SACT side-effects

Systemic anti-cancer therapy (SACT) can affect some normal cells and when it does, side effects can occur. This page describes the common side effects you may have in the days and weeks after treatment and some of the things you can do to help.

The side effects you have will depend on the particular medicine or combination of medicines you receive. Chemotherapy can have very different side effects from immunotherapy for example. Your doctor or nurse will discuss your proposed treatment with you and give you an information sheet which will describe the treatment and discuss the likely side effects. Your doctor or nurse will tell you what to expect. Some people do not get any side effects but if they do happen, please tell the doctor or SACT nurse, so that help can be given.

Rarely, there is a chance that the side effects could be life-threatening. If you would like any further information, please discuss this with your doctor.

Most SACT medicines reduce the body’s resistance to infection. Because of this, a minor illness can quickly develop into something more serious needing hospital treatment.

Symptoms of an infection include a sore throat, cough, fever or shivering. We recommend that you use a digital thermometer so you can check your temperature if you think you have an infection or if you feel unwell. You can buy one from your local chemist.

If you feel unwell, you have symptoms of an infection or your temperature is 37.5°C or above, or below 36°C, contact The Christie Hotline immediately on 0161 446 3658. Your SACT nurse will give you full details of contact numbers during your first visit.

How you can help yourself to avoid infection

Most infections come from bacteria (germs) that we normally carry on our skin or in our bowel. They are harmless when the body’s ability to fight infection is normal. It is only when resistance is low that they can cause an infection.

MRSA stands for meticillin-resistant staphylococcus aureus. It is a variety of a common germ called staphylococcus aureus which is found in the nose and throat of about a third of the population. People who carry this germ are said to be colonised with it. The germ causes no harm unless it spreads to a wound or gets into your body through another break in the skin, when it may cause an infection. It can be passed to other patients causing them to be colonised or occasionally infected. The resistant form of MRSA can be quite difficult to treat.

Clostridium difficile is a bacterium (germ) that can cause infections in the bowel. The symptoms include abdominal pain, diarrhoea and sometimes fever. The bacterium is normally kept under control by other bacteria that live in the gut; however, some medications alter the conditions within the gut allowing Clostridium difficile to multiply. It then produces toxins that cause diarrhoea and can lead to severe
inflammation of the bowel.

Things you can do to reduce the chance of infection

General

• Maintain good personal hygiene.
• While you are at the hospital, please wash your hands carefully or use alcohol hand rub. It is quicker and easier to use than soap when your hands are not actually soiled but might be carrying ‘hidden’ bugs.
• Please wash your hands with soap and water after using the toilet or any other bodily fluids including vomit, urine, sputum, or if you have any diarrhoea as SACT can remain in your system for up to 7 days. If you are a carer of a patient having SACT, try and wear gloves when handling bodily fluids at all times.
• It is fine to be around other people, including children. However, stay away from people who have a disease you can catch, such as a cold, the flu, measles, or chickenpox (if you have not had chickenpox yourself and you come into contact with someone with chickenpox or shingles, get in touch with The Christie as action may need to be taken).
• Be careful not to cut or nick yourself when using scissors, needles or knives.
• Use a soft toothbrush that won’t hurt your gums.
• Don’t squeeze or scratch pimples.
• Clean cuts and scrapes right away with warm water, soap and an antiseptic.
• Wear protective gloves when gardening.
• Please be reassured that you can usually carry on caring for your pets and handle them. Make sure you wear gloves if you handle any pet waste/clean their environment and wash your hands thoroughly afterwards.
• Do not have any vaccinations without checking with your doctor.

Food safety and hygiene

During and after cancer treatment, your immune system is weaker. You are more at risk of getting food poisoning because you are less able to fight infection. You may also be less able to cope with the symptoms of food poisoning.

It is important you are aware of food safety and hygiene including proper food preparation, storage, and good hygiene practices, as well as being mindful of how you cook your food.

Up-to-date information, including tips on food preparation and food safety, is available on the Food Standards Agency website – search ‘food safety tips’. A paper copy is available from the cancer information centres.

