Colorectal Cancer: In Treatment: Chemotherapy

• Do not be surprised if starting treatment makes cancer feel real.
• Do not expect immediate results. 
  • Standard practice is to wait two full cycles before looking for any response to chemotherapy. This can take 2 to 3 months.
  • Response is checked by repeating the same tests that originally diagnosed the cancer.
• Ask the doctor:
  • What nutrients are absorbed by the chemotherapy drugs. Also ask the doctor what foods will help replenish those nutrients and how much of the food is needed. If food alone will not be enough to replenish the lost nutrients, what supplement does he or she suggest  – and what particular brands if known. The doctor may recommend you speak with a nutritionist/dietitian who specializes in cancer.
  • For a prescription for a drug to control nausea, vomiting and pain “just in case.” You don’t have to fill a prescription. If you do fill it, you do not have to take the drugs. However, being prepared can save waiting time if you need a drug to help. (To learn how to buy, store, and pay for drugs. Even the most experienced drug consumer is likely to learn something new. See Drugs 101) 
  • When to call: For instance, call if any of the following occur. The symptoms may not signify anything important, but then again, they could. Let your doctor decide when a symptom is harmless or whether something should be done right away.
    • Symptoms which indicate there may be an infection. Symptoms of infection include a temperature of 100.5 degrees or higher, chills or sweating, a general sense that you feel poorly, a new cough, burning sensation when urinating, change in bowel habits and an ulcer on the skin.
    • Swelling in the arm or leg that becomes warm, red, and painful. Swelling may be a sign of a blood clot inside a blood vessel that can travel to your heart..
    • Dizziness, headaches, shortness of breath, heart palpitations, pale skin or a feeling of being cold. These symptoms could indicate anemia (a condition in which the blood doesn’t have enough red blood cells or hemoglobin or total volume).  
  • What would be considered an emergency and what you should do if one happens. (Pack an emergency bag "just in case."  The odds are you will not need it, but it can’t hurt). See: Medical Emergency: How To Be Prepared
  • How to get through to the doctor if you have a concern or problem that you do not think can wait until regular office hours. It’s better to call the doctor than end up in the hospital with a serious complication that should have been treated.. Most doctors have 24 hour answering services.
  • How will the drugs be administered? For example, intravenously through a port, a surgically placed line in your chest to minimize using veins? If so, consider wearing a V-neck or button down shirt. Bring a scarf to cover the parts that do not need to be uncovered and may get chilly.
  • Before, during or after treatment:
    • Are there foods to avoid? For example, grapefruit interferes with metabolism by the liver of some drugs.
    • Vitamins, antioxidants or supplements to avoid?
    • Are there other circumstances to avoid? For instance, excessive sunlight or crowds?
  • Can you exercise during treatment? Using your body can make you feel better about yourself, help you get rid of tension or anger, and build your appetite.
    • If you can exercise, to what extent?
    • Is there anything you should avoid doing?
    • Should you follow the rule that some doctors use of not exercising within 24 hours after receiving a treatment ---- or perhaps a guideline of not exercising if your blood cell counts are below a certain level that the doctor will prescribe for you? 
  • Ask whether you should protect a sex partner from drugs that may be in sperm or vaginal secretions. The amount of chemotherapy drug in sperm or vaginal secretions is likely to be very low. However, it may be recommended that  you wear a condom or use a vulva shield during sex. 
  • What to do if there is a disaster so that you cannot get to chemotherapy or the facility is shut down. For information, see: Disaster Planning
  • What cosmetics, jewelry and or nail polish you can wear. Skin and nail bed color are useful ways for the medical staff to assess your well-being and response to drugs. If you feel strongly, ask if you can leave a section of your skin or a fingernail bare for visibility – or whether a thimble-like oxygen sensor that slides over your finger can be used.
  • It is generally recommended that you do not color your hair during treatment.
  • Could lotions or aftershave cause skin irritation? Some drugs interact with lotions or aftershave.
• Keep in mind tips about how to maximize limited time with a doctor. For instance, learn the meaning of the basic medical words that are likely to come up so conversations can be faster and more precise. For more information, click here.
• If you need transportation to and from treatment, contact the American Cancer Society at 800.ACS.2345. The Society has volunteers on hand to help. The more notice you give, the more likely that the Society will be able to find a driver.
• Line up a family member or friend to go with you to the first treatment session. Such a person can provide emotional support and handle issues such as keeping written instructions for diet and after care; remember verbal instructions and assist with the drive home. Depending on the chemotherapy drug or drug used for side effects, you may feel drowsy or unable to concentrate normally when you leave the session.
• Keep in mind that treatment decisions may change as treatment goes along. A change does not mean that the original treatment was wrong. There is no way to predict how any particular treatment will affect any particular person. Medicine is a combination of science and art. 
• Stock up on single portions of your favorite comfort foods, including some in your freezer that you can defrost as needed. When you freeze foods for this period, make the portions smaller than usual for those occasions when you don't feel like eating a lot.
• If you have children, and haven't told them yet about your condition and/or treatment, now is the time to do it in an age sensitive manner. See the document in "To Learn More."
• Schedule doctor appointments for your convenience.
  • An appointment early in the day or at the beginning of that part of the day when the doctor sees patients generally gets you in and out quickly. Doctors' schedules tend to back up as the day progresses.
  • If you have appointments with different doctors and/or tests coming up, consider scheduling them for the same day or setting doctor appointments for the same day every week.
• If you are doing any complementary therapy such as acupuncture, make sure your oncologist knows.
• Decide whether you want to talk with other people in the chemo treatment room more than being superficially friendly. 
  • Not all the people you meet will be positive. Some may have stories that sound somewhat like yours, but have complications that you would rather not think about. It can be difficult to keep in mind that each of us are individual and there is no way to predict what will happen. Stories that touch a fear can replay over and over in your mind as time goes on. It is up to you to decide if meeting people in the chemo room is worth the risk. If not, headphones and a DVD player can be a best friend.
  • As Stacia put it: "Chemo sucks. But it can also be the place where you’ll meet people with invaluable wisdom to share, where you’ll laugh a little, where you’ll learn a lot, and where—if you’re lucky—you’ll find the inspiration you need to focus on kicking your cancer out and letting life in."
• If you have health insurance:
  • Check with the doctor’s office to be sure that everything is squared away with the insurance company. If not, get involved – at least to extent of following up with the doctor’s office and the insurance company to make sure treatment is being covered.
  • Start thinking about how to pay your share (co-pays, co-insurance and expenses that may not be covered by insurance).
  • When you have time, read: How To Maximize Use Of Your Health Insurance
• If you do not have health insurance:
  • Start thinking about how to pay for treatment if you haven’t already. We provide information under the general heading of How To Deal With A Financial Crunch.
  • Keep in mind that all medical bills are negotiable. We show you how. Click here. 
• Consider getting a pet.  A pet does not have to be a dog or a cat to have beneficial emotional and physical effects.

WOMEN: NOTE:

• Consider wearing flats instead of high heels to chemo treatment.
• Avoid becoming pregnant during chemotherapy treatment. Chemotherapy can be harmful to a fetus. In general, the guideline is 2‐5 years post‐treatment, but talk to your team if you need to get started earlier. As a general matter, pregnancy is not associated with increased risk of colorectal cancer.

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