Lifestyle & symptom advice - chemotherapy
This information sheet aims to provide a brief overview of practical tips
which may help prevent and cope with some of every day issues which may confront
you during treatment. By mentioning these side effects here it doesn't necessary mean you will
get them - the likelihood of side effects for each regimen is best
described in its own individual chemotherapy
advice sheet. If you have any of the symptoms or lifestyle
issues mentioned below, further detail information can
be retrieved from the
various sections of cancernet.co.uk or
given to you by your nurse:
Nausea remains a relatively common side effect of chemotherapy but with the advent of new anti-sickness drugs vomiting is unusual. It is important to treat vomiting actively as prolonged vomited leads to further problems. It is always best to prevent nausea so it is important to take your anti-sickness tablets regularly. If they fail and you actually vomit it is important you get other forms of anti-sickness medication quickly from your oncology clinic or GP. Some practical tips if you feel sick:-Fluids:
Doctor can provide further anti-sickness (anti-emetic) tablets if your symptoms persist
Fatigue. The most common complaint during chemotherapy is now fatigue. The severity of fatigue can vary from mild to a level which severely disrupts patients ability to cope at home and work. Fatigue can also be aggravated by a drop (particularly if sudden) in you red cell (haemoglobin). In this case specific treatments for anaemia should be considered. Here are some tips to help you with fatigue:-Acceptance. Try not to get disheartened with fatigue or feel guilty, it is not your fault.
Eat a healthy, balanced diet. Foods which give you sustained energy such as carbohydrates (bread, potatoes) are important. Avoid refined sugar in foods producing peaks and troughs in glucose levels.
Rest. Periods of rest or cat naps are beneficial taken throughout the day between activities.
Exercise - Regular aerobic exercise
has been shown to prevent worsening of fatigue and psychological stress in
patients receiving chemotherapy and biological therapies. In the studies which
showed this, the definition of aerobic is exercise in which a negative oxygen
balance does not occur or put another way it is not too
strenuously that it uses up more oxygen in the blood stream than can be replaced
by breathing, albeit at a faster pace – this generally would include walking,
gentle running, dancing, cycling, rowing etc.
strenuously that it uses up more oxygen in the blood stream than can be replaced by breathing, albeit at a faster pace – this generally would include walking, gentle running, dancing, cycling, rowing etc.
Distraction tactics - Listening to stimulating tapes or music. A drive for a change of scenery or a visit to friends or family are examples of diversionary activities. Try to keep a comfortable temperature and avoid being too hot or cold.
Sleep hygiene - Try to get the most of a nights sleep. See advice on sleep hygiene for some tips.Task avoidance - Avoid having to run up and down the stairs to fetch things. Plan to have set times for rests. Spread the takes over the day. Use energy saving devices if possible. Remote controls, long handle mops and dusters etc.
Task management - You cannot now do everything yourself. Organise family and other carers including social workers to help you with daily activities especially the heavy ones.
and a low white cell count Infection due to a low white cell count
remains an important cause for concern for our patients.
You should have been given advise on what to look out for and what to do if you
develop an infection, including 24 hour contact numbers.
Patients often ask what they can do to prevent infection. Unfortunately, this often out of the control of an individual patient as it is difficult to avoid people who have infections (colds, flu, chest infections etc) and there is no evidence to suggest this makes any difference. Common sense tells us however, that if its obvious that a person is unwell with infection avoid close contact. Also avoid foods which may be infected - see below. Special note has to be made regarding:
Chicken Pox and
Shingles - If someone has chicken pox avoid them altogether - If there is a
significant contact with chicken pox contact the hospital. If they agree the
risk is serious they will take a blood test to assess your immunity to chicken
pox - if you still have immunity no more needs to be done if it
has been lost you may receive a course of chicken pox anti-serum.
(For Bedford the contact numbers are nurses 01234 792651, reception 01234
792652; outside clinic hours attend the A&E's where a blood test will be
(For Bedford the contact numbers are nurses 01234 792651, reception 01234 792652; outside clinic hours attend the A&E's where a blood test will be taken)
Growth factors (e.g. Neupogen, Neulasta) are sometimes used, as well as antibiotics, to treat prevent infection and increase the white cell count ready for the next cycle. This usually involves a subcutaneous injection given once or up to 10 consecutive days after the chemotherapy administration. These can cause additional aches and pains in the bones. Many patients learn to self inject these them instead of having to wait for the district nurse to visit.
Diet and chemotherapy As a general rule it is important to maintain a healthy diet and lifestyle during chemotherapy. Make an effort to increase the amount of fresh fruit and vegetables (washed). An exception being if you are taking chemotherapy agents (eg 5 fluorouracil, irinotecan) that can cause diarrhoea - in that case the amount of fibre and fruit may need to be reduced while your have diarrhoea.
standard chemotherapy regimens no specific dietary measures are required.
is generally important to avoid foods which are likely to
contain infective materials. The risk of infection
also depends on how foods are prepared. More
care needs to be taken when eating out and to ensure all foods have not passed
their shelf life.
