Chemo & You
Updated Jan 2013

An introductory class for patients beginning chemotherapy, and their caregivers. The nuts and bolts of treatment will be explained, as well as an opportunity for questions to be answered.

Class for:

> A better understanding of chemotherapy treatment

> Increased knowledge about side effects and how to manage them

> Decreased anxiety & fear due to having treatment uncertainties addressed

> A renewed sense of control, as education provides confidence

Teaching Team:

Pam Garza, FNP-C

Cindy Lufschanowski, RPh

Carla Portnoy, RPh

Lisa Sailer, FNP-C

Texas Oncology-South Austin
Main number: 512-447-2202
Pharmacy number: 512-416-5132

Table of Contents


> EAT breakfast on treatment days

> Please sign in at the front reception desk and wait in the lobby

> Due to limited space, only one family member/friend over 14 is allowed to be with a patient during treatment

> You may eat while receiving treatment. Please be aware that strong smelling foods might be difficult for other patients to tolerate. We have juice and crackers available for our patients.

> Please do not wear perfumes or colognes

> Please turn cell phones to vibrate

> Keep cell phone conversations BRIEF and QUIET please

> Wear comfortable clothing when you come for treatments. Button-up shirts are preferred. Dress warmly.

> Feel free to bring a blanket and/or pillow. You may bring your laptop as well.

> Before you leave, make sure you thoroughly understand the use of any prescription anti-nausea medication, steroid medication, pain medication etc., which you have been given by your doctor as part of your treatment plan.

> Please call your pharmacy for refills, even if the prescription says you have no refills left.


Contact the office at 512-447-2202 during the working hours of 8:30 to 5:00 OR any time AFTER hours if you have any of the following problems because they are serious:

> You develop a new, unreported temperature of 100.5° or greater, shaking chills and profuse sweating or significant confusion not previously observed.

> You have uncontrolled vomiting over several hours that has not responded to your prescribed anti-nausea medication.

> You have sudden onset of shortness of breath or difficulty breathing.

Contact the office nurse or talk with your physician during &'' office hours because these issues are less serious:

> You need a change in your pain or nausea medications

because they don't work for you or don't work as well as they used to.

> You have uncontrolled diarrhea (3 loose stools in 24 hours) 1 that has not responded to anti-diarrhea medications.

> You have any of the following symptoms: Gum or nose bleeding that won't stop after 20 minutes of applying pressure, blood in your urine, black or bloody bowel movements, small, red dots under the skin, or increased bruising.

> Additional symptoms to talk about include: Cough producing yellow or green sputum; frequency and/or burning with urination; redness, swelling or tenderness anywhere.


To reduce nausea, consider:

- Eating smaller and more frequent meals throughout the day

- Eating dry/bland foods like cereal, toast, or crackers before getting out of bed in the morning

- Eating foods cold or at room temperature, not hot or spicy

- Drinking liquids at least 1 hour before or after mealtime

- Drinking cool, clear liquids—including sodas, like Sprite® or ginger ale

- Sucking on ice cubes, mints, or tart candy

- Using deep breathing or relaxation exercises

- Using anti-nausea medications as prescribed Avoid or limit:

- Avoid sweet, spicy, or fried/fatty foods

- Limit caffeine or alcohol (you do not have to avoid caffeine completely unless it bothers your sleep)

- Limit odors that bother you, like smoke or perfume

- Avoid lying flat for at least 2 hours after a meal

- Avoid your favorite foods when you are sick so they are not triggers for future episodes of nausea or vomiting

Please call if nausea and vomiting are not controlled with the above measures—we are here to help.


Toast, crackers, and pretzels

Sherbet, angel food cake, flavored gelatin

Cream of wheat or oatmeal

Boiled potatoes, rice, or noodles

Clear liquids, ice chips

Carbonated, non-caffeinated sodas, apple/cranberry juice

Skinned chicken that is baked or broiled, not fried



- Eating small, frequent meals throughout the day

- Eating foods low in fiber

- Eating foods and drinking liquids that are high in potassium and sodium (see bottom of page)

- Drinking plenty of fluids to replace those that are lost

- The BRAT diet (Bananas, Rice, Applesauce and Toast) is helpful

- Keep Imodium AD® or generic (loperamide) on hand

- Take Imodium AD® at the first sign of diarrhea and follow the directions on the back of the box. If no help after 24 hours of Imodium AD®, call your nurse. Avoid or limit:

- Avoid high fiber foods such as broccoli, corn, cabbage, dried beans, unpeeled fruit

- Limit coffee, tea, alcohol, sweets, and artificially flavored chewing gum

- Avoid fried, greasy, or spicy foods

- Limit milk and milk products (except yogurt) which contain lactose and can make diarrhea worse

Please call if diarrhea is not controlled with above methods—we are here to help.


