or may invade

neighboring tissues, enter blood vessels, or travel to different sites in the body.

Types of Cancer TreatmentsA. Local Therapy

• Surgery• Radiation

B. Systemic Therapy• Chemotherapy, targeted therapy and anti-

hormone therapies are given with the intent of treating local cancer cells and those that may have escaped to distant sites in the body.

My chemotherapy regimen:

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How Chemotherapy Works• Standard chemotherapy interrupts the life cycle of

the cell. - Every cell, both normal and abnormal, goes

through this life cycle.

• Cancer cells divide, or complete the life cycle, more rapidly than normal cells, and thus are more susceptible to chemotherapy.

• Rapidly dividing normal cells include: hair cells, blood producing cells (bone marrow), and cells that line the gastrointestinal tract.

Hair Loss• Hair loss may involve the scalp, eyebrows,

eyelashes or body hair and depends on the chemotherapy given.

- May start 2 to 3 weeks after your first treatment. - By 4 to 5 weeks, most of the hair will be gone.

• For dry/itchy scalp: Use mild shampoo such as Johnson’s baby, ThymuSkin, Nioxin, ALRA

• For red/tender scalp: Use ALRA lotion- Available at “Just Like a Woman” and

“Transitions” at St. Vincent and Providence.

Hair Loss• The American Cancer Society provides free wigs

through Providence, St. Vincent and Legacy Good Samaritan.

- See Headwear Handout.• Hair recovery often starts around 4 to 6 weeks

after the last treatment.• Hair may grow back a different tint or texture.• As hair returns you may use a light, non-toxic

coloring rinse for the first few months, eventually returning to stronger forms of coloring if you wish.

Oral Symptoms• Mouth sores and/or soreness can occur due to

chemotherapy affecting the lining of the mouth.- Sores will most commonly present as blisters

or ulcerations (like “canker sores”).- Throat symptoms may include soreness,

tightness and/or spasms.

Report to your Oncologist’s Office:- Mouth/throat symptoms that become

unmanageable or prevent eating/drinking.- Any dental work that may be required

during your treatment.

Oral Hygiene• Good oral hygiene can reduce chemotherapy

related symptoms.• Use a soft toothbrush and gentle flossing.• Use a gentle toothpaste and alcohol free

mouthwash twice daily. • Try these brands: Tom’s, Dr. Ken’s, Jason,

Biotene, CloSys, or Prevident.• For dry mouth, use Biotene dry mouth oral

rinse/spray 2-3 times daily.

• Salt Water and Baking Soda rinse- 1/4 teaspoon baking soda- 1/8 teaspoon salt- 1 cup warm water- Rinse mouth several times daily

Nausea and Vomiting• Nausea and/or vomiting is due to chemotherapy

stimulating nausea receptors in the brain and gastrointestinal tract.

• Anti-nausea medication will be prescribed prior to beginning chemotherapy, so that you are prepared.

- Ginger has been shown to relieve nausea, so try ginger ale, ginger tea, or ginger candy.

- Eat small frequent meals throughout the day.

Report to your Oncologist’s Office:- Persistent nausea or vomiting despite the use

of anti-nausea medication.

Esophageal Reflux- “Heartburn”• Some medications may cause heartburn by

increasing stomach acid and/or relaxing esophageal muscles.

• Symptoms may include:- “Burning” or pressure in the chest- Difficulty swallowing or sore throat- Increased burping - Nausea

• There are medications available over-the-counter and by prescription to reduce acid production and relieve symptoms.

Constipation• Some medications can slow the motility of the bowel,

causing difficulty passing stools:- Chemotherapy agents- Pain medications- Anti-nausea medications- Anti-diarrheal medications

• There are several over-the-counter remedies for management of constipation

• See Constipation Handout.

Report to your Oncologist’s Office:- No stool, small hard stools, or painful stools

for two or more days.

Diarrhea• Some chemotherapy agents can cause an increase

in the bowel motility, causing diarrhea.- Diarrhea is important to treat to prevent

dehydration.• There are both over-the-counter and prescription

medications available to manage diarrhea. • See Diarrhea Handout.

Report to your Oncologist’s Office:- More than 2-3 diarrhea episodes per day.

Dehydration• Can occur during chemo due to many factors:

- Poor oral intake due to nausea.- Excessive fluid loss through vomiting,

diarrhea, or fevers.- Lack of thirst due to a feeling of “fullness”

caused by constipation.

• Dehydration can prevent patients from fully recovering between chemotherapy cycles, and can even delay treatments.

