Symptoms and Side Effects

Loss of appetite is a common side effect of cancer and its treatment (chemotherapy and radiation therapy).

Tips for dealing with a loss of appetite:

• Eat small, frequent meals and include your favorite foods.
• Add snacks in between meals or add a milkshake for added nutritional benefit.
• Try light exercise one hour before meals.
• Vary your diet.
• Consider Meals on Wheels or other community programs.

Call your provider if you are eating less than half or less of what you usually eat for more than a week.

Your bladder and kidney can be irritated or damaged by some chemotherapy drugs.

Tips for dealing with bladder or kidney problems:

• Drink at least one to two quarts of non-caffeinated, non-alcoholic fluids a day, unless otherwise instructed by your provider.
  • Examples of fluids include water, juice, de-caffeinated coffee and tea, de-caffeinated soft drinks, popsicles, jello, yogurt, broth, and ice cream.

Call your provider if you develop any of the following symptoms:

• Pain or burning when you urinate, or frequent urination
• Change in color or odor of urine
• Blood in urine
• Change in the amount your urinate
• Change in the number of times you urinate
• Loss of bladder control
• Lower back pain

If the lungs cannot take in enough air, you may have trouble breathing. This may result from a variety of causes, including side effects of chemotherapy, or radiation therapy, stress, pain, and other reasons.

Tips for coping with breathing problems:

• Remain calm.
• Elevate the head to a 45° angle by raising bed or using pillows; do not lie flat.
• Take the prescribed medication for breathing difficulty, including oxygen if ordered by your provider.

Call your provider RIGHT AWAY or call 911 if you are experiencing any of the following:

• Shortness of breath
• Hard time breathing
• Change in breathing (faster or slower, deeper breaths or more shallow breaths)
• Pain in your chest
• Cough
• Change or increase in sputum (note the color, thickness/thinness, odor and amount of sputum)

Constipation may cause cramping, bloating, loss of appetite, stomach or back pain and nausea. Surgery, inactivity, a change in eating or drinking habits, and some medications may cause constipation.

Tips for preventing constipation:

• Keep a record of your bowel movements daily.
• Drink at least one or two quarts of non-caffeinated, non-alcoholic fluids a day, unless otherwise instructed by your provider.
• Exercise regularly. Talk to your doctor about the right balance of exercise for you.
• Eat a well-balanced high fiber diet.
• Take the prescribed/over-the-counter medications indicated by your provider.
• Only use suppositories or enemas during chemotherapy treatment if prescribed by your provider.

Call your provider if you develop any of the following symptoms:

• No bowel movements for two to three days over your usual routine, including abdominal pain or cramping
• Pain or discomfort when passing stool

Diarrhea is three or more watery stools in a 24-hour period. It can be caused by infections, some medications and treatments, or tension and stress that can result in weakness, dizziness, thirst or decreased urine output.

Tips for combating diarrhea:

• Keep a record of your stools.
• Drink at least one or two quarts of non-caffeinated, non-alcoholic fluids a day, unless otherwise instructed by your provider.
• Eat small, frequent meals.
  • Avoid eating hot or very cold liquids
  • Avoid eating fried, fatty, or greasy foods
  • Avoid dairy products
  • Avoid carbonated fluids
  • Try the "BRAT" diet - bananas, rice, applesauce, & toast
• Anxiety or worrying can make your diarrhea worse.
• DO NOT take anti-diarrheal medication without checking with your provider first.

Call your provider if you develop:

• Three watery or loose stools in a 24-hour period.

The symptoms of dehydration include: dry mouth, skin appearing loose or "crinkled", thick saliva, little or no urine, and dark-colored urine. Severe dehydration can cause confusion, and dizziness or feeling faint when changing position. It can be caused by vomiting, diarrhea, poor fluid intake, fever, and bleeding.

