Fatigue 

What to look for?

• Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.
   

What to do?

• Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
• Check with your health care team before starting any new exercise.
• Pace yourself, do not rush. Put off less important activities. Rest when you need to.
• Ask family or friends to help you with things like housework, shopping, and child or pet care.
• Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less).
• Avoid driving or using machinery if you are feeling tired.

Ask your health care team for the Fatigue pamphlet for more information. 

Diarrhea

What to look for?

• Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.
   

What to do?

If you have diarrhea:

• Take anti-diarrhea medication if your health care team prescribed it or told you to take it.
• Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol.
• Eat many small meals and snacks instead of 2 or 3 large meals.
• Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less.
• Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
• Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day.

Ask your health care team for the Diarrhea pamphlet for more information.

Nausea and vomiting

(Generally mild)

What to look for?

• Nausea is feeling like you need to throw up. You may also feel light-headed.
• You may feel nausea within hours to days after your treatment.

What to do?

To help prevent nausea:

• It is easier to prevent nausea than to treat it once it happens.
• Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
• Drink clear liquids and have small meals. Get fresh air and rest.
• Do not eat spicy, fried foods or foods with a strong smell.
• Limit caffeine (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

• Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
• Ask your health care team for the Nausea & Vomiting pamphlet for more information.
• Talk to your health care team if:
  • nausea lasts more than 48 hours
  • vomiting lasts more than 24 hours or if it is severe

Constipation

(May be severe)

What to look for?

• Having bowel movements (going poo) less often than normal.
• Small hard stools (poo) that look like pellets.
• The need to push hard and strain to have any stool (poo) come out.
• Stomach ache or cramps.
• A bloated belly, feeling of fullness, or discomfort.
• Leaking of watery stools (poo).
• Lots of gas or burping.
• Nausea or vomiting.
   

What to do?

To help prevent constipation:

• Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains.
• Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less.
• Be Active. Exercise can help to keep you regular.
• If you take opioid pain medication, ask your health care team if eating more fibre is right for you.
   

To help treat constipation:

• If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do.

Ask your health care team for the Constipation Pamphlet for more information.

Neuropathy (Tingling, numb toes or fingers)

(May be severe)

What to look for?

• Numbness or tingling of your fingers and toes may happen after starting your treatment. 
• Sometimes it can be painful and feel like burning sensation, which may be severe.

What to do?

• Talk to your health care team if you have symptoms of neuropathy.
• Numbness and tingling may slowly get better after your treatment ends.

In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice.

Fever, chills, shivering (less common)

What to look for?

• You may have a fever or chills without any signs of infection, such as a sore throat, cough or skin rash.
• Symptoms may happen at any time after you receive your treatment and usually go away as your body gets used to the medication.

What to do?

• Speak to your health care team if these feelings bother you.
• Check your temperature to see if you have a fever. 
• If you do have a fever, try to speak to your health care team. If you are unable to talk to them for advice, you MUST get emergency medical help right away.

Low neutrophils (white blood cells) in the blood (neutropenia)

(May be severe)

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.
 

What to look for?

• If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
• Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
• Do not eat or drink anything hot or cold right before taking your temperature.

You have a fever if your temperature taken in your mouth (oral temperature) is:

• 38.3°C (100.9°F) or higher at any time

  OR

• 38.0°C (100.4°F) or higher for at least one hour.
   

What to do?

If your health care team has told you that you have low neutrophils:

• Wash your hands often to prevent infection.
• Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
• Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.


 

Low platelets in the blood

(May be severe)

When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.
 

What to look for?

• Watch for signs of bleeding:
  • bleeding from your gums
  • unusual or heavy nosebleeds
  • bruising easily or more than normal
  • black coloured stools (poo) or blood in your stools (poo)
  • coughing up red or brown coloured mucus
  • dizziness, constant headache or changes in your vision
  • heavy vaginal bleeding
  • red or pink coloured urine (pee)

What to do?

If your health care team has told you that you have low platelets:

• Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
• Check with your healthcare team before you go to the dentist.
• Take care of your mouth and use a soft toothbrush.
• Try to prevent cuts and bruises.
• Ask your health care team what activities are safe for you.
• Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion.
   

If you have signs of bleeding:

• If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.
   

If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.

 

Low appetite

What to look for?

