Common questions when undergoing chemotherapy

By Jeni Jones, Support Manager, Pancreatic Cancer UK

What is chemotherapy?

Cytotoxic chemotherapy is a type of drug treatment used in the treatment of cancer. It can be given either intravenously, or in tablet form. It works on tumour cells, but also on normal body cells, especially those which divide rapidly. It is normally given in "cycles" - 2, 3 or 4 weekly cycles are the most common. Within each cycle, there may be more than one "dose" of chemotherapy.

Will I get side effects?

Chemotherapy does induce side effects. Most of the time, the side effects are manageable, and medication may be given to counteract them. As a general rule, the vast majority of people who undergo chemotherapy will get some side effects but it is unusual for every person to get all the documented side effects. Side effects can include nausea, vomiting, sore mouth, loss of appetite, taste changes, diarrhoea, constipation, hair loss, skin rashes, including changes to the nails, tingling /numbness in the fingers and toes, soreness of the hands and feet, tiredness, joint aches, swelling of the ankles, watery eyes, and vein pain.

The most important side effect is that it can affect the blood count, so there may be anaemia; low platelets, leading to bleeding; or low white cell count, specifically the Neutrophils, which would leave your body susceptible to infection. Occasionally, a person may have a rare or undocumented side effect to the chemotherapy. If this happens, the medical team will do their best to treat it.

What if I get a temperature?

If the neutrophil count drops significantly, it can result in an infection. This can be something picked up from outside, or even, from within the body. The body contains healthy colonies of bacteria, which are harmless most of the time. However, when the neutrophil (cells which fight infection) count drops, these bacteria can become harmful. If the body picks up an infection, one of the ways it has of alerting you that something is wrong, is that your temperature goes up.

Your body may react to a temperature by shaking or shivering, which is the body's way of cooling down. You may have a headache, feel generally unwell and lethargic. If this happens, you should check your temperature. Every person having chemotherapy should have their own thermometer, for personal use. These can be purchased from any chemist. The best ones to get are the digital thermometers. Occasionally, chemotherapy units may give them out free of charge.

The temperature may be checked via the mouth or under the arm with the digital thermometer. It should be in degrees centigrade, and not Fahrenheit. If you are phoning the hospital, it is important to state by which route it was taken, as the under arm temperature reads slightly lower than the oral temperature. During chemotherapy, a temperature of 38 degrees centigrade is classed as high. You should phone the chemotherapy unit or out of hours number given to you if this happens. It should not be necessary to go via your GP, as once on chemotherapy, there is provision made for you to be seen as an emergency either in the chemotherapy unit during the day, or on the oncology unit out of hours. This is classed as a medical emergency, and requires URGENT medical treatment. It is important not to ignore these signs or think that they will settle down, as this rarely happens without medical help. You will need to go to the hospital and be admitted for intravenous antibiotics, which will fight the infection in the place of the neutrophils in your body, which are too low to do it. Over time, the neutrophils will recover, and you will be discharged home when your medical team think you are ready. This type of infection is known as NEUTROPAENIC SEPSIS.

It is also possible that you may pick up an infection, but the neutrophil count will remain normal. For this, you still need to be seen at the hospital, but may be allowed to go home on oral antibiotics.

Can I take paracetamol while undergoing chemotherapy?

Paracetamol is generally a very safe and effective pain killer. However tt also lowers the body's temperature, and therefore should be used with caution during chemotherapy. This is because it may mask an underlying infection by lowering the temperature and making you feel better. However, it will not correct the infection.

You should always check your temperature before you take paracetamol. If it is normal, it is safe to take it; if it is high, you should avoid taking it. If in doubt, you should consult your oncology team.

Can I drink alcohol?

Yes, you may drink alcohol when you are undergoing chemotherapy. Sometimes, the taste of alcohol may change, so you might find you go off it. It is advisable not to over-indulge in alcohol, as it may contribute to nausea.

Can I have a flu jab?

Yes, it is fine to have a flu jab. If convenient, it might be better to have it before you start chemotherapy, but if this is not possible, you may still have it during treatment.

Will I lose my hair?

The type of chemotherapy used for pancreatic cancer does not cause hair loss. You may find that your hair thins slightly, but you should keep most of it. You can minimise the amount of "friction" caused to the hair follicles by leaving it to dry naturally after washing. It is also good to use a gentle shampoo, such as baby shampoo. Avoid excessive brushing, combing or straightening. Only use hair products when absolutely necessary. If the hair is very long, you may want to consider having it cut to a shorter length, again to avoid pulling on the follicles, which can cause the hair to fall out.

