What is chemotherapy?

Chemotherapy is one of the treatments used to cure tumours.

But aren’t tumours incurable?

Absolutely not! Most tumours are currently curable.

What other treatments are used other than chemotherapy?

Surgery, radiotherapy, hormonal treatment, and immunotherapy.

What are the differences between surgery, radiotherapy, chemotherapy, hormonal treatment, and immunotherapy?

Surgery and radiotherapy are applied at a local level treating the diseased organ; chemotherapy and hormonal treatment work on the diseased cells present throughout the whole body; immunotherapy works by stimulating the organism.

Can these treatments be used together?

Yes! The integration of the various therapeutic options is one of the strengths of modern oncology.

When is chemotherapy used?

Before surgery in order to make the surgeon’s task easier by reducing the size of the tumour (pre operative or primary chemotherapy); after surgery in order to eliminate diseased cells that may be present in the organism in locations different from that of the primary tumour (precautionary or adjuvant chemotherapy); during the course of the disease when treatments that act on a local level are not possible or when surgery is considered unsuitable; in the occurrence of a reappearance of cancer.

How is chemotherapy administered?

The most common way is to introduce chemotherapy drugs intravenously. It is also possible to administer these drugs intramuscularly, under the skin or in cavities (such as the abdomen or the thorax) according to which particular drugs are used.

How long does chemotherapy last?

The duration of chemotherapy varies according to the individual plan that the doctor chooses for each patient.

Where and by whom is chemotherapy administered?

Current Italian law restricts the administration of chemotherapy to those medical facilities where there is an adequately trained medical and paramedical staff present and where there are the necessary equipment and facilities.

Does chemotherapy have side effects?

Unfortunately it does! There are, however, many effective ways to prevent or to treat these side effects.

Is it necessary to tell your doctor about your side effects, even transitory ones, that appear during chemotherapy?

Yes. It is useful to write down any side effects noting the type, intensity, the date, the time, and the duration.

What are the most common side effects?

The reduction of white blood cells and platelets, nausea, vomiting, inflammation of the mouth, diarrhoea, loss of appetite, tiredness, and loss of hair.

Do these side effects come with every type of chemotherapy?

No! Each treatment protocol, depending on which drugs are used, can provoke specific side effects. Their duration is variable.

THE REDUCTION OF WHITE BLOOD CELLS AND PLATELETS

Why do white blood cells and platelets decrease?

Chemotherapy impacts all cells that multiply rapidly, not just the ones affected by cancer. These include white blood cells and platelets.

How long does the reduction of these cells last?

It can last for days and it usually happens between one cycle and another of chemotherapy (around the 12th-14th day from the start of therapy).

Is it dangerous?

The reduction of white blood cells and platelets can cause infections and haemorrhages. While undergoing chemotherapy, it is important to avoid unnecessary exposure to possible agents of infection by following these guidelines: avoid crowded places; wash your hands often; do not use public toilets; avoid contact with children that have recently had a polio vaccination, rubella, mumps and measles; take care to disinfect small abrasions and cuts.

Are there drugs that can help with the reduction of white blood cells?

Yes! Currently there are very effective drugs (referred to as “growth factors”) to treat and prevent the reduction of white blood cells.

How do these drugs work?

They stimulate the bone marrow to produce white blood cells.

Do these drugs have possible side effects?

Yes they can induce joint and bone pain for a few days. In some case they can lead to a fever.

What can you do in this case?

Tell your doctor and take the medicine that he/she prescribes. Usually an analgesic or fever- reducing drugs are sufficient.

What should you do if your white blood cells and platelets decrease?

Take drugs prescribed by your doctor; avoid contact with people with infections even commonplace ones such as the cold, flu, and bronchitis; favour cooked foods, avoid milk, fruit and fresh vegetables; maintain scrupulous personal hygiene paying particular attention to your mouth and to the mucous membrane; wash your hands frequently especially before meals and after going to the toilet.

When is it necessary to immediately contact your doctor?

If you have one of the following: a fever; a burning sensation while urinating; a persistent cough; vaginal secretions or a burning sensation in the vagina; haemorrhages, even small ones, or bruises.

If there is a reduction of your white blood cells and platelets is hospitalisation necessary?

Not always. Every situation should be evaluated by a doctor in order to decide, according to the patient’s condition, what treatment to recommend and to deal with eventual complications.

NAUSEA AND VOMITING

Are nausea and vomiting frequent side effects?

