Chemotherapy is a type of medicine used to treat cancer. It can be derived from natural resources, or be synthetic/man made. There are many different types of chemotherapy drugs. The type and dose of chemotherapy will depend on the type of cancer being treated, and as such, our specialists will plan cancer treatment specifically to treat each patient’s unique situation.
Chemotherapy works by destroying fast-growing cells in the body. Because cancer cells typically replicate quite frequently, chemotherapy is often a good option for treating cancer. However, the medicine can also destroy other fast-growing cells such as blood cells and those founding the lining of the mouth, the gut, bowel, skin and hair. When treatment finishes, good cells recover - and normal function usually returns.
The most common side effects of chemotherapy treatment are:
- Changed blood counts or reduced immunity.
- Nausea and vomiting.
- Sore mouth (mouth ulcers, thrush and inflamed gums).
- Hair loss.
Chemotherapy is frequently administered in cycles, with rest periods in between to allow normal cells to recover. Some chemotherapy treatments may take half an hour to administer, while others may be administered over several days.
Cancer cells repair slower than normal cells, therefore, by the next treatment cycle, the body's normal cells (red blood cells, white cells and platelets) have recovered, but the cancer cells have not.
Comprehensive chemotherapy treatments are used for a range of cancer management purposes including: curative, where the goal is to eliminate the tumour entirely; palliative care, where the goal is to improve and extend quality of life by reducing the tumour size or preventing it from growing further; and pre-operative tumour reduction where the goal is to shrink the tumour so that it can be operated on more effectively. In addition to intravenous chemotherapy, our specialists also offer monoclonal antibody or ‘targeted’ therapies, or a combination of both.
Monoclonal antibody therapy is part of a range of treatments known as immunotherapy. Designed to help the body’s own immune system better identify and fight threats like cancer, this exciting, relatively new advancement in the treatment of cancer shows great promise as the process is further refined and used to treat a greater range of cancers.
This is one of the most common side effects of chemotherapy treatment.
Nausea and vomiting is more likely to occur in the first 24 to 48 hours after a patient has received treatment. Our specialist staff are skilled in helping to control nausea and vomiting related to chemotherapy, and will generally administer effective medication intravenously prior to giving chemotherapy and again on discharge.
It is important to follow instructions provided by your team after discharge, in order to effectively manage these side effects.
Patients may experience nausea and vomiting later than 48 hours after treatment. This could be due to many factors, including:
- Alteration to taste.
- Sensitivity to sweet, salty, fatty or spicy foods.
- Sensitivity to smells.
To help manage nausea and vomiting, we recommend:
- Eating small meals, frequently.
- Avoiding strenuous activity or reclining for at least 30 minutes after eating.
- Frequent, small sips of water.
- Drinking or eating ginger. Try ginger ale, ginger beer, ginger cordial or crystallised ginger.
- Drinking peppermint tea.
- Experimenting with mild, easy to digest foods such as toast or dry biscuits.
- Avoiding greasy, salty, spicy and fatty foods.
- Preparing meals in advance to avoid cooking smells.
- Eating food that is cool or at room temperature.
- Taking anti-nausea medication exactly as prescribed.
- Using relaxation, music therapy and gentle exercise.
- Wearing loose fitting clothes.
- Using acupressure beads or anti-motion sickness beads, available from pharmacies.
- Monitoring nausea using the grading scale.
Many chemotherapy drugs can cause constipation. It may happen at any time during treatment.
There are many other triggers for constipation, which include:
- Other types of medication.
- Change in routine or lifestyle.
What medications cause constipation?
Anti-nausea drugs will increase the likelihood of constipation. If constipation continues for any longer than two days, it is important to contact your doctor for further advice.
You can try any of these helpful tips for relieving constipation; however, your specialist nurse will talk to you about medications to assist.
To reduce the chances of constipation, consider:
- Drinking 2-3 litres of fluid per day.
- Eating wholemeal breads, cereals and pasta.
- Eating fresh and cooked fruit and vegetables, including skin and seeds.
- Drinking fresh orange juice, pear juice and prune juice.
- Eating legumes and nuts.
- Eating regular meals.
- Drinking a hot beverage when the bowel feels sluggish.
- Monitoring constipation using the grading scale and contacting the doctor when indicated.
You may need to take medication to relieve the symptoms of constipation Please consult your doctor, nurse or dietician for further advice on how to manage if constipation becomes prolonged.
Will chemotherapy cause diarrhoea?
Many chemotherapy drugs may cause diarrhoea and this can happen at any time during treatment.