Tips for dealing with dehydration:

• Drink at least one to two quarts of non-caffeinated, non-alcoholic fluids a day, unless otherwise instructed by your provider.
• Continuously replenish fluids by carrying a water bottle to sip on or sucking ice chips throughout the day.
• Take your medication to prevent nausea, vomiting, and diarrhea.

Call your provider if you develop:

• Any of the above symptoms, including an inability to drink or keep fluids down for 12 hours.

Call your provider if any of these symptoms start suddenly or do not go away:

• Tenderness
• Swelling
• Dryness
• Discharge
• Change in vision

Cancer and medical treatments such as chemotherapy, radiation therapy, and surgery can cause fatigue. Cancer-related fatigue can cause you to feel week and lose interest in people and daily activities. Symptoms can be physical, psychological, or emotional. Your tiredness is not related to physical activity or how well you did or did not sleep.

Tips for dealing with cancer-related fatigue:

• Exercise daily - talk to your doctor about how much is right for you.
• Group daily activities at a time of day when you have the most energy. Take short walks or do any form of light exercise daily.
• Get plenty of rest.
• Keep a regular daily routine that is reasonable.
• Drink plenty of fluids.
• Eat well-balanced meals.

Call your provider if you develop any of the following symptoms:

• Weariness or exhaustion, and/or inability to get out of bed for 24 hours.
• Difficulty completing normal activities, such as eating or shopping.
• Feelings of inability to cope with life, stress or daily tasks.

Fever is a sign of infection. Cancer treatments, such as chemotherapy and surgery, can make you susceptible to infection. You will need an oral digital thermometer for home use. Any oral temperature greater than 100.4° is considered a fever. Take your temperature twice per day (unless otherwise directed by your physician) AND any time you feel chilled, hot or sick.

Call your provider RIGHT AWAY:

• If your fever is 100.4° or higher. DO NOT TAKE MEDICINE TO LOWER YOUR TEMPERATURE UNLESS YOUR DOCTOR TELLS YOU IT IS OK.
• If you are having shaking, chills, and/or any signs and symptoms of infection, such as diarrhea, cough, painful urination, etc.

Some people experience hair loss (or mild thinning of the hair) from taking certain chemotherapy medications. This may occur 2-3 weeks after the start of your treatment. Hair loss is temporary and almost always begins to grow back approximately 3 months after chemotherapy is completed, though your hair may be a different color or texture.

Tips for dealing with hair loss:

• Use mild shampoos
• Use a soft-bristle hairbrush
• Don't dye your hair or get a permanent
• Cut your hair short.
• Protect your scalp from the sun using sun block, a hat, or wig.

Some chemotherapy medications may affect your heart and circulatory system.

Call your provider RIGHT AWAY if you experience any of the following:

• Chest pain
• Sudden onset of shortness of breath or difficulty breathing
• Heart palpitations
• Fluttering (may feel like "butterflies" in the chest)
• Irregular heartbeat or rhythm
• Swelling of the hands and feet

Usually chemotherapy medications are administered through an IV route. IVs can be inserted into veins in the arm or through a device implanted into the large vein in the chest wall. These sites may pose a risk of infection and must be monitored carefully.

Call your provider RIGHT AWAY if you experience any of the following:

• Redness
• Pain
• Swelling
• Discharge
• Tenderness
• Leaking catheter
• Catheter has accidentally been pulled out
• Difficulty flushing catheter

Low-Normal range for hemoglobin is 11.2-15.7; hematocrit is 34-35. Low hemoglobin count is 8.0 or less. Red blood cells are cells made in the bone marrow that are made up of hemoglobin and hematocrit. Hemoglobin is part of the red blood cell made up of iron that carries oxygen through the bloodstream. Hematocrit makes up the rest of the red blood cell. When the cells are low, you are anemic.