Current anti-nausea treatment has greatly reduced the side effects. However, even despite these drugs, some patients still have them.

Do all types of chemotherapy cause nausea and vomiting?

No! The probability of these side effects developing varies according to which drugs are used.

When should anti-nausea medicine be taken?

It should be taken regularly and before the appearance of the symptoms. Instructions regarding when and how to take them and the dosage should be followed closely.

How should meals be eaten?

Eat and drink slowly, chewing food well in order to favour digestion; eat dry and slightly salty foods; have small and frequent meals; if possible avoid cooking and being in the kitchen during food preparation since the smell could cause nausea and vomiting; get some exercise before each meal.

Is it preferable to eat more in the morning or the evening?

Nausea and vomiting are generally less present in the morning, so in this case more food should be consumed in the morning at breakfast and then at a mid-morning snack.

What should you drink?

Drinks, especially sugared ones, can increase nausea if drunk at mealtime. On the contrary, sugared drinks, if consumed between meals, can help to reduce nausea. It is therefore better to drink largely between meals (juice, Gatorade, tea, mint flavoured drinks).

What should you avoid?

Rich, fatty and fried food. It is better not to eat meals in bed.

Can you drink alcohol?

It is better to avoid alcohol. Patients can drink a glass of wine with meals if they so wish.

Does your mood and emotional state influence nausea and vomiting?

Yes! Anxiety can lead to the onset or a worsening of these symptoms.

What should you do in this case?

You should take tranquillisers after consulting a doctor in order to approach more calmly chemotherapy.

When should you consult your doctor?

If you have more than three episodes of vomiting in an hour or two or three one right after another; if nausea lasts for more than three days after chemotherapy; if there is blood or dark matter in the vomit; if the vomit enters the respiratory channels; if you are unable to drink or eat for an entire day; if you are unable to take your prescribed drugs; if signs of dehydration appear (dry mouth and skin, decrease in quantity of urine, paler urine) and/or if you find yourself in a confused state.

INFLAMMATION OF THE MOUTH

Are inflammations or sores in the mouth common?

With some drugs they are!

What should you do to maintain oral hygiene?

It is important to have a strict oral hygiene regime. After each meal you should brush your teeth with a soft toothbrush. You should avoid using mouthwash that contains alcohol. If advised by a doctor, gurgle with water and bicarbonate of soda.

What should you do if you have removable false teeth?

It is advisable to remove them, wash them carefully with products for this purpose, and only use them when it is strictly necessary.

Is smoking dangerous?

Absolutely!

What should you avoid when you have inflammations in your mouth?

Hot and cold food, vinegar, citrus fruits, and tomatoes that could cause irritation or a burning sensation. Very salty and spicy food, alcohol, and coffee.

What food should you eat?

Soft foods at room temperature (for example fruit smoothies, custards, jelly, yoghurt, puddings, potato puree).

Can you take supplements?

Yes! Supplements available in the chemist can guarantee an elevated supply of calories.

What can you do when you have white spots on your tongue and palate?

Tell your doctor who supervises your treatment. You can remove them with a brush and then you should rinse your mouth out with bicarbonate of soda and brush with crystal violet.

What should you do if you have mouth pain?

You can cool your mouth with ice-cream or ice cubes. You can use local anaesthetic but only if advised by a doctor. If the pain is very strong and prevents adequate alimentation it is possibile to use local anaesthetic immediately before meals, on medical advice.

Can you take medicine for this problem?

In some cases and if your doctor advises it, medicine can be used to prevent infections. If your doctor has prescribed pain medicine that can be taken on an empty stomach, it is best to take it 20-30 minutes before meals.

When should you consult your doctor?

If you are unable to eat and/or drink adequately; if your tongue becomes very red, if it bleeds, or if white spots appears on it; if the mucous membrane begins to erode; if you get a fever; if you have difficulty in swallowing; if you have a burning sensation after swallowing.

DIARRHOEA

Is diarrhoea common?

With some drugs, yes!

Is is a serious problem?

Usually no. In some cases, however, it can cause problems due to loss of liquids and mineral salts.

What should you avoid?

Spicy food, rich food, food high in fibre (in particular wholegrain bread and pasta, fresh fruit, nuts, legumes and vegetables). You should also avoid milk and dairy products, and immediately suspend any laxatives that you may be taking.

What should you do?

It is advisable to drink small quantities throughout the day. Hydrate yourself by drinking water, tea, and fruit juice. Drinking beverages such as Gatorade and Isostad that contain electrolytes can be very helpful.

