Last update : june 2018 (under construction)

Cancer treatments are often accompanied by side effects, which manifest as symptoms of physical, and even psychological, discomfort. Although usually transitory, they can vary depending on the treatment in question and the sensitivity of each individual. 

They could signal a worsening of the disease, but it is important to know that this is rarely the case. Effective ways of managing these problems do exist, however. Being aware that these side effects are common and that their impact can be lessened helps alleviate concerns and promote a better quality of life during treatment.

The following side effects are the ones most frequently observed in oncology. For each, there is a description to help identify it, with useful tips on how to manage the attendant discomfort. Moreover, given that some of these effects - sometimes intense - require professional attention, we’ve also provided information indicating when you should tell the treatment team about them.

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Some people experience symptoms of anxiety and depression during treatment. This may be caused by the disruption in daily routine, fatigue or by feelings associated with the illness.
  • Anxiety: an emotional or physiological reaction to known or unknown events, ranging from a normal response to extreme dysfunction. It can affect decision-making, adherence to treatment, or the conduct and quality of life.
  • Depression: a range of feelings and emotions ranging from ordinary sadness to chronic despondency.

Life situations that increase the risk of anxiety and depression

  • Financial worries.
  • History of anxiety or depression.
  • Living alone.
  • Being socially isolated.
  • Being under the age of 30.
  • Being a woman.
  • Waiting for test results.
  • Experiencing withdrawal (tobacco, alcohol, drugs).
  • Having dependent children.
  • Living with advanced or recurrent disease.
  • Lack of physical activity.

Symptoms that increase the risk of anxiety and depression

  • Fatigue.
  • Pain.
  • Sleep disorder.
  • Breathlessness.

Signs and symptoms of anxiety

  • Episodes of sudden fear, discomfort or intense anxiety with or without panic attacks.
  • Difficulty or inability to perform daily activities.
  • Trouble sleeping.

Signs and symptoms of depression

  • Feelings of fatigue and exhaustion.
  • Difficulty or inability to perform daily activities.
  • Loss of interest in usually enjoyable activities.
  • Loss of appetite.
  • Powerlessness.
  • Black or suicidal thoughts.
  • Experiencing, for two weeks or more:
    • depression or loss of pleasure;
    • a sense of worthlessness;
    • insufficient or excessive sleep;
    • a sense of guilt;
    • inability to think or concentrate;
    • weight gain or weight loss.

Helpful hints: anxiety and depression

  • Use adaptation strategies that have proven effective for overcoming difficulties in the past.
  • Express your concerns with relatives and friends or a healthcare team member.
  • Locate resources and services that can help, in consultation with the healthcare team, community associations and information and listening services.
  • Be open to support from relatives and friends: helping with housework, accompanying you to appointments, babysitting, etc.
  • Join a support group.
  • Do some moderate exercise, such as walking.
  • Participate in activities that assist in anxiety management (e.g. relaxation, yoga, visualization, listening to music, adapted readings, breathing techniques and massage therapy).
  • Get professional support by meeting with your social worker or healthcare team psychologist.

Helpful hints: depression

  • Immediately consult a family doctor or a healthcare team professional or go to emergency if these helpful hints are ineffective, if symptoms persist or intensify, or are accompanied by dark or suicidal thoughts.
  • Use telephone psychosocial support resources that are available day and night, such as Tel-Aide and the Suicide Prevention Center.

Bloating

Some foods may produce gas and bloating in the stomach or intestine. This could be caused by medical treatment, lack of exercise, nervousness or hurried meals.
​​

Helpful hints

  • Eat easily digestible, low-fat foods.
  • Eat slowly to minimize discomfort.
  • Cut down consumption of foods that ferment and produce gases during digestion, such as garlic, onion, cabbage, beans, soft drinks, wine, alcohol and chewing gum.
  • Avoid drinking while eating and use a straw.

Heartburn (gastroesophageal reflux)

Heartburn is characterized by a burning sensation in the lower part of the chest, along with a sour or bitter taste in the throat and mouth. It is caused by acid from the stomach rising into the esophagus.


Helpful hints

  • Eat little, but often.
  • Drink just one hour before or after meals.
  • Do not lie down directly after eating; stay upright. Sitting is recommended.
  • Avoid eating foods that irritate the mucous membrane or promote reflux, such as tomatoes, citrus, coffee, strong spices, alcohol, soft drinks, high-fat foods, chocolate, tea, and mint.
  • Eat more lean meat and fish.
  • Consume skimmed or partially skimmed milk or dairy products.
  • Don’t smoke.
  • Avoid wearing tight clothes.

Esophagitis

Esophagitis is an inflammation of the mucous membrane covering the esophagus, the section of the gastrointestinal tract between the stomach and the mouth.


Signs and symptoms

  • Difficulty absorbing solid food.
  • Sensation of a lump in the throat, especially when swallowing.
  • Painful discomfort when swallowing.
  • Acute, progressive internal pain, intermittent or constant, felt in the chest, at the level of the sternum.

Helpful hints

  • Adopt a special protein- and vitamin-rich diet to promote growth of cells in the lining of the esophagus.
  • Ask the doctor to prescribe an antacid or an analgesic, as appropriate.
  • Consume sweet and creamy foods:
    • Milk and other dairy products (sour cream, yogurt, cottage cheese, etc.);
    • Sauces;
    • Puddings;
    • Noodles;
    • Purées;
    • Baby food.
Constipation is defined as a reduction in the evacuation of feces formed in the intestine. It is characterized by harder stools and increased difficulty in evacuating.

Certain drugs used in chemotherapy have a toxic effect on the nerves, resulting in a slowing of intestinal activity that can lead to constipation. In other cases, constipation is related to the absorption of analgesics or narcotics. Also, a liquid diet over a prolonged period can result in constipation problems.