Rice, noodles, potatoes, white bread

Plain or vanilla yogurt, smooth peanut butter

Farina or cream of wheat

Eggs cooked solid; not fried

Skinned chicken or turkey, lean beef, or fish

High sodium foods: Soups, sports drinks, crackers/pretzels

High potassium foods: Bananas, potatoes without the skin, fruit

juices, and nectars


Drink plenty of fluids (especially water)

Try warm or hot fluids one-half hour before your usual time for a bowel movement (prune juice/coffee/water)

Increase fiber in diet (bran cereals and fresh fruits/veggies with the skin on), but don't forget the water!

"Exercise" (movement) daily (15 minute walk and increase as tolerated) - be sure to drink water, especially if outdoors!

A stool softener (docusate) daily works best for prevention of constipation, NOT treatment

Laxatives if needed for treatment (if dietary changes are not working!) such as Milk of Magnesia®, Peri-Colace® or Senokot-S®, Miralax®

Do not take laxative products more than 2 days in a row without letting your healthcare provider know


Wash all raw fruits and vegetables well. It is not necessary to use a "food soap" unless desired. Scrub rough surfaces, like the skins of melons, prior to cutting.

Carefully wash your hands and food preparation surfaces (knives, cutting boards) before and after preparing food, and especially after handling raw meat.

Be sure to cook meat and eggs thoroughly.

Thaw meat in the refrigerator, not on the kitchen counter unless you will get it into the refrigerator in a timely manner.

Avoid raw shellfish and seafood. Avoid sushi.

Do not change your pet's litter boxes if possible.

Use only pasteurized ciders/juices and milk/cheese.

When eating in restaurants, avoid foods that may have bacterial contamination such as salad bars, sushi, and raw or undercooked meat, fish, poultry and eggs.

Make smoothies and juices using well washed ingredients - keep any extra refrigerated and discard at the end of the day


Adjust food choices temporarily: sources of fiber may have to be reduced.

Keep meals smaller or have healthy snacks. Think high-calorie, high-protein such as eggs, milk, cheese, and peanut butter.

Eat sugary snacks in moderation. It is not necessary to eliminate sugar totally; however, some choices are better than others, such as frozen yogurt and angel food cake. Food choices should be easy to chew and swallow. It is not always necessary to be concerned with avoiding foods high in calories and/or fat.

Your physician feels it is best to avoid alcohol on the day of chemo, as well as the following day. Consider liquid nutritional products (e.g., Boost®, Ensure®, Resource®) to assist with the intake of calories and nutrients.


If alcohol is consumed: Limit to no more than 1 drink per day for women and 2 drinks per day for men.

Alcohol side effects are magnified if taking pain medications and some anti-nausea medications.

Please discuss this issue with your physician because there are many different thoughts on this topic.

You will most likely not want to consume any alcohol on the day you receive chemotherapy, or even on the next day or two.



Say "YES" to:

- One daily multi-vitamin if desired. There is no solid scientific evidence which states that multi-vitamins can lessen side effects or improve the outcome of chemo.

- Additional Calcium with Vitamin D (Do not take calcium alone without the D)

- Either carbonate or citrate is equally good. The carbonate may be less expensive, but the citrate may be more readily absorbed in the elderly and easier to tolerate in all patients.

- Aim for 1200mg of calcium a day for women over 50 and men over 65. Younger people should get at least SOOmg to 1000mg a day. It's best to get as much as you can from your diet.

- Unless you know from a blood test that your vitamin D level is adequate, take 800 to 1000IU of D daily, especially if you are over age 65, have dark skin, and/or get little sun exposure.

- Additional magnesium oxide: 250mg to SOOmg daily

• Inexpensive and helps offset the constipation that calcium can sometimes cause. Helps with the absorption of calcium.

- Omega 3/Fish Oil - This is for heart health. It does not interfere with chemotherapy.

Say "NO" to:

- Additional Vitamins C and/or E (over and above your multi-vitamin, but food sources are OK)

- Zinc, selenium, beta-carotene, resveratrol, and other antioxidants

- Garlic in supplement form (in food sources is OK), gingko, saw palmetto, feverfew, St. John's Wort, or any other supplements without your physician's knowledge

> We don't know how most herbals/supplements interact with chemotherapy drugs because such combinations have NOT been studied.


Plan your day to prioritize what is important

Get plenty of rest, take short naps and frequent breaks

Take short walks or do light exercise

Eat a well-balanced diet; limit caffeine and alcohol intake

Get help with activities

Get up slowly to prevent dizziness

Try activities such as meditation, prayer, yoga, guided imagery, visualization

• Fatigue doesn't go away overnight. It can increase over time.

• Remember: Caregivers need help too!

Say YES to people who offer you help: It truly helps other people to help YOU.


• What can happen:

- Numbness, tingling, and/or pain in hands and feet

- Loss of balance, difficulty walking, and clumsiness

- Difficulty picking up objects

- Difficulty buttoning and zipping

- Stomach pain/constipation

- Feeling colder than normal

What to do:

- Wear non-slip slippers or socks; wear thin gloves like glove liners with tips of fingers cut out

- Clear obstacles around the house (area rugs, especially)

- Be careful going up and down stairs

- Check the temperature of bath water with your elbow

- Be extra careful with knives, scissors, and other sharp objects so that you do not cut yourself



If possible, see a dentist before starting treatment (for cleaning and evaluation ONLY)!

