Cancer Treatment
Side Effect Management

Excessive worry; trembling or shaking; Irritability; inability to rest or sleep; excessive mouth dryness.

CALL IMMEDIATELY with symptoms of chest pain, palpitations, progressive shortness of breath, or if concerned. 610-492-5900

YOU ARE NOT ALONE. Report your feelings and problems so solutions can be discussed with you. Learn about your diagnosis and treatment. Ask questions until you understand! Treat physical symptoms: see handouts on anorexia, fatigue, nausea, diarrhea, constipation, pain. Ask about resources that are available for you:

• Home Care nurses, Physical Therapists, Occupational Therapists, Home Health Aides.

• Wellness Community

• American Cancer Society

• Counseling or support groups

Discuss with our Billing Department if you are unable to afford medications or treatments. Rest and sleep are important: Report sleeping problems. Goal: uninterrupted sleep through the night. Spiritual support and prayer may be helpful.

(usually 10 to 30 minutes)

Use the power of your imagination to learn to relax, and have some control over your responses. You can choose what you want to imagine and help yourself heal!

• Close your eyes. Breathe slow and deep. Focus on slowly relaxing each part of your body.

• Think of a comforting image, such as a sunset, or a peaceful beach, or a starry night sky.

• You might choose to focus on 1 or 2 words from a prayer.

• Focus and spend time with your image, feeling comfortable and relaxed. Then, take a deep breath... exhale slowly... and open your eyes.

• You can feel relaxed and comfortable. Anytime you choose to do so, you can relax and return to this state of wellness.

• Please call if you are concerned - on any day -at any time- about any issue!

• Please call EARLY so that office visit may be scheduled if needed.

• If you are unable to sleep or eat or rest. If you are unable to perform your usual activities.

• If you have confusion, chest pain, shortness of breath, sweating.

• If you have any thoughts of hurting yourself or suicide.

• Dry, sticky mouth or increased thirst
• Concentrated dark urine or minimal urinating.
• Lightheadedness or dizziness when standing
• Muscle weakness
• Shriveled skin
• Low blood pressure or rapid heart rate

CALL IMMEDIATELY with nausea, vomiting, abdominal pain. 610-492-5900

Need to Increase Sodium (Salt) Intake:

• Eat soups, broths, crackers, pretzels.
• Add salt to foods.
• Drink at least 6 to 8 glasses (8 ounces each) of clear liquid daily if able: Gatorade, broth, Jello, fruit juices, water ices, soda, ginger ale, 7-UP.

Eat 6 small frequent meals per day and drink fluids with meals.

Keep fluids with you and SIP continuously throughout the day.

Suck on mints or hard candy (may make you thirsty so you will drink more fluids).

Intravenous fluids (IV) may be necessary.

Discuss medications:

• May need to stop taking “water pills” (diuretics) until dehydration resolves.
• May need to alter blood pressure medications until dehydration resolves.

• Please call if you are concerned - on any day -at any time- about any issue
• Please call EARLY if you are not well, so that office visit and IV fluids may be scheduled if needed
• Lightheadedness, dizziness, or weakness
• Temperature above 100.4
• Nausea and vomiting
• Persistent diarrhea
• Inability to eat or drink

• Milk and dairy products until several days AFTER diarrhea has resolved.
• Alcohol, coffee, tea and very hot and cold beverages.
• Spicy, fried, fatty foods.
• High fiber foods (bran, some cereals, raw fruits and vegetables).

Increase Sodium (Salt), Sugar and Fluid Intake:

• Eat soups, broths, Gatorade, gelatin, popsicles, water ices, flat soda.
• Let sodas stand until fizz has decreased to prevent bloating.
• Eat BRAT diet (bananas, rice, applesauce, toast).

Drink minimum 6 to 8 glasses (8 ounces each) of liquid daily if able. SIP continuously through the day.

Eat low residue foods (cooked cereals, smooth peanut butter, potatoes, processed cheese, yogurt).

As diarrhea resolves, eat pasta without sauce, white-meat chicken without skin, scrambled eggs.

Avoid dehydration – see “Dehydration Management” instructions.

Intravenous fluids (IV) may be necessary.

Cleanse rectal area with mild soap and water after each bowel movement. Use “Baby Wipes” and dry well. Apply Desitin or Balmex to rectal area after cleansing if skin is irritated.

• May need to stop taking “water pills” (Diuretics) until diarrhea/dehydration resolves.
• May need to adjust blood pressure medications until diarrhea/dehydration resolves.
• Do not take laxatives or antacids.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit and IV fluids may be scheduled if needed.
• Lightheadedness, dizziness, or weakness.
• Temperature above 100.4.
• More than 5 loose stools in 1 day or urgent, explosive, watery stools.
• Inability to eat or drink Abdominal pain or vomiting.
• If you see bloody or black stools.

