New Patient

Chemotherapy/
Immunotherapy
Guide
My Personal Information
Physician Name:______________________________________________________________________

Office phone number:_________________________________________________________________

WHEN TO CALL THE OFFICE

Please do not hesitate to call the office if you have questions, concerns or if you are
experiencing any of the symptoms discussed in this guide. If you call after business
hours, we have a call service that will take a message and contact the physician on
call. Our physicians will return calls after hours for emergency problems, such as fever,
uncontrolled pain or new onset symptoms that are severe.

Contact office immediately for any of the following:

Temperature greater than 100.4°
Excessive bruising
Bleeding that will not stop
Nausea and vomiting lasting more than 24 hours
Diarrhea lasting more than 24 hours
Severe/sudden onset of new pain
Change in mental status
Contents
1 Preparing for Your First Day of Treatment
Quick Tips During Treatment
What is Cancer?
2 Questions and Answers About Chemotherapy
5 Prescriptions
Side Effects of Chemotherapy
6 Mental Health Side Effects
16 Activity During Treatment
17 Nutrition During Treatment
18 Treatment Day
19 After Treatment
20 Survivorship
CareSpace
Patient Resources
Immunotherapy or Targeted Therapy
22 Biosimilars
23 Frequently Asked Questions
24 Biosimilar Definitions
About this guide

T
his is your guide to treatment. In it, you will find
information on common side effects and how to manage
them. You will also find information on what symptoms
or side effects to look for and when to call your physician if
there are problems. If you have any questions after reading this
information, please talk with your healthcare team.
 Preparing for Your First • Stay on schedule - You will be given a schedule
Day of Treatment for your treatments when you arrive for your
first visit. The times are flexible, but you will
Ask your physician about whether you need to
want to do everything you can to keep your
address any of these things prior to starting
appointments. If you are not feeling well,
treatment:
please come to the appointment to see your
• Do you need to see a dentist? doctor. If you miss an appointment, please
make sure that it is rescheduled as soon as
• Do you need to get a hearing or
possible. Lab work will be done before your
vision test?
treatment and, if it is acceptable, you will
• Does your treatment require that you proceed with your treatment.
see a heart doctor?
• Drink plenty of fluids – It is very important that
• Will you need a port or PICC line for you stay hydrated while on treatment. The
treatment? extra fluids will help rid your body of the toxins
that are released as a result of your treatment.
• Do you need to see a fertility doctor
The more water you drink, the better you
about fertility planning? This should be
are likely to feel between cycles. You should
discussed if you want to have children
be getting at least two to three liters of non-
after treatment is complete.
caffeinated beverages (water is preferred)
• Should you get vaccines for flu, COVID-19, each day, unless previously informed otherwise
pneumonia, chicken pox/shingles, etc.? by medical professionals
Be sure to write down any questions you have, • Stay active, but pace yourself – Light exercise
so you can talk with your physician will keep your spirits up and help with your
or nurse to get the answers you need. sleep patterns; however, it is important to
Please be aware this booklet is for general
listen to your body and rest when necessary.
knowledge only. It does not replace talking with You can find more information on activity
your healthcare team. If you have any questions during treatment later in this booklet.
about your treatment or side effects, please call
your doctor or nurse. • Take care of yourself – It is important that you
put yourself first while you are getting
Quick Tips During Treatment treatment. Try to do the things you need before
• Listen to your body – There are many changes you do things for others. Again, let others help
that can happen during treatment. Make sure you when needed.
you are talking with your healthcare team at
every appointment so we can help you with any
What is Cancer?
issues. You can find information on side effects Normal/healthy cells divide as the body needs
and nutrition later in this booklet. them. They stop dividing when they start
• Stay connected and let others help. Hopefully, touching like cells and they die at the end of
there will be family and friends, or even church their life cycle.
groups, who will be happy to help you with
Cancer cells do not behave in this way. They
transportation, housework, yardwork or
often continue to divide and crowd out the
preparing meals. Let them help and keep them
normal cells of the body and they do not die.
close. You will likely need some assistance
This is how tumors start to grow.
before treatment is complete, even if you feel
great in the beginning.

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 • Most cancers are named for the area of the Questions and Answers About
body where they begin. Chemotherapy
• When cancer spreads to other areas of the
What is Chemotherapy?
body, it is called metastasis.
Chemotherapy (also called chemo) is a type
• Treatment depends on the type of cancer and of cancer treatment that uses drugs to destroy
the stage of the disease. cancer cells.
• There are four stages of cancer. Stage I (one)
How does chemo work?
cancer typically means the cancer is small and
Chemo works by interrupting the growth of
localized to one area, and that it has not
cancer cells, which grow and divide quickly.
spread to the lymph nodes or other parts
Most chemo drugs do not know the difference
of the body. Stage IV (four) cancer is when the
between the normal cells and the cancer cells.
cancer has spread to other areas of the body;
They often affect the cells of your body that
Stage IV is often called metastatic disease.
reproduce the fastest, such as those that line your
How is cancer treated? mouth and intestines or cause your hair to grow.
• Local therapy - removes or destroys cancer in Damage to healthy cells may cause side effects.
just one part of the body. Often, side effects get better or go away after
• Surgery - you may see a surgeon before or chemotherapy is over.
after chemotherapy, depending on the plan What is the goal of chemo?
of care. Depending on the type of cancer you have and
• Radiation therapy – you may see a radiation how advanced it is, there are different goals for
oncologist for radiation treatments before, chemo treatment:
during or after chemotherapy. • Cure – if cure is the goal of treatment this
• Systemic therapy – destroys cancer cells means that the cancer cells will be killed to
throughout the body. These medications are the point of being undetectable.
given and travel to every area in your body to • Control – a goal of control means that the
best treat your cancer. treatment is expected to prevent the cancer
• Chemotherapy – information in next section. from growing or spreading to other areas of
the body.
• Hormone therapy – some patients may be
treated with hormone therapy. This type of • Palliative – this type of treatment helps to
therapy is only effective if your cancer cells are protect and preserve or even regain (in
hormone receptor positive. Your physician will some cases) your quality of life.
discuss this with you if it is something that you How is chemo used?
will need. Chemo can be used alone or with other
• Immunotherapy/targeted therapy – treatments, such as surgery or radiation therapy.
see page 20 It is given at different times depending on the
goal of treatment.
• Biosimilars – see page 22
• It can be used to help shrink the size of a
tumor before surgery or radiation (neo
adjuvant therapy).
• It can be used after surgery or radiation to
kill cancer cells that may remain in your body
(adjuvant therapy).
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• Sometimes it is used at the same time with How is chemo given?
radiation or biologic therapy to make the Chemo can be given several ways.
treatment more effective (concurrent
• Intravenous (IV) – is given directly into a vein.
treatment).
• Injection – this is a shot into a muscle or the
• Additional treatment with chemo may be
fatty tissue just under the skin.
needed if cancer returns (recurrent cancer)
or to treat cancer that has spread to other • Orally – many chemo drugs come in a pill
parts of your body (metastatic cancer). form that can be taken at home. While this can
be more convenient than other forms, it is very
How does my physician decide what
important that you stay on schedule if this is
chemo drugs to use?
how you will be getting your chemo. Make
There are many different chemo drugs. They can
sure that you understand exactly how and
be used alone or combined. Some are used for
when to take your oral medications.
many types of cancer and others may only be
used for one or two types. The decision is made • Topically – some chemo drugs come in a
depending on several things: cream that you apply to your skin.

