TREATMENT RELATED SIDE EFFECTS

If it is a MEDICAL EMERGENCY CALL 000

If you have any of the following symptoms please contact Peter Mac straight away and ask for the registrar on call, on (03) 8559 5000:

• a temperature over 38˚C or fever and chills (these might indicate an infection)
• diarrhoea that continues over 24 hours, particularly if watery
• persistent vomiting that lasts more than 24 hours or nausea lasting more than 48 hours despite taking antinausea
• any abnormal bruising and bleeding
• constipation: if you have not opened your bowels for more than two days
• a cough or shortness of breath
• a sudden decline in your health
• Any changes in mood including feeling withdrawn, depressed or anxious

Infection

Red and white blood cells and platelets are specialised cells made by the bone marrow. Neutrophils are one type of white blood cell. Neutrophils are important in helping your body to fight infections.

Chemotherapy can reduce the number of neutrophils in your blood. This means you are “neutropenic” and more at rick of infection.

It is important to tell your doctor or nurse if you feel you are developing a cold or other signs of infection. Even if the symptoms do not seem severe to you normally, you are at much greater risk and if early signs are not treated, you may become very ill quite quickly. Signs of infection include:

• a fever (temperature at or above 38˚C)
• chills or sweating
• a sore throat or sores in the mouth
• abdominal pain
• pain and burning when passing urine or frequent urination
• diarrhoea or sores around the anus
• a cough or breathlessness
• any redness, swelling, or pain, particularly around a cut or wound
• unusual vaginal discharge or itching.

It is important to know when you are neutropenic and take measures to lower your risk of infection.

Speak to your treating team about how to manage neutropenia including advice on avoiding been exposed to infection and how to prevent infections from occurring.

Contact the hospital IMMEDIATELY if you have:

• a fever (temperature at or above 38˚C) AT ANY TIME OF THE DAY OR NIGHT
• any of the other symptoms of infection listed above

If it is a MEDICAL EMERGENCY CALL 000

Be prepared to give the following information:

• last treatment date
• your highest temperature in the last 24 hours
• if you are having any shaking or chills
• any other symptoms of infection you have had
• if you are feeling dizzy or light-headed.

Some patients experience many side effects, whilst other experience none. The side effects experienced depends on the type and dose of drugs or radiation used and the individual patient.

You may also experience side effects related directly to your illness as a result of medications.

Peter Mac offers a large number of services that can help manage the side effects of cancer and it’s treatment. If you experience any side effects from your cancer or its treatment, speak to your treating team who can offer advice, support and resources, or refer you to services that can help to manage or treat these symptoms.

Fatigue

Fatigue is tiredness that cannot be relieved by resting or a good night’s sleep. It is often described as a lack of energy or a decreased ability to complete your usual activities. Some people find they can’t concentrate well or make decisions; others say it makes them feel irritable or tearful. These are normal reactions to cancer-related fatigue.

Fatigue can be related to the cancer itself, cancer treatments, low red blood cells (anaemia), loss of appetite or weight loss, pain, nausea, emotional distress or sleep problems. It is the most common side effect of chemotherapy.

Treatment related fatigue generally begins within 24 to 48 hours of having chemotherapy. It can take up to three to four months post treatment for energy levels return to normal.

For information about managing fatigue, speak to your treating team.

Consult your doctor or nurse if you:

• feel overwhelmed by your illness and treatment
• are short of breath
• feel a loss of balance when walking or getting in and out of bed or a chair, or
• get frequently dizzy.

These symptoms may suggest you blood cell count is low (anaemia) and you may need to be treated with a blood transfusion. Anaemia can make you feel very tired.

Shortness of breath

Shortness of breath is the feeling that you are having trouble breathing. This is a sign that the body is working hard to move air in and out of the lungs. Shortness of breath can be due to:

• some chemotherapy drugs or radiation therapy to the lungs
• reduced oxygen in the blood (anaemia)
• infection
• fluid in the lungs
• lung damage from smoking
• cancer that has affected the lungs
• asthma or any other chronic lung problems.

Feeling shortness of breath can be the result of, or worsened by anxiety. Anxiety about cancer and it’s treatments is common.

Shortness of breath can be concerning and frustrating. If this is a new symptom to you, it is important that you speak to your treating team to identify its cause. They can also help you with advice of how to avoid and manage shortness of breath.

Alert your doctor, nurse or the hospital IMMEDIATELY if you:

• notice a worsening in your breathing or you suddenly become extremely short of breath, or
• can’t manage you shortness of breath with the techniques given by your treating team.