Helpful hints

  • Drink at least six to eight glasses (two to three litres) of preferably warm or hot water or other fluids every day, unless otherwise directed by your medical team.
  • Gradually increase the amount of fiber in your diet with fresh fruit, raw vegetables, wholemeal bread and whole grain cereals (effective only if accompanied by an optimal fluid intake). Add one or two tablespoons of wheat bran to cereals, fruit juice, milkshakes, au gratin dishes, etc.
  • Add laxative fruits to diet (e.g. prunes, dates or figs or prune juice or nectar).
  • Exercise regularly.

Severe constipation is painful and uncomfortable. You are advised to contact the oncology team in the following situations:

  • ​Hard, swollen abdomen;
  • Severe abdominal pain;
  • Vomiting feces;
  • Recent history of abdominal surgery;
  • Change in urinary habits;
  • Difficulty performing daily activities;
  • Three or more days without a bowel movement despite a laxative medication taken properly.
Diarrhea occurs when stools are abnormally liquid and frequent compared to your personal average (over four to six bowel movements per day). The bowel movements may or not be accompanied by abdominal cramps.

This problem could be caused by the cancer itself, by the treatment received or by the medication you are taking. Diarrhea is a common side effect of  chemotherapy or (mainly abdominal) radiotherapy.​


Helpful hints
 

  • Temporarily replace whole grain bread and grain products with refined products (white bread, white rice).
  • Drink eight to ten glasses (two to three litres) of water or other liquids at room temperature, unless otherwise advised by the medical team. Compensate for the loss of electrolytes by eating foods such as bananas and potatoes, drinking sports drinks, peach and apricot nectar, or by taking an oral rehydration solution composed of a half a teaspoon of tea salt and six teaspoons of sugar in a litre of water.
  • Eat regularly.
  • Emphasize fruits and steamed vegetables as well as fish and poultry.
  • Chew slowly.
  • Eat five or six small meals a day.
  • Watch out for signs of dehydration (e.g. dizziness, thirst, dry mouth, decreased urination).
  • Check for fever.
  • Note the number and frequency of diarrheal bowel movements so that you can inform the healthcare team.
  • Avoid the following foods:
    • strong spices;
    • fried foods;
    • very sweet foods;
    • foods that have a lot of skin, membranes and seeds;
    • fresh fruit, raw vegetables, whole grain bread and cereals;
    • onion, cabbage, cauliflower, brussel sprouts, broccoli, garlic, nuts;
    • alcohol and tobacco;
    • caffeine;
    • iced drinks;
    • milk and other dairy products.

Severe diarrhea can cause dehydration and greatly weaken a person. It is advisable to contact the oncology team in the following situations:

  • liquid stools six or more times a day for more than two consecutive days;
  • presence of blood on the anus, in the stool on the toilet paper, or in the bowl;
  • absence of urine for 24 hours;
  • signs of dehydration;
  • inability to drink for more than 24 hours;
  • fever;
  • weight loss of two kilograms or more;
  • swollen or painful abdomen.​
Taking hormone blockers may affect the functioning of the endocrine glands and slightly modify your physical appearance. However, these changes will not compromise male or female characteristics, and will not call one’s sexual identity into question.

Signs and symptoms

  • For women:
    • Hot flashes and night sweats;
    • Changes in the menstrual cycle;
    • Vaginal dryness and vaginal discharge;
    • Slight weight gain;
    • Increased risk of venous thrombosis (blood clots);
    • Increased risk of endometrial cancer (tamoxifen);
    • Joint pain and increased risk of osteoporosis.
  • In men:
    • Digestive disorders (nausea, vomiting, abdominal pain);
    • Increase in the volume of the breast or breast tenderness;
    • Hot flashes;
    • Loss of sexual desire;
    • Loss of muscle and bone mass;
    • Mood swings;
    • Fatigue. 

Helpful hints

  • Exercise and follow a balanced, or appropriate, diet to minimize possible alteration in body shape.
  • Relieve joint pain with simple analgesics such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) except if medically contraindicated.
  • Tell pharmacist about any new symptoms that could be linked to new medication (particularly early in the treatment).
  • Inform the medical team of any side effects.

Fatigue

Fatigue is a feeling of weariness and exhaustion, accompanied by physical weakness and lack of energy. It is disproportionate to the amount of effort expended, does not improve with rest, and interferes with the activities of daily life. Many people experience fatigue during their treatment period. In fact, "it affects 70 to 100% of people with cancer. This is the most common and most distressing symptom to occur during treatment" (NCCN-2005). Cancer-related fatigue can have many causes, for example:
  • anemia, resulting from the cancer or its treatment;
  • nutritional deficiency;
  • sleep disorders;
  • emotional distress;
  • decreased activity;
  • pain;
  • type of treatment.

Anemia

Anemia is characterized by a decrease in the number of red blood cells (erythrocytes). This decrease means a lower level of hemoglobin, a major component of red blood cells, which are responsible for transporting oxygen to body tissues. Reduced levels of hemoglobin in the blood result in less oxygen being delivered to the tissues.

Signs and symptoms

  • sudden feeling of extreme tiredness;
  • excessive need to sit or rest;
  • rapid heartbeat;
  • chest pain;
  • problems sleeping;
  • difficulty getting up in the morning.
  • lack of energy.
  • lack of interest in activities one usually enjoys.
  • muscle pain;
  • shortness of breath after light activity, even at rest;
  • feelings of anxiety or depression;
  • difficulty concentrating, thinking clearly or making decisions;
  • negative feelings towards oneself or others.