• What type of cancer are we treating? • Intraperitoneal (IP) – this chemo goes directly
into the peritoneal cavity (the area that holds
• What is the general health of the patient?
your organs in your abdomen, such as your
Are there other health problems that need to
intestines, stomach, and liver).
be considered?
• Intra-arterial (IA) – a form of chemo that is
• Has the patient had chemo in the past?
put directly into the artery that feeds blood to
How often will I have to have chemo? your cancer.
Treatment varies for every patient. Some patients
• Intrathecal (IT) – some chemotherapy drugs
are treated weekly and others receive treatment
can go directly into the cerebrospinal fluid to
every two, three or four weeks. Your schedule
kill cancer cells.
will depend on what type of cancer you have,
what the goal of treatment is and how your body Intravenous chemo is the most common way to
reacts to treatment. get treatment. It can be given through an IV in
your arm or a port-a-cath (port) placed into your
Chemo is ordered in cycles. A cycle of treatment chest by a surgeon. Your surgeon will give you
is a period of chemo followed by a period of rest. instructions for post-op care of your port incision.
For instance, you may have a chemo treatment On treatment days, we access the port with a
one week, followed by a week of rest. These special needle and can give medication through
two weeks will be one cycle of chemo. The rest it that cannot be given through a regular IV. We
period gives your body time to recuperate and can also draw blood from your port on treatment
allow your healthy cells to rebuild. days. On days you do not have treatment, your
Can I miss a cycle of chemo? labs may be drawn from your port or your arm.
It is not a good idea to miss a treatment; When treatment is completed, the needle will
however, sometimes your doctor will adjust be removed. We will cover the area with a
your treatment schedule based on how you are band aid. Please remove the band aid when
feeling and the side effects of treatment. If this you get home.
happens, the doctor/nurse will discuss this with
you and explain the change. They will also review If you are not having a port placed, we will do our
when they plan to move forward with the next best to place an IV in a place that is easy. We try to
treatment cycle. stay away from joint areas of your wrist and elbow.

3
 Occasionally, a Peripherally Inserted Central affect the way chemo works in your system and
Catheter (PICC) is placed in the upper arm you may need to stop taking them. Please bring
and can be used for many weeks in a row for either the pill bottles or a list of your medications
treatment. to all appointments. We will need to know the
name of each medication, why you take it, how
Ports and PICCs can be a source of infection for
much you take and how often you take it.
you, so please keep the area clean and dry and
follow all instructions from your surgeon and This is also true for any herbs, minerals, vitamins
nurse after placement. or dietary supplements. Please do not start taking
anything new without discussing it with your
Sometimes chemo is put into a pump that you
physician.
take home with you. If your treatment requires
this, your physician and nurse will go over what to How will I know if the chemo is working?
expect and how to proceed. Your physician will see you regularly to assess
how you are doing. He/she will also order blood
How will I feel during chemo?
tests and may order scans or x-rays. The presence
Chemo affects people differently. There is no way
or absence of side effects is not a good indicator
for your healthcare team to know exactly how
of how well the chemo is working.
you will react to the chemo. How you react will
depend on how healthy you are before chemo, How much does chemo cost?
how well you hydrate and eat, and the amount It is very hard to say for sure exactly how much
of rest you get. Side effects usually appear about chemo costs. There are many factors that can
24-48 hours after treatment; however, they can affect costs, such as:
start right after chemo. • what type of chemo you are receiving
The most common side effect is fatigue. We • how often and for how long you will get
encourage every patient to have someone to treatment
drive you to and from treatment, especially for
• at what facility you will be receiving treatment
the first treatment. Make sure you make time to
(clinic or hospital)
rest and use the help that is offered by friends
and family. • insurance and where in the state/country
you live
Will I be able to work during chemo?
If you need to speak with someone about the
Many people can continue to work while getting
cost of your treatment, please ask to speak with
chemo, depending on the type of work they do.
a patient financial navigator.
Talk with your healthcare team about whether
you will be able to work. What are clinical trials and how can I
participate?
Can I take over-the-counter and
Clinical trials for cancer treatments are used
prescription medication while on chemo?
to help find better ways to fight cancer. These
You will likely be able to continue with your
may also be called research trials. Sometimes
regular prescribed medications during chemo;
a trial is testing a new chemo medication or a
however, always discuss what you take with your
new combination of medications. Talk to your
healthcare team. Make sure that you tell your
healthcare team to see if a clinical trial may be
doctor about all medications you take, including
an option for you.
laxatives, allergy medications, cold medicines,
pain relievers, ibuprofen or aspirin. Some
prescription and over-the-counter drugs can

4
 Prescriptions these, or other, side effects. There are many ways
we can help you combat these issues during
We will make sure you have the basic treatment.
prescriptions you will need at home before you
come on your first treatment day. Make sure to Why do I have side effects?
let us know what pharmacy you will be using Chemo works by killing your cancer cells. Most
so we can send prescriptions electronically chemo medications cannot tell the difference
for you. Your health care team will discuss the between your cancer cells and your healthy cells.
prescriptions with you and review how/when The majority of side effects you may experience
to take them.** are a result of the effects the medication has on
fast-growing, healthy cells, such as the cells that
There may be other medications that are sent
make your hair grow, the cells lining your mouth
for you to start with or before treatment. Your
or your intestines and the cells in your bone
healthcare team will go over all prescriptions
marrow that produce blood cells.
with you. Please make sure you understand
how to take all of your medications. How long will my side effects last?
This will depend on your general health and
Prescription refills – Please call the office two
**
the type of treatment you receive. Most side
to three days in advance for refills, especially for
effects will go away after treatment is complete;
narcotics (pain medications) or other controlled
however, some side effects may take months or
substances.
years to disappear.
Notes for my prescriptions:
A small number of chemo medications can cause
long-term side effects that do not go away. This
can include damage to your heart, kidneys,
lungs, nerves and reproductive system. Ask your
healthcare team if the chemo you will get is
going to potentially cause these side effects.

What can I do about my side effects?

There are many ways that your healthcare team
can ease or eliminate the side effects caused
Side Effects of Chemotherapy by chemo. Talk to your physician or nurse if you
are experiencing anything new after you start
What are side effects? treatment, as it might be a side effect. Also, see
Side effects are symptoms that are caused by the following information on how to deal with
cancer treatments. They can vary from patient to the most common side effects of chemo.
patient. Remember, the severity of side effects
does not determine the effectiveness of the Questions for my team:
treatment. Common side effects are changes
in appetite and taste, constipation, diarrhea,
fatigue, hair loss, low blood counts, mouth
sores, and nausea or vomiting. In this section,
information about potential side effects is
provided, along with suggestions that may help
ease the side effects. Always let your physician
and/or nurse know if you are suffering from

