Iowa Health Book: Cancer Center

Chemotherapy and You: A Guide to Self-Help During Treatment

National Cancer Institute
Externally reviewed by the National Cancer Institute

This booklet was written and published by the National Cancer Institute (NCI), 9000 Rockville Pike, Bethesda, MD 20892.

The NCI is the U.S. Government's main agency for cancer research and information about cancer. The NCI's publications are free. They may be copied or reproduced without written permission.

Contents

• Acknowledgments
• About this Booklet
• Understanding Chemotherapy
• Coping With Side Effects
• Eating Well During Chemotherapy
• Talking With Your Doctor and Nurse
• Chemotherapy and Your Emotions
• Paying for Chemotherapy
• A Final Word
• Resources
• Glossary

Acknowledgments
The National Cancer Institute is grateful to the numerous health professionals and patients who contributed to the development and review of this publication.

About This Booklet
This booklet will help you, your family, and your friends understand chemotherapy, the use of drugs to treat cancer. It will answer many of the questions you may have about this method of cancer treatment. It also will show you how you can help yourself during chemotherapy.

Taking care of yourself during chemotherapy is important for several reasons. For one thing, it can lessen some of the physical side effects you may have from your treatment. As you will see, some simple tips can make a big difference in how you feel. But the benefits of self-help aren't just physical; they're psychological, too. Knowing some ways to take care of yourself can give your emotions a boost at a time when you may be feeling that much of what's happening to you is out of your control. This feeling can be easier to deal with when you discover how you can contribute to your own well-being, in partnership with your doctors and nurses.

Chemotherapy and You will help you become an informed partner in your care. Remember, though, it is only a guide. Self-help is never a substitute for professional medical care. Be sure to ask your doctor and nurse any questions you may have about chemotherapy, and tell them about any side effects you may have.

You will find several helpful sections at the back of this booklet. The section on "Paying for Chemotherapy" gives you information about insurance and other payment methods. The section called "Resources" tells you how to get more information about Cancer and how to find many services available to cancer patients and their families. The "Glossary" explains many terms related to cancer and chemotherapy. Words printed in bold are defined in the Glossary.

This edition of Chemotherapy and You does not include the tear-out cards for drug information that were in previous versions. A free series of fact sheets on anticancer drugs is available from the National Cancer Institute. (See "Resources.")

Understanding Chemotherapy

What is Chemotherapy?
Chemotherapy is the use of drugs to treat cancer. The drugs often are called anticancer drugs.

How Does Chemotherapy Work?
Normal cells grow and die in a controlled way. But cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying at one or more points in their life cycle. Because some drugs work better together than alone, chemotherapy often may consist of more than one drug. This is called combination chemotherapy.

In addition to chemotherapy other methods sometimes are used to treat cancer. For example, your doctor may recommend that you have surgery to remove a tumor or to relieve certain symptoms that may be caused by your cancer. You also may receive radiation therapy to treat your cancer or its symptoms. Sometimes, as described below, your doctor may suggest a combination of chemotherapy, surgery, and/or radiation therapy.

Other types of drugs may be used to treat your cancer. These may include certain drugs that can block the effect of hormones. Doctors also may use biological therapy to boost the body's natural defenses against cancer.

Depending on the type of cancer and its stage of development, chemotherapy can be used:

• To cure cancer.
• To keep the cancer from spreading.
• To slow the cancer's growth.
• To kill cancer cells that may have spread to other parts of the body from the original tumor.
• To relieve symptoms that may be caused by the cancer.

Chemotherapy also can help people live more comfortably; this is known as palliative care.

Will Chemotherapy Be My Only Treatment for Cancer?
Sometimes chemotherapy is the only therapy a patient receives. More often, however, chemotherapy is used in addition to surgery and/or radiation therapy; when it is used for this purpose it is called adjuvant therapy. There are several reasons why chemotherapy may be given in addition to other treatment methods. For instance, chemotherapy may be used to shrink a tumor before surgery or radiation therapy. It also may be used after surgery and/or radiation therapy to help destroy any cancer cells that may remain.

Which Drugs Will I Get?
Your doctor decides which drug or drugs will work best for you. The decision depends on what kind of cancer you have, where it is, the extent of its growth, how it is affecting your normal body functions, and your general health.

Your doctor also may suggest that you join a clinical trial for chemotherapy, or you may want to bring up this option with your doctor. Clinical trials are carefully designed research studies that test promising new cancer treatments. Patients who take part in research may be the first to benefit from improved treatment methods. These patients also can make an important contribution to medical care because the results of the studies may help many people. Patients participate in clinical trials only if they choose to and are free to withdraw at any time.

To learn more about clinical trials, call the National Cancer Institute's Cancer Information Service and ask for the booklet What Are Clinical Trials All About? You also may want to ask about the videotape "Patient to Patient: Cancer Clinical Trials and You." This videotape can put to rest fears you may have about taking part in clinical trials. The Cancer Information Service can be reached by dialing 1-800-4-CANCER (1-800-422-6237).

Where Will I Get Chemotherapy
You may get your chemotherapy at home, in your doctor's office, in a clinic, in your hospital's outpatient department, or in a hospital. The choice of where you get chemotherapy depends on which drug or drugs you are getting, your hospital's policies, and your doctor's preferences. When you first start chemotherapy, you may need to stay at the hospital for a short time so that your doctor can watch the medicine's effects closely and make any adjustments that are needed.

How Often Will I Get Chemotherapy, and How Long Will I Get It?
How often and for how long you get chemotherapy depends on the kind of cancer you have, the goals of the treatment, the drugs that are used, and how your body responds to them. You may get chemotherapy every day, every week, or every month. Chemotherapy is often given in on-and-off cycles that include rest periods so that your body has a chance to build healthy new cells and regain its strength. Your doctor should be able to estimate how long you will be getting chemotherapy.

Whatever schedule your doctor prescribes, it is very important to stay with it. Otherwise, the anticancer drugs might not have their desired effect. If you miss a treatment session or skip a dose of medication, contact your doctor for instructions about what to do.

Sometimes, your doctor may delay a treatment based on the results of certain blood tests. Your doctor will let you know what to do during this time and when it's okay to start your treatment sessions again.

