Preparing for your chemotherapy cancer treatment

There are many different chemotherapy drugs to treat cancer. The chemotherapy advised for you is the best treatment for your cancer, which would have been discussed by several different specialists.

How does chemotherapy work?

Chemotherapy drugs disrupt the way cancer cells grow and divide. They also affect healthy cells; however these can usually repair following damage caused by chemotherapy whereas many cancer cells cannot and eventually die.

How will my treatment be administered?

Your chemotherapy treatment will be given over a set period of time and administered in cycles, i.e., weekly, fortnightly, three weekly, over a few months. The length of time taken to administer your treatment will vary depending on which treatment you receive.

Your treatment will be given by members of the nursing team who are trained to administer anti-cancer treatment. It will be given as an intravenous infusion or bolus into a vein in your arm. You may need a special device called a portacath, or peripherally inserted central catheter (PICC) inserted to administer your chemotherapy treatment.

Some types of chemotherapy are given over a few days and are set up in a small portable pump which you can take home. You will then have to come back to the hospital to have it disconnected.

Before each treatment, you will need to have a blood test, take a Covid-19 test, and see a doctor or nurse who will prescribe your medication.

How will I know when to attend my next treatment?

You will be given a cancer treatment record book at the start of your treatment. It includes information on treatment types, appointments, and a test results log. You will also be able to record any side effects and questions to ask the doctor or nurse at your next appointment.

Will it be painful?

You may feel a cold sensation up your arm whilst the infusion is being administered. If you feel any discomfort or notice any redness or swelling around the cannula site, then you must let the nurse know straight away.

What side effects can I expect?

Because chemotherapy drugs can affect some of the healthy cells in your body, this can cause side effects. Most side effects will go away after treatment finishes.

Everyone is different. Some people may have no side effects or mild side effects and some people may have more severe side effects because of their treatment, but this may vary depending on which chemotherapy you receive.

We would not expect you to have all the following symptoms, but it is important to be aware of them and to contact us straight away if you need advice.

Common side effects

Risk of infection

Chemotherapy can reduce the number of white blood cells in your blood. These cells fight infection so if your white blood cells are low, you are more likely to get an infection.

An infection can be serious when the number of white blood cells are low, so it is important to treat any infection as soon as possible. This is called neutropenic sepsis.

Contact the 24-hour helpline if:

• Your temperature goes over 37.5°C.
• You suddenly feel unwell, even with a normal temperature.
• You have symptoms of an infection such as: feeling shivery and shaking, a sore throat, a cough, feeling breathless, diarrhoea, needing to pass urine a lot, or discomfort when you pass urine.
• Your temperature goes below 36°C.

Bruising or bleeding

Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets are low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red or purple spots on the skin that may look like a rash

If you have any unexplained bruising or bleeding, then you must call the 24-hour helpline.

Anaemia (low number of red blood cells)

Chemotherapy can reduce the number of red blood cells in your blood, which carry oxygen around the body, causing anaemia. You may have symptoms such as:

• pale skin
• lack of energy
• feeling breathless
• feeling dizzy and light-headed

If you notice any of these symptoms, then you must call the 24-hour helpline.

Fatigue or tiredness

Feeling tired is a common side effect of chemotherapy, but it can also be a general side effect of the cancer itself.

To help cope with fatigue, you should:

• Know that you may have good days and bad days.
• Use your treatment record to identify patterns of side effects so you can plan an active life around them.
• Continue to undertake any light exercise you have been doing.
• Ask for, and accept, help from family and friends.

Diarrhoea/constipation

Chemotherapy can cause diarrhoea and some of the medication we give you to support your chemotherapy can cause constipation. If you have diarrhoea:

• Try to drink at least 2 litres (3½ pints) of fluids each day.
• Avoid alcohol, caffeine, milk products, high-fat foods, and high-fibre foods.

If you are constipated:

• Try to eat more fibre (cereals, raw vegetables, and fruits).
• Drink plenty of liquid.
• Try gentle exercise, such as short walks.

You must contact the hospital for advice if you have diarrhoea, if you are opening your bowels more regularly than normal or at night, and if you are having difficulty opening your bowels.

Nausea and vomiting

Not all chemotherapy drugs make you feel sick. If the chemotherapy you are on causes sickness, you will receive anti-sickness medicine before you start your treatment and some to take home with you. Take the drugs exactly as your nurse tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick or are sick more than once in 24 hours, contact the 24-hour helpline.

Changes in taste and smell

You may develop a bitter or metal taste in your mouth. Sucking sugar free sweets can help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. This will improve once your chemotherapy is completed.

Sore mouth

Chemotherapy may cause you to have a sore mouth and/or throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

• Tell your nurse or doctor – they can give you a mouthwash or medicines to help.
• Try to drink plenty of fluids.
• Avoid alcohol, tobacco, and foods that irritate your mouth and throat.

Hair loss

Not all chemotherapy drugs cause hair loss. Some chemotherapy drugs may make your hair thinner and some you will lose all the hair on your head. You may also lose your eyelashes and eyebrows, as well as other body hair.Hair loss usually starts 2-3 weeks after your first treatment and will begin growing back a few weeks after your last treatment.

