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Support for People with CancerChemotherapy and YouU.S. Department of Health & Human Services National Institutes of Health

About this BookChemotherapy and You is written for you—someone whois about to receive or is now receiving chemotherapy forcancer. Your family, friends, and others close to you mayalso want to read this book.This book is a guide you can refer to throughoutyour chemotherapy treatment. It includes facts aboutchemotherapy and its side effects and also highlightsways you can care for yourself before, during, and aftertreatment.Rather than read thisbook from beginning toend— look at only thosesections you need now.Later, you can alwaysread more.This book covers:Î Questions and answers about chemotherapy. Answers common questions, suchas what chemotherapy is and how it affects cancer cells.Î Side effects and ways to manage them. Explains side effects and other problemsthat may result from chemotherapy. This section also has ways that you and yourdoctor or nurse can manage these side effects.Î Tips for meeting with your doctor or nurse. Includes questions for you to thinkabout and discuss with your doctor, nurse, and others involved in your cancer care.Î Ways to learn more. Lists ways to get more information about chemotherapy andother topics discussed in this book—in print, online, and by telephone.Talk with your doctor or nurse about what you can expect during chemotherapy. He orshe may suggest that you read certain sections of this book or try some of the ways tomanage side effects.The Use of Product or Brand NamesProduct or brand names that appear in this book are for example only. The U.S. Government does not endorseany specific product or brand. If products or brands are not mentioned, it does not mean or imply that they arenot satisfactory.1-800-4-CANCER (1-800-422-6237)

Table of ContentsQuestions and Answers about Chemotherapy . 1Tips for Meeting with Your Doctor or Nurse . 8Your Feelings during Chemotherapy . 10About Side Effects . 12List of Side Effects . 13Anemia . 14Appetite Changes . 16Bleeding . 18Constipation . 20Diarrhea . 21Fatigue . 23Hair Loss . 25Infection . 27Infertility . 30Mouth and Throat Changes. 32Nausea and Vomiting . 35Nervous System Changes. 37Pain . 39Sexual Changes . 41Skin and Nail Changes . 44Urinary, Kidney, or Bladder Changes . 47Other Side Effects . 48www.cancer.govi

Foods to Help with Side Effects . 49Clear Liquids . 49Liquid Foods. 50Foods and Drinks that Are High in Calories and Protein . 51High-Fiber Foods . 52Low-Fiber Foods . 53Foods that Are Easy on a Sore Mouth. 54Foods that Are Easy on the Stomach. 55

Questions and Answers about ChemotherapyWhat is chemotherapy?Chemotherapy (also called chemo) is a type of cancertreatment that uses drugs to destroy cancer cells.How does chemotherapy work?Chemotherapy works by stopping or slowing the growth of cancer cells, which grow anddivide quickly. But it can also harm healthy cells that divide quickly, such as those that lineyour mouth and intestines or cause your hair to grow. Damage to healthy cells may causeside effects. Often, side effects get better or go away after chemotherapy is over.What does chemotherapy do?Depending on your type of cancer and how advanced it is, chemotherapy can:Cure cancer—when chemotherapy destroys cancer cells to the point that your doctor canno longer detect them in your body and they will not grow back.Control cancer—when chemotherapy keeps cancer from spreading, slows its growth, ordestroys cancer cells that have spread to other parts of your body.Ease cancer symptoms (also called palliative care)—when chemotherapy shrinks tumorsthat are causing pain or pressure.How is chemotherapy used?Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will getchemotherapy along with surgery, radiation therapy, targeted therapy, or immunotherapy.Chemotherapy can:Î Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvantchemotherapy.Î Destroy cancer cells that may remain after surgery or radiation therapy. This is calledadjuvant chemotherapy.Î Help radiation therapy and immunotherapy work better.Î Destroy cancer cells that have come back (recurrent cancer) or spread to other parts ofyour body (metastatic cancer).www.cancer.gov1