Depending on the type of cancer you have and the drug or drugs you are getting, your chemotherapy may be given in one or more of the following ways:

• Into a vein (intravenously, or IV). You will get the drug through a thin needle inserted into a vein, usually on your hand or lower arm. Another way to get IV chemotherapy is by means of a catheter, a thin tube that is placed into a large vein in your body and remains there as long as it is needed. This type of catheter is known as a central venous catheter. Sometimes, a central venous catheter is attached to a port, a small plastic or metal container placed surgically under the skin.
• By mouth (orally, or PO) in pill, capsule, or liquid form. You will swallow the drug, just as you do many other medications.
• Into a muscle (intramuscularly, or IM), under the skin (subcutaneously, or SQ or SC), or directly into a cancerous area in the skin (intralesionally, or IL). You will get an injection with a needle.
• Topically. The medication will be applied onto the skin.

Chemotherapy also may be delivered to specific areas of the body using a catheter (or a catheter plus a port). Catheters may be placed directly into the spinal fluid, abdominal cavity, bladder, or liver. Your doctor or nurse may use specific terms when talking about certain types of catheters. For example, an intrathecal (IT) catheter is used to deliver drugs into the spinal fluid. Intracavitary (IC) catheters can be placed in the abdomen, pelvis, or chest.

Two kinds of pumps - external and internal - may be used to control the rate of delivery of chemotherapy. External pumps remain outside of the body. Some are portable and allow a person to move around while the pump is in use. Other external pumps are not portable and may restrict activity. Internal pumps are placed surgically inside the body, usually right under the skin. They contain a small reservoir (storage area) that delivers the drugs into the catheter. Internal pumps allow people to go about most of their daily activities.

Does Chemotherapy Hurt?
Getting chemotherapy by mouth on the skin, or by injection generally feels the same as taking other medications by these methods. Having an IV started usually feels like having blood drawn for a blood test. Some people feel a coolness or other unusual sensation in the area of the injection when the IV is started. Report these feelings to your doctor or nurse. Be sure that you also report any pain, burning, or discomfort that occurs during or after an IV treatment.

Many people have little or no trouble having the IV needle in their hand or lower arm. However, if a person has a hard time for any reason, or if it becomes difficult to insert the needle into a vein for each treatment, it may be possible to use a central venous catheter or port. This avoids repeated insertion of the needle into the vein.

Central venous catheters and ports cause no pain or discomfort if they are properly placed and cared for, although a person usually is aware that they are there. It is important to report any pain or discomfort with a catheter or port to your doctor or nurse.

Can I Take Other Medicines While I Am Getting Chemotherapy?
Some medicines may interact with the effects of your chemotherapy. That is why you should take a list of all your medications to your doctor before you start chemotherapy. Your list should include the name of each drug, how often you take it, the reason you take it, and the dosage. Remember to include over-the-counter drugs such as laxatives, cold pills, pain relievers, and vitamins. Your doctor will tell you if you should stop taking any of these medications before you start chemotherapy. After your treatments begin, be sure to check with your doctor before taking any new medicines or stopping the ones you already are taking.

Most people are able to continue working while they are being treated with anticancer drugs. It may be possible to schedule your treatments late in the day or right before the weekend, so they interfere with work as little as possible.

If your chemotherapy makes you very tired, you might want to think about adjusting your work schedule for a while. Speak with your employer about your needs and wishes at this time. You may be able to agree on a part-time schedule, or perhaps you can do some of your work at home.

Will I Be Able to Work During Chemotherapy?
Under Federal and state laws, some employers may be required to allow you to work a flexible schedule to meet your treatment needs. To find out about your on-the-job protections, check with your local American Cancer Society, a social worker, or your congressional or state representative. The National Cancer Institute's publication Facing Forward: A Guide for Cancer Survivors also has information on work-related concerns.

How Will I Know If My Chemotherapy Is Working?
Your doctor and nurse will use several methods to measure how well your treatments are working. You will have frequent physical exams, blood tests, scans, and x-rays. Don't hesitate to ask the doctor about the test results and what they show about your progress.

While tests and exams can tell a lot about how chemotherapy is working, side effects tell very little. (Side effects - such as nausea or hair loss - occur because chemotherapy harms some normal cells as well as cancer cells.) Sometimes people think that if they don't have side effects, the drugs aren't working, or that, if they do have side effects, the drugs are working well. But side effects vary so much from person to person, and from drug to drug, that having them or not having them usually isn't a sign of whether the treatment is effective.

If you do have side effects, there is a lot you can do to help relieve them. The next section of this booklet describes some of the most common side effects of chemotherapy and gives you some hints for coping with them.

Coping With Side Effects
If you have questions about side effects, you are not alone. Before chemotherapy starts, most people are concerned about whether they will have side effects and, if so, what they will be like. Once treatments begin, people who have side effects want to know the best ways to cope with them. This section will answer some of your questions.

If you are reading this section before you start chemotherapy you may feel overwhelmed by the wide range of side effects it describes. But remember: Every person doesn't get every side effect, and some people get few, if any. In addition, the severity of side effects varies greatly from person to person. Whether you have a particular side effect, and how severe it will be, depends on the kind of chemotherapy you get and how your body reacts. Be sure to talk to your doctor and nurse about which side effects are most likely to occur with your chemotherapy, how long they might last, how serious they might be, and when you should seek medical attention for them.

What Causes Side Effects?
Because cancer cells grow and divide rapidly, anticancer drugs are made to kill fast-growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. When it does, side effects may result. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract, reproductive system, and hair follicles. Anticancer drugs also can damage cells of the heart, kidney, bladder, lungs, and nervous system. The most common side effects of chemotherapy include nausea and vomiting, hair loss, and fatigue.

Other common side effects include an increased chance of bleeding, getting an infection or developing anemia. These side effects result from changes in blood cells during chemotherapy.

How Long Do Side Effects Last?
Most normal cells recover quickly when chemotherapy is over, so most side effects gradually disappear after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over some side effects and regain energy varies from person to person. How soon you will feel better depends on many factors, including your overall health and the kinds of drugs you have been taking.

While many side effects go away fairly rapidly, certain ones may take months or years to disappear completely. Sometimes the side effects can last a lifetime as when chemotherapy causes permanent damage to the heart lungs kidneys or reproductive organs. And certain types of chemotherapy occasionally may cause delayed effects, such as a second cancer, that show up many years later.

It is important to remember that many people have no long-term problems due to chemotherapy. It also is reassuring to know that doctors are making great progress in preventing some of chemotherapy's more serious side effects. For instance, they are using many new drugs and techniques that increase chemotherapy's powerful effects on cancer cells while decreasing its harmful effects on the body's healthy cells.

The side effects of chemotherapy can be unpleasant but they must be measured against the treatment's ability to destroy cancer. People getting chemotherapy sometimes become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you talk to your doctor. It may be that your medication or the treatment schedule can be changed. Or your doctor may be able to suggest ways to reduce side effects or make them easier to tolerate. Remember though, your doctor will not ask you to continue treatments unless the expected benefits outweigh any problems you might have.