Rinse mouth frequently to remove food and bacteria and promote healing

Use an extra soft toothbrush after each meal

Use a warm salt water rinse made of 1 tsp. baking soda and 1 tsp. salt in 1 quart warm water. Rinse and spit 3-5 times a day after meals and at bedtime.

Avoid commercial mouthwashes which contain alcohol

Biotene®oral care products are a good choice and also help with dry mouth

Eat foods cold or at room temperature or try ice cream or popsicles (unless you are on a chemo called oxaliplatin)

Choose soft (well-cooked), bland foods like pudding, gelatin, mashed potatoes, yogurt, and creamed soup

Avoid alcohol, tobacco, and carbonated beverages

Avoid irritating (spicy/acidic) foods or coarse/rough foods

Consult your oncologist about medications to apply to lesions and for pain relief. BE SURE TO COMMUNICATE to your physician about lesions and pain.

Use a straw for liquids and a small spoon, such as a baby spoon for eating. Consider plastic utensils, which will also help if you have a bad taste in your mouth from some of your medications.

REMEMBER: You are at greater risk for cavities.


Keep nails trimmed and clean

Do not use fake or acrylic nails

Tea tree oil has antiseptic properties and may be used twice a day to keep cuticles moist and clean

Apply Sally Hansen's Hard as Nails® clear nail polish


Take short, warm showers rather than long, hot baths

Apply creams and lotions while skin is still moist (like Lubriderm®, Eucerin®, Keri®, Aveeno®, Aquaphor®)

Some chemotherapy drugs cause individuals to be more sensitive to the sun—use a sun block with an SPF of at least 30

Notify your doctor or nurse of any new rash or unusual skin changes

Avoid alcohol-containing products such as perfumed cologne, after-shave, and highly-scented lotions

Use mild soaps such as Cetaphil® or Dove®


This is a loss of clarity, focus, and short-term memory. It can be very difficult to manage and it may progress over time.

Make lists - carry a pad with you and write everything down Leave a message on your answering machine to remind yourself of something crucial

Use a personal organizer

Work or read in an uncluttered, peaceful environment

Have conversations in quiet places to minimize distractions

Repeat information aloud after someone gives it to you

Train yourself to concentrate and focus; say aloud to yourself, "I'm putting my keys on the dresser"

Do crossword puzzles and word games

Take a family member or friend with you to all appointments so they can take notes and help you remember important questions/instructions.

Mv Lab and Test Results: Texas Oncology-South Austin

Throughout your treatment, your health care team may monitor your Complete Blood Count (CBC). The CBC measures white blood cells, neutrophils, hemoglobin, hematocrit, and platelet counts, among others. The following is a brief overview of the key CBC measurements and the normal* value for each: Absolute Neutrophil Count (ANC)

ANC measures the number of mature infection-fighting white blood cells.

• This number should be greater than 1 .5 in order for you to receive treatment. When this number drops, we refer to the patient as "neutropenic."

Hemoglobin (HGB)

• Hemoglobin measures the amount of blood that contains iron and carries oxygen. When this number drops, we refer to the patient as "anemic."

Normal lab values for females: 1 2-1 6 g/dL and males: 1 4-1 8 g/dL

• Please note: Sometimes, our cancer patients drop lower than the above values. This is due to the fact that you may actually begin chemotherapy with a slight bit of anemia. We are watching to make sure this number doesn't drop below 10 g/dL.

Hematocrit (HCT)

•  Hematocrit measures the blood that carries iron and oxygen. When this number drops, we refer to the patient as "anemic." « Normal value range for females: 37%-47% and males: 42%-52%

• Please note: Sometimes, our cancer patients drop lower than the above values. This is due to the fact that you may actually begin chemotherapy with a slight bit of anemia. We are watching to make sure this number doesn't drop below 30%.

Platelet Count (PLT)

•  Platelets are cells that help form clots and stop bleeding. « This number should be greater than 100 in order for you to receive treatment. When this number drops, we refer to the patient as "thrombocytopenic."

Miscellaneous Information:

This is not an all-inclusive list of laboratory tests that may be performed. While receiving care at Texas Oncology, we encourage you to ask the laboratory personnel, your nurse, or your physician questions about lab tests not listed here. At the end of each appointment with your physician or nurse practitioner, you will be given a Patient Summary. This summary will provide you with the most recent lab results that are available.

If you are scheduled to receive chemotherapy and you have a port (also known as a central line), your blood will be drawn from the port. If you are not scheduled to receive chemotherapy but have an appointment for blood to be drawn, it will be drawn peripherally (usually from your forearm). Consider asking your physician for a prescription of Emla R cream to numb your port site on the days that you receive chemotherapy.

* The normal value is determined by taking an average of results from 100+ random adult samples represented by our local geographic area.