cytotoxic chemotherapy and you

Helen Loudon © [email protected] All rights reserved. of 3 Helen Loudon © [email protected] All rights reserved

CYTOTOXIC CHEMOTHERAPY and YOU

A guide for patients and nursing staff

Introduction

Oncology is the study of, and treatment of cancers; while Haematology is the name given to the medical discipline concerned with diseases of the blood and blood forming organs e.g. bone marrow, spleen, lymph nodes, thymus gland.

The following may be affected by your treatment:

� Red blood cells (erythrocytes) are needed for carrying oxygen to the tissues. When their level is low, you are ‘anaemic’ and a blood transfusion might be necessary.

� Platelets (thrombocytes) play a role in blood clotting, and when their level is low you might need a platelet transfusion.

� White blood cells (leucocytes) comprise several types, and continuously perform an important function by defending the body against bacterial and viral infection, as well as playing a role in your long term immunity.

It will be necessary for you to have regular blood tests to monitor the effects of the chemo therapy, and your doctor will decide on the next cycle of treatment based on these results.

Your doctor and the nursing staff will do all they can to prevent or minimize symptoms – please don’t hesitate to ask questions.

What is chemotherapy and how does it work?

‘Cytotoxic (i.e. cell toxic) chemotherapy can be administered intravenously, intramuscularly, orally and intrathecally (by lumbar puncture) in order to reach all parts of the body which may contain cancerous (malignant) cells.

These drugs are prescribed in combination, to enhance the duration and effect of each other, according to a regimen and dosage calculated to your individual needs.

Chemotherapy targets rapidly dividing cells, interrupting and/or altering the cell growth cycle; which is why for example, side effects commonly affect the lining of the mouth, the digestive system, bladder, skin, nails, hair and bone marrow.

The severity of side effects varies from person to person, and depends on the type of drugs you are given, their dosage and your general state of health.

Most importantly, remember that these side effects are only temporary, and will disappear after the course of treatment is given.

Side effects and how to cope with them

Fatigue and listlessness

Once the effects of chemotherapy have worn off you will regain your energy.

� Rest as much as possible

� Avoid strenuous exercise or work, or becoming overtired

� Allow family and friends to help with cooking, shopping, fetching children from school etc. (This also enables them to do something constructive to help and support you)

� Learn methods of relaxation

� Eat nutritious balanced meals containing protein, fat and carbohydrates. A vitamin and mineral supplement may be helpful, but seek advice beforehand from your doctor if/when it would be appropriate to take it

� Share your fears with your doctor or nurse. Medication for anxiety or insomnia can be prescribed if necessary.


Care of your mouth and gums

Chemotherapy affects the lining of the mouth which can result in ulceration and/or infection.

� Drink as much as possible to keep your mouth moist and clean

� Use a soft toothbrush, preferably with a small head (e.g. child’s toothbrush)

� Brush your teeth, gums and tongue gently at least three (3) times per day, and especially before going to sleep at night

� Use a dilute (preferably ‘Hibitane’ based) antibacterial mouthwash - with local anaesthetic if necessary - after brushing.

� Remove dentures as often as possible if your mouth is sore, and rather try pureed food and soups

� Report bleeding gums to your nurse or doctor immediately

� Regular visits to the dentist are recommended, to keep your teeth and gums in a healthy condition.

Nausea and/or Vomiting

Not all drugs cause this side effect, and fortunately there are effective anti-nausea medications available to combat it.

� Drink as much fluid as possible, to flush out toxic waste products, prevent dehydration and kidney injury

� Eat small portions of food, at regular (2-3 hourly) intervals

� Cold and/or savoury food may be more appetizing

� Foodstuffs rich in protein e.g. custard, ice cream, yoghurt, chicken, fish are recommended

� Keep biscuits, soft glucose sweets (e.g. ”wine gums”, “jelly babies”) on hand

� Crushed ice and ginger flavoured drinks may be helpful for nausea

� If your white cell count is very low, your doctor may restrict certain types of food (e.g. raw food, salads).

Constipation and/or diarrhoea

� Drink as much fluid as possible

� If constipated, do not strain when trying to pass a stool

� Report constipation or diarrhoea to your nurse and doctor

Pain

� If necessary, it is important that analgesia (pain medication) is taken at regular intervals, and strictly according to you doctor’s instructions

� Do not hesitate to let your nurse and doctor know if your pain is not being adequately controlled.

Hair loss (Alopecia)

Certain cytotoxic drugs are known to cause partial to complete hair loss. It is traumatic because one’s self image depends so much upon one’s hair; however the nurses and your doctor realize the emotional impact of this side effect, and will advise you on obtaining a suitable wig, turban and/or scarf as needed.

� Have your hair cut short if it is long

� Use a mild shampoo, conditioner and a wide toothed comb to minimize hair loss

� Towel-dry your hair gently. Avoid hairdryers and curling tongs

� Do not perm or colour your hair during treatment

� Avoid tight hairstyles and the use of tight elastic bands or grips

� Experiment with makeup!

Remember – hair loss is temporary and re-growth occurs within weeks. Your “new” hair will be slightly different in colour and/or texture, and may be curlier than before!


Care of the Skin

� A foam overlay should be provided on top of your mattress

� Avoid bumping and/or bruising yourself

� Report excessive bruising and any skin rashes to your nurse and doctor

� Attend to cuts or scratches with an antiseptic and cover with a dressing to prevent infection

� It is important to keep your skin in good condition with bath oils or moisturizers

� Avoid exposure to sunlight during and after treatment, as certain drugs cause extra sun-sensitivity

Infection Control

This is an important and on-going concern while you are undergoing treatment and afterwards.

Chemotherapy may cause a temporary, but significant reduction in the number of leucocytes (white blood cells) in your bloodstream, affecting your body’s ability to defend itself against infection by bacteria, viruses and certain fungi.

� Hand washing is the most important measure to prevent cross infection

� Alcohol hand rub should also be used by your nurse and doctor to augment their hand hygiene

� Your venous catheter (i.e. “drip”) site will be cleaned before use with an antiseptic in alcohol, and a sterile dressing applied.

� Please report any redness, pain or swelling around your drip site to your nurse or doctor immediately

� Avoid traction, tugging, friction or fidgeting with this catheter

� The care of your catheter and/or central line or ‘port’ is specialized, and should only be undertaken by experienced personnel

� Report a sore throat or fever to your nurse or doctor immediately

If you are admitted to hospital for chemotherapy

� It is advisable that you are cared for in a side ward ie. in isolation. Although lonely at times, it provides quieter surroundings and the opportunity for privacy and sleep

� It may be necessary to restrict your visitors to protect you from infection

� Face masks and disposable aprons may be worn by the medical team at the request of your doctor as an additional precaution

� A minimum number of staff will be allocated to your care during a shift, in order to minimize your exposure to infection

� Raw food and salads should be avoided if your leucocyte count is low. Only fruit which can be peeled is recommended (e.g. bananas, apples, oranges pears etc.)

� Fresh flowers may have to be removed from your room if your immunity is low.

It is hoped that this pamphlet will provide you with some insight into your treatment, as well as practical ways in which

to minimize side effects, should they occur.

Recommended resources for more information:

www.cansa.org.za

www.macmillan.org.uk

cytotoxic chemotherapy and you

Healthcare