Chemotherapy is an individual experience
Chemotherapy to treat breast cancer is tailored to your medical needs. It is given in many different situations including following surgery (adjuvant chemotherapy) to lower the risk of future recurrence or spread of breast cancer. It can also be given before surgery (neoadjuvant therapy) to shrink the tumor before it is removed. It is also used to treat people who have metastatic breast cancer to control the growth and further spread of cancer. Several different types of chemotherapy drugs and combinations are used depending on the specific clinical situation. You and your medical oncologist will discuss which drugs are appropriate for your situation. Side effects vary with the different chemotherapy drugs.

Nausea
Medications called anti-emetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your provider will recommend what is expected to work best for you. We have a specific anti-nausea information sheet describing the medications, dosages, side effects, and other important information which is included in your binder.

Please be prepared and have your prescriptions filled before your treatment day. Please call your practitioner if your medications do not give you adequate relief or if you experience side effects with the anti-nausea medication.

Practical Hints for Nausea

• Before your chemotherapy appointment, eat a small, light meal. Most women do better if they have something in their stomach.

• Eat what sounds good to you. Generally starches such as rice, bread, potatoes, hot cereals and puddings are well tolerated.

• Try not to skip meals. An empty stomach will worsen all symptoms. If you don't feel like sitting down to a meal, try nibbling on something that appeals to you.

• Drink plenty of fluids. Herbal teas, water, "sports drinks" and diluted juices are recommended more than soda.

• Avoid smells that are unappealing.

• Freeze meals so that you don't have to cook. Ask your family and friends to help with meals, especially following chemotherapy when you are most likely to feel nauseous.

Fatigue
Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy. Most people have to make some adjustment in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. Remember that the fatigue will go away after you recover from chemotherapy.

Practical Hints for Fatigue

• Plan your activities, such as grocery shopping, for a time when you feel the best.

• If you have children, rest when they are napping. When you feel most tired, consider hiring a baby-sitter for a few hours so that you can relax or take a nap.

• Take naps early in the day so you do not disturb your sleep pattern at night.

• Try to exercise, such as walking or swimming, every day or regularly.

Hair Loss
Many women feel that hair loss can be the most difficult aspect of chemotherapy treatment. Losing your hair can be a personal and difficult experience. Not all chemotherapy drugs cause the same amount of hair loss, so talk to your physician or nurse about what to expect. Most often, hair loss begins about two-to-three weeks after starting chemotherapy. You can lose the hair on your head, eyelashes and eyebrows, as well as other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you feel most comfortable. Many women choose different head coverings for different situations. We have many resources to assist you during this time, including the Friend to Friend Gift Shop and the Look Good, Feel Good Program, so please talk with your caregivers or visit the Resource Center on the first floor of 2356 Sutter Street.

If you decide to buy a wig, it is helpful to buy one while you still have your own hair, because you can better match color and style. Your physician can write a prescription for a "cranial prosthesis." Some insurance companies will only pay for a "cranial prosthesis."

Your hair will begin to grow back after you stop chemotherapy. It usually takes from two-to-three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often the new hair will be baby soft and curly.

Practical Hints for Hair Loss

• It is not always necessary to buy a real wig. Synthetic wigs can look as good and are less expensive, easier to care for, lighter in weight and may be more comfortable to wear.

• Before you start to lose your hair, cut it short. The hair loss won't be quite so shocking if there is less hair to lose. Put a towel over your pillow so that clean up in the morning will be easier while you are shedding your hair. Buy a drain catch for your shower. Some people choose to shave their head hair when hair loss begins.

• Refer to our wig information sheet for places to shop near you.

• Refer to the Friend to Friend Gift Shop, the Resource Center, or your local American Cancer Society for more information.

• When buying a wig, take a friend for emotional support and maybe even a laugh!

Appetite and Taste Changes
During chemotherapy you may experience taste and appetite changes and a heightened sensitivity to odors. Do not worry if you don't have an appetite the first few days or a week following chemotherapy; it is not unusual, and as you feel better your appetite will improve. Reflux, burping, or a burning sensation may worsen nausea; please report this symptom to your physician or nurse so that it can be treated. You may find that you can tolerate only certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids (8-10 eight-ounce glasses per day; more if you have a fever or diarrhea). Recommendations for healthy nutrition include a diet low in fat (<20%) and high in whole grains, fruits and vegetables, and plant based proteins. Some women want to begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed. Some women prefer small, slow changes, while others benefit from a "major overhaul." Whichever way is the best for you, we encourage you to learn about and make healthy dietary and lifestyle changes.

Many women gain weight while on chemotherapy for reasons that are not well understood. Again, if you have concerns about nutrition, please consult our staff nutritionist.

Practical Hints for Taste and Appetite Changes

• Eat what appeals to you during this time.

• Eat foods that are warm rather than hot.

• Avoid places where food is being cooked (for example, the kitchen at dinner time).

• Avoid smells that are unappealing.

• To try drink 8-10 glasses of fluid a day.

Diarrhea or Constipation
Some chemotherapy drugs can cause diarrhea. If you have more than five watery stools in 24 hours, or blood in your stool, call your care provider. Do NOT use over the counter anti-diarrhea medications like Immodium® unless advised to do so by your physician or nurse.

Some of the drugs we give to prevent nausea can cause constipation. Also, you may be more prone to constipation because your activity level and diet have changed. Please tell your practitioner if you go more than 3 days without having a bowel movement.

Practical Hints for Constipation

• To help prevent constipation try drinking 8 to 10 glasses of fluid a day.