What should you eat?

The best foods are: boiled rice, eggs, fish, grilled fish with lemon, semolina, potatoes, bananas and apples.

When should you consult your doctor?

When you have diarrhoea for several days; if you have abdominal pain or show signs of dehydration (dry mouth and skin, cramps); if your have less urine; if your urine is dark; if there is blood in your faeces; if you have a fever; if you are in a state of confusion.

CONSTIPATION

Is constipation a side effect of chemotherapy?

Yes! It can be caused by drugs used for chemotherapy as well as those given for as support medicine during chemotherapy.

Is it true that medicine used to prevent nausea and vomiting can cause constipation?

Yes! However, it is a temporary side effect that can be controlled.

Can the medicine used in pain management cause constipation?

Some can! When you use these drugs it is the doctor’s duty to provide advice in regards to diet and lifestyle in order to prevent this problem.

What should you eat if you are constipated?

Foods rich in fibre (wholegrain bread and pasta, fresh fruit and vegetables), prunes or prune juice once a day, preferably in the evening.

Should you drink more or less?

It is helpful to drink more especially between meals.

Is it better to eat more in the morning or the evening?

A big breakfast that is rich in fibre and accompanied by hot drinks can be very helpful.

Does your lifestyle influence this problem?

It certainly does! It is important to: eat at regular intervals, get adequate rest, do regular physical activity.

What should you avoid?

Using laxatives without medical supervision, caffeinated beverages (tea, coffee etc.), chocolate, cheese, and eggs.

Should you use laxatives?

Laxatives should only be taken under medical supervision, never on your own initiative.

LOSS OF APPETITE

Is loss of appetite common among chemotherapy patients?

Yes, loss of appetite is very common among chemotherapy patients.

What causes it?

It can be caused by nausea or vomiting, by anxiety, by depression, or by the cancer itself. Loss of appetite can also be caused by changes in the sense of taste and smell that chemotherapy can cause.

How long does it last?

Usually it is a temporary problem that can be resolved quickly.

Can loss of appetite cause complications?

Loss of appetite, in the most serious cases, causes a decrease in the assumption of important nutritive elements (sugars, proteins, vitamins, mineral salts), which leads to weight loss. This can weaken the patient’s immune system exposing her/him to eventual complications, as well as lowering her/his tolerance to chemotherapy and negatively affecting her/his mental state.

What should you eat if you have loss of appetite?

Choose foods high in calories (eggs, meat, fish, cheese, sweets).

How can you increase caloric intake?

Enrich your food with cheese, butter, oil, ham or mince meat, “reinforced” milk (that is, milk with added powdered milk).

When should you eat?

It is not necessary to eat at specific times. It is important to eat when you are hungry and eat many (up to 6-8) small meals a day. It can help to have your favourite food readily available.

Does it help to have a big breakfast?

Yes! The morning is when you usually are more hungry, so it is advisable to have a big breakfast followed by a mid-morning snack. You should aim to consume a third of your daily calories in the morning.

How should you present food?

Use small plates with moderate portions. Follow your taste in food. Present each plate separately.

Can you drink alcohol?

In small quantities. Alcohol before meals can stimolate appetite.

What should you use to sweeten food?

It is preferable to use honey in order to increase calorie consumption.

How can your family help?

They should not make your diet the focus of conversation. During meals they should create a relaxed atmosphere. They should set the table with care. They should avoid cooking in your presence. You should eat together.

Should you take supplements?

They can be helpful if your doctor advises taking them and if they are taken under medical supervision.

What should you do if you have trouble swallowing or chewing?

You can eat food that is blended or minced and take food supplements. Jelly, puddings, and yoghurt are good in these cases.

Can you use medicine to stimulate your appetite?

In some cases, yes! These drugs, however, should be limited to severe cases of loss of appetite that involve considerable weight loss and must be prescribed by a doctor.

When should you consult your doctor?

If you lose more than 3kg in a week; if you experience pain during meals; if the quantity of urine decreases and/or if signs of dehydration appear such as a dry tongue, skin that is dry and not elastic, cramps, tiredness, sleepiness, listlessness and a state of confusion.

HICCUPS

Are hiccups frequent among patients undergoing chemotherapy?

Usually no, even though it is a symptom that can appear.

What should you do?

Drink water slowly that is not too cold. Breathe slowly and deeply into a paper or plastic bag 3-4 times consecutively. Keep a teaspoon of sugar in your mouth for 1-2 minutes before swallowing.

