Chemotherapy

Cancer occurs when normal body cells get out of control.  Most chemotherapy drugs move around the body in the bloodstream.  They reach the cancer cells wherever they are in the body.  They damage the cancer cells.  The cells eventually die, and the cancer may then shrink or go away completely.

Unfortunately, chemotherapy drugs do not affect cancer cells only.  They can damage any cells that are actively growing and dividing for example, cells in the mouth and hair roots.  This can cause side-effects such as sore mouth or hair loss.

Normal cells recover quite quickly, so any damage to them is usually temporary.  This is why most side-effects go away when chemotherapy is over.

There are over 50 different chemotherapy drugs.  Some are given on their own, but several drugs are often given together (‘combination therapy’).

The chemotherapy you are given depends on many things, such as:

• the type of cancer you have
• what the cancer cells look like
• where the cancer started in your body
• whether the cancer has spread to other parts of the body

Your first visit

Your first appointment is usually to discuss treatment options or to prepare you for chemotherapy, rather than give it to you that day. If you are being assessed for chemotherapy you will meet your doctor and be introduced to your named nurse.  He/she will discuss your chemotherapy plan which helps to prepare you by making sure that you understand about your chemotherapy and can have your questions answered.

After this discussion, if you are happy to proceed with the chemotherapy, you will be asked to sign a consent form.

You will be told how often you will need to have chemotherapy, how it will be given and for how long.

You will have a blood test and your height and weight taken at this appointment.  If your chemotherapy is to be given through your veins we will look at your arms to check them.  This is to help plan the best way to give you chemotherapy.

Please bring a list of any medications you are taking.

A nurse will help you assess your needs for any practical, social or spiritual support.

At your first appointment at Laurel House, you will be given a factsheet or several factsheets about your chemotherapy drug(s). These factsheets cover important information so it is important to read them. You can ask us for help if you find them hard to read or understand.

We can also give you a more detailed booklet or audiobook called ‘Understanding Chemotherapy’. This should be available within the unit, or you can order it for yourself (free) from Macmillan Cancer Support.

Preparing for chemotherapy

Some people will need a PICC line inserted in preparation for their chemotherapy. This may be due to the type of chemotherapy being received or the frequency or duration of your chemotherapy. Read the PICC Line Booklet for more information

Dental health

It is very important you make sure your dental check-ups are up to date and any dental work is done before you start chemotherapy. If you need to visit the dentist while on chemotherapy, or in the six weeks after it finishes, contact us first.

Flu vaccine

We recommend that you get the flu vaccine if you will be having chemotherapy during the autumn and/or winter. Ideally this should be at least 7 – 10 days before your chemotherapy starts.

If you need to be vaccinated while on chemotherapy, or in the six weeks after it finishes, contact us first.

Other vaccines

You should not have any live vaccines while you are having chemotherapy and for 6 months afterwards.

Examples of live vaccines include Rubella, Mumps, Measles, MMR (triple vaccine for measles, mumps and rubella), BCG and Yellow fever. Ask at your local travel clinic or GP whether the vaccine you need is live.

Alternative medicines and complementary therapies

Some people take ‘alternative’ medicines. These include things such as herbal medicines and vitamins.

Some alternative medicines can prevent chemotherapy from working as well as it should. Some can make side-effects more likely to happen. If you are taking alternative medicines, or are thinking about doing so, you should discuss this with your doctor, nurse or hospital pharmacist.

If you are considering having any complementary therapies, for example, aromatherapy, you should check that the therapist is suitably qualified to work with people with cancer. Alternatively you may want to contact the Macmillan information & Support service who can signpost you to charities who provide complementary therapy. Contact them on 07795845435 or email cancerinformation@northerntrust.hscni.net

Having chemotherapy at Laurel House

Each visit to the Unit is likely to take a few hours.  For each of your appointments, you may need to have a blood test.  This can be done at your GP surgery or by us in the Laurel House Unit.  If it is done at the Unit, it can take up to an hour for your results.

Depending on your results, it may be safer for you if we delay your chemotherapy for a few days.  If so, you will be given a new appointment.

