IV Therapy

Allergic Reaction

If this side effect were to occur, you might develop hives or a rash, swelling, fever, chills, difficulty breathing, or even low blood pressure. If any of these occur as a result of your medication, you may be given additional anti-allergy medications. Your treatment will be stopped during the reaction and perhaps re-started after the reaction subsides, or stopped and rescheduled for another day, or discontinued.

Anxiety

While anxiety is not a side effect of cancer treatment, it is an emotion you may experience. If you are worried, nervous, or uneasy, share your concerns with your provider or someone you trust.

Appetite Changes and Loss of Appetite

Foods and liquids may taste different to you because the cells in your mouth, stomach, and intestines have been affected by your IV therapy. Also, if you are inactive, this may cause a decrease in your appetite. Despite a poor appetite, it is important to eat nutritiously to help your body recover from the effects of IV therapy.

Loss of appetite is one of the most common problems that occur with cancer and its treatment. For some people, loss of appetite happens for just a day or two; for others, it’s an ongoing concern. Whatever the reason, here are some suggestions that might help:

• Eat foods packed with calories and nutrition so the volume of food needed is less.
• Try eating frequent small meals throughout the day, rather than fewer large meals.
• If your appetite is better in the morning, make breakfast your largest meal of the day
• Use butter and whole milk.
• Drink high-calorie beverages such as smoothies, shakes, and supplements between meals. Liquid supplements include Boost, Ensure, or Carnation Instant Breakfast.
• Keep favorite snacks around so you can have something whenever you feel like it.
• During meals, sip only small amounts of fluids because drinking may make you feel full. If you want to have more than just a small amount to drink, drink 30-60 minutes before or after your meal.
• Try a small glass of wine or beer during a meal, as it may help stimulate your appetite.
• If food tastes bland, bitter, or metallic:
  • Drink using a straw
  • Use plastic utensils
  • Marinate food and enhance flavor with herbs and spices
• Regular exercise may help stimulate your appetite.

Anemia or Low Red Blood Cell Count

Red Blood Cells (RBCs) – also known as erythrocytes, are blood cells that carry oxygen from the lungs to all of the tissues and organs in the body. RBCs are produced in the bone marrow. When IV therapy kills cancer cells it also kills normal cells such as the red blood cells, lowering your RBC count. When your RBC count is low, you have anemia. Anemia caused by IV therapy is temporary and usually does not occur for two or more months.

You may experience the following symptoms if your RBCs are low:

• Fatigue, weakness or have a lack of energy
• Dizziness or lightheadedness
• Shortness of breath
• Chest pain – call the clinic or go to the Emergency Room for chest pain
  Difficulty concentrating
• Your skin color may become pale
• Difficulty staying warm

Things that you can do to help build your red blood cells:

• Rest when you feel tired. Ask others to help you. Shorter rest periods are better than long ones since they may interfere with nighttime sleep.
• Eat foods high in iron such as green leafy vegetables, liver, and red meat.
• Take iron supplements if recommended.
• Do important activities first so you have enough energy to complete them.
• You may receive an injection called epoetin alpha, ordered by your doctor. This medication stimulates the bone marrow to produce red blood cells more quickly.
• You may require a blood transfusion if your red blood cell count is low, specifically if your hemoglobin (hgb) is low. If you need a transfusion, we will schedule this for you at a local hospital or infusion center.

Low Platelet Count or Thrombocytopenia

Platelets, also known as thrombocytes, are cells that help your blood clot.

Platelets are produced in the bone marrow. If your platelet count is low, you have thrombocytopenia. If you are injured and start to bleed, the bleeding may last longer than normal and may be harder to stop. As mentioned before, IV therapy not only destroys cancer cells but also healthy cells, such as your platelets. If your platelet count is going to be affected by IV therapy, it will decrease 8 to 14 days after IV therapy.

If your platelet count is low, you may notice the following:

• Bruise easily or unexplained bruises
• It takes longer to stop bleeding after an injury
• Your gums bleed while brushing your teeth
• Develop nose bleeds more easily
• A headache that will not go away

If you notice any of the above signs or symptoms, notify your doctor.