We recommend using the Food Hygiene Rating Scheme when choosing a takeaway or restaurant. The best options are those with a ‘5 – Very Good’ food hygiene rating.

Your doctor may advise you to avoid certain higher-risk foods based on your neutrophil levels in your blood results. Speak to your doctor for more information on this.

If you’re struggling with eating and drinking or experiencing weight loss, please refer to the ‘Eating – help yourself’ booklet or, if you have diabetes, the ‘Eating well with diabetes when you have a poor appetite’ booklet. You can also collect a paper copy of these booklets from the cancer information centre.

Please note: this guidance is not for patients with blood cancer, please seek advice from your team if you have blood cancer.

Dietary

• Good food hygiene is important. Remember to wash your hands before handling any foods, and again after handling any raw foods. Don’t handle food if you are ill with stomach problems such as diarrhoea or vomiting.
• Ensure all knives and utensils are clean before preparing food, and cleaned again between use with raw and cooked foods.
• Food should be stored safely in the fridge. Keep uncooked foods separate from ready-to-eat food. Store raw meat in a sealable container or on the lower shelf so it can’t drip onto other foods.
• Raw meat such as beef, pork and chicken needs to be cooked thoroughly. Cook until it is piping hot in the middle to ensure any food poisoning bacteria are killed.
• Avoid takeaways and don’t re-heat ready-to-eat meals. Make sure all food is cooked thoroughly and is piping hot before serving.
• Avoid all shellfish.
• Please check that products such as cheese and yoghurt are pasteurised. Avoid unpasteurised cheeses (such as brie and camembert) and pâté as these may contain food poisoning bacteria.
• Probiotic drinks such as Actimel, Yakult or supermarket-own brands should not be drunk while you are having chemotherapy. It is also advisable to avoid bio-yoghurts.
• Avoid raw eggs and use eggs with the British Lion stamp on them. Cooked egg dishes should be served immediately and eaten piping hot.

Some SACT causes nausea (feeling sick) and/or vomiting. If this is likely with your treatment, you will be given an antisickness injection and tablets or medicines to take home.

You may notice mild nausea but if you experience persistent nausea or vomiting, contact your GP or The Christie Hotline for further advice. Otherwise, please tell your hospital doctor or SACT nurse how you got on at your next visit. There are several anti-sickness treatments available, and if the first one you are given has not worked, we can usually find one that does work for you.

During the first 24 hours after treatment, it is best to avoid heavy meals. Try light snacks instead and drink plenty of fluids. It is best to avoid alcohol at this time.

A loss of appetite for 24 hours or so after SACT is quite common. Advice about this and about other problems with eating is available in The Christie booklet ‘Eating – help yourself’. Please ask the nursing staff if you would like a copy.

Some medicines can cause hair thinning or even complete hair loss. You may also lose your body hair including eyebrows and pubic hair. Hair usually begins to fall out 10 to 14 days after treatment starts. This is normally only temporary and your hair will grow back when your treatment has finished.

Very rarely hair loss can be permanent. Some people start to get their hair back before chemotherapy is over.

Your scalp may begin to feel tingly or painful. This is normal when the hair begins to fall out. Take simple painkillers such as paracetamol if needed. If the skin on your scalp becomes dry and itchy, using a plain moisturising cream can help.

You are entitled to a wig if your treatment causes you hair loss. It is a good idea to get your wig before you lose a lot of hair, so we can match it with your natural colour. You can see a specialist wig fitter at The Christie before your treatment begins. You can obtain your free wig voucher from the information centre at The Christie at Withington. The information centres at Oldham and Salford also issue wig vouchers. Please ask staff for a copy of The Christie leaflet ‘The wig fitting service’.

The Maggie’s Centre provides support for anyone who is anticipating or experiencing hair loss. Support includes dealing with the practicalities of hair loss as well as your emotional wellbeing. You can call into Maggie’s Manchester, which is based on Kinnaird Road, Monday to Friday, between 9am and 5pm.

It is important to take special care in the sun. Some treatments can make your skin more sensitive to the sun. Try to avoid too much exposure to the sun and sit in the shade when possible. Wear loose clothing and use a high-factor sun cream. If you have lost your hair, remember to protect your head, ears and the back of your neck from the sun by wearing a hat.