It is important that you tell us how you have been feeling since your last appointment. If your chemotherapy is causing side-effects we can often help. If side-effects are severe we may be able to treat them, or it may be better for you if we delay or change your chemotherapy.

If your blood test results are OK you will be asked to wait while pharmacy gets your drugs ready. Your drugs are made up especially for you, and they must be exactly right – this can take up to a couple of hours. When your drugs are ready, your nurse will give you the chemotherapy.

Once it is over you will be able to go home. Before you leave, we will make your next appointment.  It is very important that you bring your appointment card to each visit.

You may feel tired after your chemotherapy so try to bring someone with you who can accompany you home. It is recommended that you do not drive yourself home.

Possible side effects of chemotherapy

The side effects you get will depend on the chemotherapy drugs you are having. Different drugs cause different side effects. Some side effects are mild and easily treated.

Others can be harder to manage but can often be reduced or helped in some way.   Most side effects are short term and usually stop or gradually go away when chemotherapy is over. Although the side effects can be unpleasant, the benefits of chemotherapy usually outweigh this.

If you are having a single drug you will not usually have as many side effects as someone having a combination of drugs. People having high doses of chemotherapy and who need to stay in hospital may have more complex side effects.

Your cancer doctor and named nurse will explain the side effects that your chemotherapy is likely to cause.  It is important to always tell your doctor or nurse about any side effects. They can usually prescribe medicines to reduce them or change medicines you are already taking to more effective ones.

During and after chemotherapy

Chemotherapy 24 hour Helpline

If you are receiving chemotherapy or are within six weeks of having completed the treatment please contact the Chemotherapy 24 Hour Helpline straight away.

It is very important that you are cared for safely and efficiently because your immune system will be affected by the treatment and a delay could be life threatening. Please contact us straight away if you have any of the following symptoms.

• feeling very hot or feeling very cold
• a temperature of below 36◦C or above 37.5◦C
• shivering attacks or flu like symptoms.
• breathing problems, persistent cough, coughing up green/yellow spit or blood.
• pain on passing urine, frequency of urine or blood in your urine.
• feeling or being sick.
• diarrhoea for more than 24 hours or bleeding from your back passage or in your stools.
• sore mouth or sore throat preventing you from eating or drinking.
• unexplained rash, new bruising or purple spots on your skin.
• pain not controlled by medication.
• bleeding from your gums or nose, blood blisters or bleeding that does not stop with general first aid.
• if you have a central line (“PICC”, “Hickman” or “Port a cath”) and the area around it becomes red, swollen and/or painful.
• any other symptoms which cause you concern.

24 hour helpline numbers

Contact Laurel House, Monday-Friday, 8.30am – 4.30pm on 028 9442 4201

Bank Holidays and any other times contact AMU1 (Acute Medical Unit /B1 Antrim Area Hospital) on 028 9442 4473

If you had your chemotherapy treatment in Belfast, please call the numbers below for their 24hr Helpline:

Oncology Helpline: 028 9026 3805
Haematology Helpline: 028 9026 3984

Avoiding infections

If the number of your white blood cells is low, you are more likely to get an infection. The main white blood cells that fight bacteria are called neutrophils. When they are low you are neutropenic.

Your resistance to infection is usually at its lowest 7–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.

Helpful hints

• keep clean and always wash your hands thoroughly after using the toilet and before preparing food
• stay away from crowded places and from people who you know have an infection, such as a cold
• make sure your food is thoroughly cooked, and ask your nurse if there are any foods you should avoid

Feeling sick (nausea)

Some chemotherapy drugs can make you feel sick (nauseous), or be sick (vomit). Not all drugs cause sickness and many people have no sickness at all. There are very effective treatments to prevent and control sickness.

Anti-sickness drugs

If your chemotherapy is known to cause sickness, you will be given anti-sickness drugs by injection or as tablets before your chemotherapy. You will also be given tablets to take at home afterwards. You should take these regularly, even if you do not feel sick, and exactly as your doctor has prescribed them. It is easier to prevent sickness than to treat it once it has started.