Signs of anemia:

• Increased weakness and tired sensation
• Increased shortness of breath/winded with activity or rest
• Chest pain, fast heartbeat with or without activity
• Unable to carry out your usual Activities of Daily Living (ADLs)
• Dizziness or lightheadedness when you change positions quickly
• Skin may be paler than normal

Tips for dealing with signs of anemia:

• Plan rest periods to save energy/Get enough rest and sleep.
• Take offered help from family/friends with meals and housework.
• Plan consistent periods of active exercise - i.e. short walks
• Get up slowly from lying or sitting, bend over slowly
• Your provider will decide if you need any medications or blood transfusions

Call your provider RIGHT AWAY if you experience any of the following:

• Dizzy/lightheaded, fainting feeling when changing positions
• More short of breath than usual at rest or with activity
• Fast heartbeat with or without activity
• Chest pain
• Any bleeding - in stool, urine, vaginal, nosebleeds, vomit

Normal range is 145,000 - 370,000. Platelets are blood cells in your bone marrow that help your blood clot. When your platelets are low (50,000 or less) you may bleed and/or bruise easily. The blood test that measures the number of platelets in your body is called "platelet count."

Signs that your platelets are low:

• Bruising
• Purple/red dots on your skin that look like a rash - this is called petechiae
• Bleeding that does not stop easily (nosebleeds, bleeding gums)
• Blood in: urine and/or stool; vomit (coffee ground color); or heavy vaginal bleeding
• Sudden headache, change in vision/speech, weakness on one side of your body, or facial drooping

Tips for dealing with low platelet count:

• Avoid aspirin or any medications containing aspirin (Ibuprofen, Aleve, Advil, & Naprosyn).
• Floss gently. Use a soft-bristled toothbrush, no toothpicks.
• Protect yourself from cutting or bruising your skin.
• Blow your nose gently.
• Avoid constipation by eating fruits and vegetables, whole grains, and drinking a lot of fluids.
• Use alcohol-free mouth washes.
• Electric razors only.
• Obtain providers approval before having any dental work done.
• Females: use lubricating jelly, no sexual intercourse if platelet count is less than 50,000.

Call your provider RIGHT AWAY if you experience any of the following:

• A fall or you experience trauma
• A headache, change in level of consciousness, and/or blurred vision, dizzy or lightheadedness
• Nose bleeds, bleeding gums that do not stop after 5 minutes of pressure
• Bruises/Pinpoint-sized clusters or red bumps on any area(s) of the skin - called petechiae
• Blood in urine or stool - blood tarry bowel movements
• Blood in vomit and/or coffee ground colored

Normal range is 4.0-10.0 or 4,000 - 10,000. Absolute Neutrophil count = 500 or less. Neutropenia is a white blood cell count that is less than 5,000. White blood cells are made in the bone marrow; the soft tissue in the center of many of our bones. Their purpose is to fight infection. Chemotherapy, radiation therapy and certain diseases can affect the bone marrow and cause a decrease in white blood cells. When you have a low number of white blood cells, you are prone to infections.

Signs that your White Blood Cells (WBCs) are low:

• WBC less than 5,000
• Fever of 100.4° or above.
• Discolored nasal or sputum drainage
• Burning on urination, urinary frequency, urgency
• Diarrhea
• Chills, shakes
• Redness and swelling to affected area, IV site, cuts, scrapes

Tips for preventing an infection:

• Monitor temperature at least once daily if you are not feeling well.
• Avoid crowds, people who are sick with the flu, colds, chicken pox, children who have not received the chicken pox vaccine, and other infections or contagious diseases.
• Ask your provider before getting any vaccines.
• Frequent hand washing.
• Brush your teeth with a soft-bristle tooth brush.
• Wash all fruits and vegetables under cold water.
• Protect your skin from cuts and scratches.
• Do not clean up after your pets (litter box or animal cages).
• Avoid gardening or digging in the dirt.
• Avoid fresh flowers.
• Females: Do not use tampons during your menses, no bubble baths or vaginal douches.

Call your provider RIGHT AWAY if you experience any of the following:

• Temperature of 100.4° or greater, with or without chills/shakes.
• New, dry or moist cough raising discolored sputum and/or discolored nasal discharge.
• Diarrhea
• Sore throats, hard time swallowing, white or red patches, discolored drainage.
• Skin rash, IV site redness, swelling, tenderness, discharge.