What should you avoid?

Do not force yourself to eat. Avoid fizzy drinks. Do not smoke.

When should you consult your doctor?

If the hiccups last for more than a day. If you experience breathing difficulties. If you are unable to eat an adequate amount.

HAIR LOSS

Do you always lose your hair and body hairs during chemotherapy?

No! Not all chemotherapy drugs cause the loss of head and body hair.

How long after beginning chemotherapy does your hair fall out?

It depends. For some patients it falls out immediately (12-14 days after beginning therapy), for others, in a more gradual manner.

Does your hair grow back after chemotherapy?

Yes! After finishing chemotherapy your hair will start to grow again normally.

Can you do something to prevent hair loss?

You can use caps that have been specially designed to wear before and during chemotherapy, however, they are not always effective. Do not wash your hair frequently, dry your hair gently, do not use aggressive products such as dyes or permanents.

What can you do?

Cut your hair short before it starts falling out, and, if need be, buy a wig.

ANXIETY, DEPRESSION AND INSOMNIA

Can chemotherapy cause anxiety and depression?

Yes! The combination of operations, medical treatment and exams, together with concern and fear about the future leads to anxiety and depression in many patients. Moreover, many patients experience an unjustified fear that effects their ability to carry on calmly with their daily lives.

How long do these problems last?

hey can be resolved if tackled with patience, the support of family and friends, and the help of a specialist.

Should you take medicine to resolve these problems?

Only when really necessary and under medical supervision.

Can you become addicted to these drugs?

No! They should only be taken for a limited time and with the objective to helping you overcome a particularly difficult period.

Is it possibile you will develop sleep problems?

Yes! They can be associated with the medicine or, more commonly, with a state of anxiety.

Should you take medicine?

If your doctor thinks it appropriate.

What should you do if you have insomnia?

Sleep as much as your organism demands. Avoid coffee, tea, coca-cola from the late afternoon on. Do not go to bed if you are not sleepy. Maintain your regular daily routine.

If you are anxious, depressed or you cannot sleep should you seek medical advice?

Always! These are problems that can greatly impact the quality of your life and, if addressed with competence, can be resolved quickly and effectively.

What can your family do to help?

The family environment should be as serene as possible. Opportunities to share moments of leisure or just some of the regular daily routine together should be created. Family members should talk to you and encourage you not to hide your real emotional state. They should neither play down nor make too much of a big deal of your condition.

What should you avoid at all costs?

It is absolutely necessary to avoid taking any medicine to counter anxiety or depression without medical supervision. It is very important to pay no attention to those who insist on telling you about negative experiences in cases similar to yours. Keep in mind: chemotherapy is not the same for all types of cancer, support therapies are not practiced in the same way in all hospitals and clinics, the disease itself as well as related clinical problems can influence the incidence of eventual side effects, and the ability and the will to face problems associated with cancer and its treatment varies from person to person. In conclusion, what counts is the individual experience for the daily management of problems that could arise. Anxiety, depression, and insomnia can be faced and resolved if everyone (patient, family members, and doctors) work together in a coordinated fashion towards finding a solution.

TIREDNESS

When can we define someone as tired?

When they do not have enough energy to carry out normal daily activities.

What causes tiredness?

It can be a side effect of some drugs or radiotherapy. It can also be caused by anxiety and depression. It can be caused by the cancer itself as well as from other eventual pathologies that appear.

Does the reduction of red blood cells play a role?

Yes, even though the red blood cells and haemoglobin have to be very low to cause tiredness.

What can you do?

Get adequate rest. Plan your daily activity. Do not exert yourself beyond your means.

When should you consult a doctor?

If you have to stay in bed for more than half the day. If you become confused or disoriented. If the tiredness worsens.

Is is necessary to take medicine?

Generally not. Usually tiredness is a temporary side effect that goes away once you have finished chemotherapy.

Do you have to maintain a particular diet?

It is not necessary to eat certain foods. A varied and regular diet is sufficient, and slight adjustments should only be made when advised by your doctor.

OTHER QUESTIONS AND OTHER ANSWERS

Are there are particular precautions you should do before beginning chemotherapy?

