Preparing for Chemotherapy, Immunotherapy and Oral Chemotherapy

Sometimes you may experience an intense bone achiness. This ache is often described as “flu-like” and typically lasts between two and four days following some treatments.

If you are prescribed pegfilgrastim, filgrastim or another biosimilar, we recommend that you take 10 milligrams of Claritin daily for five days beginning the day you receive the treatment.

If you experience constipation, you should follow these recommendations:

• Drink at least 64 ounces of water daily.
• Take one stool softener in the morning and one in the evening, every day. Examples of stool softeners include Colace, Senoekot and Dulcolax, which are available over the counter at most pharmacies.
• You may also take MiraLAX, which is available over the counter at most pharmacies. Mix one capful of MiraLAX in eight ounces of liquid twice daily until you start having soft bowel movements. Then, reduce to one capful daily as needed for constipation.

For diarrhea lasting longer than 12 hours, you may take the following over-the-counter options: Kaopectate or Imodium A-D (loperamide). Take two tablets after the first loose stool, then one tablet after each loose stool until diarrhea stops, with a maximum of six tablets in 24 hours.

Call your health care provider if:

• Diarrhea lasts more than 24 hours
• You need more than six tablets daily.
• The diarrhea is accompanied by bright red blood.
• You experience abdominal pain or cramping or have a fever.

While you have diarrhea, you should follow the BRAT diet, consuming mostly bananas, rice, applesauce and toast. Also, drink plenty of water, Gatorade or other sports drinks to help replace fluids and electrolytes lost in loose stools.

Fatigue, weakness or a lack of energy are very common side effects related to cancer treatment. These symptoms can occur before, during and/or after your treatment. The tiredness you feel can be cumulative and worsen as you continue through your treatment plan.

Unfortunately, there is no medication to manage this side effect. However, we strongly encourage a healthy diet, adequate hydration, managing stress and resting as much as possible to help combat fatigue. If these symptoms persist or worsen, notify your health care provider for suggestions or further instructions.

If you feel “feverish,” please take your temperature with a digital thermometer. If your temperature is 100.5 degrees or greater, please call your health care provider. If your temperature is less than 100.5 degrees and your health care provider has advised you that it is safe to take Acetaminophen (Tylenol) or Ibuprofen (Motrin/Aleve), you may take two 325mg Acetaminophen (Tylenol) or 600mg Ibuprofen (Motrin/Advil).

If your fever persists for 24 hours, or is accompanied by uncontrolled nausea, vomiting, abdominal pain or rash, please call your health care provider for further instructions.

Headaches can occur as a side effect of any cancer treatment or when using certain anti-nausea medications. If you have a history of migraines or headaches, you may be more likely to experience them during treatment. If you have headaches that persist or worsen during treatment, call your health care provider for suggestions on managing your symptoms.

Cancer treatment can cause low blood cell counts. This includes but is not limited to white blood cells, absolute neutrophils and platelets. These cells help to fight infection and prevent bleeding. While treatments are meant to kill the bad cells (cancer), they can also kill some of your good cells (white blood cells, absolute neutrophils and platelets).

Your health care provider will monitor your blood cell counts throughout treatment to help manage this side effect. Contact your provider if you have any questions or concerns about low lab counts.

If you develop mouth sores or other oral side effects, make a baking soda mouthwash (mix half a cup of warm water with half a teaspoon of baking soda) to swish and gargle with after meals and at bedtime. Alternatively, you can swish and gargle with a warm saltwater mixture (half a teaspoon of salt in eight ounces of water).

If your oral symptoms do not improve, please call your health care provider for additional instructions, especially if you experience difficulties with eating or drinking.

Your health care provider will routinely order medication to help prevent or decrease nausea or vomiting that may occur because of your treatment. These medications can be given by mouth, through an IV or by rectal suppository.

Each person may respond differently to anti-nausea medicines. Therefore, your provider will help guide you on how to best take your medicine. As a precaution against nausea following your treatment, we recommend you continue the anti-nausea medicine for 24 to 48 hours after your treatment is complete. If nausea or vomiting persists despite the medication, please call your provider immediately.

There are many anti-nausea medicines available, and not every medication works well for every person. It may be necessary to change anti-nausea medications or even to take a combination of medicines to achieve the best nausea control.

The following anti-nausea medications may have been prescribed to you. Please follow the instructions on the bottle for each medication.

• Dexamethasone
• Lorazepam
• Olanzapine
• Ondansetron
• Prochlorperazine
• Promethazine

Eating something small every two hours may also help decrease nausea. Do not take any pills on an empty stomach unless specifically instructed to do so.

You may also experience changes to your appetite or taste. Our dietician is available to discuss any dietary concerns and help you maintain a healthy diet.

Only take over-the-counter medications if your health care provider has indicated you should do so.

Skin conditions like rashes, itching and dryness are common side effects of various treatment options.

To manage these symptoms, there are several effective recommendations, including:

• Be gentle. Do not scrub, rub or scratch your skin.
• Shower with lukewarm water instead of hot water to reduce dryness, and use a moisturizing lotion after showering.
• Protect your skin from the sun, as some drugs used in cancer treatment can make skin more sensitive to sunlight. When outside, wear sunblock, a broad-brimmed hat, a long-sleeved shirt and pants as appropriate.
• Some cancer treatment drugs can cause acne-like rashes. Call your health care provider if you develop itching or a skin rash like this that is persistent. Additional medication may be prescribed.
• Some treatments can affect fingernails and toenails. The skin around your nails may become dry, brittle or cracked, and some nails can become ingrown. Do not wear fake nails or bite your nails during treatment. Talk to your provider before having a manicure or pedicure.
• Wear gloves when washing dishes or cleaning.
• Moisturize your hands and feet often.