Early (onset days to weeks)
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Infection risk (neutropenia)
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- This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening.
- Wash your hands often.
- Keep a thermometer at home and take your temperature regularly, and if you feel unwell.
- Do your mouth care regularly.
- Inspect your central line site (if you have one) daily for any redness, pus or swelling.
- Limit contact with people who are sick.
- Learn how to recognise the signs of infection.
- Ask your doctor or nurse for eviQ patient information - Infection during cancer treatment.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
- a temperature of 38°C or higher
- chills, shivers, sweats or shakes
- a sore throat or cough
- uncontrolled diarrhoea
- shortness of breath
- a fast heartbeat
- become unwell even without a temperature.
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Low platelets (thrombocytopenia)
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- This treatment lowers the amount of platelets in your blood. Platelets help your blood to clot. When they are low, you are at an increased risk of bleeding and bruising.
- Try not to bruise or cut yourself.
- Avoid contact sport or vigorous exercise.
- Clear your nose by blowing gently.
- Avoid constipation.
- Brush your teeth with a soft toothbrush.
- Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to.
- Tell your doctor or nurse if you have any bruising or bleeding.
- Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if you have any uncontrolled bleeding.
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Stomach pain
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- You may get:
- dull aches
- cramping or pain
- bloating or flatulence (gas).
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have stomach pain that you are unable to control.
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Diarrhoea
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- You may get bowel motions (stools, poo) that are more frequent or more liquid.
- You may also get bloating, cramping or pain.
- Take your antidiarrhoeal medication as directed by your doctor.
- Drink plenty of fluids (unless you are fluid restricted).
- Eat and drink small amounts more often.
- Avoid spicy foods, dairy products, high fibre foods, and coffee.
- Ask your doctor or nurse for eviQ patient information - Diarrhoea during cancer treatment.
- Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled, you have 4 or more loose bowel motions per day, and if you feel dizzy or light-headed.
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Tiredness and lack of energy (fatigue)
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- You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
- Do not drive or operate machinery if you are feeling tired.
- Nap for short periods (only 1 hour at a time)
- Prioritise your tasks to ensure the best use of your energy.
- Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
- Try some gentle exercise daily.
- Allow your friends and family to help.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Extra fluid in the body (fluid retention)
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- You may gain weight over a short amount of time.
- Your hands and feet may become swollen, appear red or feel hot and uncomfortable.
- Wear loose clothing and shoes that are not too tight.
- Try not to stand up or walk around too much at one time.
- If your ankles or legs get swollen, try raising them.
- Make sure that any cuts or areas of broken skin are treated as soon as possible.
- Tell your doctor or nurse as soon as possible if you get any of the symptoms listed above or gain 1 to 2 kg in a week.
- Tell your doctor or nurse immediately or go to the nearest hospital Emergency Department if you become short of breath.
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Liver problems
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- You may get:
- yellowing of your skin or eyes
- itchy skin
- pain or tenderness in your stomach
- nausea and vomiting
- loss of appetite
- You will have regular blood tests to check how well your liver is working.
- Tell your doctor or nurse as soon as possible if you notice that your urine is a dark colour, the whites of your eyes look yellow, or if you have stomach pain.
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High blood bilirubin levels (hyperbilirubinaemia)
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- You may get:
- yellowing of your skin or eyes
- itchy skin
- pain or tenderness in your stomach
- nausea and vomiting
- loss of appetite.
- You will have regular blood tests to check how well your liver is working.
- Tell your doctor or nurse as soon as possible if you notice that your urine is a dark colour, the whites of your eyes look yellow, or if you have stomach pain.
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High blood sugar level (hyperglycaemia)
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- You may feel thirsty and need to urinate more often than normal.
- You may get repeated infections, especially thrush.
- If you are a diabetic you will need to have your blood sugar levels checked more often. You may also need to have your diabetes medication increased.
- Tell your doctor or nurse if you get any of the signs or symptoms listed above.
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High blood cholesterol levels
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- This treatment may increase your blood cholesterol levels. This is not a side effect you will notice.
- Your cholesterol levels will be checked during your treatment.
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Low blood magnesium, potassium and calcium levels (hypomagnesaemia, hypokalaemia, hypocalcaemia)
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- This may be found from your routine blood tests and treated by your doctor.
- If it is severe you may get:
- muscle cramps or twitches
- numbness or tingling in your fingers, toes or around your mouth
- constipation
- an irregular heartbeat
- sleepy, drowsy or confused
- Tell your doctor or nurse as soon as possible if you get any of the signs or symptoms listed above.
