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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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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Nose bleeds
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- If your nose starts to bleed gently apply pressure on the soft part of nostrils below the bridge of the nose for at least 10 minutes.
- It may help to put a cold pack over your forehead or the bridge of the nose.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if your nose will not stop bleeding.
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Appetite loss (anorexia)
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- You may not feel like eating.
- Try to avoid drinking fluids at meal times.
- Try to eat small meals or snacks regularly throughout the day.
- Try to eat food that is high in protein and calories.
- If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.
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High blood pressure (hypertension)
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- You may not have any signs or symptoms if you have high blood pressure.
- If it is severe you may get headaches, shortness of breath or feel dizzy.
- Your blood pressure will be taken regularly during your treatment.
- 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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Heart problems
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- 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.
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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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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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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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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 problems during cancer treatment.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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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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Bleeding into stomach or bowel
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- This side effect is rare, but can be very serious.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of these signs or symptoms:
- severe stomach pain
- swollen and hot skin around your stomach
- bleeding
- nausea or vomiting
- fever or chills
- a fast heartbeat
- you feel short of breath.
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Joint and muscle pain and stiffness
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- You may get muscle, joint or general body pain and stiffness.
- Applying a heat pack to affected areas may help.
- Talk to your doctor or nurse about other ways to manage these symptoms. You may need medication to help with any pain.
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Kidney changes or damage
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- This treatment may cause changes to how your kidneys work. This may cause protein in your urine.
- This is not something that you will notice.
- You will have blood and urine tests to check that your kidneys are working properly.
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Bleeding (haemorrhage)
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- Tell your doctor or nurse if you have a wound that does not heal.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
- unusual bleeding or bruising
- bright red or black, tarry bowel motions (stools, poo)
- stomach pain
- slurred speech
- shortness of breath
- a fast heartbeat.
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Hand-foot syndrome (palmar-plantar erythrodysaesthesia)
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- The palms of your hands and soles of your feet may become:
- red and hot
- swollen
- painful and tender
- blistered.
- The skin in the area may also peel.
- Moisturise your hands and feet daily with sorbolene or aqueous cream.
- Keep your hands and feet clean and dry.
- Avoid hot water, instead use lukewarm water to bathe.
- Avoid direct sunlight.
- Avoid unnecessary walking, jogging or exercise.
- Wear cotton socks and avoid tight-fitting shoes.
- Tell your doctor or nurse as soon as possible if you notice any skin changes on your hands or feet.
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Hair and skin colour changes
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- You may notice changes to your hair and skin colour.
- This is not harmful and will go away after treatment.
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Changes in the way your brain works [reversible posterior leukoencephalopathy syndrome (RPLS)]
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- This treatment can have an effect on your brain, but this is rare.
- Tell your doctor or nurse immediately or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
- headaches or vision problems
- nausea and vomiting
- tiredness
- confusion
- fits (seizures)
- high blood pressure.
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