Chemotherapy Side Effects

As the science for treating breast cancer has advanced, so has the science to manage treatment side effects. Each woman experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects. Whatever you experience, remember there is no correlation between the side effects you feel and whether you derive benefit from your chemotherapy. Many women feel okay for the first few hours following chemotherapy treatment. Usually some reaction, if any, occurs about 4-6 hours later; some women experience little reaction until 12 or even 24-48 hours after treatment. We have many treatments to help you deal with side effects. Please let us know how you are feeling, so we can address your concerns and help to make you more comfortable.

Fatigue

Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy. Most people have to make some adjustment in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. Remember that the fatigue will go away after you recover from chemotherapy.

Practical Hints for Fatigue

Plan your activities, such as grocery shopping, for a time when you feel the best.
If you have children, rest when they are napping. When you feel most tired, consider hiring a baby-sitter for a few hours so that you can relax or take a nap.
Take naps early in the day so you do not disturb your sleep pattern at night.
Try to exercise, such as walking or swimming, every day or regularly.

Hair Loss
Many women feel that hair loss can be the most difficult aspect of chemotherapy treatment. Losing your hair can be a personal and difficult experience. Not all chemotherapy drugs cause the same amount of hair loss, so talk to your physician or nurse about what to expect. Read more about hair loss and how to cope on our Head Coverings for Hair Loss page, and talk to your physician or nurse about relevant clinical trials to reduce hair loss.

Nausea
Medications called anti-emetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your provider will recommend what is expected to work best for you based on the chemotherapy you will be receiving. We have a specific anti-nausea information sheet describing the medications, dosages, side effects, and other important information, which is included in your binder.

Please be prepared and have your prescriptions filled before your treatment day. We recommend getting your prescriptions filled a week in advance if possible as some medications may require prior authorization. Please call your practitioner if your medications do not give you adequate relief or if you experience side effects with the anti-nausea medication.

Practical Hints for Nausea

Before your chemotherapy appointment, eat a small, light meal. Most women do better if they have something in their stomach.
Eat what sounds good to you. Generally starches such as rice, bread, potatoes, hot cereals and puddings are well tolerated.
Try not to skip meals. An empty stomach will worsen all symptoms. If you don't feel like sitting down to a meal, try nibbling on something that appeals to you.
Drink plenty of fluids. Herbal teas, water, "sports drinks" and diluted juices are recommended more than soda.
Avoid smells that are unappealing.
Freeze meals so that you don't have to cook. Ask your family and friends to help with meals, especially following chemotherapy when you are most likely to feel nauseous.
Anti-Nausea Medication

Appetite and Taste Changes
During chemotherapy you may experience taste and appetite changes and a heightened sensitivity to odors. Do not worry if you don't have an appetite the first few days or a week following chemotherapy; it is not unusual, and as you feel better your appetite will improve. Reflux, burping, or a burning sensation may worsen nausea; please report this symptom to your physician or nurse so that it can be treated. You may find that you can tolerate only certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids (8-10 eight-ounce glasses per day; more if you have a fever or diarrhea). Recommendations for healthy nutrition include a diet low in fat (less than 20%) and high in whole grains, fruits and vegetables, and plant based proteins. Some women want to begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed. Some women prefer small, slow changes, while others benefit from a "major overhaul." Whichever way is the best for you, we encourage you to learn about and make healthy dietary and lifestyle changes.

Many women gain weight while on chemotherapy for reasons that are not well understood. Again, if you have concerns about nutrition, please consult our staff nutritionist.

Practical Hints for Taste and Appetite Changes

Eat what appeals to you during this time.
Eat foods that are warm rather than hot.
Avoid places where food is being cooked (for example, the kitchen at dinner time).
Avoid smells that are unappealing.
Try to drink 8-10 glasses of fluid a day.

Mouth Sores
Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. In most breast cancer regimens, mouth sores are less common. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed for your use.

Practical Hints for Mouth Sores

Brush your teeth with a soft toothbrush 3 times daily.
Rinse your mouth with a solution of 1 teaspoon baking soda and 1 teaspoon of salt diluted in a glass of lukewarm water 3 to 4 times daily.
Biotene® is a commercial mouthwash that also can be used 3 to 4 times daily.
Ulcer-ease® is a commercial product that may provide temporary relief from sores.

Diarrhea or Constipation
Some chemotherapy drugs can cause diarrhea. If you have more than five watery stools in 24 hours, or blood in your stool, call your care provider. Do NOT use over the counter anti-diarrhea medications like Imodium® unless advised to do so by your physician or nurse.

Some of the drugs we give to prevent nausea can cause constipation. You may be more prone to constipation because your activity level and diet have changed. You may also experience constipation if you take narcotic pain medication such as Vicodin® to treat pain that you may have. Please tell your practitioner if you go more than 3 days without having a bowel movement.