Lymphedema, or swelling caused by fluid buildup in the soft tissue, can be the result of radiation therapy or surgery. The main symptoms of lymphedema is constant swelling in the hand, foot, arm, or leg.

Tips for dealing with lymphedema:

• Keep your arm or leg raised above the level of your heart.
• Wash your skin at least once a day and apply lanolin cream.
• Avoid injuries or infection.
• Avoid putting pressure on the affected limb.
• Try gentle massage to increase comfort and improve circulation.

Call your provider RIGHT AWAY if you experience any of the following:

• Your arm(s), or leg(s) swell.
• You observe redness.
• You experience pain, heat, or fever.

Chemotherapy can cause your mouth to be a common source of complications, therefore, daily mouth care is important. A clean mouth may prevent or lessen some complications arising from cancer treatment. Chemotherapy can cause a change in your taste buds.

Tips for mouth care:

• Use a soft-bristled toothbrush after eating, avoid using toothpicks, and be gentle using dental floss (avoid flossing if platelets are low).
• Rinse your mouth four times per day with an 8oz glass of warm water and 1 teaspoon of baking soda.
• For dryness, try sucking on ice chips.
• Use lip moisturizer.
• Avoid commercial mouthwashes that are alcohol-based.
• If you wear dentures, remove them before going to sleep and place them in warm water.
• Avoid citric juices or foods containing citric acid, tomatoes, oranges, lemons.
• Check with your provider before scheduling dental work.

Call your provider if you develop any of the following symptoms:

• Dryness, soreness, redness, bleeding or painful teeth or gums
• Difficulty eating or swallowing
• White or red patches
• Ulcers (open sores), blisters

Cramps and spasms are painful tightening of the muscles. Dehydration, certain drugs, and various chemical imbalances in the blood can be the cause.

Tips for coping with leg cramps:

• Change position often.
• Exercise legs in bed by bending and straightening legs frequently.
• Keep warm.
• Contract the opposite muscle groups if you can.

Call your provider if any of these symptoms start suddenly or do not go away:

• Pain or swelling
• Muscle cramps
• Stiffness
• Difficulty walking or standing

Chemotherapy can frequently cause nausea and vomiting - DO NOT WAIT to see if the feeling passes. Take your prescribed anti-nausea medications. Some other potential causes of nausea include anxiety, constipation, dehydration, and pain medications.

Classifications:

• Anticipatory: nervousness, smells, sights, and sounds trigger nausea and vomiting
• Acute: occurs within 24 hours after receiving treatment
• Delayed (late): occurs more than 24 hours after receiving treatment
• Chronic: continuous, often related to advanced cancer

Tips for coping with nausea and vomiting:

• Eat small, frequent meals. Avoid foods that are spicy and/or greasy. Eat bland soft foods.
• Eat cold food or at room temperature to avoid triggering smells.
• Eat slowly, and do not force yourself to eat when you feel nauseous.
• Try some form of distraction, listening to music, watching TV, massage, reiki, slowly deep breaths or whatever relaxes you.
• Take your prescribed anti-nausea medications on time.
• Drink liquids such as ginger ale and fruit juice, clear soup, and caffeine-free teas.
• Apply cool cloths to your forehead and back of your neck.

Call your provider if you experience any of the following symptoms:

• Nausea/vomiting not relieved by anti-nausea medication OR if you are unable to keep your medications, food or fluids down.
• Vomiting (3 or more times per day or not relieved by medication)
• If you become dizzy or lightheaded
• Blood in your vomit
• Decreased amount or dark colored urine
• Pain or swelling in your abdomen

Chemotherapy can cause what is referred to as "chemo brain", which includes short-term memory loss, lack of recall ability, unable to focus and maintain concentration. This may resolve in the months after chemotherapy completion. Some drugs can cause peripheral neuropathy, a tingling/burning, or weakness/numbness in your hands and feet. If these symptoms persist, please notify your provider as you may benefit from seeing a specialist.