• Report sleeping problems. The goal is uninterrupted sleep through the night.
• Plan time for rest each day.
• Take short nap or breaks during day rather than one long rest period.

• Pace yourself. Do activities you enjoy when your energy level is high.
• Try to maintain as close to your usual lifestyle as you can – do shorter versions of activities you enjoy.
• Take short walk or do light exercise to promote muscle strength. Regular exercise can decrease fatigue.
• Ask your physician if home Physical Therapy could help you.
• Simplify, prioritize, delegate. Ask family and friends to help with tasks you find taxing or difficult.

• Eat high protein, high calorie foods (cheese, eggs, yogurt, peanut butter, nuts).
• Eat your largest meal whenever you have the most energy during the day.
• On days you feel well, cook large portions of foods you like. Freeze the extra portions.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit and IV fluids may be scheduled if needed.
• Lightheadedness, dizziness, or weakness.
• Temperature above 100.4.
• If you fall or feel unsteady when walking.

• Please report sleeping problems. The goal is uninterrupted sleep through the night.
• Report snoring or choking during sleep, or other symptoms that interfere with sleep (pain, heartburn, reflux).

• Treat physical symptoms: see handouts on anorexia, fatigue, nausea, diarrhea, constipation, pain, etc.
• Keep regular sleep and waking times. Develop a routine at bedtime. Avoid excess daytime napping.
• Use the bedroom only for sleep at night, not for activities such as watching TV or napping or working.
• Eat a high protein snack 2 hours before bedtime.
• Avoid alcohol or heavy, spicy, sugary foods before bed.
• Avoid drinks with caffeine (coffee, tea, soda). Avoid drinking fluids before bedtime.
• Encourage regular bowel and bladder habits. Empty the bowel and bladder before you go to bed.
• Get comfortable: Arrange soft bedcovers, pillows, and room temperature for comfort; wear soft loose clothes.
• Get quiet: Turn out lights; turn off television and radios; eliminate noise.
• Hide the clock. Turn the clock away from your view.
• Take short walk or do light exercise early in the daytime. Avoid strenuous exercise at night.

• Do activities to help relax and decrease anxiety: journaling, music, art, yoga, prayer, meditation.
• Discuss your fears and worries and concerns with your health care team.

Try deep breathing and relaxation exercise, about 10 to 30 minutes.

• Use the power of imagination to learn to relax, and have some control over your responses.
• You can choose what you want to imagine and help yourself heal!
• Close your eyes. Breathe slow and deep. Focus on slowly relaxing each part of your body.
• Think of a comforting image, such as a sunset, or a peaceful beach, or a starry night sky.
• You might choose to focus on 1 or 2 words from a prayer.
• Focus and spend time with your image, feeling comfortable and relaxed.
• Then, Take a deep breath… exhale slowly… and open your eyes.
• You can feel relaxed, comfortable. Anytime you choose to do so, you can relax and return to this state of wellness.

• If you have difficulty falling asleep, medication may be prescribed for you.
• If you have difficulty staying asleep, (for example, awakening at 2 AM then unable to promptly fall asleep), medication may be prescribed for you.
• Adjustments in pain medications, steroids, diuretics, stimulants, or other medications may be necessary.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit and IV fluids may be scheduled if needed.
• If you are unable to sleep.

• Wash hands with soap and water after toileting and when soiled and before eating.
• Keep skin moist with lotion to prevent breaks or cracks which may become infected.
• Clean all cuts and breaks in the skin with soap and water and cover with bandage or Band-Aid.
• Brush teeth or dentures twice daily. Use alcohol-free mouthwashes.
• Rinse your mouth before meals and at bedtime:
  • Make mouth rinse fresh daily: ½ tsp. salt and ½ tsp baking soda in 2 cups warm water

• Avoid contact with anyone with a cold or the flu or other infections.
• Frequent hand washing when exposed to others with colds or flu.
• Avoid crowds as much as possible. Try shopping at off-peak times.
• Avoid contact with waste materials from pets.
• Avoid uncooked foods (fresh fruits or vegetables, raw meats, uncooked eggs, sushi)
• Avoid contact with fresh flowers and plants.
• NO enemas or suppositories inserted into your rectum

• Take your temperature in morning upon arising and in evening between 4 to 7 PM and record it.
• Bring the record of your temperatures to your office visit.
• You may receive Neupogen or Neulasta injections to increase your white blood cell count.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that an office visit may be scheduled if needed.
• FEVER: Temperature above 100.4°.
• Shaking chills, night sweats.
• Severe cough or sore throat or increased mucus.
• Burning or pain with urination
• Frequent urination that is cloudy or urine with bad odor.
• Draining from any open cut or sore.
• Redness, swelling, pain, or drainage from any tubes you may have (i.e. Peg tube).