On the pages that follow, you will find suggestions for dealing with some of the more common side effects of chemotherapy.

Nausea and Vomiting
Chemotherapy can cause nausea and vomiting by affecting the stomach, the area of the brain that controls vomiting, or both. This reaction to chemotherapy varies from person to person and from drug to drug. For example, some people never vomit or feel nauseous. Others feel mildly nauseated most of the time, while some become severely nauseated for a limited time during or after a treatment. Their symptoms may start soon after a treatment or hours later. They may feel sick for just a few hours or for about a day. Be sure to tell your doctor or nurse if you are very nauseated and/or have vomited for more than a day or if your nausea is so bad that you cannot even keep liquids down.

Nausea and vomiting almost always can be controlled or at least lessened. If you experience this side effect, your doctor can choose from a range of drugs known as antiemetics which help curb nausea and vomiting. Different drugs work for different people, and it may be necessary to use more than one drug to get relief. Don't give up. Continue to work with your doctor and nurse to find the drug or drugs that work best for you.

You can also try the following ideas:

• Avoid big meals so your stomach won't feel too full. Eat small meals throughout the day, instead of one, two, or three large meals.
• Drink liquids at least an hour before mealtime, instead of with your meals.
• Eat and drink slowly.
• Stay away from sweet, fried, or fatty foods.
• Eat foods cold or at room temperature so you won't be bothered by strong smells.
• Chew your food well for easier digestion.
• If nausea is a problem in the morning, try eating dry foods like cereal, toast, or crackers before getting up. (Don't try this if you have mouth or throat sores or if you are troubled by a lack of saliva.)
• Drink cool, clear, unsweetened fruit juices, such as apple or grape juice, or light-colored sodas, such as ginger ale, that have lost their fizz.
• Suck on ice cubes, mints, or tart candies. (Don't use tart candies if you have mouth or throat sores.)
• Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
• Prepare and freeze meals in advance for days when you don't feel like cooking.
• Rest in a chair after eating, but don't lie flat for at least 2 hours after you've finished your meal.
• Wear loose-fitting clothes.
• Breathe deeply and slowly when you feel nauseated.
• Distract yourself by chatting with friends or family members, listening to music, or watching a movie or TV show.
• Use relaxation techniques.
• Avoid eating for at least a few hours before treatment if nausea usually occurs during chemotherapy.

Hair Loss
Hair loss (alopecia) is a common side effect of chemotherapy, but it doesn't always happen. Your doctor can tell you whether hair loss is likely to occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or may fall out entirely. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. In some cases, hair may grow back in a different color or texture.

Hair loss can occur on all parts of the body. not just the head. Facial hair, arm and leg hair, underarm hair, and pubic hair all may be affected.

Hair loss usually doesn't happen right away; more often, it begins after a few treatments. At that point, hair may fall out gradually or in clumps. Any hair that is still growing may become dull and dry.

To care for your scalp and hair during chemotherapy:

• Use mild shampoos.
• Use soft hair brushes.
• Use low heat when drying your hair.
• Don't use brush rollers to set your hair.
• Don't dye your hair or get a permanent.
• Have your hair cut short. A shorter style will make your hair look thicker and fuller. It also will make hair loss easier to manage if it occurs.
• Use a sunscreen, sunblock, hat, or scarf to protect your scalp from the sun if you lose a lot of the hair on your head.

Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or hairpieces. Others leave their head uncovered. Still others switch back and forth, depending on whether they are in public or at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.

Here are some tips if you choose to cover your head:

• Get your wig or hairpiece before you lose a lot of hair. That way, you can match your natural color and current hair style if you wish. You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients. Someone even may come to your home to help you. You also can buy a wig or hairpiece through a catalog or by phone. Call the American Cancer society for more information.
• Consider borrowing a wig or hairpiece, rather than buying one. Check with the local chapter of the American Cancer Society or with the social work department at your hospital.
• Remember that a hairpiece needed because of cancer treatment is a tax-deductible expense and may be at least partially covered by your health insurance. Be sure to check your policy.

Losing hair from your head, face, or body can be hard to accept. It's common - and perfectly all right - to feel angry or depressed about this loss. Talking about your feelings can help.

Fatigue/Anemia
Chemotherapy can reduce the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues don't get enough oxygen to do their work. This condition is called anemia.

Anemia can make you feel very weak and tired. Other symptoms of anemia include dizziness, chills. or shortness of breath. Be sure to report any of these symptoms to your doctor.

Your doctor will check your blood cell count often during your treatment. If your red count falls too low, you may need a blood transfusion to increase the number of red blood cells in your body.

Here are some things you can do to help yourself feel better if you develop anemia:

• Get plenty of rest. Sleep more at night and take naps during the day if you can.
• Limit your activities: Do only the things that are most important to you.
• Don't be afraid to get help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving.
• Eat a well balanced diet.
• When sitting or lying down, get up slowly. This will help prevent dizziness.

Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the bone marrow and decrease its ability to produce white blood cells, the cells that fight many types of infections. An infection can begin in almost any part of your body, including your mouth, skin, lungs, urinary tract, rectum, and reproductive tract.

Your doctor will check your blood cell count often while you are getting chemotherapy. Your doctor also may add colony stimulating factors to your treatment to keep your blood count from getting too far below normal. In spite of these extra steps, however, your white blood cell count still may drop. If this happens, your doctor may postpone your next treatment or give you a lower dose of drugs for a while.

When your white count is lower than normal, it is very important to try to prevent infections by taking the following steps:

• Wash your hands often during the day. Be sure to wash them extra well before you eat and before and after you use the bathroom.
• Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories.
• Stay away from people who have diseases you can catch, such as a cold, the flu, measles, or chickenpox. Also try to avoid crowds.
• Stay away from children who recently have received immunizations, such as vaccines for polio, measles, mumps and rubella (German measles).
• Don't cut or tear the cuticles of your nails.
• Be careful not to cut or nick yourself when using scissors, needles, or knives.
• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
• Use a soft toothbrush that won't hurt your gums.
• Don't squeeze or scratch pimples.
• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Don't rub.
• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
• Clean cuts and scrapes right away with warm water, soap, and an antiseptic.
• Wear protective gloves when gardening or cleaning up after animals and others, especially small children.
• Do not get any immunization shots without checking first with your doctor to see if it's all right.

Most infections come from the bacteria normally found on the skin and in the intestines and genital tract. In some cases, the cause of an infection may not be known. When your white blood cell count is low, your body may not be able to fight off infections. So, even if you take extra care, you still may get an infection.