Tips for coping with peripheral neuropathy:

• If your fingers are numb, be careful handling sharp, hot or otherwise dangerous objects.
• If your balance is affected, move with care, use handrails, and be sure to use a bath mat in the tub or shower.
• Protect affected areas where sensation is decreased. Wear thick socks and soft-soled shoes.
• Avoid extreme temperature changes.
• Wear warm clothing in cold weather, protect feet and hands from the cold.
• Use gloves when washing dishes, gardening, or cleaning.
• Monitor affected areas daily for cuts, abrasions, sores, and burns.

Tips for coping with Memory Loss:

• Keep a journal, diary, list, or calendar accessible to refer to.
• Try to form a daily routine and stick to it.
• Exercise your memory with crossword puzzles, reading, games, etc.
• Avoid distractions.
• Ask people to repeat themselves.
• Get plenty of sleep.
• Increase your physical activity.

Call your provider if any of the following appear as new symptoms, and they last for more than a few hours:

• When numbness, tingling, burning begins and/or prolonged tingling in feet, toes, hands or fingers (feels like pins and needles).
• Uncontrolled pain.
• Difficult picking up items located on a flat surface, buttoning or unbuttoning clothing.
• Headache, dizziness, lightheadedness, loss of balance, or difficulty walking.
• Blurred/Change in vision.
• Inability to think or speak clearly.
• Stiff neck.
• Change in wakefulness.

There are many types of medications and ways of relieving pain. You do not have to live with pain as a normal response to cancer.

Tips for coping with pain:

• Talk with your provider or nurse about your pain and about alternate methods of relieving pain, such as relaxation, biofeedback, acupuncture, physical therapy, etc.
• Take your pain medication on a regular schedule and do not skip doses.
• If your pain is not relieved, ask your doctor about changing your pain medication.

Call your provider if you have pain that begins suddenly or does not go away.

• Be ready to tell your doctor about your pain:
  • When does it happen?
  • Where do you feel it?
  • How long does it last?
  • What causes your pain?
  • What takes the pain away?
• Be able to describe your pain in terms, such as:
  • Burning
  • Throbbing
  • Tingling
  • Shooting

Cancer treatment can cause decreased sexual function. Chemotherapy can reduce the number and mobility of a man's sperm. This can cause temporary or permanent infertility, but it does not affect sexual intercourse. For women, chemotherapy can affect the ovaries and reduce the amount of hormones they produce.

Tips for coping with sexual dysfunction:

• Women may experience menopause symptoms. Vaginal dryness can be relieved using a water-base vaginal lubricant and/or vaginal moisturizer.
• Men should use an effective means of contraception during treatment because chemotherapy can harm sperm cells.
• Because permanent sterility can occur, men may want to bank sperm for future use.

Call your provider if you:

• Have questions about preventing vaginal infections, which are more likely during chemotherapy.
• Are considering pregnancy, or becoming pregnant.

The cause of skin problems are often unknown, but may be related to medications, IV access, side effects or chemotherapy, and radiation.

Call your provider if you develop any of the following symptoms:

• Redness
• Swelling
• New rash
• Itching
• Bruising
• Soreness
• Tender areas

Cancer treatment can result in weight changes. Loss of taste, decreased appetite, vomiting, nausea, and diarrhea can cause weight loss. Certain medications, decreased activity, water retention, and increased appetite can cause weight gain.

Tips for coping with weight loss:

• Drink more fluids.
• Eat high-protein foods.
• Ask your provider of nurse to refer you to a Dietician.

Tips for coping with weight gain:

• Limit fluid and salt if ankles are swollen.
• Limit high calorie foods.
• Ask your provider or nurse to refer you to a dietician.

Call your provider if you develop any of the following symptoms:

• Weight loss or gain of more than 2 pounds in one week
• Shortness of breath
• Dizziness