Helpful hints

  • Rest when fatigue is felt and, if possible, before and after each chemotherapy or radiotherapy session.
  • To improve the quality of sleep, we recommend that you:
    • avoid long naps or napping late in afternoon;
    • go to bed only when you feel tired;
    • use your bed only for sleeping or sexual activity;
    • go to bed and get up at regular times;
    • avoid caffeine and stimulating activities in the evening;
    • relax for an hour before going to bed.
  • Follow a healthy diet rich in protein, fruits and vegetables.
  • Drink eight to ten glasses (two to three litres) of fluids a day, unless otherwise specified by the medical team.
  • Choose simple, quick dishes.
  • Eat several small meals and snacks a day to ensure a regular supply of calories to the body, requiring a lower expenditure of energy.
  • If necessary, set up a meal schedule to avoid skipping.
  • Save your energy for enjoyable activities and do them when it is at its highest.
  • Request help with housework and home maintenance.
  • Take up restful activities such as reading, games, music and art.
  • Participate in activities promoting relaxation, such as massage therapy, meditation, visualization and yoga.
  • Join an anxiety management or support group.
  • Ask the medical team about options for treating or preventing anemia and the fatigue symptoms associated with it.
  • Engage in physical activity:
    • Do some moderate physical activity (e.g. daily walks during and after anti-cancer treatment), as this promotes better energy renewal and conservation;
    • Aim for a balance between activity and rest, because too much rest or lack of activity can alter the ability of muscle tissue to oxygenate, leading to muscle loss and additional fatigue;
    • Avoid feeling guilty for not immediately being able to make an effort. Doing nothing and resting may be a priority;
    • Adapt your physical activity to your individual ability. Above all, it should be a source of pleasure and well-being.
For additional information, or for guidance in maintaining or resuming physical activity, see one of the Quebec Cancer Foundation’s kinesiologists. After listening to your needs, they will be able to design an appropriate and accessible exercise program for you. Call the regional centre nearest you to make an appointment with a professional or call 1 800 363-0063 (toll free).

 

 

A decrease in the number of platelets in the blood (thrombopenia or thrombocytopenia), as a result of chemotherapy or radiation therapy, can give rise to prolonged bleeding or haemorrhaging.
  • Bleeding: blood loss, bruising (contusions) or petechiæ (small red spots under the skin) can result from a decrease in the quantity or quality of blood platelets, an alteration in coagulation factors or many other causes.
  • Hemorrhaging: bleeding, or blood escaping from the normal circulatory system of the heart and blood vessels. Hemorrhages are called "external" when bleeding is visible and "internal" when it cannot be seen (occult bleeding). It can be of capillary, venous or arterial origin. (Source: Wikipedia)

Signs and symptoms

  • Appearance of small red spots or bruises on the skin, especially in the lower and upper extremities or in the mucous membranes.
  • Prolonged bleeding following a surface cut or scratch.
  • Spontaneous bleeding from the mouth, nose, vagina, rectum and urethra.
  • Blood in the urine, feces or vomit.
  • Abnormal blood flow during menstruation.
  • Black stools.

Helpful hints

  • Protect your skin:
    • Avoid violent or hazardous physical activities;
    • Avoid wearing tight clothes and rigid fabrics;
    • Use an electric razor;
    • Use an emery board nail file.
  • Apply firm pressure for 5 to 10 minutes to stop bleeding if you cut yourself. Tell the medical team immediately if the bleeding persists for more than 15 minutes.
  • Protect your oral mucosa:
    • Avoid foods that may be irritating due to their acidity, spiciness, temperature or texture;
    • Protect your lips against chapping and dryness;
    • Clean your teeth with a soft brush;
    • Gently massage your gums (don’t use dental floss or toothpicks);
    • Gargle frequently to keep your mouth clean and bacteria-free;
    • Get your doctor’s approval prior to dental care.
  • Protect your gastrointestinal mucosa:
    • Drink plenty of water (two to three litres per day), unless otherwise specified by the medical team;
    • Exercise to prevent constipation;
    • Avoid the use of suppositories or strong laxatives;
    • Avoid enemas;
    • Avoid taking your temperature rectally.
  • Protect the lining of your airways:
    • Blow gently through both nostrils simultaneously, if you need to blow your nose;
    • Avoid blowing hard;
    • Sneeze with your mouth open, if necessary.
  • Protect the lining of your genitourinary system:
    • Drink at least 10 glasses (two to three litres) of fluids a day, unless otherwise directed by your medical team;
    • Avoid the use of vaginal douches and suppositories;
    • Use a vaginal lubricant during intercourse.
  • Have the treatment team verify your platelet count, and if it is abnormally low:
    • Avoid doing work that requires constant, demanding effort;
    • Avoid making forced exhalation with your mouth closed, while lifting heavy objects, standing up, or when on the toilet;
    • Refrain from lifting heavy objects with arms outstretched while leaning forward;
    • Avoid taking medications that may prolong bleeding time, e.g. aspirin and its derivatives, anticoagulants and alcoholic beverages.

Prolonged bleeding or hemorrhage can be serious enough to put your life in danger. You are advised to contact the oncology team in the following situations:

  • Nosebleed;
  • Blood in urine;
  • Blood in stool;
  • Blood in sputum;
  • Presence of several contusions (bruises) on the skin.

Report to emergency in the following cases:

  • Continuous nosebleed, even after applying pressure for ten minutes;
  • Vomiting blood;
  • Blood in the sputum accompanied by difficulty breathing;
  • For women: using more than one sanitary napkin per hour.
The mucous membranes in the mouth and throat are very sensitive tissue and are therefore more affected by certain treatments.

