Patient education: Chemotherapy – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is chemotherapy? — Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. It is often called "chemo" for short. It can be used alone, or together with surgery, radiation, and other treatments for cancer.

Chemo can be given by mouth or through an injection. It can be given daily, weekly, or monthly.

Your doctor will choose the type of chemo you need based on:

●The type of cancer you have

●Your overall health

●Your other cancer treatments

●Your preferences and goals of care, based on the kind of cancer you have and whether it has spread

What happens after chemo? — Chemo affects rapidly growing cancer cells, but it can affect other normal cells, too. This can cause side effects. Depending on your treatment, your doctor will tell you which side effects you are most likely to get.

How the chemo affects you will depend on the:

●Type of cancer you have

●Type of chemo medicine you will get

●Dose and how the chemo will be given

●Number of treatments, and your treatment schedule

Some side effects happen hours or days after treatment. Other side effects can show up months or years after treatment. Some side effects can get worse over the course of treatment.

What are the side effects of chemo? — Not everyone will get all or even most of the side effects. Common side effects that might occur after chemo include:

●Feeling tired during and after chemo

●Hair loss

●Sore throat or sores in the mouth

●Dry, itchy, red, or darker skin

●Skin rashes

●Nausea and vomiting

●Numbness and tingling in hands or feet

●Loss of appetite or weight loss

●Easy bruising or bleeding, often from the gums

●Higher risk of infection

●Diarrhea or constipation

●Pain in muscles or joints

There are often medicines or other ways to help manage side effects. Talk with your doctor or nurse about how to manage your side effects. After a few treatments, you might be able to see a pattern in the way chemo affects you. This will help you plan for your daily activities.

How do I care for myself at home? — If you get chemo in the hospital, you will be discharged home with a specific set of instructions. Make sure that you understand exactly what you need to do to care for yourself at home. Ask questions if there is anything you do not understand.

You should also:

●Take all of your medicines as instructed by your doctor.

●Avoid using too much energy, to help prevent getting tired. You can change your daily routines and how you go about your activities. For example, try to plan ahead, rest often, and ask friends and family for help doing chores that make you tired. For general and specific tips on ways to save your energy, see the tables (table 1 and table 2).

●Try to move your body each day, even if it is just a short walk. Exercise can increase your energy and help improve your appetite.

●Eat healthy foods, and drink plenty of nonalcoholic fluids. Healthy foods help give your body the strength to complete your chemo treatments. Eat small meals more often, instead of 2 or 3 large meals. Set specific times throughout the day to eat. Drink milkshakes, smoothies, soups, or juices if you cannot tolerate solid foods. Keep water nearby, and take small sips often.

●Protect your skin from the sun, and use sunscreen. To protect your scalp, you can also wear a hat or scarf on your head when you go outside. Some people with hair loss related to chemo or radiation therapy might prefer to wear a wig.

●Try to get at least 8 hours of sleep every night. If you have trouble sleeping, you can do things to improve your sleep habits. Avoid drinking alcohol or caffeine in the late afternoon or evening. Try to go to bed and wake up at the same time every day. Limit your naps during the day, and don't nap more than 30 minutes at a time. For more tips on ways to improve your sleep habits, see the table (table 3).

●Pay attention to any numbness or tingling in your hands or feet. Tell your doctor right away so you can avoid long-term damage. Wear supportive shoes with socks, and do not walk barefoot.

●Take good care of your teeth and mouth. Chemo can affect your ability to produce saliva, which increases plaque buildup. Visit your dentist at least 2 times each year. Make sure that your dentist knows that you are getting chemo.

•If you do not have mouth sores:

-Brush and floss your teeth 2 to 3 times a day.

-Use a toothbrush with soft bristles.

-Use alcohol-free mouthwash after brushing your teeth.

-Rinse your mouth with warm salt water after each meal. Mix a 1/2 teaspoon (2.5 grams) of salt with a cup (240 mL) of warm water.

•If you have mouth sores (called "mucositis"):

-Gently brush your teeth with a foam swab or toothbrush with very soft bristles 3 to 4 times each day. You can also use a clean cloth to wipe teeth.

-Rinse your mouth with a water, salt, and baking soda mixture every 4 hours. Mix a 1/4 teaspoon (1.25 grams) of salt, 1/2 teaspoon (3 grams) of baking soda, and 2 cups (480 mL) of warm water.

●Know that your chance of getting an infection is higher when you are getting chemo treatment. Wash your hands often with soap and water for at least 20 seconds (figure 1). You can also use an alcohol-based hand sanitizer (figure 2). Avoid people with infections, colds, COVID-19, or the flu. Consider wearing a mask in public.

What follow-up care do I need? — Your doctor or nurse will tell you if you need to make a follow-up appointment. If so, make sure that you know when and where to go.

After chemo, your doctor might order regular blood tests (often weekly) to see how the chemo affects your blood. This is important for planning later chemo doses. For most kinds of chemo, you need to come back for more treatment, either to the hospital, clinic, or doctor's office.

When should I call the doctor? — Call your doctor right away if you had chemo within the last 6 weeks and you:

●Have a fever of 101.0°F (38.3°C) or higher at any time

●Have a fever of 100.4°F (38.0°C) or higher that lasts for 1 hour or longer

●Have trouble breathing, cough a lot, or have shortness of breath

●Cannot keep any food or drink down

If you cannot reach your doctor, go to the emergency department right away.

Call your doctor or nurse for advice if you:

●Have chills or sweating

●Have a sore throat, sores in your mouth, toothache, or mouth pain that keeps you from eating

●Have very bad belly pain

●Feel pain in your anal area

●Have pain or burning when urinating, or frequent urination

●Have diarrhea or sores around your anus

●Notice redness, swelling, or pain of your skin, especially around a cut, wound, or place where you had a tube in your vein (called an "IV")

●Have unusual vaginal discharge or itching

●Have diarrhea or constipation

●Feel dizzy or weak

●Are so tired that you can't do your daily activities, including bathing, getting dressed, and eating

●Have new pain or a change in your usual pain

●Have worsening pain that can't be controlled with medicines

More on this topic

Patient education: Chemotherapy (The Basics)
Patient education: When your cancer treatment makes you tired (The Basics)
Patient education: Hair loss from cancer treatment (The Basics)
Patient education: Mouth sores from cancer treatment (The Basics)
Patient education: Nausea and vomiting with cancer treatment (The Basics)
Patient education: Managing loss of appetite and weight loss with cancer (The Basics)
Patient education: Managing pain when you have cancer (The Basics)
Patient education: Neutropenia and fever in people being treated for cancer (The Basics)
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