Can I visit a dentist?

During chemotherapy, your blood count may be affected, and this might lower your resistance to infection. Because of this, it is not recommended that routine invasive dental work is carried out once you have commenced chemotherapy treatment. Of course, emergency dental work is unavoidable, such as treating an abscess, repair of cracked/damaged teeth, and extraction of decayed teeth which are causing problems or toothache. It is a good idea to let your dentist know you are having chemotherapy before any invasive work is carried out  and you should have a full blood count to exclude a risk of infection (low neutrophils level) or risk of bleeding (low platelets level). It is better to have this done at the chemotherapy unit, so they can tell you the result immediately, and record what dental work you are to have done in your notes.

It is also a good idea for your dentist to put you on antibiotics as a precaution after the work has been carried out. These can sometimes be for a shorter period than the usual course of antibiotics. Regular dental check-up appointments should be rescheduled until after chemotherapy. You may have treatment from the hygienist if absolutely necessary.

Can my family visit?

Yes -you should lead as normal a life as possible. Seeing your family (including grandchildren) can be very uplifting, and motivates a lot of people. As long as you are not exhausted by constant visits, or lengthy interactions, then it is up to you how often you want them to visit. If you know that a member of the family is obviously sick, then it is better to avoid seeing them until they are well again. This is particularly relevant to young children, who pick up bugs in the school environment. Planned days out can be a relief to the routine of hospitals, and are good for fresh air too!

Can I work during chemotherapy treatment?

The short answer is, yes, if you feel up to it. However, you may not be able to work reliably and will therefore need to agree a flexible working routine with your employer during treatment. . In particular you may get tired, so shorter working days might be advisable. You will be entitled to sick pay if you choose not to work -check the regulations with your own employer and get it in writing at the start of treatment.

Teachers, however are advised not to work due to their environment, although they may carry on working if non-classroom work is available.

Can I use public transport?

Yes -, if this is your means of getting around, carry on as normal. Be aware that there may be people with coughs and colds around you, but it is unreasonable to live as a hermit during chemotherapy! Follow routine hygiene practices, such as washing the hands.  Similarly, you cannot avoid going out in a crowded area for the duration of chemotherapy. It is about using your common sense, and looking after yourself.

When is the best time to have chemotherapy after an operation?

You should be well recovered from the operation. The wound should be healed with no signs of infection and sutures/clips etc should have been removed. You should be able to eat and drink well, and be back to some level of normal activity and fitness before starting chemotherapy treatment. Your bowels should also be functioning normally. Any post-operative complications should be resolved e.g. chest infections, bleeding etc.
The best time to start chemotherapy is normally 6-8 weeks post-operation. However, it is possible to still commence chemotherapy after 10-12 weeks. After this time period the benefit from chemotherapy treatment lessens.

What about the sun?

Some chemotherapy can cause increased sensitivity to sunlight. Although this is only documented as a side effect of one or two particular drugs, the experience of many patients on other drugs is that they burn much easier. You should avoid direct sunlight, especially from noon to 3pm. Even the "British sun" can cause increased burning at these times. Always wear sun protection cream with a fairly high factor, especially in warmer climates. Cover the head and neck by wearing a hat (especially for bald heads). Stay in the shade wherever possible and drink plenty of fluid to keep hydrated.

If the start of chemotherapy treatment is delayed, will the cancer grow?

Most chemotherapy will be started at the right time for the patient. If it seems like there is a delay, then it is unlikely that the cancer will grow significantly during that time. Unless the cancer is very advanced, then you should not worry that it will grow more. When cancer is at the stage where it is growing rapidly, then unfortunately it is more than likely that the patient would not be fit for chemotherapy.

If a dose is delayed or reduced, will this affect my treatment?

No, your treatment will not be compromised by this. To treat a person effectively, the oncologist needs to balance the amount and intensity of side effects with treating the cancer. If the patient's body is not coping with the side effects, then a dose reduction may be necessary to prevent further harmful effects on the body. This will enable the treatment to continue as planned, without further delays prior to every cycle.

Chemotherapy affects healthy body cells as well as the cancerous ones. There are guidelines and protocols as to what action to take when a person experiences certain side effects e.g. if a patient has one cycle of chemotherapy, and has a serious drop in the neutrophil count leading to an infection, then safe practice would be to reduce the dose of subsequent cycles by 25%. This will make it "safe" for that patient. Other reasons to reduce the chemotherapy dose would be very bad nausea/vomiting; very bad tingling and numbness in the hands and feet, very bad diarrhoea etc. Be assured you will be given the right dose for your body to handle.