You may like to consider scalp cooling, which helps prevent or slow down hair loss and is available with certain chemotherapy drugs, or you may wish to consider a wig or scarves to cover up hair loss. Ask your nurse or doctor for further advice.

Skin and nail changes

Chemotherapy may affect your skin and nails. If you experience a rash that is spread over several areas of your skin or covers more than half of your body; you should tell your doctor immediately.

During treatment, and for a few months after, you will be more sensitive to the sun and more likely to burn even in cooler weather. You should wear a sun cream with a high sun protection factor (SPF) when you go out and cover up with clothing and a hat.

Try to keep your skin well moisturised but avoid perfumed products. Aveeno cream or E45 are ideal for this.Your skin may get darker but will return to its normal colour after you finish treatment.

Your nails may grow more slowly or break more easily. Ensure to moisturise your nails and cuticles regularly.

Less common side effects

Numbing or tingling hands and feet

Some chemotherapy drugs affect the nerves which could cause numb, tingling or pain in your hands or feet.

If you are finding it difficult to fasten buttons or do other fiddly tasks, then you must tell your doctor or nurse. These symptoms usually slowly improve once you have completed treatment but for some people they may never go away.

Eye problems

Your eyes may become watery or feel sore. Eye drops may help with this. If your eyes become red and inflamed, then you must tell your doctor or nurse straight away.

Sore and red palms of hands and soles of feet

You may get sore or red palms of your hands and soles of your feet and the skin may begin to peel. It can help to keep your hands and feet cool, moisturise your hands and feet regularly and avoid tight-fitting socks, shoes, and gloves.

Tell your doctor or nurse if you experience any changes to your hands and feet and they will be able to prescribe creams to help.

Changes in the way the heart works

Although less common, some chemotherapies can affect the way your heart works.

Contact the 24-hour helpline if you experience:

• pain or tightness in your chest
• breathlessness
• changes in your heartbeat

Blood clots

Having cancer and receiving chemotherapy can increase your risk of developing a blood clot.

Contact the 24-hour helpline if you experience:

• throbbing pain, redness or swelling in a leg or arm.
• breathlessness or coughing.
• sharp chest pain, which may be worse when you cough or take a deep breath.

Will chemotherapy effect my fertility or sex life?

It is important not to become pregnant or father a child whilst on chemotherapy. Chemotherapy and other anti-cancer therapies can affect both sexual function and desire due to effects of your treatment, such as fatigue and changes in body image perception.

If you do find yourself affected by either of these problems, please speak to your nurse or doctor as further advice and support is available.

What should I do if I normally take other medications?

You should ensure that the doctor in charge of your treatment is aware of any medications or supplements that you are currently taking. This includes any herbal remedies, vitamins, or probiotics. You should inform your treatment team if you are taking any of the following in particular:

• warfarin
• steroids such prednisolone or dexamethasone
• insulin
• aspirin, ibuprofen, or naproxen
• medication for gout such as allopurinol

Will I be able to work during my treatment?

If you would like to work during your treatment, you should first discuss this with your doctor, but generally if you feel well enough to there is no reason not to. Each person is different, and you may feel different from day-to-day, so it is important to pace yourself.

Will I need to pay for my prescriptions?

Patients receiving treatment for cancer do not have to pay prescription charges if they have a valid exemption certificate or card. Your GP or treating doctor can give you an application form for this. Exemption certificates and cards are valid for five years.

Should I have the flu vaccination?

We recommend that you and those close to you are vaccinated against the flu. You should ideally have a flu vaccination two weeks before the start of your chemotherapy treatment.

We advise that you avoid having a flu vaccine in the days just before and after your treatment.

You should not have any ‘live’ vaccines while you are receiving treatment, such as the shingles vaccine. If you are offered a vaccine and are unsure whether to have it, please ask your nurse or doctor for advice.

Should I have the COVID-19 vaccination?

We recommend that you have the COVID-19 vaccine; however, this should not be given on the same day as your chemotherapy treatment.

What should I do if I feel unwell?

There is a 24-hour urgent advice line for patients suffering from any side effects from their treatment. You will be given an anticancer treatment alert card with this number on when you start your treatment.

Urgent advice telephone line (020 7472 6367).

Please remember that:

• This service is not for checking appointment times or administrative enquiries.
• If you unable to reach the team, please try again as staff may be busy.
• If you have a temperature greater than 38ºC (98ºF), or experience new and severe chest pain or breathlessness, you should go straight to your nearest A&E or call 999 if you are unable to travel there safely.

You should contact the hospital if you have new symptoms which are worrying you, or you want advice about ongoing symptoms. You may be advised to attend your local emergency department for blood tests and assessment. Please take your alert card and cancer treatment record book with you.

What can I do to help myself during my treatment?

To ensure that you stay well during your treatment, you should:

• Drink plenty of fluids.
• Maintain a balanced diet and try to eat little and often.
• Continue to maintain as normal a lifestyle as possible, including light exercise.
• Maintain good mouth hygiene.
• Avoid sunbathing and exposure to the sun.
• Call the number on your alert card if you feel unwell or have urgent questions or concerns.
• Don’t go it alone – talk to family, friends, and your medical team.