• Discoloration and ridges in nails, or brittle and cracked nails.
• Swelling, pain & redness around nail, cuticle or hang-nail, possibly with pus or drainage.

• Avoid frequent contact with water or harsh chemicals.
• Trim nails and keep nails clean.
• Apply thick, alcohol-free emollient cream or moisturizer to hands & cuticles TWICE per day, such as:
  • Eucerin cream, Cetaphil cream, Aquaphor ointment, Bag Balm, Udderly Smooth Udder Cream, Vaseline Intensive Care Lotion, Zim’s Crack Crème, Vanicream, Cutemol.
• If fissures develop on tips of fingers or toes, apply Liquid Band-aid to the cracks.

• Avoid biting or picking nails, hangnails, or cuticles.
• Wear well-fitting shoes or sneakers or sandals.
• Arrange evaluation by the podiatrist if you have ingrown toenails.

• Warm soaks four times per day until resolved.
• Apply Bactroban or Neosporin antibiotic ointment to affected area 3 to 4 times per day.
• If no allergy to acetaminophen, may take 650 mg Acetaminophen every 4 hours as needed for pain.
• If no allergy to ibuprofen, may take 400 mg Ibuprofen (with food) every 6 hours as needed for pain.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit may be scheduled if needed.
• Temperature above 100.4°.
• You are unable to complete your usual daily activities due to your nail or skin changes.
• You have uncontrolled discomfort or pain.

• Fatigue
• Sneezing
• Nasal and ear congestion
• Runny nose
• Headache
• Scratchy or sore throat
• Cough

• Take your temperature between 4 to 7 PM daily. Call if temperature equal to or above 100.4.
• Get plenty of rest.
• Drink 6 to 8 glasses of fluid daily (Chicken soup, Gatorade, juice, water, hot tea with honey and lemon).
• Try using a humidifier when sleeping to loosen secretions.
• For sore throat, gargle as needed with salt water (1/4 teaspoon salt in 8 ounces warm water).
• For nasal dryness or mucus: Use saline nasal spray or drops or gel (i.e. Ocean, Ayr).

• Read the labels on all medications that you take.
• Do not mix different cold preparations, since they may counteract.
• If you do take an over the counter medication, please inform us, so we can add to your medication list.
• Try specific over the counter medications:
  • Throat soreness: Use lozenges.
  • Congestion: Guaifenesin (Mucinex) 1200 mg every 12 hours to loosen congestion. Do not use cough suppressant for a cough with thick mucus: You need to cough up the mucus.
  • DRY Hacking Cough: Robitussin DM 1 teaspoon every 6 hours AS NEEDED for cough at night.
  • Pain: Acetaminophen (Tylenol) 650 mg every 6 hours as needed or Ibuprofen (Motrin, Advil) 400 mg every 6 hours as needed (with food).

• If you have a bacterial infection, an antibiotic may be prescribed. Take as prescribed until completed.
• If you have the FLU, anti-viral medication may be prescribed. Take as prescribed until completed.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit may be scheduled if needed.
• You have chest pain, shortness of breath or difficulty breathing (call 911).
• You have a temperature above 100.4° or shaking chills.
• You are lightheaded or dizzy or weak.
• You have muscle aches and pains.
• You have a severe headache or facial pain.
• You cough up bloody or thick yellow or green mucus.
• You are unable to eat or drink.
• You feel worse, or your symptoms become worse.

• Brush your teeth upon arising in morning, after meals, and before bed.
• Use mouth rinses before meals and at bedtime and as needed throughout each day.
• Make mouth rinse fresh daily: ½ tsp salt, ½ tsp baking soda in 2 cups warm water.
• Avoid alcohol-based mouthwash.
• Suck on hard candy or chew sugar-free gum to decrease bitter or metallic tastes.
• If you have metallic taste, try using plastic utensils and non-metal containers.
• Add spices (basil, oregano, mint) or garlic to improve flavor.
• Try taking Zinc tablets 50 mg daily.

• Please call if you are concerned - on any day -at any time- about any issue!
• Please call EARLY if you are not well, so that office visit may be scheduled if needed.
• Inability to eat or drink.
• If you have no relief of symptoms.