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Kidney damage
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- This treatment can cause changes to how your kidneys work.
- You will have blood tests to make sure your kidneys are working properly.
- You may need to drink more fluids while you are having treatment. Your doctor or nurse will tell you if you need to do this.
- Tell your doctor or nurse as soon as possible if you notice that your urine changes colour or you don't need to empty your bladder as often.
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Mouth pain and soreness (mucositis)
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- You may have:
- bleeding gums
- mouth ulcers
- a white coating on your tongue
- pain in the mouth or throat
- difficulty eating or swallowing.
- Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks.
- Try bland and soft foods.
- Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so.
- Rinse your mouth after you eat and brush your teeth, using either:
- 1/4 teaspoon of salt in 1 cup of warm water, or
- 1/4 teaspoon of bicarbonate of soda in 1 cup of warm water
- Ask your doctor or nurse for eviQ patient information - Mouth and throat problems during cancer treatment.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Hearing changes (ototoxicity)
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- You may get ringing in your ears or loss of hearing.
- You may have your hearing tested before and during your treatment.
- Tell your doctor or nurse as soon as possible if you notice any changes to your hearing.
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Inflamed pancreas (pancreatitis)
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- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get:
- abdominal (stomach) pain
- a swollen stomach
- nausea or vomiting
- fever or chills
- a fast heartbeat.
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Nerve damage (peripheral neuropathy)
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- You may notice a change in the sensations in your hands and feet, including:
- tingling or pins and needles
- numbness or loss of feeling
- pain.
- You may find it difficult to do everyday activities, such as doing up buttons or picking up small objects.
- Test water temperature with your elbow when bathing to avoid burns.
- Use rubber gloves, pot holders and oven mitts in the kitchen.
- Wear rubber shoes or boots when working in the garden or garage.
- Keep rooms well lit and uncluttered.
- Ask your doctor or nurse for eviQ patient information – Nerve problems during cancer treatment.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Lung problems
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- Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment.
- You may get:
- shortness of breath
- fever
- dry cough
- wheezing
- fast heartbeat
- chest pain.
- Your doctor will monitor how well your lungs are working during your treatment.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.
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Severe skin reaction
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- One of the drugs you are receiving may cause severe skin reactions.
- This can start as a mild skin rash and develop into more serious and concerning skin problems.
- Before the rash appears, you may feel generally unwell and may experience some of the following symptoms:
- a fever
- aches
- fatigue
- cough
- blocked or runny nose
- sore throat
- sore eyes.
- The skin rash may be painful and itchy and sometimes small blisters can form.
- You may also notice mouth ulcers, pain in the mouth or throat, or difficulty eating or swallowing.
- Tell your doctor or nurse immediately or go to the nearest hospital Emergency Department if you get any of the above symptoms.
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Side effects from steroid medication
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- Steroid medication may cause:
- mood swings and behaviour changes
- an increased appetite
- weight gain
- swelling in your hands and feet
- stomach upsets
- trouble sleeping
- fragile skin and bruising
- an increase in your blood sugar level
- weak and brittle bones (osteoporosis)
- Take your steroid medication with food to reduce stomach upset
- You may need to monitor your blood sugar levels closely while you are taking steroids
- If you have diabetes, your blood sugar levels may be tested more often and your diabetic medication may need to be adjusted because of the effects of steroids. Talk to your diabetes advisor if you have any concerns
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Liver changes
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- You may get:
- shortness of breath
- bloating or feeling full
- pain in the upper left side of your stomach (abdomen)
- weight gain
- a bigger stomach
- puffy hands and feet.
- Your doctor or nurse will regularly weigh you and measure around your stomach.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the signs or symptoms listed above.
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Skin rash
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- You may get a red, bumpy rash and dry, itchy skin.
- Moisturise your skin with a gentle non-perfumed moisturising cream like sorbolene or aqueous cream.
- Do not scratch your skin.
- Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and sunscreen of SPF 50 or higher.
- Talk to your doctor or nurse about other ways to manage your skin rash.
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Blood clots (thromboembolism)
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- Blood clots can occur with this treatment.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
- redness, heat or pain in your leg(s)
- numbness or weakness in your face, arm or leg
- chest pain
- sudden shortness of breath
- dizziness
- trouble speaking
- blurred vision
- severe headache
- unexplained falls or loss of balance.
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