If you experience any side effects, call your oncology doctor. He or she made need to:

• Treat you with additional medication to address the problem
• Reduce your dose
• Pause treatment for a short period of time, or discontinue treatment in severe cases

Diarrhea

Diarrhea is a common side effect of certain cancer treatments. It is not managed, diarrhea can be very serious, so it is important to speak to your oncology doctor or nurse if you have any signs and symptoms and/or your stools are happening more often than normal.

Call your oncology doctor or nurse right away if you:

• Have 6 or more loose bowel movements a day or two in a row
• Have blood around the anal area or blood in your stool
• Lose 5 or more pounds after the diarrhea starts
• Have pain in your belly or cramps start and last two or more days
• Don’t urinate for 12 or more hours
• Get a puffy or swollen belly

Tips to help with Diarrhea:

• Drink plenty of clear liquids. Try not to drink many caffeinated drinks (such as coffee and soft drinks) and dairy products (such as milk)
• Eat small, light meals many times a day (such as bananas, rice, applesauce, or mashed potatoes)
• Try not to eat foods that are spicy, greasy, fatty, or high in fiber (such as fast food, raw vegetables, and nuts)
• Keep track of how often you have diarrhea, the amount of fluid you drink, and your weight.
• After each bowel movement, gently clean your anal area well with a mild soap or baby wipes, and pat dry. Once dry, you may apply petroleum jelly or A&D ointment to the outer rectal areas.

Mouth Care

Certain medications to treat cancer may cause mouth problems such as:

• Canker sores
• Gum or Mouth pain
• Infections in your mouth or gums
• Burning sensation of the tongue
• Red, swollen, or bleeding gums
• Change in how things taste

Call your oncology doctor or nurse if you have pain in your mouth or throat OR if your mouth looks or feels different.

Check your mouth 2 times a day. Use a small flashlight, and a padded popsicle stick to:

• Look for small cuts, ulcers, or sores in your mouth- on your gums, on your tongue, or under your tongue
• See if the inside of your mouth is redder than usual or swollen
• See if there is blood in your mouth

Tips for mouth care:

• See your dentist regularly.
• Brush your teeth gently after each meal- Use a soft toothbrush and children’s toothpaste
• Floss your teeth at least once a day
• Tell your dentist about the treatments you are taking

If you have mouth sores or dryness, rinse your mouth after you eat and before you go to bed:

• Use a salt and baking soda mixture: Add 1 teaspoon of salt and 1 teaspoon of baking soda to 1 quart of warm water; stir or shake well. Sip the solution, swish it around in your mouth, gently gargle, and then spit it out. Don’t swallow!
• Do not use mouthwash with alcohol (such as Listerine) or peroxide (such as Colgate Peroxyl)
• Use lip balm such as Chapstick to keep your lips moisturized.

If you have mouth pain:

• Suck on ice chips or popsicles
• Drink through a straw
• Talk to your oncology doctor about the over-the-counter medications that can be used for pain
• Eat soft food that can be swallowed easily
• Try not to eat hard, crusty, salty, sticky, sugary, or spicy foods
• Try not to eat or drink fruits or juices that are acidic, such as tomatoes, oranges, grapefruits, limes, and lemons.

Nausea and Vomiting

You may fell nauseated (queasy) or vomit (throw up) during cancer treatment.

Call your oncology doctor or nurse right away if you:

• Vomit more than 3 times an hour or for more than 3 hours
• See blood in your vomit
• Vomit and it looks like coffee grounds
• Can’t have more than 4 cups of liquid or ice chips per day
• Haven’t been able to eat for more than two days
• Are weak, dizzy, or confused
• Lose 2 or more pounds in 2 days
• Have dark-yellow urine

Tips for managing Nausea and Vomiting

For Nausea (upset stomach):

• Drink plenty of clear liquids such as ginger ale, apple juice, and broth
• Eat bland foods (with little to no taste) such as dry toast and crackers. Do not eat heavy, fatty meals, or greasy foods
• Try to stay away from strong odors
• Do not lie flat for at least 1 hour after eating. Rest by sitting up in a chair or recliner
• Suck on a lemon or mint candy to make a bad taste go away
  • Do not eat for 2 to 3 hours before you go to bed, and raise the head of your bed for sleeping

