Chemotherapy - General Instructions
Chemotherapy is the use of medication to kill or stop the growth of cancer cells. The medications travel throughout your body or system and thus are called “systemic” treatments. The drugs are most often injected into the bloodstream through an intravenous needle in your arm or a special catheter. Chemotherapy is usually given in what is termed “cycles” during which you have treatments for a short time and then you have 3 to 4 weeks off before beginning another “cycle.”
Chemotherapy is often used in combinations with other therapies to treat breast cancer. Each person’s reaction to chemotherapy is unique. Let’s discuss common side effects, and more importantly, how to manage these side effects. You will also be given handouts on the specific chemotherapy drugs you will be receiving.
Effect on blood cells
Most anticancer drugs cause a decrease in the number of blood cells within the bone marrow. There are white blood cells, red blood cells and platelets. White blood cells (WBCs) help your body fight infection. Red blood cells (RBCs) carry oxygen. Platelets help your blood to clot.
The normal WBC is 4.5 – 11.0 K/UL. Chemotherapy drugs cause the WBC to decrease after each treatment. The decrease begins slowly after treatment and usually reaches the lowest point 7-14 days following treatment. When the WBC decreases, and especially when it is at its lowest point, you may develop an infection. Most infections come from the normal bacteria found within the person’s own body. Antibiotics, and rarely, hospitalization may be required. The most important thing you can do is to wash your hands frequently. A face mask is not required, and you can continue all normal activities of daily living that you choose.
Call your physician immediately with a fever greater than 100.5°F
Other signs and symptoms of infection may include:
- Shaking, chills
- Loose bowels, diarrhea
- Sore throat and/or mouth sores
- Shortness of breath, difficulty breathing
- Coughing with or without mucous production
- Urinary changes – frequency, burning, pain
- Any area with redness or swelling
Increased tendency to bleed
The normal platelet count is 150-400 K/UL. When the platelet count decreases, bleeding may occur. The bleeding may be noticed on your skin (bruising, pinpoint dots) or from your nose, mouth, rectal or vaginal areas. Notify your physician with any evidence of bleeding. Low platelet counts are very uncommon with chemotherapy used to treat breast cancers.
Anemia / Fatigue / Weakness
When we speak about the red blood cell count, we refer to hemoglobin and hematocrit. The normal levels are:
Hemoglobin – 12-16 G/DL for adult females
Hematocrit – 37-47 percent for adult females
When the RBC decreases, anemia may result. Be aware of the signs and symptoms of anemia including:
- Weakness, fatigue, listlessness
- Headache, dizziness
- Palpitations or racing heartbeat
- Shortness of breath, difficulty breathing
Nausea and vomiting
Nausea (feeling sick to your stomach), vomiting (throwing up), and/or anorexia (decreased appetite) may happen with your chemotherapy. Nausea and vomiting (if they occur) usually begin the day of treatment and can last for 1-3 days after chemotherapy. In addition to taking your prescribed anti-nausea medicines, you can try:
- Eating foods and drinking beverages that made you feel better when you had the flu, or had morning sickness. These might be bland foods, dry crackers, rice, applesauce, ginger ale, or flat soda.
- Eat foods at room temperature or cold.
- Eat 5-6 small frequent meals.
Hair loss (alopecia)
Alopecia (hair loss) is a common side effect with chemotherapy. Hair loss is noted primarily in the scalp hair; other body hair is less frequently lost. Hair loss typically begins 2-3 weeks after the first chemotherapy treatment. Options for handling this side effect include wearing wigs, scarves, or other head coverings. Some women prefer to cut their hair short when hair loss begins. Re-growth of hair usually begins 6-8 weeks after the completion of chemotherapy.
Mouth sores (stomatitis)
Chemotherapy treatments can sometimes cause stomatitis (mouth sores) and esophagitis (sore throat). Problems you may experience include: ulcers in the mouth, dryness of the mouth, pain, infection, bleeding, and difficulty swallowing. If you are receiving chemotherapy that is likely to cause mouth sores, we will ask you to eat ice during the treatment to decrease the chance for mouth sores.
If you begin to develop mouth sores, rinse your mouth with a salt/soda solution (1 tsp. salt, 1 tsp. baking soda, 1 qt. water) or a hydrogen peroxide solution (1 part hydrogen peroxide to 3 parts water) every 2 hours for 1-2 minutes.
If you notice white patches in your mouth or are having difficulty eating, call your physician.
Diarrhea or constipation
Diarrhea may occur. If you have 4 or more loose stools in 24 hours, call your physician. Constipation may occur with chemotherapy or may be related to the anti-nausea medications you are taking. To help with management, include foods with bulk and increase your fluid intake. Over-the-counter medications may be used including stool softeners and milk of magnesia.