Adverse effects of Chemotherapy

Chemotherapy agents are distributed throughout the body; therefore, the side effects may affect the entire body and not just the area where the tumour is located. The effects vary between patients and depend on the type of chemotherapy. Most of the side effects gradually disappear after completing the treatment, although permanent damage may occur sometimes.

If the patient develops a fever of above 38 °C, especially if it is accompanied by a cough with purulent phlegm, fatigue, pain or blood when urinating, catheter insertion site inflammation or any other related symptoms, they should discuss it with their healthcare team as a matter of urgency.

If patients notice pain or changes in their mouth during chemotherapy, they should discuss it with their healthcare team.

Recommendations:

• Use toothbrushes with soft bristles and toothpastes with a high fluoride content.
• Maintain good oral hygiene. Use a bicarbonate solution, salt water, thyme water or an alcohol-free mouthwash.
• Use a lip balm or cocoa butter to keep lips hydrated.
• Drink water in small sips throughout the day.
• It is preferable to eat soft foods that are cold or at room temperature.

Avoid:

• Eating dry and irritating foods (pepper, citrus fruits, etc.).
• Using floss or interdental brushes.
• Smoking and irritating drinks such as alcohol or coffee.
• Professional dental cleaning procedures and tooth extractions.

Recommendations:

• Eat in a relaxed, pleasant environment.
• Patients should divide their daily intake into small amounts, eating 5–6 times a day.
• Eat easily digested foods that are soft, have mild flavours and easy to prepare; for example, yoghurt, fresh cheese, flan, custard, cottage cheese, fruit sorbets, ice cream, jelly, toast, biscuits, sandwiches, omelettes, boiled eggs, chicken, pasta, boiled or mashed potatoes.
• Savoury foods are generally tolerated more easily.
• Eat dry foods in the morning such as biscuits or toast.
• Meals should be at room temperature or cool, as hot meals may provoke the appearance of nausea.
• Drink liquids apart from meals to avoid feeling too full.
• Drink room temperature or cold drinks in small sips.
• Rest for at least an hour after each meal, preferably while seated.
• Prepare meals in advance and store them in individual containers in the freezer, these will be easy to reheat on days when the patient does not feel like cooking.

Avoid:

• Cooking or preparing meals when the patient has nausea.
• Foods with strong, pungent odours.
• Acidic, spicy or highly seasoned foods.
• Fatty foods (fried meals, rich sauces, fatty cheese, whole milk, etc.) as they hinder digestion.
• Clothes that place pressure on the stomach.
• Lying down after eating.

Recommendations:

• In the first few hours after the onset of diarrhoea, ideally patients should fast completely (eat nothing) to give the intestine time to rest.
• After 2–3 hours, they should progressively start drinking liquids in small sips: water, infusions (camomile, lime blossom tea, mint tea), juices without pulp and only a little sugar (apple, carrot), rice or carrot water and isotonic drinks.
• Substitute cow’s milk with lactose-free milk or rice milk.
• When the diarrhoea starts to subside, introduce small amounts of fat-free solid foods that are easily digested: boiled rice, rice with carrots, mashed potato, grilled or boiled white meat or white fish, cooked ham, apple purée, or grated and browned apple or quince.
• Eat steamed, boiled or grilled foods.
• Eat often and in small amounts.
• Consume foods with a high potassium content (ripe banana, peaches in syrup, apricots, etc.).

Avoid:

• Fried foods and stews, irritating condiments (e.g., pepper, paprika, nutmeg), red meats, orange juice or acidic fruits.
• Foods that cause gases (cabbage, cauliflower, broccoli, peppers, raw onion) and raw vegetables or pulses.
• Coffee, chocolate and alcoholic drinks.
• Fatty foods (avocado, olives, industrial bakery products).
• Patient should not take antidiarrhoeal agents without discussing them with their healthcare team.

Recommendations:

• Drink more liquids than normal.
• Eat more high-fibre foods (e.g., wholemeal bread or cereals, fruits, vegetables, pulses).
• Stimulate intestinal motility:
  • On an empty stomach, consume a spoonful of olive oil, a glass of warm water, infusions of mint tea, camomile or lemon balm, or orange juice with its pulp, coffee or 2–3 plums.
  • Drink cold liquids (water or juices) followed by hot liquids (coffee with milk or infusions). Drink milk and eat citrus fruits.
• Take non-fermentable fibre supplements such as flax seeds.
• Complete gentle exercise on a regular basis, for example, walk 30 minutes a day.
• Try to maintain a fixed schedule for going to the toilet in order to train the bowels.
• Adopt a position that favours the effort made by the abdominal wall and try to relax.
• Massage the abdomen gently in a clockwise direction.

Avoid:

• Strong and spicy condiments (pepper and chillies).
• Foods with a high tannin content (quince, tea, red wine and apple).
• Delaying performing bowel movements.
• Do not take laxatives, suppositories or enemas without discussing it with the healthcare team.