Any treatments or particular precautions for the specific drugs will be advised by your doctor. In general, you should follow these suggestions: wear practical and comfortable clothing (especially for patients treated in out-patient clinics); plan in advance the day of therapy so as to free yourself from work and family commitments; prepare or have someone else prepare meals for that day; organise how you are going to arrive at the hospital; take any prescribed drugs at the times indicated by your doctor; have a light and nutritious meal with little liquids; take with you, according to your own habits, a book, newspaper, music player with headphones in order to pass the time serenely; avoid appointments or commitments in the hours immediately following your treatment; when arriving home, avoid strong smells (especially paints and perfumes).

While undergoing chemotherapy do I have to change my routine?

No! You must only be careful to prevent and treat the side effects as listed above.

Can you work?

Yes! You should avoid, however, work that it arduous and physically or mentally taxing, and those that require night shifts or involve particular attention with machinery.

Can you drive?

In general, it is best to avoid driving on the day of chemotherapy and while suffering from side effects in the days immediately following it. When side effects are not present and between rounds of chemotherapy you can carry on with your normal life including driving.

Can you have sexual relations?

Yes! There is no reason to abstain from sexual relations. During chemotherapy you may experience a decrease in sexual desire, which is usually temporary, and in this case it can be helpful to ask advice from your doctor.

Should you use contraceptives?

Yes! Pregnancy during chemotherapy could result in complications both for the mother and for the unborn child.

Do irregularities develop in your menstrual cycle?

With some drugs, yes! They are usually transitory and do not require any specific treatment. You should seek advice from your gynaecologist if you stop menstruating altogether or if your cycles become very short. Sometimes, chemotherapy can induce a permanent stop of your menstrual cycle, leading to early menopause.

During chemotherapy is it possibile to put on weight?

Yes. You should tell your doctor immediately if your weight increases by more than 2 kilograms.

During chemotherapy do you see changes in your skin and nails?

During some types of chemotherapy you may notice alterations on your skin (more pigmentation, greater sensitivity to rubbing or scratching, appearance of lines or dark spots) and lines on your nails. The veins used for the injection of drugs may become dark. Tell your doctor if these symptoms appear so you can be advised about how to treat them.

Can chemotherapy induce a fever?

Some drugs can induce fever. You should tell your doctor immediately in order to identify the cause and to decide on the best treatment.

Can it cause stinging in your eyes?

Some drugs can irritate the mucus membrane on the eyeballs. You should tell your doctor immediately who can then tell you how to resolve this problem quickly.

Can it cause “pins and needles” in your hands and feet or problems in your hearing?

Yes. In these cases you must let your doctor know immediately in order to identify the cause and to decide on the best treatment.

Can it cause cardiac problems?

Some drugs can cause cardiac problems. Let your doctor know if you experience changes in your heartbeat, breathlessness, or swelling in your legs and feet, and follow rigorously all prescribed check-ups for before, during, and after chemotherapy.

Can you continue to take prescribed medicine for other conditions?

It is usually possible to continue treatments for other medical conditions, however it is essential that you tell your doctor about the drugs (as well as natural remedies) that you are regularly taking so that he/she can evaluate any eventual interactions between the drugs.

Can you do sporting or recreational activities?

Yes! Provided that, as with work, they do not involve excessive exertion that is prolonged or repeated. Going for walks in the open air is an excellent way of getting physical exercise during chemotherapy.

Can you go to the seaside or in the mountains?

Yes! However, you should avoid the sun in the hottest hours and protect your skin with a high SPF sunscreen. In any case, you should ask your doctor about getting sun exposure because some drugs cause a considerable increase in the skin’s sensitivity to ultraviolet rays and can lead to serious skin damage.

Can you see your friends, family, and children?

Yes! There is no reason to change your social habits. As already mentioned, caution must be paid to avoid people with acute infections as well as closed and crowded environments.

Is chemotherapy effective if you have no side effects?

Yes! The appearance of side effects is not an indication of effectiveness. Only your doctor can tell you about the results of the treatment after having carried out the necessary medical exams.

Can you postpone chemotherapy by a few days?

Unless your doctor advises otherwise, you should not postpone treatment. The effectiveness of chemotherapy is closely tied to doses and the timing of administration of the drugs.

What happens at the end of chemotherapy?

The side effects disappear and you can resume all your normal activities and routine.

When should you talk to your doctor or a nurse?

Remember that the medical and nursing staff do not consider their work is solely about administrating drugs. Talking over your problems, even though they appear small, in a calm way with them is the best way to avoid unnecessary risks and serious complications. You must not feel alone with cancer. The best clinical results are obtained not only with the suitable treatment but also with a serene, continuous and constructive relationship between you, the patient, and everyone who is working towards your well-being.