Be alert to the signs that you might have an infection and check your body regularly for its signs, paying special attention to your eyes, nose, mouth, and genital and rectal areas. The symptoms of infection include:

• Fever over 100 degrees F.
• Chills.
• Sweating.
• Loose bowels. (This also can be a side effect of chemotherapy.)
• A burning feeling when you urinate.
• A severe cough or sore throat.
• Unusual vaginal discharge or itching.
• Redness, swelling, or tenderness, especially around a wound, sore, pimple, or intravenous catheter site.

Report any signs of infection to your doctor right away. This is especially important when your white blood cell count is low. If you have a fever, don't use aspirin, acetaminophen, or any other medicine to bring your temperature down without first checking with your doctor.

Blood Clotting Problems
Anticancer drugs can affect the bone marrow's ability to make platelets, the blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even from a minor injury.

Be sure to let your doctor know if you have unexpected bruising, small red spots under the skin, reddish or pinkish urine, or black or bloody bowel movements. Also report any bleeding from your gums or nose. Your doctor will check your platelet count often while you are having chemotherapy. If your platelet count falls too low, the doctor may give you a transfusion to build up the count. Here are some ways to avoid problems if your platelet count is low:

• Don't take any medicine without first checking with your doctor or nurse. This includes aspirin or aspirin-free pain relievers, including acetaminophen,& ibuprofen, and any other medicines you can buy without a prescription. These drugs may affect platelet function.
• Don't drink any alcoholic beverages unless your doctor says it's all right.|
• Use a very soft toothbrush to clean your teeth.
• Clean your nose by blowing gently into a soft tissue.
• Take care not to cut or nick yourself when using scissors, needles, knives, or tools.
• Be careful not to burn yourself when ironing or cooking. Use a padded glove when you reach into the oven.
• Avoid contact sports and other activities that might result in injury.

Mouth, Gum, and Throat Problems
Good oral care is important during cancer treatment. Anticancer drugs can cause sores in the mouth and throat. They also can make these tissues dry and irritated or cause them to bleed. In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Because infections can be hard to fight during chemotherapy and can lead to serious problems, it's important to take every possible step to prevent them.

Here are some suggestions for keeping your mouth, gums, and throat healthy:

• If possible, see your dentist before you start chemotherapy to have your teeth cleaned and to take care of any problems such as cavities, abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay.
• Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch; brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special type of toothbrush and/or toothpaste if your gums are very sensitive.
• Rinse your toothbrush well after each use and store it in a dry place.
• Avoid commercial mouthwashes that contain a large amount of salt or alcohol. Ask your doctor or nurse about a mild mouthwash that you might use.

If you develop sores in your mouth, be sure to contact your doctor or nurse because you may need medical treatment for the sores. If the sores are painful or keep you from eating, you also can try these ideas:

• Ask your doctor if there is anything you can apply directly to the sores. You also may ask your doctor to prescribe a medicine you can use to ease the pain.
• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat.
• Choose soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat.
• Avoid irritating, acidic foods, such as tomatoes, citrus fruit, and fruit juice (orange, grapefruit, and lemon); spicy or salty foods; and rough, coarse, or dry foods such as raw vegetables, granola, and toast.

If mouth dryness bothers you or makes it hard for you to eat, try these tips:

• Ask your doctor if you should use an artificial saliva product to moisten your mouth.
• Drink plenty of liquids.
• Suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum.
• Moisten dry foods with butter, margarine, gravy, sauces, or broth.
• Dunk crisp, dry foods in mild liquids.
• Eat soft and pureed foods like those listed above.
• Use lip balm if your lips become dry.

Diarrhea
When chemotherapy affects the cells lining the intestine, the result can be diarrhea (loose stools). If you have diarrhea that continues for more than 24 hours, or if you have pain and cramping along with the diarrhea, call your doctor. In severe cases, the doctor may prescribe an antidiarrheal medicine. However, you should not take any over-the-counter antidiarrheal medicines without asking your doctor first.

You also can try these ideas to help control diarrhea:

• Eat smaller amounts of food, but eat more often.
• Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit. Eat low fiber foods instead. Low-fiber foods include white bread, white rice or noodles creamed cereals, ripe bananas, canned or cooked fruit without skins, cottage cheese, yogurt, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken or turkey without the skin, and fish.
• Avoid coffee, tea, alcohol, and sweets. Stay away from fried, greasy, or highly spiced foods, too. They are irritating and can cause diarrhea and cramping.
• Avoid milk and milk products if they make your diarrhea worse.
• Unless your doctor has told you otherwise, eat more potassium-rich foods because diarrhea can cause you to lose this important mineral. Bananas, oranges, potatoes, and peach and apricot nectars are good sources of potassium.
• Drink plenty of fluids to replace those you have lost through diarrhea. Mild, clear liquids, such as apple juice, water, weak tea, clear broth, or ginger ale, are best. Drink them slowly and make sure they are at room temperature. Let carbonated drinks lose their fizz before you drink them.
• If your diarrhea is severe, it is important to let your doctor know. Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. As you feel hatter, you gradually can add the low-fiber foods listed above. A clear liquid diet doesn't provide all the nutrients you need, so don't follow one for more than 3 to 5 days.
• If your diarrhea is very severe, you may need to get intravenous fluids to replace the water and nutrients you have lost.

Constipation
Some people who get chemotherapy become constipated because of the drugs they are taking. Others may become constipated because they are less active or less nourished than usual. Tell your doctor if you have not had a bowel movement for more than a day or two. You may need to take a laxative or stool softener or use an enema, but don't use these remedies unless you have checked with your doctor, especially if your white blood cell count is low. You also can try these ideas to deal with constipation:

• Drink plenty of fluids to help loosen the bowels. Warm and hot fluids work especially well.
• Eat a lot of high-fiber foods. High-fiber foods include bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.
• Get some exercise. Simply getting out for a walk can help, as can a more structured exercise program. Be sure to check with your doctor before becoming more active.

Nerve and Muscle Effects
Your nervous system affects just about all your body's organs and tissues. So it's not surprising that when chemotherapy affects the cells of the nervous system - as the drugs sometimes do - a wide range of side effects can result. For example, certain drugs can cause peripheral neuropathy, a condition that may make you feel a tingling, burning, weakness, or numbness in the hands and/or feet. Other nerve related symptoms include loss of balance, clumsiness. difficulty picking up objects and buttoning clothing, walking problems, jaw pain, hearing loss, stomach pain, and constipation. In addition to affecting the nerves, certain anticancer drugs also can affect the muscles and make them weak, tired, or sore.