 When your platelet count is low, you will need to follow these simple suggestions:

• If you injure yourself, have blood drawn, or have an injection you will need to apply pressure to the site. You may need to apply pressure to the area with a clean cloth or bandage for 5 to 10 minutes. You can also apply ice to the area to help it stop bleeding.
• When brushing your teeth, brush very gently with a soft toothbrush. Stop flossing until your platelet count recovers. Do not have dental work done without checking with your doctor.
• Avoid blowing your nose too hard, coughing harshly, or straining with a bowel movement.
• Avoid strenuous activity, such as lifting heavy objects.
• DO NOT take aspirin or ibuprofen or products containing these medications.
• If you are taking steroid medications, always take them with food or milk.
• Avoid alcoholic beverages
• Drink 8 to 10 eight-ounce non-caffeinated beverages
• Use an electric razor to avoid cutting yourself

Low White Blood Cell Count or Neutropenia

White blood cells (WBCs) – also known as leukocytes, are cells that help fight infection. White blood cells are produced in the bone marrow. There are 5 different types of WBCs. A WBC differential shows the number and description of each type of WBC. When IV therapy kills your cancer cells it also kills some of your normal cells such as your white blood cells. WBCs live for a very short amount of time, sometimes just hours after leaving the bone marrow. If your white blood cell count is going to decrease after IV therapy, it will occur 8 to 12 days afterward. When your WBC count is low, you will be more susceptible to infection.

Your doctor, APRN, PA, or nurse will check your blood counts throughout your IV therapy treatments. When your white blood cell count reaches its lowest point, called nadir, your doctor may choose to treat your low WBC count with a growth factor such as pegfilgrastim or filgrastim. Growth factors stimulate your bone marrow to produce white blood cells more quickly, thus avoiding treatment delays.

If you notice any of the following while receiving IV therapy, please notify your doctor:

• Fever – temperature greater than 100.4
• Chills
• Sore throat
• Cough
• Runny nose
• Ear ache
• Burning with urination
• Pain, redness, or swelling at the site of an injury, or at a central line, port, or needle site

When your white blood cell count is low, please follow these suggestions:

• Wash your hands frequently: before and after meals and after using the restroom. Hand washing is your best line of defense!
• Maintain good oral hygiene. Bathe daily with an antimicrobial soap and brush your teeth or rinse your mouth after meals.
• Stay away from people who are known to be ill.
• If you injure yourself, immediately wash the area with soap and water and apply an antibiotic cream or ointment.
• Avoid sunburn. Wear sunscreen if you must be outside.
• Wear gloves when working in dirt/soil.
• Maintain intact skin. Wear shoes to avoid injuring your feet.

How to Read a CBC:

Cancer treatment can make the levels of all three types of blood cells drop below normal. For this reason, your CBC is checked frequently throughout the course of your treatment

A CBC with Differential would include the following:

WBCs – White Blood Cells – The total number of all WBCs. The differential counts each type of WBC. These are reported as a percentage of the total WBC count, and also as absolute numbers. There are 5 types of WBCs, which are divided into two groups:

Granulocytes:

1. Neutrophils – fight bacterial infections. They normally account for 45- 74% of total WBCs. If your neutrophil count is low, you are said to be neutropenic and are more at risk for infection.

2. Eosinophils – Involved in allergic reactions and parasitic illnesses. They normally make up 0-7% of total WBCs.

3. Basophils – also involved in allergic reactions. They normally make up 0-2% of total WBCs.

Agranulocytes:

4. Lymphocytes – fight infections. Lymphocytes are either T-cells or B-cells, and they normally make up 16-45% of total WBCs.

5. Monocytes – Attack bacteria and viruses. They normally make up 4-10% of total WBCs.

RBCs – Red Blood Cells – The total number of all RBCs

• Hgb – Hemoglobin – A protein in RBCs that carries oxygen from the lungs and delivers it to the rest of the body.
• Hct – Hematocrit – The percentage of the blood that is made up of RBCs.
• MCV – Mean Corpuscular Volume – Measures the average size of individual RBCs.
• MCH – Mean Corpuscular Hemoglobin – Measures how much hemoglobin is in the RBCs
• MCHC – Mean Corpuscular Hemoglobin Concentration – Measures the concentration of hemoglobin in the average RBC.

PLT – Platelets – The total number of platelets in the blood.

• MPV – Mean Platelet Volume – Measures the size of the platelets.