• Take a stool softener (not a laxative) such as ducosate sodium (DSS), also known as Colace®, one tablet once or twice a day. Senekot® or Senekot-S® may also be suggested. Ask your practitioner for a recommendation.

• Stay as active as you can; consistent regular exercise can reduce constipation.

Practical Hints for Diarrhea

• To replenish lost fluids, drink 8-10 eight-ounce glasses of decaffeinated fluids per day.

• If your rectum is sore, use soft toilet paper and A&D® ointment (used for diaper rash in infants) or Anusol® which can help numb the rectum and soothe soreness.

• If you can tolerate them, try high fiber foods: prunes, bran, fruits and vegetables.

Mouth Sores
Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. In most breast cancer regimens, mouth sores are less common. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed for your use.

Practical Hints for Mouth Sores

• Brush your teeth with a soft toothbrush 3 times daily.

• Rinse your mouth with a solution of 1 teaspoon baking soda and 1 teaspoon of salt diluted in a glass of luke warm water 3 to 4 times daily.

• Biotene® is a commercial mouthwash that also can be used 3 to 4 times daily.

• Ulcer-ease® is a commercial product that may provide temporary relief from sores.

Menopause
Chemotherapy may cause temporary stopping of your periods or permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause. With menopause you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. Please feel comfortable to talk to us about any symptoms or concerns; we can provide information and possible treatment for some of the symptoms mentioned.

If your periods continue during treatment they will likely change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may eventually lead to menopause.

Practical Hints for Menopausal Symptoms

• Because you have had breast cancer we DO NOT recommend taking hormone replacement therapy.

• Eat soy products or take vitamin E (400 IU only) to reduce hot flashes.

• There are prescription medications that your practitioner may recommend for hot flashes, for example Effexor®.

• Wear light cotton pajamas to help prevent overheating when sleeping.

• Try vaginal moisturizers such as Replens® on a regular basis or other water based lubricants, like Astroglide®, as needed especially and before sexual activity. These products will help with vaginal dryness and irritation.

• Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.

• There are prescription medications, for example Estring®, that give a local dose of estrogen to the tissues in the vagina to treat vaginal dryness.

Sexuality The effects of surgery and chemotherapy on sexuality are different for each woman. Changes in how you feel sexually are very common. Please share any feelings, questions or concerns you have with your practitioner. Whether your periods continue or stop during chemotherapy, you should always use contraception or birth control measures to prevent pregnancy until it has been confirmed by blood test that you are truly in menopause. We do not recommend the birth control pill because it contains estrogen. We recommend the use of condoms, a diaphragm or other barrier methods.

Practical Hints Regarding Sexuality

• Try vaginal moisturizers such as Replens® on a regular basis, Astroglide® or other water based lubricants before sexual activity to help with vaginal dryness and irritation.

• To prevent rectal tears and infection, avoid rectal intercourse, suppositories, and enemas.

• For support, talk to your partner about changes in sexual interest and response. Discuss changes with a support group, therapist, friend or family.

• Discuss concerns about sexuality with your physician or nurse.

• Read the Breast Care Center handout and other written materials on sexuality and breast cancer.

Fever and Infection
Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are made in the bone marrow and help fight against infection. Neutrophils are one type of the WBCs that fight infection. Often the neutrophil count will determine whether or not you will receive chemotherapy on schedule. A fever of 101º F (38.3º C), or chills with or without a fever, can be a serious sign of infection. You must call your oncologist should this occur even at night or on the weekend.

An infection is most likely to occur when your WBCs or neutrophil count is low. You are most susceptible to a bacterial infection about 7-12 days after your chemotherapy infusion. Most bacterial infections occur as a result of your body's inability to fight off normal bacteria present in your gastro-intestinal tract or skin. Bacterial infections do not commonly occur as a result of being in a crowed place. So, if you are feeling well, we encourage you to continue to go out to the movies or out for a meal. However, viral infections are common and are transmitted easily. Wash your hands frequently and avoid close contact with anyone who is ill during this time.

Practical Hints Regarding Fever & Infection

• If you have a fever of 101º F (38.3º C), with or without chills, call your care provider immediately. If you cannot reach your oncologist, go to an emergency room.

• Keep a thermometer in your home and know how to take your temperature.

• If you are unsure how to take your temperature, ask your care provider.

• Do not eat, drink or smoke for 10 minutes before taking your temperature.

• Leave the thermometer under your tongue for three minutes.

• Call your care provider as soon as possible if you develop a cough, sore throat, pain or burning when you urinate.

• To help prevent infection, we encourage good hand washing.

• Avoid rectal intercourse, tampons, douches, enemas, and rectal thermometers.

• Do not eat raw food such as sushi & sashimi, caesar salad or milk shakes made with raw eggs until you complete chemotherapy and your blood counts have returned to adequate levels. Raw foods may carry bacteria that can lead to infection.

• Wash hands and cutting boards well after food preparation.

• Always tell your doctor before going to the dentist.

Questions and Concerns
The Breast Care Center Oncology Practice is open from 8:30 AM to 5:00 PM, Monday through Friday. If you have a question or concerns, the staff will take your message and your nurse or physician will call you back. Please allow two days notice for medication refill. If your call is urgent, please tell us immediately when you call.

If you are calling at night, on a weekend or a holiday, please call the same clinic number. You will speak with the answering service which will take your name and number, and then a physician will call you back. Please be prepared to tell the answering service:

1. Your name and doctor

2. Your type of cancer

3. The type of chemotherapy and the date when you last received treatment

4. The names of any other medications that you are taking

5. The phone number of your pharmacy