• Loss of interest in food or not feeling hungry.
• Weight loss.

What to do?

• Try to eat your favourite foods.
• Eat small meals throughout the day.
• You may need to take meal supplements to help keep your weight up.
• Talk to your health care team if you have no appetite.

Ask your health care team for the Loss of Appetite pamphlet for more information.

Headache; mild joint, muscle pain or cramps 

What to look for?

• New pain in your muscles or joints, muscle cramps, or feeling achy.
   

What to do?

• Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
• Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may hide an infection that needs treatment or they may increase your risk of bleeding.
   

Ask your health care team for the Pain pamphlet for more information.

Cough and feeling short of breath

(May be severe)

What to look for?

• You may have a cough and feel short of breath.
• Symptoms that commonly occur with a cough are:
  • Wheezing or a whistling breathing
  • Runny nose
  • Sore throat
  • Heartburn
  • Weight loss
  • Fever and chills
• Rarely this may be severe with chest pain, trouble breathing or coughing up blood.
   

What to do?

• Check your temperature to see if you have a fever.
• If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
• If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.

Rash; dry, itchy skin

(May be severe)

What to look for?

• You may have cracked, rough, flaking or peeling areas of the skin.
• Your skin may look red and feel warm, like a sunburn.
• Your skin may itch, burn, sting or feel very tender when touched.
   

What to do?

To prevent and treat dry skin:

• Use fragrance-free skin moisturizer.
• Protect your skin from the sun and the cold.
• Use sunscreen with UVA and UVB protection and a SPF of at least 30.
• Avoid perfumed products and lotions that contain alcohol.
• Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Trouble Sleeping

Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends.
 

What to look for?

• You may find it hard to fall asleep or stay asleep.
• How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep.
• You may wake up too early or not feel well-rested after a night's sleep.
• You may feel tired or sleepy during the day.
   

What to do?

Talk to your health care team if it does not improve or if it is severe

Mild swelling

(May be severe)

What to look for?

• You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.
   

What to do?

To help prevent swelling:

• Eat a low-salt diet.

If you have swelling:

• Wear loose-fitting clothing.
• For swollen legs or feet, keep your feet up when sitting.

Pains or cramps in the belly

What to look for?

• Pain or cramps in your belly.
• Constipation and diarrhea can cause pain in your belly.

What to do?

• If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.

Low blood pressure (may be severe); Dizziness

What to look for?

• You may feel tired, dizzy or light-headed.
• You may have nausea (feeling like you need to throw up), vomiting or blurred vision.
• You may faint (pass out).
   

What to do?

• Check your blood pressure often. Talk to your health care team to find out what a safe blood pressure is for you.
• If you feel dizzy or unwell lay down right away so that you do not fall. Try to get up and move slowly only once you feel better.
• Do not drive a motor vehicle or operate machinery if you feel dizzy.
• Your blood pressure may drop when the medication is being given to you. Let your health care team know right away if you start to feel dizzy or lightheaded.

Too much or too little salt in your body

What to look for?

• Muscle spasms, cramping, weakness, twitching, or convulsions.
• Irregular heartbeat, confusion or blood pressure changes.
   

What to do?

Get emergency medical help right away for severe symptoms.

Eye problems 

What to look for?

• Your eyes may feel dry, irritated, or painful.
• They may look red and have a lot of tears.
• They may feel sensitive to light and your vision may be blurry.
   

What to do?

• Avoid wearing contact lenses.
• Wear sunglasses with UV protection.
• Use protective eyewear (goggles or helmet with face mask) when playing sports, mowing the lawn or doing anything that may get particles or fumes in your eyes.
• You may try artificial tears (eye drops) or ointment.

Heartburn; stomach upset; bloating

What to look for?

• Pain or burning in the middle or top part of your chest. It may get worse when you are lying down or bending over or when you swallow.
• A bitter or acidic taste in your mouth.
   

What to do?

• Drink clear liquids and eat small meals.
• Do not eat acidic, fatty or spicy foods.
• Limit caffeine (like coffee, tea) and avoid alcohol.
• Avoid smoking or being around tobacco.
• Sit up or stand after eating. Do not lie down.
• Raise the head of your bed six to eight inches. You may need to use extra pillows to do this.