Report to your Oncologist’s Office:- Lightheadedness or Dizziness- Decreased amount/frequency of urination or dark/foul smelling urine

Hydration• Drink: 8 to 10 (8-oz) glasses of fluids per day:

- 4 to 5 servings should be water- The other 4 to 5 servings can be: flavored

water, broth, Pedia-lyte, coconut water, milk, rice/hazelnut/almond milk.

If you have a breast cancer diagnosis please check with your provider regarding the use of Soy.

- Coffee, tea or other caffeinated beverages are diuretics and should be limited to 1 to 2 cups per day.

- Replace 2 hydrating beverages for every 1 dehydrating beverage.

“Chemo-Brain”• Cognitive changes resulting in:

- Difficulty with word finding- Decreased attention span- Decreased ability to multi-task

• Can last weeks to months following treatment.- Rarely it can last years or be permanent.

• Prevention/Minimization: - Keep the mind active by doing word games

such as crossword or Sudoku and exercise. - See http://www.cancercare.org, or

Lumosity.com

Neuropathy• Some chemotherapy can cause dysfunction of

nerves resulting in numbness/tingling and difficulty with dexterity or fine motor skills.

• It can be cumulative, and usually improves once chemotherapy is completed.

- In a small percentage of patients it will worsen or persist after chemotherapy is completed.

• See Neuropathy handout.

Report to your Oncologist’s office:- Neuropathy that is worsening and/or affecting

quality of life.

Fatigue• Day 1: Typically you feel good if pre-treatment

symptoms are under control. • Day 2: You may start winding down • Day 3: This is often the “down day” when you

will want to stay in bed, but this is not the best response.

- Get out of bed and sit up in recliner or chair.- Every 1-2 hours get up and move around for 15

minutes, then return to rest.- Eat more food and drink more fluids.

Fatigue• For management of fatigue we also recommend

you stay active!

• Data shows that, with moderate exercise, patients maintain and can even gain strength during chemotherapy treatment.

• We suggest: Walking, Swimming,Yoga,Tai-Chi - 4 to 5 times per week- Up to 1 hour each day- Can be 15-20 minutes at a time- Moderate level or 50% maximum heart rate

Complete Blood Count (CBC)

Complete Blood CountRed blood cells

Normal Range Normal RangeMen Women

• Hemoglobin (g/dL) 14-18 12-16• Hematocrit (%) 42-52 37-48

Report to your Oncologist’s Office:- Shortness of breath- Dizziness or lightheadedness- Increased tiredness; decreased stamina

These may be signs/symptoms of Anemia

Complete Blood Count (CBC)White blood cells

Normal Range Normal RangeMen Women

• WBC 4.5 – 11 4.3 – 11

Report to your Oncologist's Office:- Fever of 100.5 or higher- Chills or sweats- Cough, shortness of breath or cold/flu

symptoms- Urinary changes such as pain, frequency or

hesitancy- Red or draining skin wound

These may be signs/symptoms of infection

Complete Blood Count (CBC)Platelets

Normal Range Normal RangeMen Women

• Platelets 150-350 150-350

Report to your Oncologist’s Office:- Unusual bruising- A cut that takes longer stop bleeding- Frequent nosebleeds

These may be signs/symptoms of a low platelet count

Nutrition• Report ALL herbal and nutritional

supplements to your oncologist.- Use of high dose vitamins may interfere with

the effectiveness of chemotherapy and need approval from your oncologist.

• Eat more like a diabetic:- Carbohydrate, protein, fiber & fat in each meal- Eat 5 to 6 small meals per day- Eat 5 to 9 fruits & vegetable servings per day. - Eat a rainbow of colors- See Basic Nutrition Handout.

• Monitor weight and food & fluid intake- Report greater than 5 pound weight loss

In Review: Contact your provider for:1. Any symptom not controlled with support medications:

• mouth sores, nausea/vomiting, heartburn, constipation or diarrhea.

2. Fevers of 100.5 or higher or infectious symptoms.3. Worsening neuropathy or pain.4. Lightheadedness or other signs of dehydration.5. Abnormal bleeding or unexplained bruising.6. Any new concerning symptom.

If you call after hours or on a weekend, you will be connected to the provider on call. For an emergency, such as chest pain, sudden shortness of breath, or sudden weakness/numbness, call 911 or go to the ER.

Tell Us About Yourself• Please complete the following handouts and return

them to a medical assistant, nurse, or your provider

- Distress Scale- Nutrition Assessment

• These will be used to help identify your needs to be sure that we are providing you the best care possible.

THANK YOU

We understand that this is a difficult journey for you and your family. We are honored that you have chosen us

to be your guide.