On the day of chemotherapy and the next few days, our patients may feel tired and sluggish. At the same time, they can be sleepy, joyless, and inappetent. In this case, it may be necessary for the patient to be accompanied by relatives for the first few days. They may have difficulty driving. They may not be able to fully perform their daily activities. Nausea and vomiting, which we call early side effects and are the most common, can also manifest themselves in this period. After getting through the first few days, life starts to return to normal again. If the conditions are right, they can start working again. However, it is recommended that the person take a break from work during the treatment, and work part-time or in an environment that is arranged in a way that he/she does not get tired, if necessary.

Chemotherapy can damage fast-dividing normal cells as well as cancerous cells. In fact, this is the underlying cause of many side effects. Since our body has rapidly dividing normal cells, bone marrow, digestive system, reproductive organs, and hair follicles, side effects are most common in these regions. Oncology patients should be informed about possible side effects by submitting the treatment consent forms and obtaining approval.

Most of the side effects of chemotherapy treatment occur during treatment and disappear with the discontinuation of treatment. disappears. The disappearance time of the side effects may vary depending on the patient's body and the characteristics of the drugs used. Although very rarely, permanent organ damage and secondary cancer types can be seen in some patients, depending on the drugs used and the patient's health condition before treatment.

Today, many auxiliary methods can cope with the side effects of chemotherapy treatment. With the advancement of technology, new cancer drugs with fewer side effects have also started to be used in treatments.

Weakness in Chemotherapy

It is necessary to combat weakness, which is the most common complaint of cancer patients. Although the exact cause of weakness is not known, it is thought that it is caused by a single cause. In such a situation, along with various medications and complementary medicine methods that the medical oncologist may deem appropriate, patients can overcome weakness in the following ways:

• By using his/her energy rationally,
• By planning his/her daily activities well,
• By doing light walks and exercises,
• By preventing sleep problems,
• By trying to minimize the side effects encountered in chemotherapy treatment,
• By combating pain and depression,
• By paying attention to drinking plenty of fluids,
• By improving his/her nutrition level to the maximum level.

It will also be useful for patients to record the symptoms they experience during the day, note the changes in their energy levels and report them to the physician.

Nausea and Vomiting in Chemotherapy

Nausea and vomiting are not as much of a problem as before during treatment. With effective and new drugs in this regard, these side effects are much less common. It will be much easier to combat nausea and vomiting when the following precautions are taken into account as well as medications.

• Plenty of fluids should be taken one hour before and after, but not with meals,
• Meals should be chewed slowly and lengthily,
• A small amount of food should be eaten at frequent intervals,
• Meals should be eaten at room temperature or cold so that odors do not disturb,
• If desired, dry food should be eaten in the morning (if there are no mouth sores),
• 500 mg-1000 mg ginger or equivalent natural ginger should be taken daily,
• Cold, pulp-free, and sugar-free fruit juices such as apple or grape juice should be preferred,
• Loose clothes should be worn,
• When nausea occurs, deep and slow breaths should be taken,
• Various relaxation techniques should be used,
• Disturbing odors should be avoided,
• The person should have a rest by lying flat 2 hours after the meal,
• A light meal should be eaten before chemotherapy, but if nausea and vomiting occur during treatment, food should not be eaten a few hours before,
• Problems such as ulcers, gastritis, or reflux should be treated at the same time,
• Coffee, alcohol, and cigarettes should be avoided,
• Stressful social environments should be avoided.

Hair Loss in Chemotherapy

It is a temporary side effect. After the chemotherapy is completed, the hair starts to grow again. Sometimes the structure and color of the newly growing hair may be different. Not all chemotherapy drugs cause hair loss. The same drug may cause hair loss at different rates in different patients. Generally, hair loss starts in 3-4 weeks, sometimes it can be delayed even more. There may be an increase in sensitivity on the scalp after chemotherapy, it should be tried not to irritate and not be exposed to the sun directly. There is no harm in using wigs, bandanas, scarves, etc. after hair loss. For hair that has not been lost yet, methods such as dyeing, perm, and blow-drying should be avoided. 

Due to this temporary side effect, which depresses female patients more, patients with long hair are recommended to shorten their hair before starting treatment. The use of some drugs or ice caps that are claimed to prevent hair loss will not be beneficial.

Skin and Nail Problems in Chemotherapy

During chemotherapy, there may be temporary skin and nail changes that are usually not serious. For example, redness, rashes, itching, dryness, peeling of the skin, acne, etc. Some drugs can cause color changes on the skin along the vein where they are given.