5
 Mental Health Side Effects Depression
Many people struggle with feelings of sadness
Anxiety
after they get the diagnosis of cancer and during
It is perfectly normal to feel anxious about a
treatment. This is normal and can change from
diagnosis of cancer and starting treatment. It
day to day. However, if you are struggling with
is a very frightening time for patients and their
these feelings for more than a day or two at a
families. Anxiety may feel like overwhelming fear
time, it may be a sign of depression. This can be
or stress, worry or even moments of complete
a serious problem and needs to be addressed
panic. Anxiety can cause many different feelings
with your healthcare team. If you feel like you are
in your body.
depressed, please speak to your doctor or nurse.
• It may affect your appetite, causing you We need to know if there is a problem so we can
to not want to eat. help. Some signs of depression are:
• It can cause headaches and muscle pains or • a feeling of helplessness or hopelessness or
tightness. that your life has no meaning
• It can upset your stomach, causing diarrhea • no interest in being with your family or friends
or nausea/vomiting.
• not enjoying the hobbies/activities you used
• It can cause shortness of breath or make it to enjoy
hard to breath.
• crying for long periods of time or every day
• It may make you feel restless and unable
• decrease in appetite or loss of weight
to sit still.
• changes in your energy level, sleeping all the
• It may cause difficulty sleeping at night.
time, or not sleeping well
Not dealing with the anxiety can make it harder
• thoughts of taking your own life, thinking
for your body to fight the cancer.
about a plan to commit suicide or frequent
Things to do to manage anxiety: thoughts of death or dying
• Listen to relaxing music or use guided
If you experience any of these signs, please talk
meditation.
with your healthcare team immediately.
• Do things that you enjoyed prior to
your diagnosis. If you ever feel like harming yourself or others
and you cannot get in touch with your healthcare
• Get plenty of rest and do it in a quiet place.
team, call 911 or go to the nearest Emergency
• Journal your feelings or read for pleasure. Room. You can also call the National Suicide
• Get light exercise as you are able. Prevention Lifeline at 1-800-273-8255.
• Talk with your healthcare team about how Chemo Brain
you are feeling and see how they can help. This is a term used to describe the feeling of
Caregivers can help with these feelings by: fogginess or cloudy thinking that can happen
during cancer treatment. Sometimes the
• Staying with the patient during these times. medications given during treatment can affect
Try to be reassuring and stay calm. the brain and how the patient carries on with
• Talk with the patient about things that you daily life. Many patients describe it as “feeling
would have discussed prior to their diagnosis. like you are walking around with your head in a
• Speak with the healthcare team if you are cloud.” It may be harder for you to stay focused
worried about the patient. on your normal activities. You may have trouble

6
remembering things like names or dates. You Drink at least eight cups of water or other fluids
may not be able to find the right words or it may each day. Many people find that drinking warm
take you longer to do things than usual. It can or hot fluids, such as coffee and tea, helps with
happen quickly and last through all of treatment constipation. Fruit juices, such as prune juice,
and even after treatment is completed. may also be helpful.

Things to do to manage chemo brain: Be active every day. You can be active by walking,
riding a bike or doing yoga. If you cannot walk,
• Make lists and write everything down. ask about exercises that you can do in a chair or
• Use a planner for keeping appointments and bed. Talk with your doctor or nurse about ways
important dates. you can be more active.
• Do puzzles, games or take a class to exercise Check with your doctor or nurse before using
your brain. fiber supplements, laxatives, stool softeners
or enemas.
• Make sure to get enough sleep and eat well.
You also need to make sure to stay hydrated. Ask your doctor, nurse or dietitian about foods
that are high in fiber. Eating high-fiber foods
• Follow a daily routine.
and drinking lots of fluids can help soften your
• Do not try to do to many things at once. stools. Good sources of fiber include whole-grain
Keep multi-tasking to a minimum. breads and cereals, dried beans and peas, raw
• Keep a journal of your day-to-day issues so vegetables, fresh and dried fruit, nuts, seeds and
they can be tracked. popcorn.
Constipation Let your doctor or nurse know if you have not
Constipation is a condition that causes bowel had a bowel movement in two days. Your doctor
movements to occur less often than usual, may suggest a fiber supplement, laxative, stool
the stool to be hard or dry and/or you have softener or enema. Do not use these treatments
trouble passing the stool. This can be caused without first checking with your doctor or nurse.
by several things, including pain medication, Should you need medication you can take:
chemo treatments, anti-nausea medications,
• Senekot® – one to two pills twice daily or
dehydration, location of the cancer, decreased
activity and not eating/drinking enough. • Peri-Colace – one to two pills twice daily
Constipation can also cause gas, bloating, nausea If constipation persists, you can also take:
and abdominal pain. Everyone’s bowel patterns • MiraLAX® – one packet (17 grams) diluted
are different, so it is important that you know in eight ounces of liquid once or twice daily
what is normal for you.
• Dulcolax® – 10 mg orally twice daily
Please call the doctor’s office should you have
Diarrhea
persistent constipation (no bowel movement in
Diarrhea is having frequent, soft, loose or
two to three days) or abdominal pain.
watery bowel movements. When fluids and
Things to do to manage constipation: food pass too quickly through the body, there
Keep a record of your bowel movements. Show is not time for the absorption of nutrients.
this record to your doctor or nurse and talk about This can cause electrolyte imbalances,
what is normal for you. This makes it easier to dizziness, dehydration and weight loss. Some
figure out whether you have constipation. chemotherapy medications can cause diarrhea.
If you experience this, take IMODIUM-AD®, as
directed by your physician.

7
 Call the office if you have any of these Ask your doctor if you should try a clear liquid
symptoms: diet. This can give your bowels time to rest.
• four or more loose stools in a 24-hour period Most people stay on this type of diet for five
that are not controlled with IMODIUM-AD® days or less.
or diet adjustments Avoid:
• racing heart or feeling like it is skipping beats • drinks that are very hot or very cold
• feeling dizzy or lightheaded • beer, wine and other types of alcohol
• urine output is decreased • milk or milk products, such as ice cream,
• pain or cramping with the diarrhea milkshakes, sour cream and cheese

• fever over 100.4° • spicy foods, such as hot sauce, salsa, chili
and curry dishes
Things to do to manage diarrhea:
• greasy and fried foods, such as french fries
Eat five or six small meals and snacks each day
and hamburgers
instead of three large meals. Many people find it
easier to eat smaller amounts more often. • foods or drinks with caffeine, such as regular
coffee, black tea, cola and chocolate
Ask your doctor or nurse about foods that are
high in salts, such as sodium and potassium. • foods or drinks that cause gas, such as cooked
Your body can lose these salts when you have dried beans, cabbage, broccoli, soy milk
diarrhea and it is important to replace them. and other soy products
Foods that are high in sodium or potassium • foods that are high in fiber, such as cooked
include bananas, oranges, peach and apricot dried beans, raw fruits and vegetables, nuts,
nectar, and boiled or mashed potatoes. and whole-wheat breads and cereals
Drink eight to 12 cups of clear liquids each day. Fatigue
Examples include water, clear broth, ginger ale or Fatigue can make you feel weak, worn out, tired
sports drinks, such as Gatorade® or Propel®. or make you feel like you are moving extra slow.
Drink slowly and choose drinks that are at room Resting does not always help. Fatigue is different
temperature. for every person. This can be caused by the
chemo treatment, stress, anxiety or generally
Let carbonated drinks lose their fizz before you
feeling overwhelmed. As you continue treatment,
drink them. Add extra water if drinks make you
there are increased demands on your body and
thirsty or sick to your stomach.
a great deal of energy is used to rebuild healthy
Eat low-fiber foods. Foods that are high in fiber cells. Fatigue may also be more severe if you are
can make diarrhea worse. Low-fiber foods include getting chemotherapy and radiation at the same
bananas, white rice, white toast and plain or time.
vanilla yogurt.
Things to do to manage fatigue:
Be gentle when you wipe yourself after a bowel
Exercise.
movement. Instead of toilet paper, use a baby
Staying active is the best way to help combat
wipe or squirt of water from a spray bottle to
fatigue. A walk, bike ride or a short session of
clean yourself after bowel movements. Let your
yoga can help give you extra energy.
doctor or nurse know if your rectal area is sore or
bleeds or if you have hemorrhoids. Eat and drink well.
Often, this means five to six small meals and
snacks a day rather than three large meals.