Breathing Problems

A few IV therapy medications may cause breathing problems. This is usually temporary. Notify your doctor or nurse immediately if you notice that you are having difficulty breathing.

To help you breathe easier, you should:

• Stop Smoking!!
• Perform deep breathing every 4 hours while you are awake. This practice expands your lungs. To deep breathe, take a deep breath, filling your lungs up with air, hold your breath for 5 seconds, and then breathe out. Repeat this 10 times if you can.
• Sit in a chair rather than lying in bed during the day.
• Rest when needed.

Constipation

Constipation is difficulty moving your bowels, often accompanied by hard stool. Some drugs, such as IV therapy and pain medications, such as opioids, can cause constipation. Constipation can also occur if your diet lacks enough fluid or fiber, or if you have been inactive.

Here are some suggestions for preventing and treating constipation:

Know your normal routine.

What is your routine? What is normal for you?
Knowing your normal routine will help you recognize constipation

Treating Constipation

• Increase your fluid intake
• Drink at least eight 8-ounces of fluid every day.
• Good Choices: water, decaffeinated drinks, or hot/warm juices, such as a cup of warm prune juice
• Have a hot drink about one-half hour before your usual time for a bowel movement
• Increase your intake of high-fiber foods.
• Try foods such as whole-grain bread and cereals, dried fruits, wheat bran, fresh fruits and vegetables, beans, and legumes.
• Avoid cheese
• Try to exercise every day.
• Try to walk every day even if for a short period

Preventative Measures:

• Stool softeners such as Colace are available over the counter
• Mira Lax (polythene glycol), mix with 8oz of any type of liquid daily
• Senokot-S/Senokot

Some drugs, such as IV therapy and pain medications, can cause constipation. This problem can also occur if your diet lacks enough fluid or fiber, or if you have been inactive.

Dental and Gum Problems

Cancer and cancer treatment can cause tooth decay and other problems with your teeth and gums. For example, radiation to your mouth can affect your salivary glands,making your mouth dry and increasing your risk of cavities. If you eat often or eat a lot of sweets, you may need to brush your teeth more frequently. Brushing after every meal is a good idea.

Here are some other ideas for preventing dental problems:

• See your dentist regularly.
• Use a soft toothbrush and use toothpaste for sensitive teeth.
• Rinse your mouth with warm water when your gums and mouth are sore. Or use 1/4 tsp baking soda and 1/8 tsp salt, dissolved in 1 cup warm water for a gentle mouth rinse.

Depression

Depression related to your IV therapy or your condition is more than feeling “blue” or “down”. It is a depressed mood and a loss of interest or pleasure in activities. Depression may be associated with a lack of participation in daily activities, difficulty sleeping, sleeping too much, feelings of hopelessness or worthlessness, difficulty thinking, and recurrent thoughts of death. Depression is a treatable medical condition.

To assist with depression, you may need to:

• Talk to your doctor, APRN, PA, or nurse about your thoughts and feelings
• Meet with a counselor
• Participate in activities that give you pleasure
• Spend time with those who love and care about you
• Take a medication prescribed by your doctor to help with depression

Diarrhea

Diarrhea means loose bowel movements that are sometimes frequent. Abdominal cramping may accompany diarrhea. IV therapy can cause diarrhea by altering the cells that line the digestive tract. Diarrhea caused by IV therapy is usually temporary.

Diarrhea caused by immunotherapy may be a sign of colitis and should be treated with medications that are not listed in this section. Please call the clinic if you are receiving immunotherapy and are experiencing diarrhea.

To help with diarrhea:

Begin taking over the counter medications such as Imodium AD:

• 1st dose Take 2 caplets
• During the day Take 1 caplet after each loose stool
• During the night Take 2 caplets at bedtime and every 4 hours until morning
• Stop taking Imodium when you have NOT had a bowel movement for 12 hours
• If taking 8 tablets of Imodium AD per day, notify your doctor as another medication to control your diarrhea may need to be added
• Keep track of the number of loose stools that you are having per day
• Drink plenty of fluids to replace what you lose with diarrhea.
• Eat small amounts of food throughout the day instead of three large meals.
• Eat and drink foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. These foods and liquids include bouillon or broth, bananas, peach and apricot nectar, boiled or mashed potatoes, and sports drinks such as Gatorade or Powerade.