Patients who are prone to diarrhoea should discuss the issue with their specialist or nurse.
To reduce diarrhoea, it is important to decrease fibre intake. The following tips may be helpful:
- Drink plenty of fluids to replace the water lost with diarrhoea.
- Choose white bread, cereals and pasta.
- Avoid legumes, nuts and foods that are high in fibre.
- Eat cooked vegetables rather than raw.
- Try to avoid very hot or very cold foods.
- Avoid alcohol, fruit juice, strong tea and coffee.
- Fluids could include a sports drink.
- Eat small, frequent meals that can be bland and eat them slowly.
- Try to avoid very spicy or fried foods.
- If diarrhoea persists, it is important to take good care of the skin around the bottom. This can include using a ph neutralising cleanser and water to clean the area rather than rubbing with towels or toilet paper. Baby wipes for sensitive skin can also be used. Consider applying a barrier cream such as paw paw ointment, zinc /castor oil cream or Bepanthen Cream.
- Monitor diarrhoea using the grading scale and contact your doctor when indicated.
- If the problem cannot be controlled, medication may be required.
Chemotherapy may cause mouth ulcers in some patients. Cells in the mouth are fast-growing, which means they will be affected by chemotherapy.
Tips for dealing with mouth ulcers:
- Check each morning and evening to monitor for changes in the mouth and use the grading scale. Contact your doctor when indicated.
- Mouth washes should be done after each meal and before going to bed at night.
- Increase the frequency of mouth washes if the ulcers get worse and consult nursing staff for further advice.
- Keep lips moist.
- Keep the mouth clean and moist.
- Remove dentures before mouthwashes, cleaning them and gums before putting them back in again.
- Avoid alcohol based elixirs and commercial mouthwashes as these might dry your mouth out and make things worse.
- Use a soft tooth brush to prevent trauma. This should be regularly replaced.
- Avoid flossing only if platelets count is below 40.
- Avoid food that may cause trauma to your mouth (very hot/cold beverages, sharp chips).
- Some medications, in combination with chemotherapy, can cause problems with the jaw. Please tell your specialist team if jaw pain becomes an issue.
- Consult your doctor before seeing a dentist during treatment.
- Salt: 1/4 teaspoon of salt to one cup of warm water.*
- Sodium Bicarbonate: 1/2 teaspoon of sodium bicarbonate to one cup of warm water.*
*at the advice of the consultant
Many patients undergoing treatment for cancer have identified fatigue as a major symptom of their illness. Fatigue may also be described as feeling lethargic, tired, listless or washed out. Fatigue can occur any time throughout treatment.
Travelling to hospital regularly for medical appointments and chemotherapy treatment and being away from home, can all create fatigue.
Tips for preventing fatigue
- Gentle exercise can help combat fatigue, so continue daily walks or activities.
- Eat well-balanced meals and ensure you drink plenty of fluids.
- Ask about our wellness programs designed specially for our cancer patients.
- Reduce stress by engaging in activities such as listening to music, reading a book, relaxation and meditation.
- If you need an afternoon nap, take one! Take small frequent rests or breaks for no more than one hour, rather than a long break or sleep.
- Try to balance activity and rest. Set small manageable goals when planning a schedule but ensure rest periods are included.
- Consider ways to lighten the load of every day life. Online grocery shopping is a great way to make life easier and many large supermarkets offer an online service.
- Think of ways to save energy. Break daily activities into smaller tasks. Consider things like sitting down to fold the washing.
Not all chemotherapy causes hair loss. Some people may experience hair thinning or no hair loss at all. The extent of hair loss depends on the drugs prescribed and the individual.
When hair loss does occur, it is because chemotherapy targets all fast growing cells. Unfortunately, hair follicles may temporarily become casualties of the battle.
Hair loss usually happens within three weeks of the first chemotherapy session. At that time, the scalp may become tender and using a silk pillow case may provide some relief.
Often, hair will come out in clumps rather than evenly. It is also common for hair loss to include eyelashes, eyebrows and pubic hair.
Hair loss is temporary for most people. Usually when treatment is over, the hair will start to grow back.
Hair may initially be very fine and soft when it grows back. And there may be other changes, for example, it may be curly, thicker or finer than it was previously. It may even grow back a slightly different colour.
Tips for hair and scalp care during and after chemotherapy:
- Use a gentle shampoo and conditioner.
- Dry hair naturally or only use a hair dryer on low. Avoid using curling wands, straighteners, heated roller and hair dryers on high as they cause further damage.