Contact your doctor or nurse at the hospital if:

• the anti-sickness drugs do not stop you feeling or being sick – other more effective drugs can be prescribed
• you are being sick and are not able to drink enough fluids
• If you cannot keep down tablets, your doctor can prescribe injections or suppositories to take until the sickness is controlled

Try to have a small meal a few hours before chemotherapy but not just before it. If you are managing to eat well in between treatments, do not worry if you cannot eat much for a couple of days after chemotherapy.

Helpful hints

• if possible, let someone else cook or prepare food for you
• eat cold or frozen foods that only need heating up (defrost thoroughly), if the smell of cooking bothers you
• avoid fried, fatty foods or foods with a strong smell
• try eating dry food, such as toast or crackers, first thing in the morning
• ginger can help reduce feeling of sickness – try crystallised ginger, ginger tea or ginger biscuits
• sipping a fizzy drink can help – try mineral water, ginger beer or ale, lemonade or soda water and sip slowly through a straw

Some complementary therapies, such as acupuncture, may help but ask your cancer doctor first.

Mouth care

Chemotherapy can cause different mouth problems, such as a sore mouth, mouth ulcers or infection. Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems.

Some chemotherapy drugs can make your mouth sore and you may get mouth ulcers about 5–10 days after they are given. Mouth ulcers can become infected or you may develop an infection in your mouth.

The most common mouth infection is called thrush (or candidiasis). It shows as white spots on your mouth and tongue, or your tongue and mouth lining become red and swollen. Thrush is treated with anti-fungal tablets.

Always let your doctor or chemotherapy nurse know if you have mouth ulcers, or any problems with your mouth. They can give you mouthwashes, medicines and gels to heal ulcers and clear or prevent any infection.

It is a good idea to see your dentist before you start treatment. Dental treatment may need to be delayed during chemotherapy because of the risk of infection and a sore mouth.

Helpful hints

• clean your teeth or dentures gently every morning, evening and after meals using a soft-bristled or children’s toothbrush and rinse your mouth regularly with water.
• if your toothpaste stings or brushing your teeth makes you feel sick, try using a mouthwash of one teaspoon of bicarbonate of soda dissolved in a pint (570mls) of warm water.
• if your doctor prescribes a mouthwash for you, use it regularly as prescribed to prevent soreness
• gently use dental tape or floss once a day (unless you have low platelets)
• keep your lips moist by using a lip balm

A sore mouth or ulcers can make eating and drinking uncomfortable. These tips may help you:

• add gravies and sauces to your food to keep your mouth moist and make swallowing easier
• try to drink at least 3 pints (1.5 litres)  of fluid a day  (water, tea, weak coffee and soft drinks)
• avoid hot spices, garlic, onion, vinegar and salty food
• avoid neat spirits, tobacco and acidic drinks (orange and grapefruit juice)

Diarrhoea and constipation

Some chemotherapy drugs can cause diarrhoea, usually in the first few days. Let your nurse or doctor know if this happens as they can prescribe medicine to reduce this. .

Make sure you drink plenty of liquid (up to two litres a day) to replace fluid you are losing with diarrhoea. Eat less fibre (cereals, raw vegetables and fruits) until the diarrhoea improves.

Sometimes diarrhoea can be more severe, and it is important to contact the Laurel House Chemotherapy 24hour Helpline if this happens.

In addition, some chemotherapy drugs and also anti-sickness drugs and painkillers can cause constipation. Let your nurse or doctors know if this happens so they can prescribe drugs to prevent or treat it.

Try to eat more fibre (cereals, raw vegetables and fruits) and drink plenty of liquid. Gentle exercise, such as short walks, can help to improve constipation.

Fatigue

Some people feel very tired during chemotherapy. This is normal. It can be very frustrating and difficult to cope with, especially for people who normally have a lot of energy.  The hardest time may be towards the end of the course of chemotherapy.