Try these foods as well:

• rice and noodles
• cream of wheat
• soft canned or cooked fruit without skins, such as applesauce
• peanut butter
• skinned chicken or turkey, lean beef, or broiled or baked fish

Avoid:

• raw vegetables
• high fiber vegetables, such as broccoli, corn, beans, cabbage, peas, and cauliflower
• very hot or cold food or beverages.
• caffeinated beverages, such as coffee, tea, and soft drinks.
• If you have a sudden, short-term bout of diarrhea, drink only clear liquids for the next 12-14 hours. This will allow your bowel to rest and replaces the important fluids lost during diarrhea.
• Be careful when using milk or milk products. Lactose can make diarrhea worse.
• If your anal area becomes sore you will want to keep the area clean by using unscented wipes or hemorrhoid wipes after each loose stool. Follow up with an over-the-counter ointment such as Desitin, A&D Ointment, or Preparation H.

Notify your doctor if:

• You have taken 8 Imodium AD and you are still having loose stools
• If your temperature is 100.4 or greater
• If you have signs of dehydration: dark urine, decreased urine volume, dry skin or mouth, sunken eyes, thirst that is unrelieved, or light-headedness

Dry Mouth

IV therapy and radiation therapy to the head and neck area can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth can also change the taste of food.

Fatigue

Fatigue is a lack of energy or unusual or excessive tiredness not relieved by sleep. When receiving IV therapy, you may have a change in your normal activities, a change in your diet, or may not sleep as well. A change in any of these areas can create the feeling of fatigue or tiredness. This tired feeling or lack of energy may not improve with rest. Fatigue is temporary and your previous energy level should return a few weeks after completing IV therapy.

To help with fatigue, you can:

• Plan necessary activities for the time of day when you have the most energy, for instance early in the day. Say NO to activities if your energy is low.
• Tackle those activities that mean the most to you and accept help with others.
• Take rest breaks, including one 20-minute nap.
• Try to go to sleep and wake up at the same time every day.
• Try techniques such as meditation, qigong, tai chi, and yoga
• Exercise daily. Even a short walk will help you to feel better. Exercise helps you to sleep better at night, improves your appetite, and helps you cope with stress better.

Fever

An elevated temperature can occur after you receive your IV therapy. It is your body’s response to the medications. Otherwise, you should not have a fever. If you develop a fever that is 100.4 or greater, you should call your doctor or nurse.

When you have fever, you should:

• Check your temperature every 4 hours
• Drink extra non-caffeinated beverages
• Take Tylenol (acetaminophen) every 4 hours. DO NOT take aspirin or ibuprofen as it can cause bleeding.
• Start antibiotics as instructed by your doctor

Hair Loss

IV therapy attacks cancer cells and normal cells, which includes your hair follicles. Depending upon the type of IV therapy and the dose, some or all your hair may fall out. This may include your eyebrows, eyelashes, facial, and pubic hair.

Your hair will begin to grow again a few weeks after completing IV therapy. Your new hair grow may grow back a different color or texture. This change may last up to two years.

To help with hair loss:

• Use a mild shampoo
• Avoid over combing or brushing. Use a soft bristle brush.
• Use low heat when drying your hair.
• Keep your hair short. Short hair hides thinning hair better.
• Avoid hair color and hairspray.
• If you are planning on wearing a wig, obtain the wig before you lose your hair to better match your current color and style. Our local Cancer Support Home provides wigs for free.
• Other options for covering your head during times of hair loss or thinning are to wear a hat, turban, or scarf.

Scalp Cooling may prevent or reduce hair loss. Highlands Oncology offers the DigniCap Scalp Cooling System. Scalp cooling minimizes hair loss from certain IV therapy treatments for men and women with solid tumor cancers such as those associated with breast, prostate, ovarian, uterine, and other tissues.

Cooling of the scalp may reduce IV therapy-induced hair loss through:

• Reduced blood flow to the scalp. Vasoconstriction in the scalp area limits the amount of IV therapy agent delivered to the hair follicles.
• Reduced metabolism to the scalp. Lower scalp temperature slows normal cellular activity.

If you are interested in this scalp cooling, please discuss it with your doctor or nurse.

Hand-Foot Syndrome

Some IV therapy medications may cause ringing or other noises in your ears or may decrease your ability to hear high tones. If you experience this side effect, you need to report this to your doctor.