Nausea and vomiting

Nausea is an unpleasant wave-like feeling in the back of the throat and/or stomach that may or may not result in vomiting. Some people with cancer may have nausea due to their cancer or due to treatments, including chemotherapy. ‘Anticipatory’ nausea or vomiting is promoted by the memory of a treatment that caused sickness previously. For others, anxiety about cancer and/or treatment can cause nausea and/or vomiting.

Fortunately, nausea can usually be managed by medication and other simple techniques. Your doctor may give you medication, called antiemetics to help prevent or control your nausea. ALWAYS follow your doctor’s instructions when taking these medications.

Ask your treating team for advice about managing nausea and/or vomiting.

Consult you doctor or nurse if:

• nausea is not controlled with antinausea drugs
• you are unable to eat due to ongoing nausea
• you are unable to take your medications, or;
• vomiting is uncontrolled.

Loss of appetite

Good nutrition is needed for general good health. During illness, it is important that you have a well-balanced diet that includes proteins, fats, carbohydrates, vitamins and minerals, to maintain energy, and to keep your immune system strong.

Due to your illness or treatments however, there may be a period of time that you may not be able to eat in the same way as before. Pain, nausea, vomiting, diarrhoea, mouth problems or even a change in food preferences or taste might cause you to lose interest in food. Depression, anxiety and stress associated with cancer and its treatment, might also cause a loss of appetite.

Speak to your treating team for advice if you are experiencing a loss of appetite.

Consult your doctor, dietitian or nurse if you:

• are unable to drink fluids
• feel dizzy when standing or feel other symptoms of dehydration
• are unable to eat solid foods, or
• are continuing to lose weight

Weight loss

There may be times when you cannot eat as much as you usually do and this can cause weight loss. Weight loss can cause extreme tiredness and fatigue and results in an inability to carry out everyday tasks.

Weight loss can be a result of other side effects of cancer and cancer treatments such as fatigue, nausea, vomiting, constipation, diarrhoea, mouth problems, taste changes and poor appetite.

If you are experiencing weight loss, or any of the symptoms that cause weight loss, speak to your treating team for advice on maintaining you weight.

Consult your doctor, nurse or dietitian if:

• you continue to lose weight
• your weight loss is drastic, or
• you experience nausea and vomiting that cannot be controlled by medication.

Mouth problems

Sometimes your illness or treatment can affect your mouth, lips or throat causing them to become dry and sore. This can result in difficulties eating, chewing or swallowing and cause discomfort.

A sore and dry mouth, lips and throat can be very frustrating and your treating team can suggest products such a sprays and creams that act as artificial saliva. It is also important that you keep your mouth clean and healthy to help prevent infection.

Please speak to your treating team for advice on treating mouth problems and tips for good oral hygiene during your treatment.

Please consult your doctor or nurse if:

• you develop red/white areas in your mouth
• the pain in your mouth is severe and you are finding it hard to swallow
• you are avoiding eating and drinking all together because of your mouth problems, or
• you have bleeding in the mouth.

Taste changes

It is common to experience changes in your taste as a result of your illness and its treatment. Taste changes are often associated with chemotherapy or radiation therapy and the change is usually short term. A change in taste may result in you disliking certain foods that you would normal eat and can cause a loss of appetite and lead to weight loss.

For advice on how to cope with taste changes, please speak to your treating team.

Consult your doctor, dietitian or nurse if you experience on going or rapid weight loss.

Diarrhoea

During some treatments, the lining of the bowel may become irritated and sensitive, causing short-term changes to how your bowel works. Chemotherapy can lead to discomfort in the stomach (cramps or wind pains), fluid and pale bowel motions and more wind than usual. These symptoms may occur shortly after the start of treatment and correct themselves within a week or so of its completion.

Episodes of more frequent bowel motions and diarrhoea are common. This might be as a result of radiotherapy to the pelvis, some chemotherapy drugs, other medications such as antibiotics, anxiety, infection, a change in diet or a food allergy.

Replacing fluid that you may have lost through frequent bowel movements and diarrhoea is very important. Once your bowel movements have returned to normal, it is important that you resume a healthy diet including fresh fruit, vegetables and wholegrains.

For advice on controlling and managing bowel changes, please speak to your treating team.

Consult your doctor, dietitian or nurse if you:

• have unexplained diarrhoea that persists for more than a couple of days or causes you discomfort or distress
• follow management advice from your treating team for several days and your diarrhoea persists, or
• become very dehydrated and are finding it hard to replace your fluids

Constipation

Constipation is when you are unable to move or open your bowels, having to push harder than normal to move your bowels, or using your bowels less often than is usual for you. Bowel movements bay be small, dry and hard. They could also resemble small amounts of diarrhoea like lose stool; however, you might feel like you are never completing your bowel movement.