In general dry food e.g. biscuits, breakfast cereals, can be resealed or stored in
a sealed container for up to one week.
Whereasmoist foods e.g. milk, desserts - should be refrigerated and consumed within 24 hours.
Extra care needs to be used when receiving chemotherapy regimens which are likely to cause a prolonged period of a low white count. While the neutrophil count is low, the body is more vulnerable to infection (i.e. neutrophils <0.5). A detailed detailed dietary advise sheet is available in this situation.
Some chemotherapy agents do cause hair loss.
You will be told the likelihood of this happening to you It usually
starts 3-4 weeks after the first course and may be lost completely. You may also
experience thinning and loss of eyelashes, eyebrows and other body hair. This is
temporary and your hair will re-grow after treatment, although it may at first be
a different texture, very like a baby's hair. Some departments use a cold
cap system to minimise hair loss. Your clinic nurse can arrange
for you to have a wig before your treatment starts (NHS prescription charge,
prices are approximately £55 for an acrylic wig, £140 for half real
hair wig and £205 for a full real hair wig).
Some tips for coping with hair loss include:-
care You may have a sore mouth after chemotherapy
or radiotherapy and it is important that you maintain good oral
Some tips to prevent mouth problems include:
Some tips to treating a painful mouth include:
Your veins Three types of damage can occur, The first two are relatively common and although annoying are not particularly serious. The third called extravasation is urgent and should be taken very seriously
You may experience darkening of the veins in your hands and arms. This is normal, usually doesn't hurt and should fade once your course of treatment has been completed. Very gentle massage with natural oils is sometimes helpful combined with regular exercise of the hands an fingers (ie opening and closing a fist and with the hands flat, opening and closing the fingers)
Towards the end of your chemotherapy course, some veins may feel hard and 'cord-like'. In these veins the blood has clotted (superficial thrombosis) which may take several months to resolve. Your doctor may recommend a low dose of aspirin (ask before taking it yourself).
These chemotherapy drugs can cause irritation and tissue damage if they leak out of the vein whilst injected. This is called extravasation. All nurses who administer chemotherapy have completed an intensive training programme and are fully aware of what to do if extravasation occurs. Rarely problems can start after you have left the Hospital. Look out for pain, stinging or burning sensations, redness or swelling around the area where the chemotherapy was given. If you notice any of these symptoms after you have left the Hospital, contact the emergency numbers you have been given. In the meantime, keep the arm raised and place a cool (not ice) pack on the area.
Sexual issues For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent causing menopausal symptoms. You should not become pregnant during chemotherapy, as chemotherapy will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant. It is not possible to catch cancer from your partner during sexual contact.
Exercise It is a misconception that exercise should be avoided following a diagnosis of cancer. There are several good reasons why exercise is often helpful.
Cancer and certainly its therapies often cause fatigue. Light and stimulating exercise can help to reduce this. This has to carefully balanced. Although plenty of rest is important, between these times it is better to be active. For example a sleep after lunch may be required but then it would be useful to put on a pair of training shoes and go for walk in the open - preferably in pleasant stimulating surroundings such as a park or riverbank. Although this seems a great effort at first, patients often find their overall levels of fatigue are reduced.
Cancer and its therapies increase the risk of thrombosis - particularly if there is any disease in the pelvis or lower abdomen. On top of this if patients are less active this further increases the risk. Regular exercise cause the blood to be pumped through the veins and reduce the risk of it stagnating and clotting in the veins.
The steroids often given with cancer therapies can often cause osteoporosis ( thinning of the bones). Exercise by far is the best way of keeping the bone strong and healthy.
Steroid can also cause muscle weakness - again light exercise can make the muscles stronger.
Many patients (particularly women) put on weight during cancer therapies. Steroids are one reason, hormone therapies such as tamoxifen are another. Both are exacerbated by lack of exercise. Clearly regular light exercise will reduce the risk of weight gain.
Nausea can be a problem with some cancer therapies. If it is mild sometimes an walk or gentle run can do wonders.
Your Bowels Some patients experience constipation which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP. Other chemotherapy agents can cause diarrhoea - it is important to know if this is likely to happen to you - in this case the amount of fruit and vegetables will need to be reduced if diarrhoea develops. As a general rule don't cut back on fruit & veg. until diarrhea develops.
Normal sleep can be disturbed during chemotherapy. Patients understandably worry
at night and often chemotherapy is given with steroids (eg Dexamethasone)
to help prevent sickness. Steroids often cause wakefulness and
sometimes agitation. Try to keep a regular sleep pattern.
Some tips to help sleep:
Discontinuing or reduce the use of caffeine, alcohol and nicotine.
Avoid drinking large amounts of liquids prior to bedtime
Avoid hunger or excessive eating prior to bedtime
Avoid taking daytime naps.
Establish a regular pattern of sleeping - set a time to go to bed & when to wake up.
Sleep only as much as you need to feel rested.