8
Keep foods around that are easy to fix, such as Keep a diary of how you feel each day.
canned soups, frozen meals, yogurt and cottage This will help you plan how to best use your time.
cheese. Drink plenty of fluids each day—about Share your diary with your nurse. Let your doctor
eight cups of water or juice. or nurse know if you notice changes in your
Plan time to rest. energy level, whether you have lots of energy or
You may feel better when you rest or take a short are very tired.
nap during the day. Many people say that it helps Talk with your doctor or nurse.
to rest for just 10 to 15 minutes rather than nap Your doctor may prescribe medication that can
for a long time. If you nap, try to sleep for less help decrease fatigue, give you a sense of well-
than one hour. Keeping naps short will help you being and increase your appetite or may also
sleep better at night. suggest treatment if your fatigue is from anemia.
Try not to do too much. Hair Loss
With fatigue, you may not have enough energy Chemotherapy can affect the cells that cause
to do all the things you want to do. Choose the hair growth. Not all chemotherapy will cause
activities you want to do and let someone else hair loss. Ask your healthcare team if the type
help with the others. Try quiet activities, such as of chemo you are getting will cause hair loss.
reading, knitting or an online activity. DigniCap®, a scalp cooling system, is available at
Sleep at least eight hours each night. some offices and may prevent hair loss with some
This may be more sleep than you needed before chemotherapy drugs. Talk with your physician for
chemotherapy. You are likely to sleep better at further information.
night when you are active during the day. You Hair loss usually occurs two to three weeks after
may also find it helpful to relax before going to the start of treatment. Hair may fall out in clumps
bed. For instance, you might read a book, work or just start to thin. If you choose to buy a wig,
on a jigsaw puzzle, listen to music or do other this can be done prior to losing your hair.
quiet hobbies. A prescription for a wig can be written for you.
Plan a work schedule that works for you. You will need to inquire with your insurance
Fatigue may affect the amount of energy you if they will cover the cost of a wig. There are
have for your job. You may feel well enough to also some local groups who provide wigs for
work your full schedule. Or you may need to free to cancer patients. Ask your nurse for this
work less—maybe just a few hours a day or a information. Hair will usually start to grow back
few days each week. If your job allows, you may six to eight weeks after treatment is complete.
want to talk with your boss about ways to work Things to do before hair loss:
from home. Or you may want to go on medical
leave (stop working for a while) while getting Cut your hair short or shave your head.
chemotherapy. You might feel more in control of hair loss if you
first cut your hair or shave your head. This often
Let others help.
makes hair loss easier to manage. If you shave
Ask family members and friends to help when
your head, an electric shaver is recommended
you feel fatigue. Perhaps they can help with
instead of a razor.
household chores or drive you to and from
doctor’s visits. They might also help by shopping Be gentle when you wash your hair.
for food and cooking meals for you to eat now or Use a mild shampoo, such as a baby shampoo.
freeze for later. Dry your hair by patting (not rubbing) it with a
soft towel.

9
 Sleep on a satin pillowcase. cells in your body to drop but this is a normal
Satin has less friction than most cotton cases and side effect. If your WBC count is too low, we will
may be more comfortable for you. not be able to do your treatment and you will be
given infection precautions by the nurse. There
Do not use items that can hurt your scalp.
are medications that can be given to help boost
These include:
these cell counts. Your healthcare team will talk
• straightening or curling irons with you about these medications, if needed.
• brush rollers or curlers
When am I at the highest risk for infection?
• electric hair dryers
The term 'nadir' means low point. You are at the
• hair bands and clips highest risk for infection when you hit nadir after
• hairsprays each chemo cycle. This usually occurs seven to
• hair dyes ten days after your treatment day.

• products to perm or relax your hair What are the symptoms of infection I should
look for?
Things to do after hair loss:
Fever is often the first sign of infection. Call your
Protect your scalp.
physician’s office if you run a fever of 100.4
Your scalp may hurt during and after hair loss.
or higher. The number for the office can be
Protect it by wearing a hat, turban or scarf when
found on the front of this guide. Do not take
you are outside. Try to avoid places that are very
medications that will reduce your fever without
hot or very cold. This includes tanning beds and
your physician’s approval. These are medications
outside in the sun or cold air. And always apply
such as ibuprofen (Motrin® or Advil®), naproxen
sunscreen or sunblock to protect your scalp.
(Aleve®) or acetaminophen (Tylenol®).
Stay warm.
Other symptoms of infection include:
You may feel colder once you lose your hair, as
body heat can be lost through your scalp. Wear a • chills
hat, turban, scarf or wig to help you stay warm. • swelling or redness anywhere on the body,
especially a wound, IV site or port
Talk about your feelings.
Many people feel angry, depressed or • a new or worsening cough
embarrassed about hair loss. If you are very • pain with urination or cloudy urine
worried or upset, you might want to talk about
If you experience chills, dizziness, shortness of
these feelings with a doctor, nurse, family
breath, changes in mental status or confusion,
member, close friend or someone who has had
go to the nearest Emergency Room or call 911
hair loss caused by cancer treatment.
for assistance.
Low Blood Counts Things to do to prevent infection:
Your blood counts may be altered by treatment
and your physician will be following them closely. Wash your hands often with soap and water.
Be sure to wash your hands before cooking and
Neutropenia eating, after you use the bathroom, blow your
This is a low white blood cell count (WBC) nose, cough, sneeze or touch animals. Carry
and a low neutrophil count. White blood cells hand sanitizer for times when you are not near
are the cells that fight infection in your body. soap and water.
Chemotherapy often causes the number of these

10
Use sanitizing wipes to clean surfaces and items Clean cuts right away.
that you touch. Use warm water, soap and an antiseptic to clean
This includes public telephones, ATM machines, your cuts. Clean your cut like this every day until
doorknobs and other common items. your cut has a scab over it.

Be gentle and thorough when you wipe yourself Be careful around animals.
after a bowel movement. Do not clean your cat’s litter box, pick up dog
Instead of toilet paper, use a baby wipe or squirt waste or clean bird cages or fish tanks. Be sure
of water from a spray bottle to clean yourself. Let to wash your hands after touching pets and/or
your doctor or nurse know if your rectal area is other animals.
sore or bleeds or if you have hemorrhoids.
Do not get a flu shot or other type of vaccine
Stay away from people who are sick. without first asking your doctor or nurse.
This includes people with colds, flu, measles or Some vaccines contain a live virus, to which you
chicken pox. You also need to stay away from should not be exposed.
children who just had a “live virus” vaccine for
chicken pox or polio. Call your doctor or nurse if Practice food safety rules.
you have any questions. Keep hot foods hot and cold foods cold. Do
not leave leftovers sitting out. Put them in the
Stay away from crowds. refrigerator as soon as you are done eating.
Try not to be around a lot of people. For
instance, plan to go shopping or to the movies Wash raw vegetables and fruits well before
when the stores and theaters are less crowded. eating them.
Avoid those that cannot be washed well, such
Be careful not to cut or nick yourself. as raspberries.
Do not cut or tear your nail cuticles. Use an
electric shaver instead of a razor. And be extra Do not eat raw or undercooked fish, seafood,
careful when using scissors, needles or knives. meat, chicken or eggs.
These foods may have bacteria that can cause
Watch for signs of infection or changes around infection.
your catheter.
Signs to look for include drainage, redness, Do not eat or drink items that are past the
swelling or soreness. Tell your doctor or nurse freshness date.
about any changes you notice near your catheter. Do not eat foods that have moldy spots, even
if you cut them out.
Maintain good oral care.
Thrombocytopenia
Brush your teeth after meals and before you go
This is a low platelet count. Platelets are the
to bed. Use a very soft toothbrush. You can make
clotting cells of the body. Chemotherapy can
the bristles even softer by running hot water over
cause the number of these cells in your body to
them just before you brush. Use a mouth rinse
drop. If your platelets are low, you are at risk for
that does not contain alcohol. Check with your
bleeding. You may need a platelet transfusion or
doctor or nurse before going to the dentist.
a delay in your chemotherapy treatment if your
Take good care of your skin. platelet count is too low. The nurse will discuss
Do not squeeze or scratch pimples. Use lotion bleeding precautions with you.
to soften and heal dry, cracked skin. Dry yourself
after a bath or shower by gently patting your skin.
Be careful not to rub your skin.