Many medications can cause constipation. Constipation can also be caused or worsened by a lack of activity or eating and drinking less than normal.

Constipation can be painful, uncomfortable and very frustrating. It is important to monitor your bowel movements and try to keep them as regular as possible so bowel movements are easy to pass. Ignoring constipation can worsen its symptoms.

Sometimes, eating a higher fibre diet can actually worsen your constipation, particularly if it is a side effect of the medications you are taking. It is important to speak to your treating team about your constipation so they can recommend effective management. If you have medication associated constipation, often you will also be given medication to help manage this.

Speak to your treating team for advice to manage your constipation. If your medications change or increase, ask for advice on how to keep your bowel motions regular and prevent constipation.

Consult your doctor or nurse if you:

• have questions regarding your medication, or
• have not opened your bowels for 48 hours and this is not normal for you.

Hair loss

Chemotherapy can cause hair loss, which can be called ‘alopecia’. It may begin as early as the first few days of your treatment or may take up to a few weeks to occur. Hair loss usually begins with the hair on your head but you may experience hair loss on the rest of your body.

The amount of hair loss is different for everyone. Some people may experience thinning, while others may lose all of their body hair. Your hair loss is dependent on the type of chemotherapy you are receiving.

The hair loss is not permanent and while some regrowth may occur during treatment, full regrowth will usually start about six weeks after your chemotherapy has finished.The colour and texture of your hair may be different from what it was before treatment.

It is important to note that not all chemotherapy will cause hair loss and your treating team will let you know if you are likely to experience this.

Speak to your treating team about coping with hair loss and advice around skin care for these areas.

Peter Mac also offers a range of support services to help manage hair loss, including a headwear and wig library and Look Good, Feel Better workshops.

Menopausal symptoms and breast cancer

If you are having chemotherapy to treat breast cancer, you may experience menopausal symptoms. Menopause refers to a woman’s final menstrual period. Around two thirds of women who are younger than 50 when their breast cancer is diagnosed will go through treatment-related menopause. It is possible that your periods will not return.

The likelihood of the symptoms of or early menopause will depend on your age and the type of chemotherapy you are having.

Symptoms of early menopause may include:

• irregular menstrual periods
• hot flushes
• night sweats
• vaginal dryness
• painful sexual intercourse
• loss of sex drive
• difficulty sleeping
• difficulties with bladder control
• tiredness and mood swings
• skin and breasts becoming less supple and less firm
• brittle bones, which means they are more likely to fracture.

It is important that you seek support from your treating team and be open with your partner and other loved ones if you are at risk of early menopause.

Please speak to your treating team for advice on how to manage the symptoms, both physical and emotional, of early menopause.

Weight gain

Weight gain may occur with some cancer treatments. This is especially common for women receiving treatment for breast cancer. Excess weight can affect your overall health and the way you feel physically and emotionally.

You may experience weight gain as a result of side effects from chemotherapy, other treatments and medications that may cause inactivity, swelling due to fluid (called oedema), an increased appetite or early menopause.

Speak to your treating team for advice about maintaining your weight during treatment.

Consult your doctor or nurse if you have signs of fluid retention (oedema) including: swelling around your wrists and ankles, feeling that your watch, rings or other jewelry or the skin itself feels tight or if indentations are left when you press on swollen skin.

Peripheral neuropathy

Peripheral neurothapy refers to the nerves in your body being damaged. This can cause a feeling of pins and needles in your hands and feet.

You may notice that you have trouble doing up buttons or picking things up. You may feel weaker or not feel cold and hot as well as you normally do. These changes in sensation can build up over time and will often not disappear until several months after you chemotherapy.

Consult your doctor if you experience any loss of sensation. Your treating team will monitor you to see how much the loss of sensation is affecting you and your everyday activities.

Skin sensitivity

Treatment can cause changes to your skin, making it irritated, more sensitive to the sun or to skin products that didn’t cause irritation before treatment. Skin may become:

• red
• dry
• itchy
• discolored
• pimply.

It is important to be aware of sun sensitivity during treatment and always take precautions when going outside including sunscreen and protective clothing.

You may also experience changes in the strength and look of you finger and toenails.

The Look Good, Feel Better program can help you manage changes to your skin.

Speak to your treating team for advice on managing skin changes during treatment.

Cancer treatments may cause birth defects. While you are having treatment, and for a while after completing treatment, women should avoid becoming pregnant and men should not father a child. Treatment can pose a risk to the unborn child. Use effective contraception during this time (such as condoms).