Useful tips

  • Eat as usual, but change the texture of food so as not to irritate your mouth and throat.
  • Cook food longer than usual.
  • Add broth, vegetable cooking water, milk soup or clear soup to cooked food.
  • Use baby food as a replacement for home-made puree if you are unable to cook.
  • Place these foods in the freezer for about five minutes before eating; their taste will be more enjoyable.
  • Mix pureed meat into soups, clear soups, creams and vegetable purees.
  • Grind nuts and grains into a fine powder and mix with yogurt, ice cream and fruit compote.
  • Avoid:
    • Strong and pungent spices, such as curry, chili, pepper, etc. Go for milder seasonings, such as herbs and onion powder;
    • Pickled or acidic foods (lemons, oranges, etc.);
    • Very salty or hard foods (vegetables, toast, nuts, etc.);
    • Vey hot food (let it cool down);
    • Tobacco and alcoholic beverages.
  • Put the meal through a blender: when pain in the mouth or throat makes it difficult or impossible to handle solid food, putting the food through the blender is the ideal solution. By altering the texture of food, you can eat what the rest of family is eating at any time, and even try out new recipes. Here are some tips for better mixing:
    • Make sure meat is cooked before putting it into the blender;
    • Cut cooked food and bread into cubes;
    • Melt butter and margarine before adding, so that they blend better with other foods;
    • Add enough liquid to achieve the desired consistency. One portion of liquid to one solid portion usually produces the right consistency;
    • Season less liberally, because the taste is more pronounced in a liquid meal than in a solid meal.

Stomatitis: definition

An inflammation of the mouth and a potentially ulcerous, uncomfortable and painful condition that primarily affects the oral mucous membrane, the soft palate, the anterior part of the tongue and the floor of the mouth, and may be accompanied by infection. Associated symptoms may make chewing, swallowing and speech difficult. Radiation therapy to the region of the head and throat (ENT sphere cancers) and certain chemotherapies are the most common causes of stomatitis.

Signs and symptoms

  • Redness and swelling at the corners (junction) of mucosal tissue and on the lips.
  • Sensation of dryness and burning in the mouth.
  • White spots on the tongue and mucous membrane, accompanied by a metallic taste in the mouth; these spots detach easily to reveal a red, ulcerated surface;
  • Appearance, especially on the lips, painful and irritating vesicles (blisters), that itch and are filled with pus (herpes simplex);

Helpful hints

  • ​Have a high protein snack following the treatment session.
  • Favor a soft, nutritious diet.
  • Start the meal by lubricating your mouth with a tablespoon of cream or oil.
  • Take small sips of water between bites to moisten your mouth.
  • Avoid liquids coming into contact with an irritated mouth by using a straw.
  • Consume iced foods or liquids to help relieve the symptoms of irritation.
  • Rest in a sitting position in a quiet room (avoid lying down for at least two hours after eating).
  • Examine your mouth every day, morning and night, and note any changes in the appearance and texture of your mouth, lips, gums, teeth, saliva and tongue.
  • Monitor any change of taste in your mouth and in your taste perception.
  • Drink ice water or suck ice cubes for 30 minutes during chemotherapy.
  • Maintain oral hygiene:
    • Clean your mouth within 30 minutes after eating and repeat every 4 hours;
    • Avoid commercially-available toothpastes and mouthwashes as well as antiseptics based on glycerine and lemon because they contain chemicals that irritate and dry out the oral mucosa;
    • Replace your usual toothpaste and mouthwash with a solution of water, salt and baking soda:
      • Recipe: mix one teaspoon of salt and one spoonful of baking soda with one litre of boiled water. This solution must be prepared daily and kept at room temperature;
    • Gargle for at least 30 seconds with 15 ml of this solution, spit and repeat 4 times a day, more often if necessary;
    • Brush your teeth with a soft brush or a foam mini-brush at least twice a day and floss once a day if tolerated (do not floss or use toothpicks if gums are bleeding);
    • Clean dentures just as often; if your mouth is very painful, only wear them to eat;
    • Keep lips moist with cream or ointment for the lips;
    • Drink two to three litres of fluid per day, unless otherwise directed by the medical team.
  • Avoid alcohol, tobacco and foods that can irritate the oral mucosa due to their acidity, seasoning or texture.

Stomatitis can be very painful and uncomfortable. We advise you to contact the oncology team in the following situations:

  • Presence of painful or bleeding ulcers (four or more);
  • Unrelieved pain;
  • Significant weight loss for one or two weeks;
  • Inability to drink or eat;
  • Difficulty breathing.

Dry Mouth (xerostomia)

Some treatments that affect the salivary glands can reduce saliva production. They can also make your saliva thick and sticky. This results in discomfort, influences food intake and increases the risk of cavities. It is common in people receiving radiation therapy to the head and throat (ENT). Rigorous oral and dental hygiene is required to counter or mitigate these effects.

Helpful hints

  • Drink two to three litres of fluid per day, unless otherwise directed by the medical team.​
  • Eat popsicles or drink iced water or unsweetened fruit juice.
  • Eat sweets or sugarless gum designed to promote salivation; you can find these in pharmacies.
  • Eat meat together with sauce and broth to help you swallow it more easily.
  • Avoid drinks and foods that make you thirsty: coffee, dark chocolate, salt, spices, alcohol, sauces and savory dishes.
  • Use a spray or gel saliva substitute (sold in pharmacies).
  • Prevent ulcers and tooth decay by maintaining good oral and dental hygiene.
  • Moisturize your lips with a cream or ointment for the lips.
  • Make sure to rinse your mouth in the morning because saliva that has accumulated during the night can cause nausea.
  • Use a mild mouthwash consisting of the following solution: one teaspoon of salt and one teaspoon of baking soda mixed with one litre of boiled water. Repeat several times a day, and continue to use it in addition to any mouthwash prescribed by the oncologist.
  • Brush your teeth after every meal.
  • Drink unsweetened or sugarless lime or lemon beverages or add some lemon juice to a glass of water.​
Lymphedema is a swelling caused by an abnormal accumulation of fluid in the subcutaneous tissue. There are two types of lymphedema: primary lymphedema, which may be present at birth or develop later, and secondary lymphedema, which is caused by damage to the lymphatic system due to trauma, surgery or radiation having affected the lymph nodes or vessels. (Source: Lymphedema Association of Quebec)

Signs and symptoms

  • Swelling, sudden or gradual, noticeable by the indentation left by pressing the skin or by tight clothing or jewelry.
  • Feel of heaviness, tightness.
  • Pain, throbbing or tenderness.
  • Swelling increases in hot, humid weather, or after exercise.