11
 Call your physician’s office if you have any of will follow your blood counts closely during
these symptoms: treatment.

• bruises, especially if you did not bump Call your physician’s office if you have any of
into anything these symptoms:
• small, red spots on your skin • Your level of fatigue changes or you are not
• red- or pink-colored urine able to do your usual activities.
• black or bloody bowel movements • You feel dizzy or like you are going to faint.
• bleeding from your gums or nose • You feel short of breath.
• heavy bleeding during your menstrual • It feels like your heart is pounding or beating
period or for a prolonged period very fast.
• vaginal bleeding not caused by your period Nausea/Vomiting
• headaches or changes in your vision Nausea and vomiting can occur while you are
getting treatment, right after, or hours or days
• a warm or hot feeling in your arm or leg
later. New drugs can help prevent nausea and
• feeling very sleepy or confused vomiting. These are called antiemetic or anti-
Things to do to prevent bleeding or injury: nausea drugs. You may need to take these drugs
one hour before each treatment and for a few
• Brush your teeth with a soft toothbrush and days after. Antiemetic medications will also be
do not floss your teeth. given intravenously prior to your treatment.
• Be careful with any sharp objects like knives
or tools. How long you take anti-nausea drugs after
treatment will depend on the type of therapy you
• Do not climb on ladders or stools to
are getting and how you react to it. If one anti-
prevent falls.
nausea drug does not work well for you,
• Use an electric razor when shaving. your doctor can prescribe a different one.
• Protect your hands and feet from scrapes or
You may need to take more than one type of
cuts by wearing gloves while working in the
drug to help with nausea. Talk with your doctor
yard and wearing shoes at all times.
or nurse about treatments to control nausea and
• Blow your nose gently. vomiting caused by treatment.
• Apply gentle but firm pressure to any cuts
If you are still suffering from nausea or vomiting
you get until the bleeding stops.
after taking the medications and adjusting your
Anemia diet, please call the office.
This is a low red blood cell count (RBC). Red
blood cells carry oxygen to your tissues and Things to do to prevent or manage nausea
waste away from the tissues. Chemotherapy can or vomiting:
cause the number of these cells to drop. If these Take anti-nausea meds as prescribed.
counts are low, you may experience some fatigue Do not wait until you are vomiting to start
and shortness of breath. There are medications taking them.
that can be given to help boost these cell
counts or you may need a blood transfusion if
your blood count falls too low. Your healthcare
team will discuss this with you, if needed, and

12
Prevent nausea. Suck on small bites of popsicles or fruit ices.
One way to prevent vomiting is to prevent You may also find sucking on ice chips helpful.
nausea. Try having bland, easy-to-digest foods
and drinks that do not upset your stomach. Suck on sugar-free mints or tart candies.
These include plain crackers, toast and gelatin. Do not use tart candies if you have mouth
or throat sores.
Plan when it’s best for you to eat and drink.
Some people feel better when they eat a light When you feel like vomiting, breathe deeply and
meal or snack before chemotherapy. Others slowly or get fresh air.
feel better when they have chemotherapy on an You might also distract yourself by chatting with
empty stomach (nothing to eat or drink for two friends or family, listening to music or watching a
to three hours before treatment). movie or TV shows.

Eat small meals and snacks. You may also use essential oils or homeopathic/
Instead of three large meals each day, many complementary treatments.
people find it easier to eat if they have five or six These should be discussed with your healthcare
small meals and snacks. It also helps not to drink team first.
a lot before or during meals and to avoid lying Mouth Sores
down right after you eat. Sometimes chemotherapy can harm fast-growing
cells, such as those that line your mouth, throat
Drink plenty of fluids between meals.
and lips. This can affect your teeth, gums, the
This will help with nausea but will also help to
lining of your mouth and the glands that make
remove the toxins caused by the treatment
saliva. Most mouth problems go away a few days
from your system. Hydration is important during
after chemotherapy is over.
chemo. Fluids can be obtained through:

• water or broths Mouth and throat problems may include:

• sports drinks (Gatorade or Powerade®) • dry mouth

• powdered electrolyte products (Drip Drop or • changes in taste and smell, such as when food
Ensure® Rapid Hydration) tastes like metal or chalk, has no taste or does
• caffeine free teas not taste or smell like it used to

• ginger ale or Sprite • infections of your gums, teeth or tongue

• increased sensitivity to hot or cold foods
Eat and drink items that are not too hot nor
too cold. • mouth sores or areas of tenderness
Give hot foods and drinks time to cool down • white or dark patches
or make them colder by adding ice. You can
• trouble eating when your mouth gets very sore
warm up cold foods by taking them out of the
refrigerator one hour before you eat or warming Things to do to manage mouth and throat
them slightly in a microwave. Drink cola or ginger problems:
ale that is warm and has lost its fizz.
Visit a dentist at least two weeks before starting
Avoid strong smells. chemotherapy treatment.
Try to avoid foods and drinks with strong smells, It is important that your mouth is as healthy as
such as coffee, fish, onions, garlic and foods that possible, which means having all your dental
are cooking. work done before chemotherapy starts. If you
cannot go to the dentist before chemotherapy

13
 starts, ask your doctor or nurse when it is safe Be careful what you eat when your mouth
to go. Be sure to tell your dentist that you have is sore.
cancer and about your treatment plan.
Choose foods that are moist, soft and easy to
Check your mouth and tongue every day. chew or swallow. These include cooked cereals,
By checking your mouth, you can see or feel mashed potatoes and scrambled eggs.
problems (such as mouth sores, white spots or
infections) as soon as they start. Inform your Use a blender to puree cooked foods so that
doctor or nurse right away if you see any of they are easier to eat. To help avoid infection,
these problems. be sure to wash all blender parts before and after
using them. If possible, it is best to wash them in
Keep your mouth moist. a dishwasher.
You can keep your mouth moist by sipping water
throughout the day, sucking on ice chips or sugar- Take small bites of food, chew slowly and sip
free hard candy, or chewing sugar-free gum. Ask liquids while you eat.
your doctor or nurse about saliva substitutes if Soften food with gravy, sauces, broth, yogurt
your mouth is always dry. or other liquids.
Brush your teeth, gums and tongue after each Eat foods that are cool or at room temperature.
meal and at bedtime. You may find that warm and hot foods hurt your
Use an extra-soft toothbrush. You can make the mouth or throat.
bristles even softer by rinsing your toothbrush in
hot water before you brush. Suck on ice chips or popsicles. These can relieve
mouth pain.
If brushing is painful, try cleaning your teeth with
cotton swabs or Toothettes®, which are shaped Call your doctor, nurse or dentist if your mouth
sponges on a stick. hurts a lot. Your doctor or dentist may prescribe
medicine for pain or to keep your mouth moist.
Use a fluoride toothpaste or special fluoride gel Make sure to give your dentist the phone number
that your dentist prescribes. of your doctor and nurse.
Do not use mouthwash that has alcohol. Instead, Avoid things that can hurt, scrape or burn your
rinse your mouth three to four times a day with mouth, such as:
a solution of baking soda, salt and warm water
followed by a plain water rinse. • sharp or crunchy foods, such as crackers and
potato or corn chips
There are many recipes for this solution, but
• spicy foods, such as hot sauce, curry dishes,
an example is 1/4 teaspoon baking soda, 1/8
salsa and chili
teaspoon salt and one cup of warm water.
Swish/gargle every two hours as needed. • citrus fruits or juices such as orange, lemon
and grapefruit
Gently floss your teeth every day.
• food and drinks that have a lot of sugar, such
If your gums bleed or hurt, avoid those areas but
as candy or soda
floss your other teeth. Ask your doctor or nurse
about flossing if your platelet count is low. • beer, wine and other types of alcohol
• toothpicks or other sharp objects
If you wear dentures, make sure they fit well and
keep them clean. Also, limit the length of time • tobacco products, including cigarettes, pipes,
that you wear them. cigars and chewing tobacco

14
Skin and Nail Changes Things to do to manage skin and nail changes:
Chemotherapy treatments can affect your skin Sprinkle yourself with cornstarch.
and nails. These effects are usually mild but can Take quick showers or sponge baths instead of
be worrisome if you are not prepared. Many of long, hot baths.
these changes will get better once you have
finished chemotherapy. Pat, rather than rub, yourself dry after bathing.