Hand-foot syndrome is painful red swelling of your hands and feet, which may progress to dryness, scaling, itching, and blisters.

Try:

• Applying ice pack around wrists and ankles, but not directly onto the skin
• Submerge hands and feet in cool water
• Take cool showers
• Use alcohol-free creams such as 10% urea cream
• Visit a podiatrist for foot care
• Wear loose-fitting clothes

Avoid:

• Hot water
• Sun exposure
• Rubber gloves
• Contact with cleaning supplies
• Friction on the feet such as when jogging

Hormone therapy

Hormone therapy may cause side effects such as fluid retention, weight gain, hot flashes, and, in some cases, blood clots. In women, hormone therapy may interrupt menstrual periods, or cause vaginal dryness, and/or infertility. Women taking hormone therapy should talk with their doctor about contraception during treatment. In men, hormone therapy may cause impotence, loss of sexual desire, or infertility.

Hearing Changes

Some IV therapy medications may cause ringing or other noises in your ears or may decrease your ability to hear high tones. If you experience this side effect, you need to report this to your doctor.

Injection Site Reaction

IV therapy can sometimes cause symptoms at your IV site or along the vein. If you notice burning, stinging, swelling, redness, or pain at the time your IV therapy is infusing, notify your nurse right away. If you notice redness, swelling, warmth, or pain at your IV site or along a vein once you return home, you need to call your doctor or nurse.

Immunotherapy

When receiving immunotherapy, if you develop any of the following problems or your symptoms worsen, call your doctor at 479-587-1700.

• Lung problems (pneumonitis) may include shortness of breath, chest pain, a new or worsening cough.
• Intestinal problems (colitis) may include diarrhea or more bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; or severe stomach-area (abdomen) pain or tenderness.
• Liver problems, including hepatitis, may include yellowing of your skin or the whites of your eyes, nausea or vomiting, pain on the right side of your stomach area (abdomen), dark urine, or bleeding or bruising more easily than normal.
• Hormone gland problems (thyroid, pituitary, adrenal glands, and pancreas) may include rapid or irregular heartbeat, weight loss or weight gain, increased sweating, feeling more hungry or thirsty, urinating more often than usual, hair loss, feeling cold, constipation, deepening voice, muscle aches, dizziness or fainting, or headaches that will not go away, or an unusual headache.
• Kidney problems, including nephritis and kidney failure, may include a change in the amount or color of your urine.
• Skin problems may include rash, itching, blisters, peeling skin, or sores. You also may experience painful sores or ulcers in your mouth, nose, throat, or genital area.
• Problems in other organs, which may include changes in eyesight, eye pain, severe or persistent muscle or joint pain, severe muscle weakness, low red blood cells (anemia), swollen lymph nodes, tender lumps on the skin, confusion, fever, balance problems, stiff neck, memory problems, seizures (encephalitis), or chest pain (myocarditis).

Mouth Sores/Sore Throat

Mouth sores, tender gums, and a sore throat or esophagus can result from radiation therapy, IV therapy, or infection. Mouth sores will occur 5 to 14 days after IV therapy. These sore patches will sometimes heal between cycles of IV therapy or they may not heal completely until IV therapy is stopped. If you have a sore mouth or gums, call your doctor or nurse. There are medications available that may help with mouth or throat discomfort.

To help with mouth sores:

• Drink plenty of liquids to help keep your mouth moist.
• Brush your teeth after meals and at bedtime using a soft toothbrush.
• If you have dentures, clean them after every meal to remove debris. Do not use denture adhesive.
• Avoid very hot foods or drinks as they may cause additional irritation.
• Avoid mouthwashes that contain alcohol because alcohol is drying.
• Stop smoking!! Avoid chewing tobacco
• If you are uncomfortable, or unable to eat, call your doctor or nurse.

Try soft foods that are easy to chew and swallow, such as:

• milkshakes
• bananas, applesauce, and other soft fruits
• cottage cheese, yogurt
• mashed potatoes, noodles
• macaroni and cheese
• custards, puddings, gelatin
• scrambled eggs
• oatmeal and other cooked cereals
• soft vegetables, such as cooked peas or carrots
• pureed meats

To help with mouth sores, continued:

Avoid foods or liquids that can irritate your mouth.