Patients receiving chemotherapy should be protected from the sun, and should not go out between 10:00 and 16:00, when the sun is at its highest point, because permanent stains and rashes may occur on the skin. Sunscreens with an SPF of at least 20 should be used.

Color changes (darkening or yellowing), easy breakage, and vertical or horizontal lines may occur on the nails.

One of the important side effects of targeted smart drugs that have been used recently is that they cause widespread rashes on the skin. Seeing this side effect is accepted as an indication that it is effective.

When chemotherapy drugs are given intravenously, they may leak out of the vein between the tissues due to excessive movement of the arm. Some drugs can cause very serious tissue damage. Although such a situation is rarely encountered in experienced centers, patients should immediately alert the staff when there is abnormal pain and discoloration in the arms of the drug administered. When skin symptoms occur, they should inform their physicians as soon as possible.

Intestinal Problems in Chemotherapy

• Constipation

In addition to the direct cause of constipation by some cancers, various drugs such as some chemotherapy drugs, painkillers, nausea drugs, and depression drugs can also cause constipation. In addition, constipation is seen in patients who move less and do not take enough fluids and fibrous foods. Patients who cannot defecate for one or two days at the most should inform their physicians about their condition. Patients should not use random medications, and they should apply constipation treatments that the physician deems appropriate.

• Diarrhea

Rarely, some cancers can also cause diarrhea, but mostly chemotherapy drugs lead to diarrhea. Patients with cramp-like pain, fever, and bloody diarrhea that lasts longer than 24 hours should consult their physicians immediately and should never use medications on their own. The physician may administer fluids intravenously in severe fluid losses, but diarrhea that is severe enough to require hospitalization rarely occurs. A patient with diarrhea should take the following precautions: 

• Plenty of fluids should be taken,
• A small amount of food should be eaten at frequent intervals,
• Since potassium loss can be seen in diarrhea, foods, and beverages rich in potassium such as bananas, potatoes, apricot-peach, and nectar should be consumed,
• Mainly foods with low fiber content should be consumed (white bread, rice, vermicelli, mashed or baked potato, ripe banana, egg, white melted cheese, yogurt, chicken, or turkey excluding skin, and fish)
• Foods containing high fiber should be avoided during diarrhea (grains and legumes),
• Very hot or cold foods should be avoided,
• Tea, coffee, and alcohol should be avoided, milk should not be drunk,
• It should be kept in mind that fried foods and fatty and spicy foods can increase diarrhea.

Kemoterapide Ağız içi Sorunları

Kemoterapinin etkisiyle ağız, boğaz ve diş etlerinde hafif kızarıklık ve sızlamadan ciddi, kanamalı ağız yaralarının açılmasına varabilen ve ‘mukozit’ olarak adlandırılan ağız içi sorunları oluşabilir. Mukozit oluşumu, ağız hijyeni bozuk ve ciddi diş-diş eti problemi olan hastalarda daha fazla görülür. O nedenle özellikle yüksek doz kemoterapi uygulanacak hastalar önceden diş-diş eti tedavilerini yaptırmalı daha sonra kemoterapiye başlamalıdırlar.

Kemoterapi esnasında ise yumuşak bir diş fırçası ile diş ve diş etlerini tahriş etmeden, nazikçe her yemekten sonra fırçalanmalıdır. Diş fırçaları iyice temizlenip kuru bir yerde muhafaza edilmelidir. Her yemekten sonra ve gece yatmadan önce ayrıca ılık tuzlu suyla ağız çalkalanmalıdır. Ağız içinde travma yaratacak nedenlerden uzak durulmalıdır. Örneğin; ağza sert ve sivri cisimler sokulmamalı, yemekler yavaş yenmeli, yanak ve dil ısırılmamaya çalışılmalıdır. Kabuklu kuruyemişler yenmemelidir.

Ağız ve boğaz yaraları ortaya çıkınca tedavi eden hekim haberdar edilmeli, ağrı varsa tedavisi yapılmalıdır. Yaralar geçinceye kadar yumuşak sulu gıdalarla beslenilmeli, tahriş edici, sert yiyeceklerden uzak durulmalıdır. Sıcak yiyecekler tahrişi artırdığında  dolayı, yiyecekler soğuk veya oda ısısında olmalıdır. Bununla birlikte bol sıvı alınmalıdır. Nadiren ağızdan beslenemeyecek kadar ciddi ağız yaraları oluşabilir ki, bu durumda ya doğrudan mideden tüplü beslenmeye ya da damardan beslenmeye geçmek gerekebilir.