In some cases, nerve and muscle effects - though annoying - may not be serious. In other cases, nerve and muscle symptoms may indicate serious problems that need medical attention. Be sure to report any suspected nerve or muscle symptoms to your doctor.

Caution and common sense can help you deal with nerve and muscle problems. For example, if your fingers become numb, be very careful when grasping objects that are sharp, hot, or otherwise dangerous. If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs and using bathmats in the bathtub or shower. Do not wear slippery shoes.

Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy. Possible side effects include redness, itching, peeling, dryness, and acne. Your nails may become darkened, brittle, or cracked. They also may develop vertical lines or bands.

You will be able to take care of most of these problems yourself. If you develop acne, try to keep your face clean and dry and use over-the-counter medicated creams or soaps. For itching, apply cornstarch as you would a dusting powder. To help avoid dryness, take quick showers or sponge baths rather than long, hot baths. Apply cream and lotion while your skin is still moist and avoid perfume, cologne, or aftershave lotion that contains alcohol. You can strengthen your nails with the remedies sold for this purpose, but be alert to signs of a worsening problem because these products can be irritating to some people. Protect your nails by wearing gloves when washing dishes, gardening, or performing other work around the house. Get further advice from your doctor if these skin and nail problems don't respond to your efforts. Be sure to let your doctor know if you have redness, pain, or changes around the cuticles.

Certain anticancer drugs, when given intravenously, may produce a fairly dramatic darkening of the skin all along the vein. Some people use makeup to cover the area, but this can become difficult and time-consuming if several veins are affected, which sometimes happens. The darkened areas usually will fade on their own a few months after treatment ends.

Exposure to the sun may increase the effects some anticancer drugs have on your skin. Check with your doctor or nurse about using a sunscreen lotion with a skin protection factor of 15 to protect against the sun's effects. They may even suggest that you avoid being in direct sunlight or that you use a product, such as zinc oxide, that blocks the sun's rays completely. Long-sleeve cotton shirts, hats, and pants also will block the sun.

Some people who have had radiation therapy develop "radiation recall" during their chemotherapy. During or shortly after certain anticancer drugs are given, the skin over the area that was treated with radiation turns red - a shade anywhere from light to very bright - and may itch or burn. This reaction may last hours or even days. You can soothe the itching and burning by putting a cool, wet compress over the affected area. Radiation recall reactions should be reported to your doctor or nurse.

Most skin problems are not serious, but a few demand immediate attention. For example, certain drugs given intravenously can cause serious and permanent tissue damage if they leak out of the vein. Tell your doctor or nurse right away if you feel any burning or pain when you are getting IV drugs.

These symptoms don't always mean there's a problem, but they always must be checked out at once.

You should also let your doctor or nurse know right away if you develop sudden or severe itching, if your skin breaks out in a rash or hives, or if you have wheezing or any other trouble breathing. These symptoms may mean you are having an allergic reaction that may need to be treated at once.

Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or permanent damage to the kidneys. Be sure to ask your doctor if your anticancer drugs are among the ones that have this effect, and notify the doctor if you have any symptoms that might indicate a problem. Signs to watch for include:

• Pain or burning when you urinate.
• Frequent urination.
• A feeling that you must urinate right away ("urgency").
• Reddish or bloody urine.
• Fever.
• Chills.

In general, it's a good idea to drink plenty of fluids to ensure good urine flow and help prevent problems; this is especially important if your drugs are among those that affect the kidney and bladder. Water, juice, coffee, tea, soup, soft drinks, broth, ice cream, soup, popsicles, and gelatin are all considered fluids. Your doctor will let you know if you must increase your fluid intake.

You also should be aware that some anticancer drugs cause the urine to change color (orange, red, or yellow) or to take on a strong or medicine-like odor. For a short time, the color and odor of semen may be affected as well. Check with your doctor to see if the drugs you are taking have this effect.

Flu-Like Syndrome
Some people report feeling as though they have the flu a few hours to a few days after chemotherapy. Flu-like symptoms - muscle aches, headache, tiredness, nausea, slight fever, chills, and poor appetite - may last from 1 to 3 days. These symptoms also can be caused by an infection or by the cancer itself, so it's important to check with your doctor if you have flulike symptoms.

Fluid Retention
Your body may retain fluid when you are having chemotherapy. This may be due to hormonal changes from your therapy, to the effect of the drugs themselves, or to your cancer. Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen. You may need to avoid table salt and foods with a high sodium content. If the problem is severe, your doctor may prescribe diuretics, medicine to help your body get rid of excess fluids. However, don't take any over-the-counter diuretics without asking your doctor first.

Sexual Effects: Physical and Psychological
Chemotherapy may - but does not always - affect sexual organs and functioning in both men and women. The side effects that might occur depend on the drugs used and the person's age and general health.

Men
Chemotherapy drugs may lower the number of sperm cells, reduce their ability to move, or cause other abnormalities. These changes can result in infertility, which may be temporary or permanent. Infertility affects a man's ability to father a child but does not affect his ability to have sexual intercourse.

Because permanent sterility may occur, it's important to discuss this issue with your doctor before you begin chemotherapy. If you wish, you might consider sperm banking, a procedure that freezes sperm for future use.

Men undergoing chemotherapy should use an effective means of birth control with their partners during treatment because of the harmful effects of the drugs on chromosomes. Ask your doctor when you can stop using birth control for this purpose.

Women
Anticancer drugs can damage the ovaries and reduce the amount of hormones they produce. As a result, some women find that their menstrual periods become irregular or stop completely while they are having chemotherapy.

The hormonal effects of chemotherapy also may cause menopause-like symptoms such as hot flashes and itching, burning, or dryness of vaginal tissues. These tissue changes can make intercourse uncomfortable, but the symptoms often can be relieved by using a water-based vaginal lubricant. The tissue changes also can make a woman more likely to get vaginal infections. To help prevent infection, avoid oil-based lubricants such as petroleum jelly, wear cotton underwear and pantyhose with a ventilated cotton lining, and don't wear tight slacks or shorts. Your doctor also may prescribe a vaginal cream or suppository to reduce the chances of infection. If infection does occur, it should be treated right away.

Damage to the ovaries may result in infertility, the inability to become pregnant. In some cases, the infertility is a temporary condition; in other cases, it may be permanent. Whether infertility occurs, and how long it lasts, depends on many factors, including the type of drug, the dosage given, and the woman's age.