These include:

• citrus fruits, such as grapefruit, orange, lemon and lime
• tomato-based foods such as salsa, spaghetti sauce and pizza
• spicy or salty foods
• raw vegetables, granola, toast, chips or other rough, coarse or dry foods
• alcoholic beverages
• Cook foods until they are soft and tender.
• Use a blender or food processor to puree your food.
• Thin foods with gravy, butter or margarine to make it easier to swallow.
• Use a straw to drink liquids.
• Try foods cold or at room temperature. Hot foods can irritate a tender mouth and throat.
• Try sucking on ice chips.
• Try drinking lukewarm to warm bouillon or broth; it can soothe throat pain.
• Rinse your mouth often with water to remove food and bacteria
• If you see small, white patches in your mouth, tell your doctor or nurse. This may be an infection that may require special attention.
• Ask your doctor or nurse about anesthetic sprays and mouthwashes that can numb your mouth and throat and allow you to eat.

Nausea/Vomiting

Nausea occurs when you feel queasy or sick to your stomach. Nausea may occur with or without vomiting, can occur after surgery, IV therapy, and radiation therapy. Nausea and vomiting occur most often within 24 hours of receiving IV therapy; however, nausea and vomiting may occur days later. Some people may never experience nausea, but for those who do, there are measures available that effectively control this side effect.

If you are currently receiving IV therapy treatments, take your anti-nausea medication as instructed to prevent nausea and vomiting. You may be instructed to take this medication for a day or two following your treatment. It is easier to prevent nausea and vomiting than it is to stop it once it has started. If you have nausea or vomiting that is not controlled by your medications, call – we can help.

Here are some ideas that will help if you experience nausea:

• Take your anti-nausea medication 30 to 60 minutes before you eat

Try foods that are easy on the stomach:

• toast, crackers, pretzels
• yogurt, sherbet, popsicles
• angel food cake
• cream of wheat, rice, or oatmeal
• potatoes, rice, or noodles
• soft, bland fruits and vegetables
• clear liquids such as broth and cranberry juice
• ice chips
• carbonated beverages such as Sprite, 7-Up, or ginger ale

Avoid foods that are:

• greasy, fried, or high in fat
• very sweet, such as candy, cookies or cakes
• spicy, hot, or highly seasoned foods
• Eat cold or room temperature foods; hot foods may add to nausea.
• Eat small amounts every two hours
• Avoid foods with a strong smell or odor
• Drink few liquids with meals. Drinking large amounts of fluid can increase nausea, so sip liquids throughout the day. Using a straw may help.
• Rinse out your mouth before and after eating.
• Avoid commercial mouthwashes because they may contain alcohol and can dry your mouth.
• Suck on hard candy such as peppermint or lemon if you have a bad taste in your mouth.
• Rest sitting up after meals.
• If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
• If nausea occurs during radiation or IV therapy, avoid eating for one or two hours before treatment. Try eating bland, soft foods on treatment days.
• Wear loose-fitting clothes.
• Apply a cold, wet cloth to your forehead or throat.

Vomiting

Vomiting may follow nausea and may be caused by the treatment, food odors, gas in the stomach or bowel, or motion. In some people, certain associations or surroundings, such as the hospital, may cause vomiting.

Try these suggestions to help prevent and treat vomiting:

• Do not eat or drink anything until you have the vomiting under control.
• Once the vomiting is under control, try small amounts of clear liquids, such as 7-Up, Sprite, bouillon, or Jell-O.
• When you are able to keep down clear liquids, try eating small amounts of soft foods such as creamed soups, cream of wheat, pudding, frozen yogurt, or gelatin.
• Once you can tolerate soft foods, gradually work your way back to your regular diet.

Neuropathy

Also called IV therapy-induced peripheral neuropathy (CIPN), may cause burning, shooting, or stabbing pain; numbness; tingling; decreased ability to feel hot and cold; and decreased strength.

Suggestions:

• Consult a Highlands Oncology physical therapist about therapeutic exercises, balance retraining, and the use of walking devices.
• Use oven mitts when handling hot and cold items
• Reduce your fall risk by paying close attention to walking surfaces and wearing non- slip shoes.
• Remove area rugs and keep walkways clear of clutter.