Skin changes may include: Wash with a mild, moisturizing soap.

Itching, dryness, redness, rashes and peeling
Put on cream or lotion while your skin is still
Sensitivity to the sun (when you burn quickly) damp after washing. Tell your doctor or nurse if
This problem can happen even to people who this does not help.
have very dark skin color.
Do not use perfume, cologne or aftershave lotion
Hyperpigmentation that has alcohol.
A problem that results in dark patches on your
Take a colloidal oatmeal bath when your whole
skin or a darker skin color. Dark patches may
body itches. Colloidal oatmeal is a special
occur in the following locations:
powder you add to bath water.
• around your joints
Acne-type rash:
• under your nails
Keep your face clean and dry.
• in your mouth
Ask your doctor or nurse if you can use
• along the vein used to give you chemotherapy
medicated creams or soaps and which
• under tape or dressings ones to use.
• in your hair
Sensitivity to the sun:
Radiation recall Avoid direct sunlight.
Some chemotherapy causes skin in the area
where you had radiation therapy to turn red. During the summer, the sun tends to be the
The color can range from very light to bright red. strongest from 10 a.m. until 4 p.m.
Your skin may blister, peel or be very painful. Use sunscreen lotion with an SPF (skin protection
Allergic reactions to chemotherapy factor) of 30 or higher. Or use ointments that
Some skin changes mean that you are allergic block the sun’s rays, such as those containing
to the chemotherapy. Let your doctor or nurse zinc oxide.
know right away if you wheeze or have trouble Keep your lips moist with a lip balm that has an
breathing along with: SPF of 30 or higher.
• sudden and severe itching
Wear light-colored pants, long-sleeve cotton
• rashes shirts and hats with wide brims.
• hives
Do not use tanning beds.
Nail Changes
Besides becoming darker, your nails may also turn
yellow or become brittle and cracked. Sometimes
your nails will loosen, lift from the nailbed and fall
off, but new nails will grow back in.
15
 Radiation Recall • Use the bed for sleep or sex only. Do not
Protect the area of your skin that received watch television in bed.
radiation therapy from the sun. • Take any sleep aid medications at the same
time every evening.
Do not use tanning beds.
• Try to go to bed when you are tired and
Place a cool, wet cloth where your skin hurts. around the same time each night.

Wear clothes that are made of cotton or other • Adjust the temperature in the bedroom for
soft fabrics. This includes your underwear (bras, maximum comfort.
underpants and t-shirts). Questions for my team:

Nail Problems
Wear gloves when washing dishes, working in the
garden or cleaning the house.

Let your doctor or nurse know if your cuticles are

red and painful.

Use tea tree oil if your nail beds loosen.

Sleep Problems Activity During Treatment

It is common for cancer patients to have trouble
sleeping. This can be caused by pain, anxiety, Exercise during treatment is important for many
depression, side effects of treatment, night reasons. It can help to reduce fatigue, helps
sweats or staying overnight in the hospital. Your keep your strength up, improves heart health,
body will need more sleep as you go through improves sleep and mood and gives you more
treatment, as well. energy. We encourage you to stay as active
as you can. You can continue to work during
Not getting enough sleep can cause: treatment if your job is not something that will
• increased pain increase your risk for injury or infection. You
can also continue with your hobbies and we
• memory changes
encourage light exercise, such as walking or
• increased fatigue biking. Please do any outdoor exercises in the
• decreased healing cooler times of day and be careful to keep skin
covered and protected from the sun.
• increased sickness/infection
Things to do to manage problems with sleep: Some helpful hints when exercising:

• Get enough exercise during the day, light • Always talk with your doctor before starting
exercise is fine; 30-60 minutes per day at least any new fitness routine.
two to three hours before bedtime. • Ask family or friends to join you.
• Avoid drinks with caffeine or alcohol in • You can use a fitness tracker to help you
the evening. stay motivated.
• Drink warm decaffeinated or herbal tea or • Doing a little exercise is better than
milk before bedtime. doing nothing.
• Have someone give you a massage or try • We want you to keep as much of your
relaxation techniques prior to going to bed. schedule as you can while in treatment.
16
• Work – ask your doctor if you can continue to A serving size can be 1/2 cup cooked fruits or
work during treatment. vegetables, one cup raw fruits or vegetables or
• Hobbies – continue to do the things that make one baseball sized piece of fresh fruit. Getting
you happy, just do not overdo it. enough nutrition is helpful in fighting off fatigue,
constipation and weight loss. A balanced diet is
• Nap as needed, but do not stay in bed all day.
the most important thing to have.
If you have trouble with daily activities, let your
doctor or nurse know. Protein is important while you are going through
Be Safe!!! treatment because this is what you body will
use to rebuild the healthy cells and help you
• Do not exercise if you are not feeling well,
keep your muscles strong. You should have
have a fever, are feeling nauseated or are
protein with every meal. Many people also use
throwing up.
protein drinks/shakes to help keep up with the
• If you have swelling in your ankles or protein demand. This can also provide additional
unexplained weight gain or if you have calories. Try not to drink these at mealtime but
difficulty breathing while at rest, please call between meals instead.
the office immediately.
Plant based proteins include:
• Avoid public gyms if your white blood count
Nuts, nut butters, seeds, legumes and soy.
is low.
• Avoid contact sports if you have a port-a-cath Animal based proteins include:
or central line (PICC). These include football, Beef, pork, chicken, eggs, milk, cheese, fish
basketball, wrestling or lacrosse. You also do or other seafood and yogurt.
not want to use a rifle on the side of port/line.
It is important that all the meats that you eat are
Trauma to the area can damage the site.
thoroughly cooked. Do not eat anything raw or
• You can swim if your port site is healed and it unwashed while on treatment.
is not in use. If you have a PICC line in place,
do not swim. Food safety is a must while on treatment.