For vomiting (throwing up what’s in your stomach):

• Keep track of how often you are vomiting, the amount of fluid you drink each day, and your weight
• After vomiting stops, try to slowly sip a small amount of cool liquid. You may want to suck on some ice chips or frozen juice chips. Your oncology doctor may also prescribe a medication for nausea and vomiting

Fatigue

Fatigue, or feeling tired, weak, or like you don’t have any energy is a common side effect on cancer treatments.

Call your oncology doctor or nurse if you:

• Are too tired to get out of bed and this last for 24 or more hours
• Can’t think clearly
• Can’t sleep at night
• Feel tired (out of breath or heavy/fast heartbeat) after doing small activities

Tips for managing Fatigue:

• Get a good night’s sleep each night. The right amount varies by person, but is usually around 7 to 8 hours
• Try to keep good sleep habits
  • Go to bed at the same time each night
  • Wake up at the same time each day
• Try not to eat heavy meals before bedtime
• If you have caffeine, make sure it’s 6 to 8 hours before you go to bed. Remember, caffeine is in liquids (such as soft drinks and coffee), food (such as chocolate), and some medicines
• Make sure your bedroom is quiet and dark and is a comfortable temperature
• Be as active as possible. Talk with your doctor about which types of activity may be right for you. It is best to start slowly. Only do more when you know your able to.
• Plan. Decide which activities are most important to you. Try to schedule important activities throughout the day if possible, so you can take breaks.
• Eat a nutritious and well-balanced diet (make sure you have enough calories and protein to give your body the energy it needs)
• Consider meeting with a registered dietitian who specializes in helping people with cancer

Hand-Foot Syndrome (HFS)

Certain medications used to treat cancer may cause HFS, which is a side effect that causes symptoms such as pain and swelling in your hands or feet. You may also hear your doctor call HFS palmar-plantar erythrodysesthesia syndrome (PPES).

Call your oncology doctor or nurse if you have any of the following problems with your hands or feet:

• Your skin is red or swelling
• You feel tingling/burning or your skin is sensitive to touch

You have thick calluses or blisters:

• Your skin is cracked, flaking, or peeling
• Your skin has blisters, ulcers, or sores
• You have a hard time walking or using your hands (especially if it’s because of pain)

Tips to Help with Hand-foot syndrome

• Heat may make your symptoms worse or more likely to happen
• Try not to put your hands and feet in hot water
• Try to stay out of direct sunlight or other heat sources
• If your hands and feet feel hot, use an ice pack to cool them for 15-20 minutes
• Take cool showers or baths
• Try to avoid pressure, friction, or rubbing
• Don’t use hammers, shovels, knives, or other tools
• Wear loose clothing or comfortable, well-fitting footwear
• Gently pack your skin dry after washing your hands or bathing
• Use cotton gloves and socks to help protect your hands and feet
• Talk to your doctor about using creams such as clobetasol and halobetasol- these can be found at your local drug store

Hypertension (High Blood Pressure)

Hypertension is a common side effect in people taking certain cancer medicines. It is important to take your blood pressure before you start taking your medicine and regularly during your treatment. Keep a record of your blood pressure measurements so you can tell you doctor if there is a change

Call your oncology or nurse if:

• Your blood pressure suddenly goes up
• Your blood pressure is outside the recommended range (normal blood pressure is 120/80). Talk to your doctor about your blood pressure goals
• You have unusual or new pain (such as bad headaches)
• You have shortness of breath
• You’re bleeding or have unexplained bruises

Tips to Help with Hypertension

• Take your blood pressure regularly. Talk to your doctor before you get started
• Be Healthy!
  • Eat a diet of whole grains, fruits, vegetables, and low-fat dairy products (such as yogurt)
  • Don’t have too much salt, caffeine, or alcohol

* Remember to always keep yourself informed with reliable sources.