Rash

A rash may develop when taking drugs that target EGFR (epidermal growth factor receptors). The rash will develop on the face and upper body and usually occurs within the first few weeks of taking these medications. You may notice redness or a warm sensation like a sunburn before the rash begins. After several days, tender pimple-like bumps, which may be filled with pus, appear and the surrounding skin feels slightly tender. Rashes tend to be mild to moderate.

Your doctor will prescribe medications to prevent the rash, such as creams or lotions and oral medication. Simple lifestyle adjustments aimed at protecting your skin, such as wearing sunscreen, may also help. Do not use any acne medications or anything that will dry your skin, these can make the rash worse and lead to infection.

A rash caused by immunotherapy will need to be treated with steroids.

Sex, Sexuality, and Fertility

Cancer treatment may impact every aspect of your life, including your sex life. Although intimacy and sexuality may not be a top priority at first, as cancer treatment goes on, it should become a topic of conversation with your partner, and perhaps your doctor.

Cancer and Sexuality: Intimacy Issues for Men

Cancer treatment may result in a number of different side effects, which will vary from person to person depending on the type of cancer and type of cancer treatment.

Common sexual side effects that male cancer patients may experience during or after treatment include:

• Low libido
• Genital pain
• Reaching orgasm too quickly
• Nausea, fatigue, pain, and depression that can lead to sexual problems or loss of interest in sex
• Anxiety or concern about intimacy and sexuality, such as how you will perform or how you look
• Infertility
• Inability to release semen during orgasm
• Erectile dysfunction

Cancer and Sexuality: Intimacy Issues for Women

Intimacy issues for women will also depend on the type of cancer, its treatment, and the individual.

Common sexual problems and concerns of female cancer patients during and after treatment include:

• Low libido
• Vaginal dryness
• Pain during intercourse
• Tightening of the vaginal muscles, preventing intercourse
• Infertility
• Early menopause
• Inability to have an orgasm

For both men and women, some issues may only be temporary, like low libido and pain during intercourse. Other problems, like infertility, can be permanent. It’s important to discuss these potential long-term issues with your partner and your doctor to find out what can be done to alleviate them or find alternatives.

Cancer and Sexuality: Preparation and Communication

Many find talking about sex and sexuality during or after cancer treatment an uncomfortable or embarrassing topic. However, communication is necessary. As you re-engage in sexual relations, be open to new types of sexual contact as well as new positions that may make intimacy more comfortable as well as more pleasurable. Keep in mind that you may need products like vaginal lubricant or moisturizer to help with intercourse. A healthy sex life is an important part of a healthy relationship. Worrying about your sex life may only make any problems worse, so talk to your partner about your fears, concerns, and limitations.

Fertility and Sexual Side Effects in Men:

• Fertility and Men with Cancer
• Sexuality for the Man with Cancer
• Sex and men with Cancer (Overview)

Fertility and Sexual Side Effects in Women:

• Fertility and Women with Cancer
• Sexuality for the Woman with Cancer
• Sex and Women with Cancer (Overview)

Taste and Smell Changes

Weight Loss

Many cancer patients lose weight during their cancer treatment because of the cancer itself, loss of appetite, the treatment, or emotional worries.

Here are some ideas for slowing weight loss or even gaining a few pounds. The tips listed under Loss of Appetite may help, too.

• Add butter and margarine to soups, potatoes, hot cereals, noodles, and cooked vegetables. Stir into cream soups, sauces, and gravies.
• Combine butter and margarine with herbs and seasonings and spread on cooked meats, hamburgers, fish, and egg dishes.
• Use melted butter as a dip for seafood and raw vegetables.
• Use whipped cream on desserts, gelatin, pudding, fruit, pancakes, and waffles.
• Use whole milk and cream in soups, egg dishes, batters, pudding, and custards.
• Mix milk and cream with noodles, pasta, rice, and potatoes.
• Use whole milk instead of low fat.
• Use cream instead of milk in recipes.
• Melt cheese on top of the casseroles and vegetables.
• Add cheese to omelets and sandwiches.

Weight Gain

Some patients find their weight does not change during treatment. They may even gain weight. This is particularly true for breast, prostate, and ovarian cancer patients taking certain medications such as steroids, hormone therapy, or IV therapy. However, weight gain may also be the result of increased appetite and eating extra food and calories. You may want to attend our Weight Management Class held monthly at each clinic.