What is chemotherapy?

• It is one of the many available treatments for patients with cancer
• Special chemotherapy drugs are used to tackle the disease, with the aim to destroy cancerous cells.

How does it work?

• There are many chemotherapy drugs in common use. Sometimes they are given singly, and sometimes in combination. The decision about which treatment to offer is based on many factors and will be assessed by the physicians. Chemotherapy treatment can be used in combination with radiotherapy and/or surgery, and this increases the chances of completely getting rid of the cancer or, at least, being able to confine it from spreading.
• Apart from being able to kill cancerous cells, chemotherapy also offers relief from pain caused by the disease, contributing to the patient’s quality of life.

How and where will the treatment be given?

• Most chemotherapy is administered to the patient through a drip into a vein in the arm, or sometimes into a major vein via a semi-permanent “central line” such as a Hickman Line or Porta-cath.
• Some chemotherapy can be given in other ways, for example with tablets.
• Most of the treatments are carried out at our Chemotherapy Daycare Unit, which is spacious, with many hours of physical light and a wonderful view to the city below and the ocean beyond.
• Some more complex treatments might need to be administered at our wards as an inpatient.
• Treatments are carried out according to the personal chemotherapy program which has been worked out by the medical team, always in cooperation and agreement with the patient. The options are: Daily. Weekly. Every 3 weeks. Once a month. And once every 6 months.

When is chemotherapy used?

• Prior to surgery, in order to destroy the cancerous cells before they spread and cause metastases, but mainly to reduce the tumor in order to make it more operable with a more conservative surgical procedure.
• Post surgery treatment, namely auxiliary, with the aim to destroy those cancerous cells which might of “escaped” during the major operation. This “additional chemo” treatment may reduce the possibility of the tumor coming back.
• When we have metastasis, then chemotherapy is administered in order to control and eradicate symptoms. This treatment is called palliative care.

What are the side-effects?

Some chemotherapy drugs have very-few side-effects, and between their treatment visits patients can often carry on living their normal, everyday lives. Other treatments, however, may be more disruptive. This depends on the type of chemotherapy you are having. Each drug is different.

Immediate

• Nausea and vomiting (feeling sick)
• Tiredness and weakness
• Hair loss
• Inflammation of mouth and lips (stomatitis), taste changes, gastritis, colitis.
• Skin rashes
• Allergic reactions
• Low white blood cell count (neutropenia) and fever
• Anaemia
• Myelotoxicity (bone marrow suppression), thrombocytopenia (low platelet count) and
• and hematoma (collection of blood outside of blood vessels)

Later – occurring mainly 6 weeks after treatment

Ultimate – they normally appear months or even years after chemo treatment.

• absence of menstruation (Amenorrhea)
• Sterilization

How are the side-effects treated?

Each medication has side-effects.

These depend on the type and dose of the drug administered to the patient. There are specific things that one can do in order the patient can take to avoid or mitigate the so avoid or reduce the effects of chemotherapy.

All doctors are well informed about the possible occurrence of side effects and the best way to treat them. And of course are always available and willing to instruct and advice you accordingly. So, please feel free to ask whatever yoy feel that troubles you.

What should I do in case I get infected?

If you develop any of these symptoms during your chemotherapy treatment sessions, or within 4 months after completing the circle, you must contact us immediately:

• Fever count above 38οC
• Sore throαt
• Chesty cough
• Gastroenteritis or uncomfortable stomach and pain
• Urinary tract infection
• Generally not feeling well, having a sense of weakness, or flu symptoms
• Redness or effusion around the Hickman or any other central Line, i.e. a soft plastic tube, or catheter, that is tunnelled beneath the skin and placed in a large vein, and can be used to place fluids and drugs straight into the bloodstream.
• Shivering causes by stimulation of the Hickman or another Central Line.

According to your medical record and clinical situation, your doctor will decide whether you should receive Chemotherapy in injected form at the Hospital, or at home with pills which will be given to you.

The chemotherapy drugs enter your blood circulation and are rejected through our body’s biological fluids. The type of medication administered is that which defines how long this cleansing procedure might take.

The highest concentration of secretions usually happens during infusion and within the first 48 hours after chemotherapy. The biological fluids in which drugs are found are blood, urine, feces, tears, saliva, vomit, sweat, semen and vaginal fluids.

Protective measures during chemotherapy and for 48 hours thereafter:

1.  After using the toilet, make sure you close the lid and then flush twice for a better and more hygienic cleaning.
2. It is more safer that men and women sit on the toilet, in order to avoid splashing, which could be infectious for other people.
3. After using the toilet, wash your hands thoroughly with warm water (not hot) and plenty of soap.
4. Use paper wipes to dry your hands.
5. If you had to throw-up in the toilet, make sure to press the flush twice, and clean the external surface with water and soap or antiseptic wipes. If you used a container to vomit in, empty it into the toilet and again flush twice. It’s better if you have one-use containers, and only for yourself.
6. The person who helps you with your personal hygiene should always wear one-use gloves and clean hands thoroughly after discarding them. If that person, by mistake, should touch any of your body fluids, immediate cleansing, again with soap and water, of that area is necessary.
7. Wash your close separately from those of other members of your family. Use the most comprehensive program on your washing machine. Do not hand-wash.
8. Use a condom for all sexual interactions.
9. All one-use gloves, sanitary napkins and diapers must be placed in a plastic disposable bag and tightly tied before being dispersed to waste collection.
10. Pregnant and breast-feeding mothers should avoid contact with anything which might have been touched by a patient undergoing chemotherapy treatment.