Although pregnancy may be possible during chemotherapy, it still is not advisable because some anticancer drugs may cause birth detects. Doctors advise women of childbearing age - from the teens through the end of menopause - to use birth control throughout their treatment.

If a woman is pregnant when her cancer is discovered, it may be possible to delay chemotherapy until after the baby is born. For a woman who needs treatment sooner, the doctor may suggest starting chemotherapy after the 12th week of pregnancy when the fetus is beyond the stage of greatest risk. In some cases, termination of the pregnancy may be considered.

Sexuality
Sexual feelings and attitudes vary among people during chemotherapy. Some people find that they feel closer than ever to their partners and have an increased desire for sexual activity. Others experience little or no change in their sexual desire and energy level. Still others find that their sexual interest declines because of the physical and emotional stresses of having cancer and getting chemotherapy. These stresses may include worries about changes in appearance; anxiety about health family or finances; or side effects including fatigue and hormonal changes.

A partner's concerns or fears also can affect the sexual relationship. Some may worry that physical intimacy will harm the person who has cancer; others may fear that they might catch the cancer or be affected by the drugs. Many of these issues can be cleared up by talking about misunderstandings. Both you and your partner should feel free to discuss sexual concerns with your doctor, nurse, or other counselor who can give you the information and the reassurance you need.

You and your partner also should try to share your feelings with one another. If it's difficult for you to talk to each other about sex, or cancer, or both, you may want to speak to a counselor who can help you communicate more openly. People who can help include psychiatrists, psychologists, social workers, marriage counselors, sex therapists, and members of the clergy.

If you were comfortable with and enjoyed sexual relations before starting therapy, chances are you will still find pleasure in physical intimacy during your treatment. You may discover, however, that intimacy takes on a new meaning and character. Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important. Remember that what was true before you started chemotherapy remains true now: There is no one 'right way' to express your sexuality. It's up to you and your partner to determine together what is pleasurable and satisfying to you both.

The American Cancer Society has two free booklets on sexuality that may be helpful, one for women and one for men. Contact your local unit or the national office for copies.

Eating Well During Chemotherapy

It is very important to eat as well as you can while you are undergoing treatment. People who eat well can cope with side effects better and are able to fight infection more easily. In addition, their bodies can rebuild healthy tissues faster.

Eating well during chemotherapy means choosing a balanced diet that contains all the nutrients the body needs. A good way to do this is to eat foods from each of the following food groups: fruits and vegetables; poultry, fish, and meat; cereals and breads; and dairy products. Eating well also means having a diet high enough in calories to keep your weight up and, most important, high enough in protein to build and repair skin, hair, muscles, and organs.

You also may need to drink extra amounts of fluid to protect your bladder and kidneys during your treatment.

What If I Don't Feel Like Eating?
Even when you know it's important to eat well, there may be days when you feel you just can't. This may happen because side effects such as nausea or mouth and throat problems make it difficult or painful to eat. You also can lose your appetite if you feel depressed or tired. If this is the case, be sure to read the sections in this booklet on your particular discomforts. They will give you tips that can make it easier for you to eat.

When a poor appetite is the problem, try these hints:

• Eat small meals or snacks whenever you want. You don't have to eat three regular meals each day.
• When possible, take a walk before meals; this may make you feel hungrier.
• Try changing your mealtime routine. For example, eat by candlelight or in a different location.
• Eat with friends or family members. When eating alone, listen to the radio or watch TV.
• If you live alone, you might want to arrange for "Meals on Wheels" or a similar program to bring food to you. Ask your doctor, nurse, local American Cancer Society office, or the Cancer Information Service about these programs, which are provided in many communities.

The National Cancer Institute's booklet Eating Hints provides more tips about how to make eating easier and more enjoyable. It also gives many ideas about how to eat well and increase your protein and calorie intake during cancer treatment. For a free copy of Eating Hints, call the Cancer Information Service at 1-800-4-CANCER.

Can I Drink Alcoholic Beverages?
Small amounts of alcohol can help you relax and increase your appetite. On the other hand, alcohol may interact with some drugs to reduce their effectiveness or worsen their side effects. For this reason, some people must drink less alcohol or avoid alcohol completely during chemotherapy. Be sure to ask your doctor if it's okay for you to drink beer, wine, or other alcoholic beverages.

Should I Take Vitamin or Mineral Supplements?
There is no single answer to this question, but one thing is clear: No diet or nutritional plan can "cure" cancer, and taking vitamin and mineral supplements should never be considered a substitute for medical care. You should not take any supplements without your doctor's knowledge and consent.

Talking With Your Doctor and Nurse

Some people with cancer want to know every detail about their condition and their treatment. Others prefer only general information. The choice of how much information to seek is yours, but there are questions that every person getting chemotherapy should ask. These include:

• Why do I need chemotherapy?
• What are the benefits of chemotherapy?
• What are the risks of chemotherapy?
• What drug or drugs will I be taking?
• How will the drugs be given?
• Where will I get my treatments?
• How long will my treatment last?
• What are the possible side effects?
• Are there any side effects that I should report right away?
• Are there any other possible treatment methods for my type of cancer?

This list is just a start. You always should feel free to ask your doctor, nurse, and pharmacist as many questions as you want. If you don't understand their answers, keep asking until you do. Remember, when it comes to cancer and cancer treatment there is no such thing as a "stupid" question. To make sure you get all the answers you want, you may find it helpful to draw up a list of questions before your appointment. Some people even keep a "running list" and jot down each new question as it occurs to them.

To help remember your doctor's answers, you may want to take notes during your appointment. Don't feel shy about asking your doctor to slow down when you need more time to write. You might also ask if you can use a tape recorder during your visit. That way, you can review your conversation later as many times as you wish. Some doctors like this idea and others don't, so be sure to check before you try it. Another way to help you remember is to bring a friend or family member to sit with you while you talk to your doctor. This person can help you understand what your doctor says during your visit and help refresh your memory afterward.

Chemotherapy and Your Emotions

Chemotherapy can bring major changes to a person's life. It can affect overall health, threaten a sense of well-being, disrupt day-to-day schedules, and put a strain on personal relationships. No wonder then, that many people feel fearful, anxious, angry, or depressed at some point during their chemotherapy.

These emotions are perfectly normal and understandable, but they also can be disturbing. Fortunately, there are ways to cope with these emotional "side effects," just as there are ways to cope with the physical side effects of chemotherapy.