Go to bed only when you are sleepy
If you are unable to fall asleep within 20 - 30 mins
leave the bed and
perform a relaxing activity until drowsy and ready for sleep.
Exercise routinely but do not exercise within 3 hours of bedtime.
Engage in a quiet relaxing activity before bedtime
Do not watch TV or read in bed
Avoid temperature extremes, noise and light when in beds.
Ensure room is dark - use black out curtains if necessary
Risk of Blood Clots
Some tips to help avoid clots:
Stop smoking (if relevant)
Avoid long periods of immobility (one memorable patient recently developed a pulmonary embolus after being stuck on a motorway in a traffic jam!)
Avoid being overweight - of course, very little can be done to achieve a substantial weight reduction but try to walk briskly at least 20 minutes every day
It’s important to get the blood pumping as much as possible through the
veins. General exercises such as walking, running, cycling and dancing as
will increase the blood flow but exercising the arm and hand is even more
Ask your doctor if you could take a low dose of aspirin
Working during treatment Some people like to carry on working during their treatment, either full-time or part-time. Some people need to carry on working as much as possible for financial reasons. Before treatment, it is often difficult to know exactly how the treatment may affect you and it is helpful to let your employer know this, so that they are aware you may need to change your work plans at short notice. Some people choose to give up work completely during their treatment but this depends on many factors including you side effects, treatment logistics, type of work and motivation to work.
You may also
need to take time off during your treatment. This time off may be taken as
sickness absence, or an agreed reduction in working hours or days per week. If
this is the case you may need details regarding sick
pay and benefits.
helpful to talk about your need for time off with your employer so that they can
support you in the best way possible.
helpful to talk about your need for time off with your employer so that they can
support you in the best way possible.
If you are
self-employed and you cannot work due to illness, you are entitled to Incapacity
Benefit as long as you have been paying the correct national insurance
specific rules for calculating the income of self-employed people and
entitlement to certain benefits differs from that of an employee, especially in
the case of Jobseeker's Allowance and Income Support. Depending on
your particular circumstances, the benefits you may be eligible to claim include
Housing/Council Tax Benefit, Working/Child Tax Credits, NHS Benefits, Incapacity
Benefit, Disability Living Allowance, and Attendance Allowance.
Driving In general most patients can drive during chemotherapy and radiotherapy with some notable exceptions:
If you are a professional driver, (i.e. HGV,
PSV(Bus), Taxi, Fireman, Policeman or Ambulance driver), you may not be allowed
to drive. This may be a temporary ban
while undergoing treatment or a permanent ban due to the site of your cancer.
Please ask your doctor or a member of the Primrose Oncology nursing staff if you
Driving for personal use is allowed for most people with cancer. The exceptions are if you have a brain tumour, brain metastases or are prone to fitting, when driving may be banned permanently or for a given period of time. This is a regulation made by the licensing authorities, not a decision made by the doctor. Driving under the effects or side effects of a drug, in particular Morphine, is an offence. Occasionally the DVLC will allow a patient to drive if they are on a stable dose but permission must be obtained from the DVLC.
If the doctor advises you not to drive,
please take his/her advice and bear in mind that if you ignore this advice your
driving will not be covered by your insurance policy. Also your
driving insurance premium may be raised. This will depend on the site of your
cancer - Driving insurance will be refused if you have been advised
Travel If you are planning a holiday please discuss it with your doctor. For detailed information refer to our travel advice sheet.
Some treatments can be adjusted to take account of this, but others cannot.
Some treatments may put you at risk of infection and would be best advised to not travel outside of the UK.
Speak to your doctor in clinic.
Speak to your doctor in clinic.
Travel insurance Some high street travel insurance companies will give you medical
insurance as long as you have a certificate from your doctor saying you are fit
enough to travel. You should be able to make claims on your insurance for
emergency medical care abroad, even if that treatment is necessary because of
your cancer. But to claim, you must have told them about the cancer when you
applied for the cover. If they have knowingly taken this risk, they must
pay according to the policy.
If you have had treatment for cancer during the 12 months before your trip, many high street travel insurance companies will only insure you for treatment or emergencies unrelated to your cancer. So you can get travel insurance, but if you need treatment as a result of the cancer, you will have to pay for it yourself.
You should be able to claim for emergency medical care abroad, even if that
treatment is necessary because of your cancer. Again, this depends on you
disclosing your medical history fully to the insurance company when applying for
the cover. If they have knowingly taken the risk, they must pay according
to the policy.
The policies of travel insurance companies can be many and varied: some offer more appropriate cover than others. Be sure to shop around and check your policy carefully.
Holiday insurance can be a problem as many policies will not cover you for an existing illness, even if you feel well enough to travel. This may affect the cancellation cover and cover for sudden illness while you are away.
Financial issues and Insurance Existing mortgages and house insurance premiums are not normally affected by having cancer. If you are hoping to take out a new mortgage then the Bank/Building society may require further information about your cancer and treatment before giving you a loan. Obtaining new Life Insurance may be difficult so you are advised to discuss this with your doctor before applying.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.