Questions for my team: • Be sure not to cross contaminate your raw

meats with your fresh fruits and vegetables
while shopping or putting away.
• Wash all fruits and vegetables before you
eat them.
• Be sure to keep the counters in your kitchen
clean. Wipe them down with antibacterial
wipes or bleach water regularly and especially
after having raw meat out on the counter.
• Do not eat/drink anything unpasteurized.
Nutrition During Treatment
• It is important that you wash your hands before
Eating well during chemotherapy treatment is preparing or eating food, after using the
essential. You should fill your plate at mealtimes restroom and after touching any pets.
with 2/3 fruits, vegetables, whole grains and • Do not put cooked foods back onto a plate
legumes (beans/peas) and only 1/3 of your that held raw meat without washing it first.
plate should be animal products. Have at least
• Properly package and refrigerate any leftovers
five servings of fruits and vegetables every day.
immediately after the meal is finished.
17
 It is also very important to stay hydrated. We uncommon for patients to feel cooler once
recommend at least two to three liters of fluids we have started the IV fluids associated with
per day. You should start this the day before treatment. If we will be using a port for your
your first treatment and continue until the full treatment, please wear a button-down shirt or a
completion of treatment. Remember, any drink shirt with a wide neck so that we can have access
with caffeine should not be counted in the total to your port. If we are using an IV in your arm,
amount of fluids. make sure that you wear short sleeves or can
push the sleeve up past your elbows.
If you would like more information about nutrition
during treatment or if you are having trouble When you come in for treatment, we will get your
with eating/weight loss, please talk with your vital signs (blood pressure, temperature, heart
healthcare team. We can connect you with our rate and weight). Once we know your blood work
staff nutritionists. and your vital signs are good, we will proceed
with treatment as planned.
Notes about my nutrition:
There are often medications that are given
to support you while you are getting therapy.
These medications will be given prior to
getting the actual treatment and are things like
Tylenol®, antihistamines (Benadryl®), anti-nausea
medications and steroids. The purpose of these
medications is to help keep you comfortable
during treatment and decrease the likelihood
of reactions.
Treatment Day Any time we give you a new medication we will
ask you for your name and date of birth. This is
We use many different treatments to treat cancer.
for your safety and to assure that you are getting
These medications can be used alone or together
what is planned for you specifically.
in combination treatments. Your doctor, along
with the rest of your team, will use guidelines to Once these medications are infused, there will be
decide what the best plan of treatment is for you. an observation period to allow these medications
There are many factors that go into the decision, to work and provide their maximum benefit.
such as diagnosis and your general health, just to Treatment infusion will then begin. You should
name a few. not feel anything different while the treatment
is being infused. If you have any change in how
Some patients will be in the treatment room for
you feel during the infusion, please alert your
less than an hour and others will spend all day.
nurse immediately. This might be anything from
We will always check your blood work before
itching, shortness of breath, chest pain, low back
we get started to assure that your labs are good
pain, chills, sweating or tingling of your mouth
prior to giving any treatment.
or lips. The sooner you make the nurse aware,
Remember: If your WBCs or platelets are too the sooner they can respond to help alleviate
low, we will not be able to give your treatment your symptoms.
that day.

Please make sure that you dress warmly or bring

a jacket with you in case you get cold. It is not

18
You may get up and move around during When using the restroom:
treatment. Please feel free to use the restroom
• It is important that you flush twice after using
or refill your water as needed. If you need
the toilet for at least the first 48 hours after
assistance, the staff nurses will be more than
you have gotten treatment.
happy to help; you need only ask.
• If possible, use a separate bathroom from
Things I want/need to take with me on everyone else in the house. If this is not
treatment days: possible, make sure to wipe down the toilet
seat after each use with a sanitizing wipe.
• Wash your hands after using the toilet and
make sure not to touch any surfaces until you
have washed your hands.
• If you are using a bedside commode or
bedpan, make sure to use gloves when
emptying and cleaning.
You can enjoy your friends and family if you feel
After treatment up to it. Please make sure that anyone you are
spending time with is not sick. If you have visitors
Treatment medications are excreted in your in your house, wipe down the frequently touched
bodily fluids. This means there may be a small surfaces (door knobs, light switches, sink handles,
amount of medication in your urine, stool, saliva, etc.) after everyone leaves. It is important to wear
vomit, semen and vaginal fluids. It is important a mask when in public to protect yourself from
that other people in the house are not exposed the germs of others. Try to run your errands when
to these fluids. there will be a fewer number of people or have
someone else run the errands for you.
There are some basic guidelines to follow when
you get home, after you have received treatment. If you plan to have sexual intercourse while
It is important that you handle your own soiled receiving treatment:
clothing/linens whenever possible. If someone
else must handle these things, they need to • Use barrier contraceptives for the first 72 hours
wear gloves and wash their hands right away after treatment. This is important for both men
afterwards. If someone accidentally touches and women.
body fluids, they need to wash their hands • Do not get pregnant while on treatment or let
immediately. anyone who is pregnant be exposed to any
body fluids. Keep all children away from body
If there are soiled clothes/linens: fluids, as well.
• You should gather all soiled articles and wash If you are taking an oral anti-cancer pill, these
immediately. Wash separately from all other same precautions need to be used for the
clothing/linens in hot water using your normal entire time you are on treatment. Do not allow
laundry detergent. anyone else to touch your pills except you. If
• If the soiled articles cannot be washed right someone else needs to help you with your meds,
away, place them in a plastic bag and seal they should wear gloves when handling the
them until they can be washed. medications. Do not flush unused pills down
• When finished cleaning up soiled clothing the toilet or throw them away in the garbage.
or linen make sure to wash your hands.
19
 Survivorship American Cancer Society
General cancer information, as well as resources
Survivorship begins at diagnosis. The focus is on for information on diagnosis, transportation and
the health and life of the patient who is going caregiver/family support
through treatment and after treatment to the end Customer Service: (800) 277-2345
of their life. Survivorship includes issues that have cancer.org
to do with the patient’s ability to get healthcare
National Comprehensive Cancer Network
and follow-up treatment for any physical and
Guidelines for treatment by cancer type
sexual health, psychosocial or financial concerns.
nccn.org/patients/guidelines/cancers.aspx
It also deals with the late effects of treatment,
secondary cancers and quality of life. National Cancer Institute
Information on cancer from diagnosis to research
Our physicians continue to see patients after cancer.gov
active treatment is complete. Please let us know
Cancer.Net
how we can help you maintain your best quality
Sponsored by the American Association of
of life during your survivorship journey.
Clinical Oncology – gives physician approved
information about diagnosis, treatment, clinical
CareSpace trials and symptom management
cancer.net
You can access your medical chart from home if
you have internet access. Chemocare.com
Look up your chemotherapy medications and
Go to FLCancer.com learn how to manage side effects
chemocare.com
Click on “CareSpace” in the top right corner.
The first time you log in you will need the
Immunotherapy or Targeted Therapy
instructions sent via email by the office staff.
Follow the instructions to complete registration. Our body’s immune system is an intricate system
From here you can access your lab results, view designed to seek out foreign cells and destroy
pathology and radiology reports and update them. This is what happens when we get a cold
your medication list. You can also message your or the flu. However, the body may not recognize
doctor from here. If there is something you cancer cells as foreign because cancer cells are
cannot view, it is usually because the doctor most often developed from our healthy cells
has not signed off on it yet. that have mutated. The mutated cells may not
be different enough for the immune system to
Patient Resources recognize these cells should be destroyed.

When looking for information online, be careful Immunotherapy, sometimes known as targeted
about your web searches. Be sure that the site therapy, are types of medications that can be
you are looking at is up to date, is reputable and used to boost the immune system to help it
is not trying to get you to buy something. You better fight cancer. Often, this type of therapy
also need to be careful of anything that claims can be targeted so that the immune system
to “cure” cancer. Some trusted sites that you attacks the specific cancer cells while overlooking
can go to for information on your diagnosis and the normal healthy cells of the body. This
treatment and for managing side effects are: generally means less side effects than traditional
chemotherapy.

20
Over the last several decades, there has been against a specific type of cancer. They can be
much research done to help find more effective given to prevent the cancer from starting at all,
ways to treat cancer. Through this research, these or as treatment, and this is given after there is
“new” treatments were discovered. already a known cancer.