- Brush hair gently and try to use a soft bristle brush.
- Protect the scalp from the sun by wearing a hat or sunscreen whilst outside.
- Information on obtaining a wig is available from our chemotherapy nurses.
- Discuss any concerns regarding hair loss with your specialist team.
At times of increased stress, it is common to suffer changes to sleep patterns including:
- Trouble falling asleep.
- Waking and having trouble going back to sleep.
- Waking frequently throughout the night.
- Difficulty waking up.
- Waking too early in the morning or poor quality sleep.
- Chemotherapy itself can lead to poor sleep, especially in the first night or two after each treatment. Some medications such as steroids used in chemotherapy treatment can cause insomnia if taken too late in the day.
- Talk to your specialist team for help with sleeping.
Combating sleeping problems:
- Try drinking warm milk prior to bed.
- Reduce coffee or tea intake at night.
- Try a warm bath.
- Listen to music or relaxation tracks
When dealing with body waste after chemotherapy, there are some key things to be aware of. It will take seven days for all traces of chemotherapy to leave the body. During this time, any bodily fluids such as vomit, urine and faeces must be handled with care in order to protect other people from the effects of chemotherapy.
- Gloves should be worn when emptying pans and urinals for seven days after completion of treatment.
- When disposing of waste (urine, vomit, faeces) simply flush down the toilet with the lid closed and a full flush.
- Colostomy bags should be double-bagged and placed directly into the wheelie bin.
- If urine or vomit is spilled, please wear gloves and wipe the area down with either a flushable toilet wipe or paper towels that can be disposed directly into the rubbish. Clean area down with water and neutral detergent.
- Clean the toilet regularly, if body fluids come into contact with any surface, follow the guide below:
- Wear a pair of disposable gloves.
- Use toilet paper to clean up and then flush contents down the toilet using a full flush.
- Clean the area with water and household detergent using a disposable sponge.
- Put used gloves and sponge inside 2 plastic bags.
- Seal the bag by tying the ends.
- Put the bag into the wheelie bin.
If body fluids come into contact with clothing or linen, follow the guide below:
- Wear a pair of disposable gloves when handling contaminated clothes or linen
- If unable to wash immediately, place items in a plastic bag for a short period of time only
- Place items separately from other linen into the washing machine with detergent for one full cycle
- Put used gloves inside 2 plastic bags
- Seal the bag by tying the ends.
- Put the bag into the wheelie bin.
For disposal of products that have been contaminated by body waste (gloves, incontinence pads, condoms, hygiene pads or tampons, dressings or stoma bags), follow the guide below:
- Put items into 2 plastic bags.
- Seal the bag by tying the ends.
- Put the bag into the wheelie bin.
It is acceptable to dispose of cytotoxic waste in septic tanks. Maintenance workers who service the septic tank should be advised that the tank contains cytotoxic waste. If using a composting toilet, it is a good idea to contact the manufacturer for further direction.
Good nutrition is vital throughout cancer treatment and beyond. It is essential to discuss nutrition with your specialist team during treatment.
We have highly qualified dietitians at Hollywood Private Hospital, who can work closely with cancer patients when requested, so that all nutritional needs are met.
To consult with a dietitian, please let the treating nurse know, so that an appointment can be made.
Good food hygiene is also essential, especially when preventing infection.
Store raw meat on the bottom shelf of the fridge and use separate cutting boards when preparing meat products.
- Cook food thoroughly, particularly chicken, seafood, meat and eggs.
- Thaw frozen foods in the fridge or microwave and never re-freeze frozen food once thawed.
- Wash fruit and vegetables prior to preparing and eating.
- Ensure dairy products are pasteurised and use only commercial honey.
- Only eat takeaways if freshly cooked but avoid all buffets, hot boxes and sushi.
- Wash hands with soap before preparing, cooking and eating food.
- Always use clean surfaces when preparing and cooking meals.
Desire and feelings of intimacy may change during treatment. The physical side effects of chemotherapy may leave patients exhausted. However, some people find that the experience of illness can lead to increased desire for intimacy.
It is recommended that sexually active males wear a condom, and sexually active females use lubricant, for at least 7 days after receiving treatment.
Also use a condom for oral sex or intercourse. Vaginal and seminal secretions may contain trace amounts of chemotherapy. If necessary, it is also important that a reliable contraceptive is used, as chemotherapy may be harmful to a developing embryo. It is important to note that you may still be at risk following a vasectomy or if you are not in true menopause.
Learn more about Hollywood Private Hospital Cancer Care