You need to be on the lookout for symptoms and see a doctor or a specialized lymphedema therapist upon the onset of symptoms, since early treatment helps minimize swelling and reduce complications. Request immediate medical treatment if the following signs appear (cellulitis):

  • Spreading redness or rash, accompanied by itching;
  • Increased swelling;
  • An increase in skin temperature;
  • A sudden fever and chills.

Preventing lymphedema after a dissection

For those who have had a lymph node dissection (removal of nodes from the armpit) following breast surgery, steps need to be taken to resist infection and to facilitate circulation, since their defense system on the operated side has been modified. In addition, the skin in the operated area is more sensitive, which is why extra care needs to be taken.

IMPORTANT: These precautions do not apply to those who have only had a sentinel node biopsy.

Helpful hints

  • Protect your skin and devote meticulous attention to reducing the risk of infection (cellulitis).
  • Cleanse the skin thoroughly with mild soap, dry well and apply a moisturizer.
  • Be very careful to avoid cuts, scrapes, splinters and stings. Use an electric razor to avoid cuts and skin irritation.
  • If cut or scratched, clean the wound with soap, apply a disinfectant and, if necessary, an antibiotic ointment.
  • Protect skin with sunscreen with a high sunburn protection factor and with mosquito repellent to avoid bites and insect bites.
  • Exercise regularly to reactivate blood flow in the operated arm.
  • Avoid moving or carrying very heavy objects with the operated arm, and until functional recovery of the arm.
  • Make sure not to have any tight sleeves, jewelry or bracelets on the operated side.
  • Avoid lying on your arm on the operated side if it tends to swell or is painful.
  • Inform the medical team if there is any swelling, itching, or skin discolouration in the operated area or swelling of the arm and hand.
  • Avoid, if possible, taking your blood pressure on the arm on the operated side.
  • Do not hesitate to use your arms, even if there is numbness in the arm on the operated side, since this is a normal phenomenon that gradually recedes.
  • Avoid, if possible, any blood tests or injections on the operated side, except in cases of extreme emergency. In addition, no vaccine should be administered to the operated arm.
  • Allow your nails to grow on the side of the operated arm; do not cut the cuticles. Avoid injury during the manicure.
  • Wear rubber gloves when washing in hot water, performing yard work or using steel wool.
  • Eating a balanced diet and maintain an average body weight.
  • Avoid extremes in temperature, such as intense cold or long exposure to high heat (e.g. hot tubs and saunas).

Additional precautions when traveling by air

  • Wearing a compression garment to prevent or limit swelling due to drop in atmospheric pressure.
  • Consult a qualified therapist before a flight.
  • Move the affected limb often during the trip flight keep the lymph fluid moving.
  • Drink enough water before and during the flight to avoid dehydration.
Please click on the following links for more information:

Le lymphœdème, c’est possible de le prévenir et de le traiter. (French only)

(Sources : www.infolympho.ca and www.centredesmaladiesdusein.ca/fileadmin/cha/Microsite/CMS/traitements1.pdf)

Exercise

To prevent lymphedema or improve fitness, the kinesiologists at the Quebec Cancer Foundation offer a personalized program that includes specific exercises, such as crunches, rotations and exercises with weights, to those affected by cancer . Call the nearest regional center to make an appointment with a professional. 

Régie de l'assurance maladie du Québec Assistance Program

A multilayer repayment program for bandages and compression garments used to treat lymphedema has been available since January 1, 2014. This program contributes toward improving access to treatment, since lymphedema is still not covered under the public insurance plan. For details, visit Portal santé mieux-être du government du Québec.
 
Skin conditions are some of the temporary, occasional effects of chemotherapy. The most frequently observed signs include dry skin, changes in color, increased sensitivity to sunlight, ulcers or acne reactions. During combined chemotherapy and radiotherapy, a rash may develop on an area of the body that has been irradiated.

The skin on the area treated by radiotherapy may become red, irritated, tanned or appear to be suffering from a sunburn. These predictable side effects should clear up after the end of treatment.

Useful tips

  • Don’t use soap, cosmetics, perfume, ointment that is not prescribed by your doctor, sun lamps or hot water bottles;
  • Use only lukewarm water, never hot;
  • Don’t expose the treated area to sun and cold;
  • Avoid wearing scratchy fabrics and tight-fitting clothing;
  • Use mild soap to wash clothes that come in direct contact with the skin;
  • Avoid public pools;
  • Avoid rubbing, scratching or massaging the skin; if you experience itching, your doctor may prescribe a cortisone spray.
While undergoing chemotherapy or radiation therapy, some people notice that their food has a bitter or metallic taste. Others find meat to have an unpleasant taste. Flavours, such as sweet or salty, can also be perceived differently.

