Chemotherapy Information

Every person’s experience of chemotherapy is very different, as the drugs can affect people differently. Whilst on chemotherapy, you do have a weakened immune system. This means you are very vulnerable to infection. If these infections are left untreated, then potentially, it can be fatal. We have a 24 hour access telephone service, seven days a week for if you become unwell. Unwell, in this case, means a temperature above 37.5 degrees, shivers and shakes, feeling like you are cold, experiencing vomiting, diarrhoea, burning on passing urine or any symptoms that concern you. If you experience any of these, you can and should contact the helpline. The helpline number is 01908 660033. That is the number for the main hospital switchboard, where you can ask them to ‘bleep 1090’. When the nurse answers, she will ask you a series of questions such as your name, what chemotherapy you’re on and the reason for your call.

From this call, the nurse will advise you on the best route to take. Out of hours (evenings, weekends, nights), you might need to attend the emergency department. If attending the emergency department due to a potential infection, your alert card categorises you as a higher risk patient so you will be seen sooner.

When you are seen, they will check your pulse, your temperature and blood pressure, take some bloods and give you a dose of intravenous antibiotics. Depending on what your bloods show and your condition will depend

whether one you go home or if you get admitted to hospital. If admitted, the acute oncology will come and see you on the ward and if needed, you will be brought over to the inpatient ward on the Cancer Centre.

Chemotherapy circulates in your bloodstream, treating cancer cells anywhere in the body. Chemotherapy damages cells as they divide, so unfortunately, it’s not selective enough to just destroy cancer cells and it tends to also destroy your good cells and that’s often why side effects occur. Some of the side effects include hair loss and a sore mouth.

One of the biggest areas it affects is your blood cells. Blood cells are produced in your bone marrow and you have three main types. The three main types of blood cells are red blood cells, white blood cells and platelets. Red blood cells give you energy and we call these hemoglobin. If your red blood cells drop, we can correct that by giving you a blood transfusion. The second blood cell is called a platelet, and these stop you from bleeding. If you cut yourself, the body forms a scab – which is platelets. White blood cells (in particular neutrophil and neutrophils) are your bacteria eating cells, and chemotherapy can make them either very low or absent.

Seven to ten days after chemotherapy is when you’re at your most vulnerable. This is when your bloods are at their lowest point. When they start picking up again, and you maybe able to be given chemotherapy again. During your low blood phase, you have to be more careful about keeping an eye on your temperature and any symptoms of unwellness. Please remember, you can contact the telephone service if you need any assistance or advice.

Try your best to avoid crowded areas, avoid people that are knowingly unwell and pay close attention to hand hygiene. Do ensure that you’re eating foods before the use by date.

When your white blood cells are low, it’s called neutropenia. This is a word that you will often hear. If you get a temperature while your white blood cells are low, it’s called neutropenic sepsis. Neutropenic sepsis is a life-threatening situation, where you will be admitted to hospital and you will be given intravenous antibiotics.

Nausea
Some chemotherapy drugs can cause nausea, so when you have chemotherapy we use anti-sickness drugs before the chemotherapy starts. You will be given these anti-sickness drugs to go home with (enough for two or three days). Vomiting does not tend to be such an issue anymore with chemotherapy because of the anti-sickness drugs being used. If you feel nauseous, there’s a few things that you can do before coming in for chemotherapy. You can eat something small, avoid unpleasant smells, try not to skip meals, Another potential side effect of chemotherapy is fatigue, which is usually more of a physical tiredness. If you experience this, we suggest you have regular rest and try to carry on being as active as you can.

Hair Loss

Of course, there is a risk of hair loss. There are some chemotherapy regimes that cause you to lose your hair on your head, eyebrows, eyelashes and other bodily hair. Once chemotherapy is over, it does grow back. From your first chemotherapy, there is about three weeks until you’ll start noticing that your hair is falling out. When this happens, some people prefer to shave it off. If it’s a hair losing or hair thinning regime, we do refer you to our hair wig fitting service.

Appetite and Taste Changes

Another problem that people have when they have chemotherapy is sometimes their taste changes, which can affect the appetite. Most people say that some of the food they eat is quite bland or can all taste the same. The best way around this is choosing a spicier flavoured food so you can taste it. If you have any issues with your appetite or you’re not eating well, please tell a nurse when you come in for your treatment so we can refer you to our dietitian for assistance and advice.

Diarrhoea

Another potential side effect of chemotherapy is the risk of diarrhoea. Of course, there will be certain drugs that have a higher risk than others. We don’t want you to get episodes of diarrhoea, partly because one is not very nice, but also if it’s

if it’s a severe it can leave you dehydrated. In some cases, we would send you home with a drug like loperamide which helps stop the severity of it. If you have three to four episodes over what you would normally have, you please must ring the telephone service so we can rule out an infection that’s representing itself as diarrhoea.

Constipation

In the same way, some chemotherapy drugs can cause you to be constipated. If you have a tendency to constipation, you may have to take a laxative. If you don’t normally suffer from constipation and you get it with the chemotherapy, please do let us know and we’ll prescribe a laxative to take. Some possible suggestions to help reduce the risk of constipation is drinking lots of fluids, stay as active as you can and try to have some foods high in fibre as well as prunes and fruit bran.

