Taste changes

Some chemotherapy drugs cause taste changes and a dry mouth. Try using hard candy like lemon drops or non-alcohol mouth washes to help.

Mouth sores

Certain types of chemotherapy can cause mouth sores. Tell us if you experience open sores or any soreness in your mouth.

You can make a salt water and baking soda rinse by combining 1 cup of warm water with ¼ teaspoon each of salt and baking soda. Other ways to treat mouth sores include:

• Postponing your chemotherapy treatments until the sores heal
• Getting good oral care
• Drinking plenty of water for hydration
• Using mouth rinses such as Biotene® or non-alcohol-based mouthwashes
• Getting medicated mouthwashes available by prescription, to help with discomfort so you can eat
• Avoiding spicy or acidic foods

Mouth care

If you have mild soreness or mouth redness:

• Brush with a soft toothbrush 4 times per day, and floss daily.
• Apply a lip moisturizer.
• Avoid consuming very hot liquids.

Mouth rinse recipe

• 1 tablespoon of baking soda and 1 tablespoon of salt in 2 pints of water. Swish and gargle 4 times a day.
• Avoid over-the-counter mouth rinses like Listerine® or Scope.
• Biotin Mouthwash 3 times daily (to help prevent mouth sores)
• Stomatitis cocktail (prescription numbing mouthwash if you develop mouth sores)

Constipation

This digestive disorder can result from taking certain pain and anti-nausea medications and from some chemotherapies. We recommend:

• Drinking plenty of water to stay hydrated
• Getting regular exercise
• Taking a stool softener or laxative recommended by your doctor

Options your care team may recommend include:

• Colace 100 mg (docusate sodium): Take 1 to 2 tabs twice daily (stool softener).
• Senokot: Take 1 to 2 tabs twice daily for constipation.
• Miralax 17 g: Mix with water or juice and drink daily (this is a good medication for daily maintenance; it does not work well once you are constipated).
• Smooth move tea (gentle) for those who are more sensitive to laxatives. It is available at Whole Foods or other natural grocers.

Other more natural options that may work for you:

• Drink 2 to 3 liters of fluid per day (especially if you take fiber supplements or have a high-fiber diet).
• Try to get moderate exercise 20 to 30 minutes per day.
• Limit alcohol to 1 glass per night.
• Try ground fresh flax seeds over your cereal. It also tastes great toasted then ground with a little salt.
• Try fresh celery sticks.
• Try prune juice or pureed prune baby food (still a great option after all these years).

Diarrhea

This condition can be a side effect of certain types of chemotherapy and targeted therapies and can leave you vulnerable to dehydration. Our recommendations include:

• Tell your care team if you have diarrhea for more than 2 days, if you have had more than 3 episodes of diarrhea in a day, or if you notice blood.
• Eat bland foods that are gentle on your digestive system, such as the BRAT diet: bananas, rice, applesauce, and toast.
• Stay hydrated by drinking plenty of water or electrolyte drinks to replace needed nutrients.

Some people will alternate between constipation and diarrhea during the chemotherapy. If you have diarrhea:

• BRAT diet: bananas/rice/applesauce/toast
• Drink plenty of fluids. Avoid sugary or processed foods that can exacerbate diarrhea.
• Imodium Over the counter, take as directed. Do not exceed 8 tablets per day. Call your care team if you have more than 3 loose stools per day.
• If Imodium is not effective, alert your care team for a prescription alternative (Lomotil)

Nausea, vomiting, and heartburn

Some chemotherapies can cause nausea and vomiting. Symptoms are usually the worst for the first 4 to 5 days after treatment. Not everyone gets nausea or vomiting. It depends on the type of chemotherapy you are having.

Typically, your team will prescribe you an anti-nausea regimen before your chemo starts. Be sure to pick it up from the pharmacy before your chemo starts. Be sure to call if you have severe nausea or vomiting. We can prescribe anti-nausea medications (anti-emetics) to prevent vomiting so that you can continue to eat and don’t become dehydrated.

This symptom is usually well controlled with the right medications. We rarely have patients who have vomiting after treatment. More commonly, patients will describe mild nausea or lack of appetite for a few days after treatment. The best way to treat nausea is to prevent it! We will give you medications during the chemotherapy and ask you to take some medications at home after to help prevent onset of nausea. These are the medications you should take with your treatment:

• Zofran (Ondansetron)
• Reglan (Metoclopramide)
• Zyprexa (Olanzapine)
• Compazine (Prochlorperazine)
• Decadron (Dexamethasone)

Start these medications the same night after treatment.

Take them on a schedule as below during the hours you are awake. Sometimes these medications need prior authorization from your insurance before you can get them- your pharmacy will let you know if you need this and our team will help you get it authorized. Not all chemotherapy will require a nausea regimen. We will tell you what we recommend you take.

• Drink at least 2 to 3 liters (8 to 10 glasses or 2 to 3 quarts) everyday unless directed otherwise by your doctor. Examples of fluids are water, juice, sports drinks, broth, popsicles, and jello.
• Avoid eating any raw fish, raw eggs, or raw meat. It is okay to eat fruits and vegetables, make sure to wash them well.
• Hand washing is the number one defense to fight off infection. Please be sure to frequently wash your hands when needed.

Muscle and joint aches

Muscle aches can be caused by chemotherapy. They typically start the day after treatment and can last for 2 to 3 days. Paclitaxel is one of the chemotherapy drugs we give that can cause this. You can take anti-inflammatory drugs such as Motrin/Ibuprofen or Tylenol to help with the pain. Warm packs, warm baths, and massages are also good options. Not everyone will experience these symptoms, and for some they may be very mild.

Neuropathy

More common neuropathy symptoms include numbness in your fingers or toes. If it extends to your hands, feet, ankles, or lower legs, call your care team right away to consider adjusting your chemotherapy dose.

If neuropathy interferes with daily activities such as writing, fastening buttons, or opening bottles, let us know. We can either reduce your chemotherapy dose or prescribe medications to treat the neuropathy, if the condition is painful.

Symptoms usually go away when treatment ends but can persist for months or, less commonly, for years.

Vision changes

Chemotherapy and anti-nausea medications can both cause vision changes, a rare side effect. The condition is temporary, so you won’t need a new contact lens or glasses prescription. Symptoms include:

• Blurred vision
• Red, itchy, or dry eyes
• Watery eyes

Published June 2019
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