Helpful hints

  • Brush your teeth before each meal with a soft brush so as not to irritate your mouth.
  • Avoid mouthwashes containing alcohol.
  • Start your meal with fresh fruit.
  • Give preference to your favorite foods.
  • Eat food cold or at room temperature rather than hot.
  • Replace beef and pork with other sources of protein (chicken, fish, tofu, beans, chickpeas, lentils and other legumes).
  • Incorporate meat into soups and sauces, cut into small pieces or pureed.
  • Before cooking meat, marinate it in sweet fruit juices, Italian dressing, or sweet and sour sauce.
  • Sprinkle hot or ready-to-serve cereals with ground nuts.
  • Season meat with various spices or herbs, such as basil, oregano or rosemary.
  • Avoid very hot spices (paprika, pepper, mustard, etc.) and pickled or salted foods.
  • Try eating sour foods (unless they are painful to the mucous membranes in your mouth) such as oranges, lemonade, cranberry juice, pickles and pineapples, in order to promote salivation and reduce the metallic taste.
  • Mask the bitter, metallic taste in the mouth with fruit, chewing gum and sugar-free lemonade.
  • Use plastic utensils if the food has a metallic taste.
  • Eliminate foods that have a strong odour (coffee, certain fish, cabbage, onions, broccoli, etc.).
  • Rinse your mouth several times a day because food tastes better when your mouth and teeth are clean:
    • Recipe: mix one teaspoon of baking soda and one teaspoon of salt in one litre of water.
  • Eliminate unpleasant odours from the air.
Nausea and vomiting are often temporary and do not affect everyone receiving treatment for cancer.
  • Nausea: subjective feeling of being about to vomit.
  • Vomiting: sudden expulsion by the mouth of the stomach contents with or without heaving.
Here are some tips that can help those affected.

Helpful hints

  • Take anti-nausea medication as prescribed by the doctor at the onset of nausea.
  • Take anti-nausea medication 20 to 30 minutes before meals.
  • Drink clear fluids such as water, sports drinks, broth and ginger ale.
  • Eat five or six small light meals or snacks per day. Choose times when nausea is less pronounced, even at night. Eat in a relaxed atmosphere and take time to rest afterwards. Lying down is not recommended; a sitting or half-sitting position is best (place two or three pillows under your head, as needed).
  • Eat mostly cold or lukewarm food.
  • Avoid strong odours.
  • Avoid fried, spicy, fatty or very salty dishes.
  • Choose foods that are pleasant to the taste or make you feel less nauseous.
  • Do not force yourself to eat if you feel nauseous.
  • Use relaxation or meditation techniques.

Helpful hints: vomiting

  • Limit intake of food and drink when vomiting occurs, and until it stops.
  • From 30 to 60 minutes after vomiting, gradually consume clear liquids. If clear liquids are tolerated, try eating dry foods like crackers, toast, dry cereal and pretzels. If these are tolerated, add foods rich in protein, such as eggs or chicken.

Severe vomiting can cause dehydration and greatly weaken a person. It is advisable to contact the oncology team when the following situations arise:

  • Five or more vomiting episodes per day;
  • No food for 24 hours
  • Inability to ingest liquid without vomiting;
  • Signs of dehydration include dizziness, dry mouth, skin folds, thirst, decreased urination, more concentrated urine, and increased heart rate;
  • Blood in vomit;
  • Severe associated abdominal pain;
  • Inability to perform everyday activities. 
Peripheral neuropathy is the result of damage to peripheral neurons caused by a chemotherapeutic agent.
 

Symptoms

  • Tingling, burning, weakness or numbness in the hands or feet.
  • Difficulty walking or pain while walking.
  • Weak, sensitive, tired muscles with painful twinges.
  • Loss of balance, clumsiness.
  • Difficulty picking up objects and buttoning clothes.
  • Tremors.
  • Jaw pain.
  • Hearing loss, tinnitus.
  • Stomach pain.
  • Constipation. 
Inform the treatment team if one or more symptoms appear, as an adjustment in the chemotherapy dose, a change in medication or initiation of a special treatment or monitoring may prove necessary. The damage sometimes does not disappear completely. 

Helpful hints

  • Check for the presence of numb patches in the hands or feet, every day.
  • Exercise caution when handling sharp, hot, cold or dangerous objects.
  • At home, keep passageways clear and remove carpets and rugs you could trip on.
  • If muscle strength or balance is reduced, move slowly and use handrails.
  • If you feel dizzy, take the time check your balance before getting up.
  • Use a rubber mat in the tub or shower.
  •  
  • Wear comfortable shoes.
  • Avoid very hot or very cold water and, if necessary, consider turning down the thermostat on the water heater.
  • Avoid drinking alcohol, as it may worsen symptoms.
  • Maintain adequate hydration and a high fiber diet.
  • Ensure that your home temperature remains temperate, because extreme heat or cold could worsen symptoms.
  • Consult a physical or occupational therapist if technical assistance (cane, walker), an exercise program or adapted equipment is required.
Videos (in French only)
 

Febrile neutropenia is the most common complication of chemotherapy. In people with cancer, especially those receiving chemotherapy, the white blood cell count can be lowered considerably.

Neutrophils are part of the white blood cells produced by the bone marrow; they play an important role in preventing infections as they are the body's first line of defense.
Neutropenia is an abnormally low level of neutrophils and increases the risk of infection. It most often occurs is between 7 to 21 days after the last chemotherapy was administered; this period is called the nadir.

When neutropenia (low white blood cell count) is accompanied by fever and other signs of infection, it is known as febrile neutropenia, and is characterized by the following:
  • Neutrophil count (number) <1000 (normal: between 3000 and 7000);
  • Fever of 38.3°C or 38°C for an hour or more. 

