Patient information - Non-Hodgkin lymphoma (NHL) - R-CHOP21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone)

• This treatment can cause serious injury if it leaks from the area where it is going into the vein. 
• This can cause pain, stinging, swelling or redness at or near the site where the drug enters the vein. 
• If not treated correctly, you may get blistering and ulceration. 
• Tell your doctor or nurse immediately if you get any of the symptoms listed above during or after treatment.

• You may get redness and itching along the vein where your chemotherapy is being infused.
• This will usually go away within 30 minutes of stopping the injection.
• Tell your doctor or nurse as soon as possible if you get any of the symptoms listed above. Your nurse will check to make sure the drug has not leaked out of the vein. 

• You may get: 
  • a fever
  • chills or sweats 
  • muscle and joint pain 
  • a cough
  • headaches.
• Tell your doctor or nurse if you get any of the symptoms listed above. 
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have a temperature of 38°C or higher.

• Allergic reactions are uncommon but can be life threatening.
• If you feel unwell during the infusion or shortly after it, or:
  • get a fever, shivers or shakes
  • feel dizzy, faint, confused or anxious
  • start wheezing or have difficulty breathing
  • have a rash, itch or redness of the face

While you are in hospital: Tell your doctor or nurse immediately.

After you leave: Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department.

• You may feel sick (nausea) or be sick (vomit).
• Take your anti-sickness medication as directed even if you don’t feel sick.
• Drink plenty of fluids (unless you are fluid restricted).
• Eat small meals more frequently.
• Try food that does not require much preparation.
• Try bland foods like dry biscuits or toast.
• Gentle exercise may help with nausea.
• Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment. 
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.

• Your urine will turn an orange or red colour.
• This is not harmful and should only last for up to 48 hours after treatment.

• You may find that food loses its taste or tastes different.
• These changes are likely to go away with time.
• Do your mouth care regularly.
• Chew on sugar-free gum or eat sugar-free mints.
• Add flavour to your food with sauces and herbs.
• Ask your doctor or nurse for eviQ patient information - Taste and smell changes during cancer treatment.

• 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.

• 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.

• You may have bowel motions (stools, poo) that are less frequent, harder, smaller, painful or difficult to pass.
• You may also get:
  • bloating, cramping or pain
  • a loss of appetite 
  •  nausea or vomiting.
• Drink plenty of fluids (unless you are fluid restricted).
• Eat plenty of fibre-containing foods such as fruit, vegetables and bran.
• Take laxatives as directed by your doctor.
• Try some gentle exercise daily.
• Tell your doctor or nurse if you have not opened your bowels for more than 3 days.

• 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.

• You may get: 
  • blood in your urine, sometimes with blood clots
  • pain or burning when you urinate
  • the urge to urinate more than normal
  •  stomach or pelvic pain or discomfort.
• When you go home, make sure you drink plenty of fluids (unless you are fluid restricted).
• Empty your bladder often.
• Tell your doctor or nurse as soon as possible if you notice any blood in your urine.

• 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.

• 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.

• 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.

• You may feel dizzy, light-headed, tired and appear more pale than usual.
• Tell your doctor or nurse if you have any of these signs or symptoms. You might need a blood transfusion.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.

• Your hair may start to fall out from your head and body.
• Hair loss usually starts 2 to 3 weeks after your first treatment.
• You may become completely bald and your scalp might feel tender.
• Use a gentle shampoo and a soft brush.
• Take care with hair products like hairspray, hair dye, bleaches and perms.
• Protect your scalp from the cold with a hat, scarf or wig.
• Protect your scalp from the sun with a hat or sunscreen of SPF 50 or higher.
• Moisturise your scalp to prevent itching.
• Ask your doctor or nurse about the Look Good Feel Better program 

• This treatment can affect your central nervous system. This can be very serious.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following symptoms:
  • trouble with your speech or vision
  • confusion or memory loss
  • changes in your personality 
  • weakness in your arms and legs
  • poor balance or coordination
  •  fits (seizures).

• You may get:
  • chest pain or tightness
  • shortness of breath 
  • swelling of your ankles 
  •  an abnormal heartbeat.
• Heart problems can occur months to years after treatment.
• Tell your doctor if you have a history of heart problems or high blood pressure.
• Before or during treatment, you may be asked to have a test to see how well your heart is working.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.

• 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.