Managing tiredness

• try to cut down on things you do not really need to do
• ask family and friends, who are often keen to help in any way they can, to help with tasks such as shopping, household jobs or gardening
• if you have children, ask for help looking after them when you have chemotherapy and for a couple of days after
• some people may need extra childcare help and a social worker can usually arrange this for you
• make sure you get plenty of rest. But try to take some gentle exercise, such as short walks or more if you feel up to it, as well. This will give you more energy and helps to keep some of your muscles working
• some people choose to, or need to, carry on working during chemotherapy. Most employers will reduce your hours and change work duties to make things easier for you the tiredness will get easier when chemotherapy is over. But it can be three or four months until you feel back to normal. Some people find that they still feel tired a year or so afterwards.

The Macmillan information and support service run quarterly fatigue management workshops. These consist of 5 one-hour workshops with Allied Health Professionals who will give you information & support with your cancer related fatigue. To sign up for the next workshop, please contact the Macmillan Information & Support Service on 07795845435 or email cancerinformation@northerntrust.hscni.net

Sex and contraception

Chemotherapy should not have a long-term effect on your sex life. The side effects will usually gradually wear off when your treatment is finished. Feeling low or anxious can also affect your sex life. The anxiety may not be about sex. You might also have worries about the cancer, how your family is coping or about money.

It is important to use effective contraception during chemotherapy to avoid a pregnancy as the drugs might harm a developing baby. Your doctor or nurse will advise you to use reliable contraception during chemotherapy and for a few months afterwards.

It is usually best to use ‘barrier’ methods such as condoms, the cap or the coil (non-hormonal if you have breast cancer). Chemotherapy side effects, such as sickness and diarrhoea, can make the contraceptive pill less effective. If you are taking it you need to check with your cancer doctor if it is okay to continue using it.

For more information about sex and contraception during or after chemotherapy please visit contact the NHSCT Macmillan Information & Support Service on 07795845435 or email cancerinformation@northerntrust.hscni.net

Fertility

Unfortunately, some chemotherapy drugs can cause infertility (inability to become pregnant or to father a child). It is important to discuss your infertility risk with your cancer doctor before you start chemotherapy. If you have a partner, it is a good idea to include them in this discussion. Although chemotherapy can affect fertility, it is still possible for a woman to get pregnant or for a man to get his partner pregnant during chemotherapy. It is important to avoid pregnancy when you are having chemotherapy as the drugs could harm a developing baby.

For more information about fertility during or after chemotherapy please contact the NHSCT Macmillan Information & Support Service on 07795845435 or email cancerinformation@northerntrust.hscni.net

Hair loss

Some chemotherapy drugs cause all or most of your hair to fall out, which can be very upsetting. There are lots of ways you can cover up, if you choose to, such as using wigs, hats, turbans, scarves or bandanas.

Hair loss usually starts within a few weeks of starting chemotherapy or, very occasionally, within a few days. You usually notice your hair coming out more when you brush, comb or wash it, and you may find hair on your pillow in the mornings. You may lose underarm, body and pubic hair as well. Some chemotherapy drugs also make the eyelashes and eyebrows fall out.

Your hair will usually grow back over a few months once you have finished treatment. It will be very fine at first and may be a slightly different colour or texture than before. You will probably have a full head of hair after 3–6 months. To begin with, you should try to look after the condition of your hair.

Look Good Feel Better are a charity that provide support for women and men who are experiencing cancer related hair loss. Their workshop ‘Hair Loss, Scalp Care and New growth’ is a practical workshop presented by partner charity, Cancer Hair Care, with expert advice and support on hair loss, how and when to safely colour your hair and what to expect with new hair growth. The session also covers advice on daily scalp care and moisturising, safe scalp massage and how to create an ideal platform for new hair growth whilst undergoing treatment.

To book a workshop, please visit A leading cancer support charity – Look Good Feel Better : Look Good Feel Better

Wig Provision in the Northern Health and Social Care Trust

A wig referral can be made for you through your team at Laurel House.