Practical Hints for Constipation

To help prevent constipation try drinking 8 to 10 glasses of fluid a day.
Take a stool softener (not a laxative) such as docusate sodium (DSS), also known as Colace®, one capsule once or twice a day. Senokot® or Senokot-S® may also be suggested. Ask your practitioner for a recommendation.
Stay as active as you can. Consistent regular exercise can reduce constipation.

Practical Hints for Diarrhea

To replenish lost fluids, drink 8-10 eight-ounce glasses of decaffeinated fluids per day.
If your rectum is sore, use soft toilet paper and A & D ® ointment (used for diaper rash in infants) or Anusol® which can help numb the rectum and soothe soreness.
If you can tolerate them, try high fiber foods: prunes, bran, fruits and vegetables.

Low Blood Counts
Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are made in the bone marrow and help fight against infection. Neutrophils are one type of the WBCs that fight infection. Often the neutrophil count will determine whether or not you will receive chemotherapy on schedule. A fever of 101°F (38.3° C), or chills with or without a fever, can be a serious sign of infection. You must call your oncologist should this occur even at night or on the weekend.

An infection is most likely to occur when your WBCs or neutrophil count is low. You are most susceptible to a bacterial infection about 7-12 days after your chemotherapy infusion. Most bacterial infections occur as a result of your body's inability to fight off normal bacteria present in your gastro-intestinal tract or skin. Bacterial infections do not commonly occur as a result of being in a crowded place. So, if you are feeling well, we encourage you to continue to go out to the movies or out for a meal. However, viral infections are common and are transmitted easily. Wash your hands frequently and avoid close contact with anyone who is ill during this time.

Practical Hints Regarding Fever and Infection

If you have a fever of 101° F (38.3° C), with or without chills, call your care provider immediately. If you cannot reach your oncologist, go to an emergency room.
Keep a thermometer in your home and know how to take your temperature.
If you are unsure how to take your temperature, ask your care provider.
Do not eat, drink or smoke for 10 minutes before taking your temperature.
Leave the thermometer under your tongue for three minutes.
Call your care provider as soon as possible if you develop a cough, sore throat, pain or burning when you urinate.
To help prevent infection, we encourage good hand washing.
Avoid rectal intercourse, tampons, douches, enemas, and rectal thermometers.
Do not eat raw food such as sushi and sashimi, Caesar salad or milk shakes made with raw eggs until you complete chemotherapy and your blood counts have returned to adequate levels. Raw foods may carry bacteria that can lead to infection.
Wash hands and cutting boards well after food preparation.
Always tell your doctor before going to the dentist.

The table below will help you understand your temperature in both Fahrenheit and Centigrade:

**Fahrenheit to Centigrade Conversion Table**
Fahrenheit	Centigrade
98.6	37
99	37.2
100	37.8
101	38.3
102	38.9

*Remember, always call your physician with a temperature of 101°F or 38.3° C

Menopause
Chemotherapy may cause temporary stopping of your periods or permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause. With menopause you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. Please feel comfortable to talk to us about any symptoms or concerns. We can provide information and possible treatment for some of the symptoms mentioned.

If your periods continue during treatment they will likely change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may eventually lead to menopause.

Practical Hints for Menopausal Symptoms

Because you have had breast cancer we DO NOT recommend taking hormone replacement therapy.
Eat soy products or take vitamin E (400 IU only) to reduce hot flashes.
There are prescription medications that your practitioner may recommend for hot flashes, for example Effexor®.
Wear light cotton pajamas to help prevent overheating when sleeping.
Try vaginal moisturizers such as Replens® on a regular basis or other water based lubricants, like Astroglide®, as needed and especially before sexual activity. These products will help with vaginal dryness and irritation.
Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.
There are prescription medications, for example Estring®, that give a local dose of estrogen to the tissues in the vagina to treat vaginal dryness.

Sexuality
The effects of surgery and chemotherapy on sexuality are different for each woman. Changes in how you feel sexually are very common. Please share any feelings, questions or concerns you have with your practitioner. Whether your periods continue or stop during chemotherapy, you should always use contraception or birth control measures to prevent pregnancy until it has been confirmed by blood test that you are truly in menopause. We do not recommend the birth control pill because it contains estrogen. We recommend the use of condoms, a diaphragm or other barrier methods.

Practical Hints Regarding Sexuality

Try vaginal moisturizers such as Replens® on a regular basis, Astroglide® or other water based lubricants before sexual activity to help with vaginal dryness and irritation.
To prevent rectal tears and infection, avoid rectal intercourse, suppositories, and enemas.
For support, talk to your partner about changes in sexual interest and response. Discuss changes with a support group, therapist, friend or family.
Discuss concerns about sexuality with your physician or nurse.
Read the Breast Care Center handout and other written materials on sexuality and breast cancer.