How Can I Get the Support I Need
There are many sources of support you can draw on. Here are some of the most important:

• Doctors and nurses. If you have questions or worries about your cancer treatment, talk with members of your health care team.
• Counseling professionals. There are many kinds of counselors who can help you express, understand, and cope with the emotions cancer treatment can cause. Depending on your preferences and needs, you might want to talk with a psychiatrist, psychologist, social worker, sex therapist, or member of the clergy.
• Friends and family members. Talking with friends or family members can help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can. You may find, though, that you'll need to help them help you. At a time when you might expect that others will rush to your aid, you may have to make the first move.

  Many people do not understand cancer, and they may withdraw from you because they're afraid of your illness. Others may worry that they will upset you by saying "the wrong thing."

  You can help relieve these fears by being open in talking with others about your illness, your treatment, your needs, and your feelings. By talking openly, you can correct mistaken ideas about cancer. You can also let people know that there's no single "right" thing to say, so long as their caring comes through loud and clear. Once people know they can talk with you honestly, they may be more willing and able to open up and lend their support.

  The National Cancer Institute's booklet Taking Time offers useful advice to help cancer patients and their families and friends communicate with one another.

• Support groups. Support groups are made up of people who are going through the same kinds of experiences as you. Many people with cancer find they can share thoughts and feelings with group members that they don't feel comfortable sharing with anyone else. Support groups also can serve as an important source of practical information about living with cancer.

  Support can also be found in one-to-one programs that put you in touch with another person very similar to you in terms of age, sex, type of cancer, and so forth. In some programs, this person comes to visit you. In others, a "hotline" puts you in touch with someone you can talk with on the telephone.

  Sources for information about support programs include your hospital's social work department, the local office of your American Cancer Society, and the National Cancer Institute's Cancer Information Service.

How Can I Make My Daily Life Easier?
Here are some tips to help yourself while you are getting chemotherapy:

• Try to keep your treatment goals in mind. This will help you keep a positive attitude on days when the going gets rough.
• Remember that eating well is very important. Your body needs food to rebuild tissues and regain strength.
• Learn as much as you want to know about your disease and its treatment. This can lessen your fear of the unknown and increase your feeling of control.
• Keep a journal or diary while you're in treatment. A record of your activities and thoughts can help you understand the feelings you have as you go through treatment and highlight questions you need to ask your doctor or nurse. You also can use your journal to record the steps you take to cope with side effects and how well those steps work. That way, you'll know which methods worked best for you in case you have the same side effects again.
• Set realistic goals and don't be too hard on yourself. You may not have as much energy as usual, so try to get as much rest as you can, let the "small stuff" slide, and only do the things that are most important to you.
• Try new hobbies and learn new skills. Exercise if you can. Using your body cam make you feel better about yourself, help you get rid of tension or anger, and build your appetite. Ask your doctor or nurse about a safe and practical exercise program.

How Can I Relieve Stress
You can use a number of methods to cope with the stresses of cancer and its treatment. The techniques described here can help you relax. Try some of these methods to find the one (or ones) that work best for you. You may want to check with your doctor before using these techniques, especially if you have lung problems.

• Muscle tension and release. Lie down in a quiet room. Take a slow, deep breath. As you breathe in, tense a particular muscle or group of muscles. For example you can squeeze your eyes shut, frown, clench your teeth, make a fist, or stiffen your arms or legs. Hold your breath and keep your muscles tense for a second or two. Then breathe out? release the tension, and let your body relax completely. Repeat the process with another muscle or muscle group.

  You also can try a variation of this method, called "progressive relaxation." Start with the toes of one foot and, working upward, progressively tense and relax all the muscles of one leg. Next, do the same with the other leg. Then tense and relax the rest of the muscle groups in your body, including those in your scalp. Remember to hold your breath while tensing your muscles and to breathe out when releasing the tension.

• Rhythmic breathing. Get into a comfortable position and relax all your muscles. If you keep your eyes open, focus on a distant object. If you close your eyes, imagine a peaceful scene or simply clear your mind and focus on your breathing.

  Breathe in and out slowly and comfortably through your nose. If you like, you can keep the rhythm steady by saying to yourself, "In, one two; Out, one two." Feel yourself relax and go limp each time you breathe out.

  You can do this technique for just a few seconds or for up to 10 minutes. End your rhythmic breathing by counting slowly and silently to three.

• Biofeedback. With training in biofeedback, you can control body functions such as heart rate, blood pressure, and muscle tension. A machine will sense when your body shows signs of tension and will let you know in some way such as making a sound or flashing a light. The machine will also give you feedback when you relax your body. Eventually, you will be able to control your relaxation responses without having to depend on feedback from the machine. Your doctor or nurse can refer you to someone trained in teaching biofeedback.

• Imagery. Imagery is a way of daydreaming that uses all your senses. It usually is done with your eyes closed. To begin, breathe slowly and feel yourself relax. Imagine a ball of healing energy - perhaps a white light - forming somewhere in your body. When you can "see" the ball of energy, imagine that as you breathe in you can blow the ball to any part of the body where you feel pain, tension, or discomfort such as nausea. When you breathe out, picture the air moving the ball away from your body, taking with it any painful or uncomfortable feelings. (Be sure to breathe naturally; don't blow.) Continue to picture the ball moving toward you and away from you each time you breathe in and out. You may see the ball getting bigger and bigger as it takes away more and more tension and discomfort.

  To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say to yourself, "I feel alert and relaxed."

  If you choose to use imagery as a relaxation technique, please be sure to read the caution in the following section.

• Visualization. Visualization is a method that is similar to imagery. With visualization, you create an inner picture that represents your fight against cancer. Some people getting chemotherapy use images of rockets blasting away their cancer cells or of knights in armor battling their cancer cells. Others create an image of their white blood cells or their drugs attacking the cancer cells.

  Visualization and imagery may help relieve stress and increase your sense of self-control. But it is very important to remember that they cannot take the place of the medical care your doctor prescribes to treat your cancer.

• Hypnosis. Hypnosis puts you in a trance-like state that can help reduce discomfort and anxiety. You can be hypnotized by a qualified person, or you can learn how to hypnotize yourself. If you are interested in learning more, ask your doctor or nurse to refer you to someone trained in the technique.

• Distraction You use distraction any time an activity takes your mind off your worries or discomforts. Try watching TV, listening to the radio, reading, going to the movies, or working with your hands by doing needlework or puzzles, building models, or painting. You may be surprised how comfortably the time passes.

Paying for Chemotherapy

The cost of chemotherapy varies with the kinds and dose of drugs used, how long and how often they are given, and whether you get them at home, in a clinic or offices or in the hospital. Most health insurance policies (including Medicare Part B, which helps pay for doctors bills and many other medical services) cover at least part of the cost of many kinds of chemotherapy.