If you have any queries regarding your wig requirements, referral or wig delivery please contact the NHSCT team as below;

Causeway area: Dermatology Tel: 028 7034 6053 or email: Geraldine Monaghan at Geraldine.Monaghan@northerntrust.hscni.net

All other areas: Oncology and Dermatology Tel: 028 9442 4000 exts: 334750/334271 or email: Sinead Laverty at Sinead.Laverty@northerntrust.hscni.net or Samantha Neilly at Samantha.Neilly@northerntrust.hscni.net

You may also wish to contact Laurel House directly on 028 9442 4240 if you need to speak to someone urgently and are an oncology patient.

All face to face appointments for wig fittings are now held only in Rema salon in Antrim town, unfortunately no further appointments can be offered in the Macmillan Belfast Cancer Centre.

If you have any difficulties in contacting Browns, who provide the wigs, please let our team in NHSCT know as soon as possible so we can support you and address difficulties as soon as possible on your behalf.

Helpful hints

• cutting hair short before chemotherapy can stop the weight of long hair pulling on the scalp, which can make hair fall out earlier.
• wearing a hairnet, soft cap or turban at night stops your hair becoming tangled and helps to collect loose hair.
• you can ask your own hairdresser to cut and style your wig for you.

Emotional support for hair loss

Many people see their hair as an important part of their appearance and identity. You may worry about how your different appearance will affect your relationships with family and friends. You may also feel uncomfortable about socialising and feel less confident.

Other people find their hair loss can act as a visible reminder to themselves and others that they have cancer. This may make you feel vulnerable and exposed, especially if you feel forced to tell people about your cancer diagnosis when you do not wish to do so. It can also be a shock if your eyebrows, eyelashes, beard or moustache and pubic hair fall out. You may feel even more vulnerable and this can affect the way you feel about yourself.

All these reactions are completely normal. It may take a while for you to come to terms with your hair loss, and to talk with others and deal with their reactions. Most people find that their family and friends are very supportive, and that it can help to talk through their feelings about losing their hair. In some cultures, hair is seen as a symbol of fertility and desirability, or a sign of health and status.

At the hospital, you will probably meet other people who have had hair loss, who can often give helpful advice and personal hints on how they have coped. You can also meet people at cancer support groups.

Some people find it easier to talk to someone they do not know. You can use our counselling service (link to psycho-oncology service in services available on site) if you are finding it hard to cope with hair loss or other aspects of your cancer and its treatment.

Skincare

Some drugs can affect your skin. It may become dry or slightly discoloured. Chlorine in swimming pools can make this worse. Your skin may also be more sensitive to sunlight, during and after treatment.

Tell your cancer doctor or nurse if you develop any skin changes or rashes.

Helpful hints

• avoid wet shaving – an electric razor is less likely to cause cuts.
• use moisturising cream if your skin is dry or itchy, but check with your nurse before using creams if you’re also having radiotherapy
• if you are out in the sun wear a high-factor suncream (at least SPF 30) on exposed areas

Drinking alcohol

For most people, having the occasional alcoholic drink should not affect your chemotherapy treatment. But it is best to check with your doctor or nurse first.

Breastfeeding

Breastfeeding during chemotherapy is not advised as the drugs could be passed on to a baby through breast milk. If you want to give your baby breast milk during chemotherapy, you may be able to express extra milk before treatment starts and freeze it. You may be able to express milk, which you cannot keep or use, throughout your chemotherapy so that you are still producing milk when chemotherapy finishes.

You may then be able to start breastfeeding after chemotherapy. But this will depend on whether you are having any other treatment that could interfere with breastfeeding.

Your cancer doctor and specialist nurse will advise you if this is possible and if so when it is safe to start. Having chemotherapy will not affect your ability to produce breast milk in the future.

Holiday travel

If you are going abroad on holiday, it is important to remember that you should not have any ‘live’ vaccines while you’re having chemotherapy. These include:

• MMR (the triple vaccine for measles, mumps and rubella)
• BCG (tuberculosis)
• yellow fever
• oral typhoid

There are some vaccines that you can have if necessary.  If you are travelling abroad, ask your doctor if you need any vaccines and whether it is safe for you to have them.   Sometimes people who have, or have had, cancer can find it difficult to get travel insurance.