Patient information - Testicular cancer metastatic - BEP (bleomycin, etoposide, cisplatin)

• 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.

• 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.

• You may get: 
  • a fever
  • chills or sweats 
  • muscle and joint pain 
  • a cough
  • headaches.
• The drug bleomycin can cause a fever or flu-like illness within the first day of having the treatment.
• You can take paracetamol to help settle these symptoms.  
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if the symptoms do not settle or you become unwell. 

• You may have discomfort or a dull ache in your pelvis, back, arms or legs.
• To reduce the pain, take paracetamol before each injection.
• Tell your doctor or nurse as soon as possible if your pain is not controlled.

• 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:
  • 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 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.

• 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.

• 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 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.

• 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.

• 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.

• 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.

• 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.

• 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 

• Heart problems can occur months to years after treatment.
• Tell your doctor if you have a history of heart problems.
• During and / or after treatment, you may be asked to have tests to monitor your heart health.
• Exercise, diet and regular check ups play an important role in maintaining heart health.

• You may have darkening of your skin, especially in areas that are exposed to the sun.
• You may also notice darkening of your tongue, gums and over your finger joints.
• These skin changes may fade over time.
• Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and a sunscreen of SPF 50 or higher.

• 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 you doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.
• Ask your doctor or nurse for eviQ patient information about lung damage from bleomycin treatment. 

• Your nails may:
  • grow more slowly
  • become darker
  • develop ridges or white lines
  •  become brittle and flaky
• In some cases, you may lose your nails completely.
• Keep your nails clean and short.
• Avoid things like biting your fingernails, getting a manicure, pedicure or false nails.
• Wear gloves when you wash the dishes, work in the garden, or clean the house.