How does my doctor decide which chemotherapy drugs to use?This choice depends on:Î The type of cancer you have. Some types of chemotherapy drugs are used for many typesof cancer. Other drugs are used for just one or two types of cancer.Î Whether you have had chemotherapy before.Î Whether you have other health problems, such as diabetes or heart disease.Where do I go for chemotherapy?You may receive chemotherapy during a hospital stay, at home, or in a doctor’s office, clinic,or outpatient unit in a hospital (which means you do not stay overnight). No matter whereyou go for chemotherapy, your doctor and nurse will watch for side effects and make anyneeded drug changes.Home Safety after Chemotherapy TreatmentsAfter receiving chemotherapy, you and your caregivers need to take special care to preventcontact with your body fluids. These fluids include urine, stools, sweat, mucus, blood, vomit,and those from sex. Your doctor or nurse will suggest home safety measures that you andyour caregivers should follow, such as:Î Closing the lid and flush twice after using the toilet.Î Sitting on the toilet to urinate, if you are male.Î Washing your hands with soap and water after using the restroom.Î Cleaning splashes from the toilet with bleach wipes.Î Using gloves when handling body fluids and washing your hands after removingthe gloves.Î Wearing disposable pads or diapers if incontinence is an issue and wearing gloveswhen handling.Î Washing linens soiled with body fluids separately.Î Using condoms during sex.The length of time that you and your caregivers need to follow these guidelines mightdiffer depending on the policy where you receive treatment and the drugs that you receive.Your doctor or nurse will tell you how long you and your caregivers need to practice thesesafety measures.21-800-4-CANCER (1-800-422-6237)

How often will I receive chemotherapy?Treatment schedules for chemotherapy vary widely. How often and how long you getchemotherapy depends on:Î Your type of cancer and how advanced it isÎ The goals of treatment (whether chemotherapy is used to cure your cancer, control itsgrowth, or ease the symptoms)Î The type of chemotherapyÎ How your body reacts to chemotherapyYou may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatmentfollowed by a period of rest. For instance, you might receive one week of chemotherapyfollowed by three weeks of rest. These four weeks make up one cycle. The rest period givesyour body a chance to build new healthy cells.Can I miss a dose of chemotherapy?It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse maychange your chemotherapy schedule due to side effects you are having. If your schedulechanges, your doctor or nurse will explain what to do and when to start treatment again.How is chemotherapy given?Chemotherapy may be given in many ways.Î Injection. The chemotherapy is given by a shot in amuscle in your arm, thigh, or hip, or right under theskin in the fatty part of your arm, leg, or belly.Î Intra-arterial (IA). The chemotherapy goes directlyinto the artery that is feeding the cancer.Î Intraperitoneal (IP). The chemotherapy goesdirectly into the peritoneal cavity (the area thatcontains organs such as your intestines, stomach, liver, and ovaries).Î Intravenous (IV). The chemotherapy goes directly into a vein.Î Topical. The chemotherapy comes in a cream that you rub onto your skin.Î Oral. The chemotherapy comes in pills, capsules, or liquids that you swallow.www.cancer.gov3

Things to know about getting chemotherapy through an IVChemotherapy is often given through a thin needle that is placed in a vein on your handor lower arm. Your nurse will put the needle in at the start of each treatment and removeit when treatment is over. Let your doctor or nurse know right away if you feel pain orburning while you are getting IV chemotherapy.IV chemotherapy is often given through catheters or ports, sometimes with the helpof a pump.Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in alarge vein, often in your chest area. The other end of the catheter stays outside your body.Most catheters stay in place until all your chemotherapy treatments are done. Catheters canalso be used for drugs other than chemotherapy and to draw blood. Be sure to watch forsigns of infection around your catheter. For more information on Infection, see page 27.Ports. A port is a small, round disc made of plastic or metal that is placed under your skin.A catheter connects the port to a large vein, most often in your chest. Your nurse can inserta needle into your port to give you chemotherapy or draw blood. This needle can be left inplace for chemotherapy treatments that are given for more than 1 day. Be sure to watch forsigns of infection around your port. For more information on Infection, see page 27.Pumps. Pumps are often attached to catheters or ports. They control how much and howfast chemotherapy goes into a catheter or port. Pumps can be internal or external. Externalpumps remain outside your body. Most people can carry these pumps with them. Internalpumps are placed under your skin during surgery.How will I feel during chemotherapy?Chemotherapy affects people in different ways. How you feel depends on how healthy youare before treatment, your type of cancer, how advanced it is, the kind of chemotherapy youare getting, and the dose. Doctors and nurses cannot know for certain how you will feelduring chemotherapy.There are many ways to manage chemotherapy side effects. For more information, see theList of Side Effects section starting on page 13.41-800-4-CANCER (1-800-422-6237)

Can I work during chemotherapy?Many people can work during chemotherapy, as long as they match their schedule to howthey feel. Whether or not you can work may depend on what kind of work you do. If yourjob allows, you may want to see if you can work part-time or work from home on days youdo not feel well.Many employers are required by law to change your work schedule to meet your needsduring cancer treatment. Talk with your employer about ways to adjust your work duringchemotherapy. You can learn more about these laws by talking with a social worker.Can I take over-the-counterand prescription drugs whileI get chemotherapy?This depends o