Common symptoms

  • Increased body temperature (may be the only symptom).
  • Chills and tremors.
  • Mild hypotension.
  • Sight confusion.
  • Flu-like symptoms.
 Useful hints for preventing febrile neutropenia
  • Wash hands frequently. One good tip: always carry a small bottle of liquid hand sanitizer.
  • Drink two to three litres of fluid per day, unless advised otherwise by the medical team.
  • Do not eat the following foods: raw milk cheeses, sushi, raw meat, raw eggs and other foods that have stood at room temperature for a long time (e.g. buffets).
  • Use a toothbrush with flexible bristles.
  • Remove your dentures at night.
  • Take a shower or bath every day.
  • Avoid the use of suppositories, enemas or other invasive procedures.
  • Avoid crowds and people who may be ill.
  • Keep any wounds clean and dry.
  • Handle cat or bird litter or birds with gloves.

WARNING!

Anyone receiving chemotherapy, must report to emergency if their body temperature is 38.3°C or 38°C for an hour. Do not take acetaminophen or anti-inflammatory medication, which could mask fever.
 

Importance of treating febrile neutropenia

Among the major side effects of chemotherapy, the most serious are febrile neutropenia and infection.
 
Untreated, febrile neutropenia can cause serious infections that may require hospitalization and even put the life of the patient in danger. The oncology team will verify the number of white blood cells prior to each chemotherapy cycle. If this number is too low, some chemotherapy treatments can be postponed for a few days. For others, treatment will be administered to alleviate neutropenia.
 
You should talk with the oncology team to learn about the risk of febrile neutropenia associated with the treatment you are about to receive.
  
(Source : Neutropénie fébrile : ce que les patients et les aidants doivent savoir)
 
References
In most cases, people with cancer who are receiving chemotherapy experience disruptions in appetite. These problems are often the result of the cancer and its treatment and may also arise from emotional and social factors associated with the disease.

Helpful hints

  • Take advantage of your most active and convenient moments by:
    • Eating foods with high nutritional value;
    • Consuming energy or protein drinks such as Ensure or Boost;
    • Eating outside of mealtimes (be guided by your appetite);
    • Preparing frozen meals that you can appreciate at difficult moments.
  • Eat small snacks during the day and choose foods that are rich in protein and calories:
    • Malted milk, ice cream, peanut butter;
    • Grated cheese on vegetables and in soups, stews and casseroles;
    • Desserts made with eggs, such as puddings and custards;
    • Addition of powdered milk to cereals, scrambled eggs, sauces, creams and desserts.
  • Make meals a time of pleasure and relaxation:
    • Pay special attention to atmosphere and lay the table with care;
    • Eat five or six small meals a day;
    • Stimulate your appetite though smell and sight;
    • Focus on meals served at room temperature; these are easier to tolerate than hot meals;
    • Eliminate “light” low-sugar or low-fat products, unless there is a medical need;
    • Go for foods that stimulate your appetite: sorbets, apples, crackers, alcoholic beverages, chewing gum, broth;
    • Maintain good oral hygiene;
    • Be guided by your appetite in planning meals;
    • Opt for light cooking; fried food is harder to digest;
    • Avoid drinking during meals;
    • Eat slowly and chew thoroughly;
    • Consume liquids, such as beverages and soups, at the end of the meal;
    • Keep your favourite foods within easy reach;
    • Vary menus by using frozen meals in individual portions;
    • Accept help from friends and family in preparing meals.
  • Stay as active as possible. Do some moderate physical activity, such as walking for 15 to 20 minutes (once or twice a day) or for 30 to 60 minutes (3 to 5 times a week).
The Quebec Cancer Foundation has a large number of books on diet and cancer treatment, many of which feature recipes. Check out the Vivre avec le cancer section (In French only).
Hair loss is a common side effect of some chemotherapy; onset usually occurs after two or three weeks of treatment. In the case of radiotherapy, hair loss only occurs in the area treated with radiation, but with chemotherapy it can occur all over the body. Hair loss may be gradual, barely noticeable, but can also occur abruptly. In any event, it is a hard experience to endure.

The hair usually grows back after treatment is completed. As it is growing back, the texture and colour may be different. It may sometimes be thicker and stronger than before. These effects are usually temporary; the hair will resume its previous appearance after a while. Despite this reassurance, hair loss is often experienced, very understandably, as an attack on personal integrity that adds to the anxiety already felt about coping with the illness. Most people treated with chemotherapy nevertheless consider hair loss to be a reasonable price to pay in exchange for a remission of the disease and the hope of a cure.

Helpful hints
 

  • Caring for the hair and scalp:
    • Use a very mild shampoo and conditioner to untangle hair.
    • Wash your hair every four to seven days;
    • Rinse your hair thoroughly and gently pat dry with a towel;
    • Avoid using electric dryers, styling rollers, curling irons, elastics, hair clips and clamps;
    • Avoid hair colouring as far as possible; otherwise, use a plant-based dye. At the end of chemotherapy, it is recommended that you wait at least six months before applying your usual dye. You may also continue using a vegetable dye;
    • Never use permanents;
    • Keep your hair short.
  • Ways to slow hair loss:
    • Avoid brushing your hair vigorously;
    • Use a satin pillowcase or antistatic tissue on the pillow to reduce friction against the scalp;
    • Wear a hairnet to bed;
    • Learn about the methods used by the medical team to reduce the effects of certain chemotherapies during treatment sessions.
  • Ways to minimize the impact of hair loss:
    • Wear turbans, scarves and hats to conceal hair loss. Harmonized with the rest of your outfit, these accessories can be attractive;
    • Sign up for a "Look Good Feel Better" workshop to help you choose headwear, or for makeup tips;
    • Shop for a wig before the start of treatment. Choosing the colour and style will be easier before hair loss begins. However, the presence of hair can make the fitting more difficult, even impossible. In this case, a photograph can be useful in helping you choose; 
    • Give the maximum of importance to choosing a wig; if it is flattering, it will be as pleasant to wear as a new article of clothing. Visit several places where wigs are manufactured and sold to compare value, comfort, weight, after-sales maintenance and repair services, ease of upkeep at home, etc.
    • Ask someone you know who understands how important this purchase is for you, to accompany you.
Chemotherapy and radiation can produce skin reactions of varying intensity, such as changes in the colour, texture or integrity of the skin and mucous membranes (e.g. inside the mouth, nose, etc.). The most common side effects include dry skin, changes in colour, increased sensitivity to sunlight, ulcers and acne reactions.
 

