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Coping with Chemotherapy

Once the decision has been made to have chemotherapy, patients may have many different concerns.

Three common questions are:

  • Will I lose my hair?
  • How will my chemotherapy be given?
  • What can be done to control nausea and other unpleasant side effects of treatment?

Coping With Hair Loss
Adriamycin and some other drugs usually cause hair loss. If you plan to wear a wig, we suggest that you:

  • Have your hair cut as short as possible before starting treatment.
  • Save a large lock of hair from the front/top of your head where the color is lighter as a color reference.
  • Purchase a synthetic wig ( they are cheaper and easier to maintain) before you lose your hair, for ease of matching the color and style to your own hair. Make sure that the wig is returnable in case you change your mind after you get it home.

Hair usually doesn't start falling out until 2-3 weeks after beginning treatment. If you lose the hair on your head, you may also lose your eyebrows and eyelashes, as well as body hair. To catch the hair lost at night, consider buying a mesh cap or other type of head cover or put a towel over your pillow and use a plastic drain catch in the tub or shower to keep the hair from clogging the drain. Use a mild shampoo and the low heat setting on your blow drier. Hair straighteners, permanents, brush rollers and permanent hair dye will cause your hair to come out faster. Once your hair is gone, if your scalp or other parts of your body are dry, apply an inexpensive moisturizer often. Hair may grow back in a slightly different color or texture, but generally it returns to its original texture.

Your wig or hair piece, because it is needed as a result of cancer treatment, is a tax deductible expense. Also, it may be at least partially covered by your health insurance. If so, ask your doctor for a prescription for a "cranial prosthesis".

Hair loss is often the hardest part of cancer treatment for a woman to accept. If you feel angry and depressed, accept that these feelings are normal. Try to share how you feel with family and close friends. Support groups, either in person or on the web, are also helpful.

How Will My Chemo Be Given?
Chemotherapy is usually given in pill form or into a vein intravenously (IV). The drugs are given through a thin needle, usually in a vein on your hand or lower arm. If the lymph nodes in your underarm have been removed, make sure the IV is not inserted on that side, to avoid causing lymphedema (swelling) and possible infection. Also, avoid having blood drawn, or blood pressure taken on that side.

Instead of having a needle inserted into a vein for every treatment, many women opt for a more permanent access, such as a Hickman line or portocath. The Hickman line is a thin silicone tube inserted into a large vein, that exits through the chest wall. The portocath is completely inserted under the skin and so requires minimal care. Both can be left in for months or even years.

Chemotherapy May Involve Long Waits
Most infusion centers have a TV, but consider bringing a book, CD player, Walkman, knitting, pillow and blanket. A thermos and snacks for the wait and drive home are also a good idea. If possible, bring someone, to be with you and to help with driving home in case you don't feel well.

Coping With Side Effects
Every person reacts differently to chemotherapy, and different drugs cause different side effects. How you react to the chemo has no relationship to whether or not it is helping you.

Nausea and vomiting can occur soon after treatment or days later, but antinausea medicines today are very effective in relieving or preventing nausea and vomiting. Most people feel fine for the first hours after a treatment and find this is a good time to eat a meal. A reaction is often experienced 4-6 hours after treatment, but can happen as much as 12 or even 24 hours later. Some patients have flu-like symptoms around the third day after treatment.

Usually your doctor will give you antinausea medicine before your chemotherapy and then ask that you take it on a regular schedule. Request and fill prescriptions before your treatment day. There are several effective medicines available; your doctor will be able to give you a different one if the first medicines don't relieve your symptoms.

Before your chemo appointments, to reduce nausea, keep drinking fluids and eat a light meal. It is very important to drink enough fluids during treatment, 8-10 (8oz.) glasses a day, and more if you have fever or diarrhea. If you are nauseous during or right after treatment let your doctor know. You may lose your appetite for a while following chemo so eat whatever appeals to you. If you find yourself burping or have a burning sensation in your chest or throat caused by reflux - food backing up into your throat—report these symptoms so they can be treated.

If you are nauseous, avoid big meals, fatty or fried food and food smells - or any smell - that bother you. Prepare and freeze meals in advance. Eat your food warm rather than hot. Eat small meals 6-8 times a day. Eat and drink slowly and drink at least an hour before or after, instead of with, meals. Avoid fizzy drinks. Try flat ginger ale, non-acid juices, sports drinks and, of course, water. Avoid caffeinated drinks like tea, coffee, and many sodas. Juice popsicles are another way to get more fluids. Sucking on cracked ice or tart candies may help with a dry mouth. If you feel nauseous in the morning try keeping dry foods like cereal or crackers by the bed so that you can eat them before getting up. Rest in a chair after eating, but don't lie flat for at least two hours.

Some chemo drugs can cause diarrhea or constipation. If you have 3 or 4 watery stools in 24 hours, or blood in your stool, or are constipated, call your doctor and, again, ask beforehand so you can have any needed medicines available.

Chemo lowers your resistance to infections. You are most susceptible to a bacterial infection about 7-12 days after a chemo treatment. Wash your hands often and avoid being close to anyone who is ill. Postpone teeth cleaning, other dental work or inoculations. Keep a thermometer handy. Call your doctor at once, even if it's at night or on the weekend, if you have a temperature of 100.5 degrees Farenheit or over or chills - with or without fever - a cough, sore throat or pain or burning when you urinate. Don’t eat any raw foods or foods containing raw eggs during treatment.

Another side effect, mouth sores, can also cause difficulty in swallowing. While you are on chemotherapy, it is especially important to keep your mouth clean. If mouth sores should occur, continue brushing with a soft bristle toothbrush after every meal. If you find it too painful to brush, ask your doctor or nurse what you may use. Rinse your mouth often with a solution of one teaspoon baking powder and one teaspoon salt, diluted in a glass of lukewarm water. Don't use commercial mouthwashes containing alcohol.

Many people receiving chemotherapy feel tired. Rest is important, but staying in bed all day will not help improve the tiredness. Try to balance rest periods with continued activity. Plan necessary activities for times when you feel the most energetic. Try to get some exercise, like walking and yoga, as well as sunshine and fresh air, every day. Don't forget to protect your skin with sun block.

Keep a journal with your concerns and symptoms for doctor visits. Discuss different situations and get any necessary prescriptions beforehand. If your call to the doctor is urgent, tell the office or answering service immediately. When calling after office hours, give your name, doctor's name, type of cancer, type of chemotherapy, date you last received treatment, the names of any other medications you are taking and your pharmacy's phone number. Another doctor may be on duty and this information is important. Consider keeping by the phone.

Emotional Support
Try to bring a relative or close friend with you for treatments and meetings with your doctor. Record and/or take notes; it's hard to process such important information alone.

Your doctor or nurse can put you in touch with an American Cancer Society (ACS) Reach to Recovery volunteer who has had breast cancer. If you are concerned about your appearance, ask about a Look Good...Feel Better group in your area for free samples and advice on applying make-up. Check with your hospital for support groups or call ACS at 1-800-ACS-2345 for information on support groups in your area. For reliable information on cancer and to access the ACS online support group, the Cancer Survivor's Network, visit the ACS website at www.cancer.org.

Para solicitar información en español, llame al 1-800-ACS-2345. Un especialista en información sobre el cáncer le asistirá en español.

F/W 2003 Updated 9/1/2004