While we do not have an immunotherapy to treat Immunotherapy can be used alone or with
every type of cancer, there is progress being other chemotherapies in order to develop the
made daily in the discovery of new treatments. most effective treatment for each patient. They
Immunotherapy will not be effective for every are given through an IV or a port, the same as
patient because each patient's cancer is unique traditional chemotherapy.
and what works for one patient may not work for Please note, the side effects of immunotherapy are
**

another. different than that of chemotherapy. No matter where

your cancer began, side effects from immunotherapy
Types of immunotherapy include: can affect your whole body. Side effects may appear
shortly after beginning treatment, within the first
• Monoclonal antibodies – these are proteins couple of months or even after you finish treatment.
that are made in a lab and act like human Many of these immune side effects are treatable. Your
antibodies in the immune system. They can doctor may prescribe steroids or other medications
to help manage any problems. Rare, but serious, side
be used to target a very specific part of the effects can lead to death, especially if left untreated,
cancer cell. so it is important that you always notify you doctor
immediately if you have any symptoms. Once you
• Checkpoint inhibitors – these types of drugs
have started immunotherapy you will also need to tell
work by blocking checkpoint proteins that are any doctor who is treating you for any condition that
on the surface of cancer cells from binding with you have had immunotherapy, even after you have
their partner proteins. This prevents the “off” completed treatment.
signal from being sent, allowing the immune Immunotherapy-Specific Side Effects
system to attack and kill the cancer cells.
Skin – rashes, redness, itching, skin changes,
• CAR-T therapy – this type of therapy uses the pain, swelling, soreness, dry, peeling skin,
patient's own T-cells, which are collected from blisters or sores
the blood and specially altered to fight cancer.
When these cells are re-infused into the Things to do to manage skin side effects:
patient, they are able to latch on to a specific • Avoid scratching or using soap and hot water
antigen on the patient's tumor cells and on skin.
kill them.
• Apply a cool cloth or some type of cooling
• Cytokines – these are small proteins that help moisturizing cream.
carry messages between cells in the immune
• Contact your doctor immediately if you
system. They also send signals that can help
experience severe inflammation, swelling,
make abnormal cells die and normal cells
intense itching or a widespread or quickly
live longer.
worsening rash.
• Oncolytic viruses – these are a type of virus
that infects and breaks down cancer cells but Abdomen – nausea, vomiting, loss of appetite,
not normal cells. They can occur naturally abdominal cramping or pain, fever, fatigue,
or be made in a lab. diarrhea, constipation, increase in number of
stools, or blood or mucus in the stool
• Cancer vaccines – These are used to stimulate
the immune system’s response by introducing
the virus in order to build immunity or fight

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 Things to do to manage abdominal side effects: Things to do to manage hormonal side effects:

• Drink plenty of water to prevent dehydration • Eat a healthy diet and exercise regularly.
and avoid rich, spicy foods. • Continue taking any thyroid medication you
• Call your doctor if you experience an increase have been prescribed.
or changes in your bowel movements,
• Call your doctor immediately if you experience
especially if your stools are mushy or watery,
headaches with dizziness, confusion,
or if you have symptoms that interfere with
drowsiness or fainting, vision changes, fever,
your daily activities.
nausea or vomiting.
• Contact your doctor immediately if you
experience severe abdominal pain, especially Biosimilars
with a fever.
Biosimilars are a group of safe and effective
Lung – cough, shortness of breath or chest pain
medications for treating many illnesses, such as
Things to do to manage respiratory side effects: chronic skin and bowel diseases (like psoriasis,
irritable bowel syndrome, Crohn’s disease and
• Continue use of asthma or allergy prescriptions
colitis), arthritis, kidney conditions and cancer.
during your treatment.
• Call your doctor if you experience a new Biosimilars are FDA-approved medications that
cough or your cough worsens. are similar to, and chemically undistinquishable
from, the original biologics.
• Call your doctor immediately if you experience
chest pain or you develop difficulty breathing, Biologic medicines are usually made from natural
especially if it is sudden. sources, using advanced science.
Liver – fever, chills, muscle or joint aches, Same expected benefits and risks – Compared
headaches, drowsiness, fatigue, sweating, with their original biologics, biosimilars:
nausea, vomiting, abdominal pain (especially on
the upper right side), loss of appetite, bruising or • are made with the same types of natural
bleeding more easily, yellowing skin or eyes, pale sources
stools or dark urine, or confusion • are given in the same form

Things to do to manage liver side effects: • provide the same treatment benefits
• have the same potential side effects
• Drink plenty of water to prevent dehydration
and eat a well-balanced diet. • have the same strength and dosage
• Avoid alcohol and taking more prescription Access – Biosimilars may provide patients with
pain medication than recommended. more access to important treatments:
• Call your doctor immediately if you experience • more options
fever, drowsiness, or confusion, if your skin has
• more competition in the health care market
turned yellow, or you have severe stomach
pain or swelling. • lower costs

Endocrine – fatigue, headache, nausea, vomiting,

abdominal pain, constipation, weight gain or
loss, dizziness, confusion, drowsiness, fainting,
vision changes or loss of sexual function

22
Safe and effective – The FDA makes sure • performing quality checks during medication
biosimilars are as safe and effective as the production
original biologic by:
• reviewing patient safety reports made to FDA
• approving biosimilars after a careful review of
data, studies and tests
• continuing to monitor safety and effectiveness

Frequently Asked Questions

What are biological medications? for Medicare & Medicaid Services (CMS) and plan
providers can generally provide this information.
Biological medications (also called biological
products) can be made of sugars, proteins, living Is it safe to take a biosimilar if I started
cells, tissues or a combination of these. They are treatment on the reference product first?
made from natural and living sources like animal
and plant cells, and microorganisms, such as Generally, biosimilar medications can be used
bacteria or yeast. whether or not you have been treated first with
the reference product. Always talk to your health
Biological medications are usually more care provider about available treatment options
complex than other drugs. They are often more and potential risks and benefits.
complicated to purify, process and manufacture.
How will I know if I am using a biosimilar
What is a biosimilar medication? medication for my treatment?

A biosimilar is a medication that is highly similar Talk to your health care provider about the
to a medication already approved by the FDA medications you are prescribed or are taking.
– the original biologic (also called the reference Often, biological medications, including
product). Biosimilars also have no clinical biosimilars, are given in a hospital or an infusion
differences from the original reference product. center. Talk to the doctor or nurse who is giving
This means you can expect the same safety and you the treatment. If you have a prescription,
effectiveness from the biosimilar over the course your doctor or pharmacist can tell you what you
of treatment as you would the reference product. are prescribed and what you are being given at
Biosimilars are made from the same types of the pharmacy.
sources (e.g., living cells or microorganisms) and
are just as safe and effective as their original How are biosimilars different from generics?
reference products. Biosimilars are like generics in some ways, in
Will I save money by using a biosimilar? that both types of medications are compared
to a reference (original) product for approval.
Reducing costs is one reason Congress created Biosimilars and generics are both versions of
the FDA-approval pathway for biosimilar previously FDA approved medications and may
medications. However, the FDA does not offer more affordable treatment options.
regulate whether insurance companies cover
or reimburse the cost of biosimilars. If you have Biosimilars and generics are approved through
insurance, check with your insurance provider to different abbreviated pathways that avoid
find out what’s included in your plan. If you are duplicating certain costly clinical trials.
covered by Medicare or Medicaid, the Centers

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Both biosimilar and generics go through a In contrast to a chemical, which is created in
rigorous review process. Once FDA-approved, a lab and can be generally copied, a biologic
these medications are just as safe and effective medication is made from natural and living
as the reference products to which they are sources and cannot be exactly copied. So, the
compared; however, there are differences information needed to demonstrate that a
between biosimilars and generic drugs. For biosimilar is related to a biologic can be much
example, biosimilars are generally made from more extensive than what is generally needed for
natural and living ingredients, and generics are a generic.
often made from chemical ingredients.
Talk to your doctor to learn more.

Biosimilar Definitions
Reference Product: A reference product is the single biological product, already approved by the FDA,
against which a proposed biosimilar product is compared.

Biosimilar Product: A biosimilar is a biological product that is highly similar to, and has no clinically
meaningful differences from, an existing FDA-approved reference product.

Interchangeable Product: An interchangeable product is a biosimilar product that meets additional

requirements to show that an interchangeable product produces the same clinical result as the reference
product in any given patient.

Source: FDA.gov

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