Further treatment measures for chemotherapy taken orally with pills

1. Store all chemotherapy medication in a safe place, away from children and home pets. Always follow your pharmacist’s instructions.
2. There is a yellow sticker on every box with chemotherapy drugs, with the following warning: Σε κάθε κουτί με φάρμακα χημειοθεραπείας τοποθετείται από το φαρμακείο κίτρινη αυτοκόλλητη ετικέτα με την ένδειξη.
   CYSTROSTATIC DRUGS – CAUTION WHEN USING – ALWAYS WEAR PROTECTIVE GLOVES
3. After taking your chemotherapy pills, wash your hands with soap and water.
4. If the pill is given to you by another person, ask him or her to wear gloves and to hand it to you, or place it in a small cap so you can take it yourself.
5. If you have difficulty in swallowing the pill, you must tell your doctor about it. You should not break-up thew pills, or remove the gelatin capsule if it has a coating. All pills must be swallowed in whole, and must not be chewed or broken into pieces.
6. If you get ill and throw-up having taken your medication, don’t take another pill or capsule. Call your doctor.
7. Do the same, ie contact you doctor, if by mistake you should take more medication than that which has been subscribed to you.
8. If you have completed your sessions/cycles, and some medication has not been used, return it to the pharmacy. They know how to deal with unused medicine. You must never throw chemotherapy drugs away, neither in the toilet, nor in a waste-bin.

It is important for you to know however that chemotherapy is not transmitted from person to person. 
You are free to hug and kiss your beloved ones.
Just follow the tips we have just given you, and all will be fine. There is no need to be afraid. Just a bit cautious.

Useful nutritional advice and recommendations:

1. Maintaining body weight and fat-count at a normal level (Body Mass Index, BMI = kg/m2, where kg is a person’s weight in kilograms and m2 is their height in metres squared.)
2. Identify and treat eating disorders that occur due to treatments.
3. Consumption of small and frequent meals (at least 6 per day), i.e. 3 main meals (breakfast, lunch, dinner) and 3 smaller snacks at around 10am, in the afternoon and before bedtime.
4. Avoid drinks with added sugar, eg soft drinks, fruit drinks, etc.
5. Limit consumption of red meat and processed meat: Beef, pork and lamb.
6. Avoid entirely or limit as much as possible the consumption of alcoholic beverages. Your doctor will advice you accordingly.
7. Limit consumption of salty foods as well as those preserved in salt or processed with salt. E.g. Biscuits, cakes, shrimps, chips, crackers, bread, breadsticks, salted canned foods, processed foods (eg salami, pepperoni, hot dogs, sausages, hams), delicatessen foods, crepes, salty and canned fish, ready-made sauces, packaged soups, etc.
8. Take advantage of the times when you feel well, and treat yourself with a hearty and rich meal.
9. Select foods that are easy to chew, swallow and digest.
10. Add physical activity to your everyday life.

Our Department of Integrative Oncology has much to offer as far as nutrition and psychology of the patient is concerned. Ask you physician to advise you accordingly.

Nausea

1. Consumption of small and frequent meals. This helps to reduce the feeling of nausea.
2. We recommend you drink fluids slowly throughout the day. Avoid drinking water or other beverages during mealtime.
3. Rinse mouth before and after eating.
4. Food should be served at room temperature.
5. Prefer foods without strong flavor.
6. Choose foods high in carbohydrates (eg white bread, low-fiber breakfast cereals, rice, spaghetti, etc.) and low to moderate fat (oil, margarine, butter, olives, avocado, etc.).
7. Select easy digestible foods, which you can eat slowly.
8. Test foods containing ginger, and see whether they are OK with you. Again, you can always refer to our in-house nutritionist.
9. If nausea occurs in the morning, try having a bite of toast or a simple cracker before getting out of bed.
10. Of course the best time for you to prepare your food is when do not feel and unwell nauseous.
11. Enjoy your favorite foods when you feel better.
12. After our meal, we recommend you leave the table and enjoy in calmness the rest of your day.

Foods to be avoided

1. The very sweet ones, spicy, with strong taste and odour, such as fried foods, candies, cakes, garlic, onion etc.
2. The main meal or one of the “in-between” snacks about 2-3 hours before your treatment. Food not taken properly may cause a reaction according to the type of your treatment, and could make the feeling of nausea more intense.

Loss of appetite

1. Eat 5-6 small meals throughout the day instead of 3 large ones. With small and frequent meals, the stomach is less stressed, resulting in better digestion and absorption of food.
2. Chose foods high in calories, protein (meat, poultry, fish, egg whites – but with no fat at all – cheese, etc.) and nutrients.
3. Eat larger meals when you feel well and relaxed.
4. A small snack before going to bed at night, gives you some extra calories which you need, and it doesn’t affect your appetite.