Recommendations:

• Eat small portions and at least 4 or 5 times a day.
• Enrich meals in order to provide maximum nutritional benefit:
  • Soups and purées: small portions of cheese, chopped boiled egg, croutons, diced ham, nuts, cream, butter, powdered milk, oatmeal or olive oil.
  • Vegetables: uncooked olive oil, béchamel sauce, mayonnaise, sautéed ham, nuts.
  • Rice dishes: tomato sauce, egg yolk, sautéed cured ham, garlic or onion.
  • Pasta: cream or tomato sauces, Parmesan cheese, bacon or butter.
  • Desserts: sugar, honey, jam, cream, chocolate, powdered or condensed milk, nuts, yoghurt with comport or milkshakes.
• Prepare aesthetically attractive meals.
• Patients should capitalise on the periods when they have the most appetite, for example at breakfast time, to eat a more complete intake.
• Try to eat in a relaxed, pleasant environment. 

Avoid:

• Heavy, greasy or fried meals and foods that produce gases.
• Repugnant or unpleasant smells when eating.

Recommendations:

• Pay great attention to oral hygiene. Use toothbrushes with soft bristles and toothpastes with a high fluoride content.
• Use a bicarbonate solution, salt water, thyme water or an alcohol-free mouthwash.
• Drink small amount of liquid frequently (acidic fruit juices, infusions with lemon, water with aromas, bicarbonated drinks).
• To stimulate saliva or to moisten the mouth, chew pieces of fruit (pineapple) or sugar-free xylitol chewing gum, or suck ice cubes or caramels.
• Eat soft, ground foods in broths or sauces: flans, custards, ice cream, yoghurt, soups, stews, juices, fruits in syrup or compotes.
• Dress with lemon or vinegar.
• Oral moisturisers (artificial saliva) can provide a useful substitute.

Avoid:

• Dry, fibrous foods (nuts, biscuits, toast, grilled meats or fish, etc.) and oily and thick foods that require large amounts of saliva to chew and swallow.
• Highly seasoned and salty foods.
• Alcohol and alcohol-based mouthwashes.

Recommendations:

• Prepare meals that look appetising and smell pleasant.
• Use mouthwashes before eating.
• Chicken, turkey and eggs are usually better tolerated than red meat as they are less pungent.
• Patients that perceive a metallic taste should replace their usual cutlery with plastic utensils.
• Use mild spices or condiments when preparing meals.
• Serve food at room temperature (it produces less smell).

Avoid:

• Foods with pungent or strong odours such as cabbage and oily fish (e.g., sardines, salmon).
• Ambient smells and areas where food is cooked.

Recommendations:

• Skin is usually more sensitive and vulnerable to infections, so it is important to incorporate routine hygiene, hydration and sunscreen habits for both the face and body.
• Wash hands before handling foods and after going to the toilet.
• Keep nails clean and short.
• Change toothbrushes at least every 3 months.

Avoid:

• Sharing food utensils, drinks and personal hygiene items.
• Contact with faeces from pets.
• Patients should not get vaccinations without first discussing them with their healthcare team.
• Insofar as possible, avoid direct contact with people who have an infectious condition (flu, measles, etc.).

Recommendations:

• Maintain a relaxed lifestyle and avoid stressful situations or activities that require a significant physical exertion.
• Patients should ensure they get enough rest and restful sleep at night.
• Complete some physical exercise each day, inasmuch as possible and without overexerting.

Recommendations:

• Take care when handling sharp or cutting objects.
• Use an electric shaver.
• Use a soft-bristled toothbrush and lip balm or cocoa butter to prevent cracked lips and dryness.

Avoid:

• Waxes and razor blades.
• Traumas and wounds. Wear closed-toed shoes to avoid falls.
• Constipation.

Recommendations:

• Hair care. Use mild shampoos and soft-bristled brushes. Only use ammonia-free dyes. It is a good idea to test how the hair reacts to the dye before full application.
• Protect and care for the scalp. Apply sunscreen and wear a hat or head scarf for protection from the sun. Hydrate the scalp.
• Adapt to the hair loss. If necessary, patients can cut or shave their hair. Always use an electric shaver to avoid cutting the skin.

Avoid:

• Aggressive hair treatments.
• Using a hair dryer.

Recommendations:

• Tell the healthcare team about any changes to the skin or nails.
• Use factor 50 sunscreen and apply it every 2–3 hours when outdoors.
• Wear hats for protection and avoid direct exposure to the sun between 12:00 and 4:00 pm.
• Use neutral soaps (such as syndet bars or ones with a physiological pH) and lukewarm water when showering. Maintain skin hydrated.
• Apply perfume-free and preservative-free, hypoallergenic moisturising creams after showering.
• Avoid products that irritate the skin such as perfumed soaps, creams and strong detergents. Do not use exfoliants or products that scratch the skin.
• Wear comfortable footwear and loose-fitting socks/tights.
• Wear comfortable, loose-fitting clothes made with natural fibres.

Recommendations:

• Protect the hands and feet from extreme temperatures (wear gloves and socks).
• Use lukewarm water when showering, washing your hands or doing the washing up.
• Wear loose-fitting clothes and comfortable footwear.
• Avoid handling cold drinks or ones containing ice cubes and ice cream.

Recommendations

• Women who wish to have children can freeze their eggs for use after finishing the treatment.
• Most of the local symptoms can be improved by applying lubricants before sexual intercourse.
• Use vaginal moisturises on a regular basis.
• Discuss the situation with your partner openly and honestly.

Recommendations:

• There are several ways of preserving sperm for men who wish to have children in the future.
• Discuss the situation with your partner openly and honestly.
• Patients with a low platelet count (thrombocytopaenia) should ask their healthcare team whether sexual intercourse is appropriate.