Coping with chemotherapy

Food may taste differently: bland, salty, bitter or metallic leaving you with a loss of appetite. Maintaining a diet that is low-fat (<20%), and rich in vegetables, fruits, whole grains, and high plant-based proteins is recommended for healthy nutrition for cancer patients. Some practical tips for handling changes in taste and loss of appetite include:

• Eat in small quantities and frequently; have snacks like crackers and nuts handy through the day.
• Eat food at room – or cold temperature.
• Eat slowly and chew food properly.
• Use a smaller dish or plate to serve your smaller meals.
• Try chewing on gum or ginger lozenges.
• Don’t replace meals with tea and water. If solid meals are intolerable, try a liquid energy-dense diet like Ensure or other hospital-grade milk or supplement powders.

Talk to a dietitian about any nutritional concerns. She/he will help you achieve your dietary requirements.

Some chemotherapeutic drugs can cause inflammation of the mouth lining (mucositits) and lead to ulcers. It develops about 5-10 days from starting with treatment and takes about 3 to 4 weeks to clear up post-treatment. Alkeran/Melphalan or 5-FU (5-fluorouracil) can cause mouth ulcers.

A good tip is to bring a bottle of iced water and take it with you to sip with a straw to prevent mouth ulcer. Take it by mouth for 5 minutes before treatment until about 30 minutes after the treatment ends. Other practical tips are to:

• Use a soft toothbrush to brush teeth twice a day for 90 seconds. Floss daily, but gently to avoid causing injury or bleeding to your gums.
• Avoid alcohol-based mouthwashes. Instead, use this home-made mouthwash to rinse up to 4 times daily: 1/4 tsp baking soda + 1/8 tsp salt in 1 cup warm or room-temperature water.
• Clean and remove dentures after every meal, morning and evening.
• Avoid smoking, drinking alcoholic beverages, and eating spicy, sour, salty, or acidic foods (oranges, lemons, etc.)
• Avoid dry, and rough food. Instead chew on gum, ice chips, and flavoured ice blocks.
• Use petroleum-based lip balm to keep your lips soft.
• Keep well-hydrated with fluids; eat chilled watermelon.
• Ask your doctor about artificial saliva or saliva substitutes, and other medications that can help ease your sores.
• Inform your medical provider of persistence of dry mouth and presence of ulcers.

Chemotherapy can irritate your gut’s lining or nerve supply, producing either constipation (e.g. in vinca-alkaloids) or diarrhoea. For example, painkillers used in conjunction with drugs in chemotherapy (e.g. Morphine) is notorious for causing constipation. Here are some tips to handle these side-effects:

• When experiencing diarrhoea, replace lost fluids. Maintain hydration by drinking small but frequently and use oral rehydrating tablets/powder when needed.
• Do not use antidiarrheal drugs unless prescribed by your doctor. If you have more than 3 watery stools in 24 hours, or if your excrement is mixed with blood, contact your doctor immediately.
• If you have any constipation, it is best to tell your carer, nurse, or doctor. The doctor can adjust your medications or prescribe you laxatives or stool softeners.
• Eat plenty of fresh fruits and vegetables. Unless the doctor limits your water intake, aim to keep hydrated by drinking 8-10 glasses of water a day.
• If diarrhoea or constipation is leaving your anus sore and chaffed (broken skin), ask your nurse or doctor about an appropriate moisturising creams.

Fatigue is the most common and distressing side effect of cancer and cancer treatment. Click here to read more about the how-to on handling cancer-related fatigue.

Use of steroids prescribed to assist with nausea will make you more alert at nighttime, leading to sleeplessness.

Work with an exercise physiologist to assist with initial effects of fatigue, within the first few days of treatment.

Treatment can often damage the peripheral nerves, found in your fingers and toes, leading to peripheral neuropathy. Often described as a burning or tingling sensation, along with numbness and muscle cramps, it not only causes discomfort and pain but can also lead to high risk of falls, mobility concerns and difficulty driving.

Along with medication, you may find the following helpful to relieve symptoms:

• exercises for your fingers and toes
• foot care including wearing appropriate footwear
• ensuring your environment is as uncluttered as possible
• caution with mobility and activities of daily living
• mindful living.

Skin problems like acne and rashes can be an expected side effect or an allergic reaction to a chemotherapy drug you’re given. It is best to be informed about what warning signs to look out for. Contact your nurse/doctor immediately if the acne/rash is severe or is accompanied with difficulty of breathing, fever, and nausea and/or vomiting.

• Your doctor can prescribe you moisturisers or anti-itch medications and creams to help with inflammation, soreness, or itching.
• Hair loss is one of the visible side-effects that negatively impacts a person’s self-esteem. It usually occurs 3-4 weeks post-treatment. All bodily hair may be affected, leaving your scalp sensitive or dry. If you have not made arrangements to cut your hair or trim it down yet, you can opt to do so. Avoid harsh hair products and use a soft hairbrush. Apply a prescribed skin cream for itching/dryness. Also, consider wearing a hat, scarf/turban, a wig, or go for the bald-look. Wear a cotton, breathable cap (Look Good Feel Good) when sleeping, to assist with heat loss as a high percentage of heat is lost through your head. There is no right or wrong way to deal with hair loss – do what is suited for the occasion. Most importantly, do what is comfortable for you.
• Nail discolouration, cuticle dryness and itching, and nail dryness/brittleness are some of the effects of drugs on your nails. Keep proper body hygiene and use moisturizers on cuticles and nails. Use a cuticle trimmer or let a proper podiatrist handle this job. Marks on nails eventually grow out, you can opt to cover them with non-drying nail varnish.

Battling cancer in itself will often leave you feeling depressed. Handling hair loss, fatigue, and other side effects of chemotherapy may likewise add to or create a state of depression for you. Talk to a mentor/counsellor, family member, friend, or to a carer, doctor, or nurse about feelings of worthlessness, loneliness, or feelings of hopelessness. Find out more on our emotional support pages.