Infection in Chemotherapy

With chemotherapy, the body's immune system weakens and becomes open to germs. Especially the elderly and patients with additional problems such as diabetes, kidney failure, cardiovascular diseases, and respiratory distress have a higher incidence of infections. In the event that a cancer patient gets infection, especially if chemotherapy and/or radiotherapy are also administered, the general condition may deteriorate much faster than expected, and this can be life-threatening for the patient. Even within a day, the patient's condition can change.

Therefore, attention should be paid to the following situations:

• After starting the treatment, the person should not enter among crowded groups of people unless it is necessary (cinema, theatre, bazaar-market, public transport, etc.). When entering a crowded environment if it has become necessary, it should be finished as soon as possible, and a mask should be worn at that time. During the time spent outside, hands should never be contacted with the mouth and face, and hands should be washed after returning home. Shaking hands with people, hugging, and kissing should be avoided. People who show signs of influenza infection should be avoided.
• Another important source of germs is food and drink. During chemotherapy, foods cooked on the same day and under strict hygienic conditions should be consumed. Any food that can be peeled should be peeled before being consumed. Vegetables and fruits should be carefully washed with plenty of water. Raw meat and raw eggs should never be eaten.
• Eating out should be avoided unless it is necessary.
• Patients who have pets during the treatment should be very careful, we recommend that they send away their pets from the house temporarily, if possible.
• A digital thermometer should be kept at home and the physician should be contacted immediately when the patient feels feverish or chills and shivers start. No medication should be taken to reduce fever without consulting a physician.
• Men should prefer electric machines while shaving instead of razors.
• Gloves should be worn while dealing with garden work.
• Live vaccines should not be administered during chemotherapy, and the physician's instructions should be followed.
• After each defecation, the anal area should be cleaned without irritation, painful hemorrhoids should be reported to the physician.
• A warm shower and cleaning with soft sponges should be preferred without irritating the body.
• Pimples should not be squeezed, and proper dressings should be made for injuries that occur in the body.
• Symptoms that may be the focus of infection should be noticed and the physician should be informed. For example, in symptoms such as burning during urination, frequent urination, diarrhea, painful hemorrhoids or pain in the anus area, cough, expectoration, mouth and throat pain and sores, pain and swelling around the nails, vaginal discharge and itching, redness and pain around the catheter, pain in the sinuses, a physician should be consulted immediately.

Blood and Coagulation System in Chemotherapy

Both cancer itself and the treatments can cause problems in the bleeding and coagulation system. In patients with cancer, the coagulation system can be activated easily and can sometimes lead to life-threatening problems. Patients should consult their physician in the following situations:

• Formation of small red spots on the skin
• Unexpected bruising
• Red or bloody stools
• Vaginal bleeding (unexpected) or periods that last longer than expected
• An increase in temperature, redness, and swelling in the leg can be a symptom of a serious disease called “deep vein thrombosis,” the most common cause of which is prolonged inactivity.

Nerve and Muscle Problems in Chemotherapy

Although it can cause various problems in our nervous system with some cancers, the most common one caused by chemotherapy drugs is nerve damage.

Most of them are temporary, but recovery may take up to 1 year. However, some of them may be permanent and may not heal. These conditions are called neuropathy.

Symptoms such as numbness, tingling, burning, pain when walking and resting, tremors, hearing loss, constipation, difficulty in holding objects, loss of balance, decrease in muscle strength, pain caused by contact with cold, and difficulty in walking can be symptoms of neuropathy. It is recommended to report these situations to the physician.

Sexual Life in Chemotherapy

Sexual life, which is a natural requirement of daily life, does not need to be interrupted during chemotherapy. While some patients may have a decrease in sexual desire, some patients either do not feel a difference or, on the contrary, may experience an increase.

Sometimes, there may be a disruption in sexuality because of the wrong fear of getting cancer in the spouses or partners of the patients. However, first of all, patients should be able to discuss this issue comfortably with their physician, and the spouses should come to a decision together for the most appropriate sexual life.

Another important issue is the possibility of damage to the sperm or eggs of our patients of childbearing age due to chemotherapy. Against this possibility, patients should discuss sperm and egg preservation methods with their physicians and take precautions before treatment.