Helpful hints

  • Use only topical medication (cream or ointment) that is recommended or prescribed by the oncologist.
  • Avoid soaps and scented products based or petroleum jelly or alcohol.
  • Have showers or baths in lukewarm water with mild, non-perfumed soap.
  • Dry the skin by dabbing (do not rub).
  • Use a natural water-based moisturizing cream, without perfume or lanolin, only on intact skin.
  • Avoid exposing the treated area to sun and cold.
  • Use an SPF 30-60 sunscreen as needed, and follow the instructions for applying it.
  • Wear loose clothing.
  • Avoid rubbing, scratching or massaging irritated skin.
  • Use an electric razor or do not shave the irritated area.
  • Avoid waxes and depilatory creams.
  • Avoid extreme temperatures (e.g. no ice packs or heating pads on the skin).
  • Avoid applying adhesives to irritated skin.
  • Use artificial tears, drops or gel in the event of dry eye or tearing.
  • Apply a moisturizing gel inside the nostrils in the event of dry nose.
  • Use a mild soap to wash clothes that come in direct contact with the skin.
  • Avoid public pools.
In general, chemotherapy disrupts the reproductive functions of both men and women. Women may experience irregularity, even an interruption in the menstrual cycle, or the occurrence of hot flashes, especially as they approach menopause. However, it is still possible to get pregnant. It is therefore strongly recommended to use contraception. Chemotherapy can have a harmful effect on fetal development.

Women of childbearing age should talk with a member of the medical team about the best choice of contraception during treatment, family planning, future projects and their family. In most cases, once chemotherapy is completed, the menstrual cycle will resume as before, and a normal pregnancy may be considered, depending on the doctor's advice.

In men, there may be a decrease in sperm count and lessened sperm viability. This decrease in fertility in no way hinders erection and sexual activity. Some chemotherapy treatments can permanently impair fertility.

Hence, chemotherapy can affect fertility in women and men, but it does not compromise the ability to have sex. On the other hand, it is possible that anxiety about the illness, fatigue and a diminished sense of well-being can temporarily result in lower sexual desire.
Cancer treatments generally have a disruptive effect on sexual activity. Usually this is a temporary situation. Fertility and reproductive performance, however, may be compromised permanently.

Note that certain treatments, such as surgical or radiotherapy interventions on the reproductive organs, have specific side effects that are not dealt with in this section.

Side effects associated with chemotherapy

In general, chemotherapy disrupts the reproductive functions in both men and women.
In women, there is often an irregularity of the menstrual cycle and even an interruption of menses or the onset of hot flashes, especially upon the approach of menopause. However, pregnancy is still possible. Women should not plan to become pregnant during chemotherapy and should therefore use adequate contraception. Women of childbearing age should talk with a member of the medical team about the choice of contraceptive method to be used during treatment, about family planning, and about fertility preservation, if indicated. In most cases, once the chemotherapy is completed, the menstrual cycle will return to normal, and a normal pregnancy may be envisaged, as advised by the physician.
 
In men, there is a decrease in sperm count; endurance is also diminished. This decreased fertility in no way hinders attaining erection and engaging in sexual activity.
 
Some chemotherapy may permanently compromise fertility. Contraception and means of preserving fertility should be discussed with a member of the treatment team.
 
Chemotherapy can therefore affect the fertility of both women and men, but does not compromise the ability to have sex.
 

Warning!
When receiving chemotherapy, blood and body fluids, including vaginal secretions and semen, become temporarily toxic. This condition can last for up to four days after receiving the drug (chemo). Consequently, condom use is highly recommended when having sex at such times.
 

Generally, libido (sexual desire) is affected throughout the chemotherapy and may continue some time afterwards, due to various proven side effects. However, at the end of treatment, when the individual feels better and the side effects have faded or disappeared, desire usually reverts to its usual level.

Remember that the mere physical presence of someone person receiving chemotherapy or external beam radiation is not dangerous.

There is no danger related to hugging and kissing a person receiving chemotherapy or external beam radiation therapy.
 
Do not hesitate to ask for help with any concerns you may have related to sexuality. The treatment team will be able to provide you with adequate information or recommend appropriate professional help, as needed. 

Fertility

See Section Fertilité: démarches à faire pour la préserver (avant le traitment). (French only)
 
The urinary tract system contains two kidneys, which filter your blood to remove waste through your urine. The urine remains in the bladder between evacuations (micturition) to eventually be eliminated through the duct known as the urethra.

The destruction of cancer cells increases the amount of waste that the kidneys have to filter, so it is important to provide the amount of liquid required to properly remove the surplus. In addition, some chemotherapies are nephrotoxic, that is to say, they can harm the kidneys when they are filtered.

Helpful hint

  • Drink as much liquid (water, juice, soup, yogurt, malted milk, etc.) as possible: about ten glasses (two to three litres) per day, unless the medical team instructs you to restrict daily liquid intake (fluid restriction).

Urinary incontinence

Another common side effect is urinary incontinence. This is usually associated with surgical treatment or radiation therapy and mainly occurs in those affected by prostate and bladder cancer. We will not deal with how to manage this adverse effect in this section. However, we invite you to click on the following link for information on the topic: Ne choisissez pas la fuite.
 

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