Some treatments can cause temporary diarrhoea or constipation. Please let your Christie doctor or nurse know if this occurs. You can be given medicine to help with this. Constipation can sometimes become a serious problem, so get it treated early. Changing your diet may also help. Please ask for a copy of ‘Eating - help yourself’, which gives helpful tips on how to cope with these problems.

When SACT is injected intravenously, the veins can sometimes become hardened and sore or darker in colour. The veins will usually return to normal gradually. We can continue your treatment using other veins or a central line.

To maintain a healthy mouth, clean your teeth twice a day using a medium small head toothbrush and fluoride toothpaste. Rinse your mouth thoroughly with water after cleaning.

Use a saline mouthwash to maintain a clean mouth. Add a teaspoon of salt to a cup of water (250ml), rinse your mouth regularly throughout the day. If the solution is too strong, reduce to half a teaspoon of salt.

We may recommend an antibacterial mouthwash 4 times a day. This can be prescribed by your GP or Christie doctor. Do not use commercial mouthwashes which tend to be harsh as they can dry and irritate the tissues.

If you develop a sore mouth, use the mouthwash 4 times a day as long as you are able to tolerate it. You can dilute the mouthwash with water. If your mouth becomes too sore, use water rinses instead as often as you find helpful – at least every 2 to 4 hours. Some people find sucking ice helpful. Avoid hot liquids and spicy foods, and drink plenty.

If the soreness fails to clear up quickly, this may be a sign of infection and you should contact your Christie doctor or nurse, or the chemotherapy treatment centre for advice.

With some SACT, you may feel very tired. If you do, take more rest and try to get help with the housework. You may also want to take some time off work. If you need practical help at home, please ask the staff to refer you to a social worker. However, it is beneficial to take gentle exercise as well as taking rest. There is a Christie booklet demonstrating exercises.

People with cancer are at a higher risk of developing bloods clots. The medical name for this is a thromboembolism or a deep vein thrombosis (DVT). The most common place to develop a clot is in the leg.

You must contact The Christie Hotline immediately if you experience any of the following: pain, redness and swelling around the area where the clot is, the area may feel warm to touch.

Sign of a clot in the lung

• breathlessness,
• pain in your chest or upper back,
• light headedness,
• coughing up blood.

For any chest pain, please call 999 immediately.

You can help to prevent a clot by taking regular short walks to keep the blood moving, do simple leg exercises such as bending and straightening your toes every hour if you are unable to move around much and drink plenty of fluids. Most clots can be treated successfully using drugs to help thin the blood (anticoagulants).

These only occur with certain medicines and include:

• tingling or numbness in the tips of the fingers and toes
• alteration in taste
• hearing loss, ringing or buzzing in the ears
• jaw pain
• muscle aches and fever
• watery eyes
• dry, red and sore skin on hands and feet

If any of these effects are likely with your treatment, you will be told beforehand. Some of these may be described on the SACT leaflet. As with the other side effects of SACT, they are usually temporary.

Feelings and emotions

Sometimes during chemotherapy, you may begin to feel anxious and on edge, or low and fed-up. This often improves as treatment progresses, but if you continue to feel like this, please let your doctor or SACT nurse know as they can usually do something to help.

There are counsellors on the staff here. If you think counselling sessions at The Christie would help you, ask your doctor or nurse to refer you. You can also contact a social worker. Local cancer centres often offer counselling.

Some side effects may become evident only after a long time. However, your doctor can take action to avoid these for most patients, so the potential benefit you receive from treatment should outweigh the risks of serious long-term side effects to the heart, lungs, kidneys and bone marrow. With some medicines there is also a small risk of an increased chance of developing another cancer.

Sometimes the use of steroids and/or hormone treatment for breast and prostate cancer, and the use of specific SACT drugs can affect the strength of bones causing thin bones (osteoporosis) and an increased risk of fractures. If any of these problems specifically applies to you, the doctor will discuss these with you and note this on your consent form.