Sore Mouth

Sometimes, chemotherapy can cause you to have a sore mouth, which can impact certain things like your ability to eat and drink. If you get a sore mouth, just call the telephone service and we can give you some remedies such as soothing mouthwashes. The other concern with a sore mouth is especially if it gets ulcerated it’s a break in your body’s defences, potentially allowing infection getting in.

Dental Reviews

Prior to chemotherapy, we recommend you have a dental review just to make sure you’ve got no major work that needs doing, such as a filling. Once you start Chemotherapy, it’s much more difficult to get things like that sorted due to the risk of infection. We are able to hold chemotherapy until you get your dental problems reviewed.

Peripheral Neuropathy

Another potential side effect of chemotherapy is a condition called peripheral

Neuropathy. Peripheral neuropathy manifests itself with tingling and numbness in your fingers and toes. This can start off mild but it can change each time we give you some more chemotherapy. Essentially, this is damage to your nerve endings. The nurse will be sure to ask you about if you’ve got any pins and needles or numbness. This is not an emergency situation, but we do need to know. and it could be that

Fertility and Menstruation

Another area that can get affected is your fertility. For women, if you’re of childbearing years, it is essential you use some form of contraception whilst undergoing chemotherapy. If you haven’t got children would like some in the future, we try to organise that before starting chemotherapy. We would refer you to Oxford for fertility advice. If you are in childbearing years, then the nurse will perform a pregnancy test before each cycle of chemotherapy. If you’re still having periods, these can be affected by having chemotherapy by pushing you into an early menopause.

For men, we can refer you to the fertility clinic too. We will fill out the necessary forms and take some blood tests, and the clinic will liaise with you to discuss and perform sperm banking. This will be discussed before you get to the pre-chemotherapy assessment.

Allergic reactions

Some chemotherapy can come with a risk of allergic reactions, which will be discussed with you at your next appointment if it is linked to a drug that you’re going to be receiving. Allergic reactions often manifests itself as shivers and shakes, an itchy cough, a tight throat etc. If that happens whilst you’re having chemotherapy, we pause treatment, and recover you before restarting. Once we start the chemotherapy again, we start it at a slower rate and we give you what’s called a pre-medication beforehand which generally would be some paracetamol, some steroids and an antihistamine.

Often, people ask if they can have their flu vaccine and / or their COVID vaccine. Whilst you’re on chemotherapy, we still want you to have your vaccines but please be aware it may not give you as much protection as it usually would.

Before every cycle, you will see a nurse in clinic for a 20 minute appointment

where the nurse reviews your blood pressure, your pulse and your temperature. The nurse will review how you’ve been since the last cycle of chemotherapy and check you’ve got no toxicities or side effects that need addressing. If there are side effects that we need to address, we would discuss them with a doctor and take a blood test. The blood test is looking at your hemoglobin (your red blood cells), your platelets and your neutrophils (your white blood cells).

When you come in for your chemotherapy, the nurse will either cannulate you or you may have a line. Once the nurse has cannulated you, they’ll put up a drip and give you anti-sickness drugs and some steroids (which we use as anti-sickness for some regimes). With chemotherapy, there’s always a risk of the drug going outside the vein, which we don’t want. This is called extravasation. Some drugs may cause no damage, but some drugs can be damaging to the tissue. Please alert a nurse as soon as possible if you feel any change of sensation, stinging, burning or anything that’s different. If this happens, the nurse will come and stop the infusion. They will check how well the cannula is working, check that it is still in the vein and check if it is bleeding back.

Sometimes, we can’t use cannulation for chemotherapy and will have to put in a temporary line. If you have very poor veins, the best thing to do is to have a line inserted – as we don’t want the cannulation to be the most stressful part of the day! Additionally, repeated cannulation can cause an increased risk of extravasation.

The line is inserted under local anaesthetic and stays in until the end of chemotherapy. The lines reduce the risk of extravasation, and they the lines can be used to take blood from, so there’s no more needles when you come in for a blood test. However, they can come with potential side effects or complications. Because it is a foreign object in the body, there is a risk of infection. Each time the lines are accessed, they’re done aseptically (as clean as possible), but if you get a line infection, it tends to mean that you need to come into hospital and take some intravenous antibiotics and potentially have the line removed.

Another complication of a line is a risk of blood clots. If that’s going to happen, it tends to be within the first few weeks of the line being inserted. Signs of infection include a swollen arm, a sore arm, and the veins looking more obvious. If you experience any of these symptoms, give our telephone service a call and we will bring you in and assess you.

If you have pre-existing medical conditions, some chemotherapies do require a scan of your heart, called an echocardiogram. For some regimes, you’ll get these scans periodically because some chemotherapy, in the longer term, can cause problems to the heart. The risk is very small, but it’s still something we consider and keep an eye on to make sure that you’ve got a normal functioning heart.

We would like to make you aware that prescriptions that we give out at MKUH are free, there is no charge. When you attend the Cancer Center, there’s also free parking. All you need to do is present your ticket at the reception desk, where we will validate it for you.

In the Cancer Centre, we have a health and wellbeing team. These are a group of professionals which includes two information support nurses, a dietitian, a physiotherapist, a psychologist and citizens advice bureau clinics. If you need any of these people, please mention to a nurse and we will refer you to them. If your family needs any information and support, we can refer them to our information support nurses who will contact you and make an appointment either over the phone or face to face.