Sometimes, however, an insurer may not pay for the use of certain drugs for certain kinds of cancers - at least not at first. If your insurer denies payment for your treatment, don't give up. Most people do get payment eventually.

Teamwork with your doctor and the office staff is important. Be sure to let them know if you have been denied payment. They can consult with your insurer and help answer any questions your insurer may have. They also can consult with the company that makes the drug or drugs you are taking. Often, these companies can provide information or other services that will help you get payment.

In some states, Medicaid (which makes health care services available for people with financial need) may help pay for certain treatments. Contact the office that handles social services in your city or county to find out whether you are eligible for Medicaid and whether your chemotherapy is a covered expense.

If you need help paying for treatments, contact your hospital's social service office, the Cancer Information Service, or the local office of the American Cancer Society. They may be able to direct you to other sources of help. Another possibility is the Leukemia Society of America; to find a chapter near you, check the white pages of your local telephone book.

A Final Word

The National Cancer Institute hopes Chemotherapy and You helps you and your family, whether you are waiting to begin chemotherapy or already have begun your treatment. Discuss the information in this booklet with your doctor and nurse, and take good care of yourself during your chemotherapy. By working together, you, your family, and your health care providers will make the strongest possible team in your fight against cancer.

Resources

Information about cancer is available from many sources, including the ones listed below. You may want to check for additional information at your local library or bookstore and from support groups in your community.

Cancer Information Service
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients and their families and friends, the public, and health care professionals. The staff can answer questions in English or Spanish and can send free National Cancer Institute booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4-CANCER (1-800-422-6237), connects callers with the office that serves their area.

PDQ
People who have cancer, those who care about them, and doctors need up-to-date and accurate information about cancer treatment. To meet these needs, PDQ was developed by NCI. PDQ contains an up-to-date list of clinical trials all over the country. The Cancer Information Service, at 1-800-4-CANCER, can provide PDQ information to doctors, patients, and the public.

American Cancer Society
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office (at the above address) and local units all over the country. To obtain further information about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under American Cancer Society in the white pages of the telephone book.

Other Booklets
National Cancer Institute printed materials, including the booklets listed below, are available from the Cancer Information Service free of charge by calling 1-800-4-CANCER.

• Advanced Cancer: Living Each Day
• Eating Hints: Recipes and Tips for Better Nutrition During Cancer Treatment
• Facing Forward: A Guide for Cancer Survivors
• Questions and Answers About Pain Control (also available from the American Cancer Society)
• Radiation Therapy and You: A Guide to Self-Help During Treatment
• Taking Time: Support for People With Cancer and the People Who Care About Them
• What are Clinical Trials All About?
• What You Need To Know About Cancer. A series of booklets about different types of cancer.
• When Cancer Recurs: Meeting the Challenge Again

Glossary

This glossary reviews the meaning of some words used in Chemotherapy and You. It also explains some words related to chemotherapy that are not mentioned in this booklet but that you may hear from your doctor or nurse.

Adjuvant therapy: Anticancer drugs or hormones given after surgery and/or radiation to help prevent the cancer from coming back.

Alopecia: Hair loss.

Anemia: Having too few red blood cells. Symptoms of anemia include feeling tired, weak, and short of breath.

Anorexia: Poor appetite.

Antiemetic: A medicine that prevents or controls nausea and vomiting.

Benign: A term used to describe a tumor that is not cancerous.

Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also called immunotherapy.

Blood count: The number of red blood cells, white blood cells, and platelets in a sample of blood. This is also called complete blood count (CBC).

Bone marrow: The inner, spongy tissue of bones where blood cells are made.

Cancer: A general name for more than 100 diseases in which abnormal cells grow out of control; a malignant tumor.

Catheter: A thin flexible tube through which fluids can enter or leave the body.

Central venous catheter: A special thin, flexible tube placed in a large vein. It remains there for as long as it is needed to deliver and withdraw fluids.

Chemotherapy: The use of drugs to treat cancer.

Chromosomes: Threadlike bodies found in the nucleus, or center part, of a cell that carry the information of heredity.

Clinical trials: Medical research studies conducted with volunteers. Each study is designed to answer scientific questions and to find better ways to prevent or treat cancer.

Colony-stimulating factors: Substances that stimulate the production of blood cells. Treatment with colony-stimulating factors (CSF) can help the blood-forming tissue recover from the effects of chemotherapy and radiation therapy. These include granulocyte colony-stimulating factors (G-CSF) and granulocyte-macrophage colony-stimulating factors (GM-CSF).

Combination chemotherapy: The use of more than one drug to treat cancer:

Diuretics: Drugs that help the body get rid of excess water and salt.

Gastrointestinal: Having to do with the digestive tract, which includes the mouth, esophagus, stomach, and intestines.

Hormones: Natural substances released by an organ that can influence the function of other organs in the body.

Infusion: Slow and/or prolonged intravenous delivery of a drug or fluids.

Injection: Using a syringe and needle to push fluids or drugs into the body: often called a "shot."

Intra-arterial (IA): Into an artery.

Intracavitary (IC): Into a cavity or space, specifically the abdomen, pelvis, or the chest.

Intralesional (IL): Into the cancerous area in the skin.

Intramuscular (IM): Into a muscle.

Intrathecal (IT): Into the spinal fluid.

Intravenous (IV): Into a vein.

Malignant: Used to describe a cancerous tumor.

Metastasis: When cancer cells break away from their original site and spread to other parts of the body.

Palliative care: Treatment to relieve, rather than cure, symptoms caused by cancer. Palliative care can help people live more comfortably.

Peripheral neuropathy: A condition of the nervous system that usually begins in the hands and/ or feet with symptoms of numbness, tingling, burning and/or weakness. Can be caused by certain anticancer drugs.

Per os (PO): By mouth; orally.

Platelets: Special blood cells that help stop bleeding.

Port: A small plastic or metal container surgically placed under the skin and attached to a central venous catheter inside the body. Blood and fluids can enter or leave the body through the port using a special needle.

Radiation therapy: Cancer treatment with radiation (high-energy rays).

Red blood cells: Cells that supply oxygen to tissues throughout the body.

Remission: The partial or complete disappearance of signs and symptoms of disease.

Stomatitis: Sores on the lining of the mouth.

Subcutaneous (SQ or SC): Under the skin.

Tumor: An abnormal growth of cells or tissues. Tumors may be benign (noncancerous) or malignant (cancerous).

White blood cells: The blood cells that fight infection.

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All contents copyright © 1992-1997 the Author(s) and the University of Iowa. All rights reserved.
Last Modified: May 09, 1997