Cancer treatment 50 years ago was very different from today. Blood cancers were seen as virtually untreatable diseases but now survival rates are high and rising. This means the quality of life during and after successful completion of treatment has become increasingly important. So the challenge is to cure your cancer with the least possible side effects. Side effects include all the common stuff like being sick but also things like pain management, fatigue, depression and lifestyle issues.

Common short-term side effects include 

• nausea and/or vomiting
• diarrhoea 
• hair loss
• depression

Most side effects can be counteracted. You should discuss any side effects you experience with your care team; remember they are there to help. It can be useful to keep a diary of side effects to help your care team decide what is causing them.

Chemo and my kidneys
Chemotherapy is pretty toxic stuff. At the beginning of the first treatment when the cancerous cells die they release high levels of uric acid. Our body makes this waste product normally but in the quantities produced during chemotherapy it is poisonous and can damage the kidneys. If this is a problem for you, you will be given a drug to protect the kidneys. It is also very important that you drink plenty of fluid to prevent damage to your kidneys.

Can I drink alcohol?
There are many different views regarding whether or not you can drink, and how much, whilst you are receiving chemotherapy. Some drugs though, must be taken on a strictly no alcohol basis. Your doctor will let you know when it is safe to drink again. Where drinking alcohol is allowed, moderation as always, is the key. Unfortunately, that means self-control for a while for the party animals amongst you!

Will I lose my hair?
Honestly, you will almost certainly lose your hair because of the high doses of drugs needed to fight the cancer, but it will grow back.  Physical appearance is often seen as a minor consideration for cancer sufferers but for young people it can be very important.

There are options available such as:

• Wigs - some are available for hire or you can talk to your local Leukaemia Foundation support services co-ordinator 
• If you are purchasing a wig you may be eligible for a rebate as follows:
  • Assistance towards the cost of purchasing a wig may be provided by your treating hospital. Check with the hospitals social work department.
  • Private health insurance, contact your fund to determine your eligibility for a rebate.
• Hats
• Headscarves
• Going au naturel

What can I do about pain?
Effective pain management can make the treatment of blood cancers much more bearable. For most people pain will not be a big problem but for those it affects there is no need to suffer in silence, in the belief that pain management will compromise your treatment. On the contrary, evidence suggests good pain management can improve quality of life enormously. It is important to find out which pain medications you are allowed to take. For example, ibuprofen is often not allowed as it may affect platelet function. Talk to your specialist, he/she will discuss with you the best options for managing your pain.  Also remember that morphine and morphine like drugs given for severe pain do not cause addiction and is often the most effective pain killer.

Will treatment affect my eating habits?
Treatment for cancer makes some people feel nauseous and vomit. This can be a very unpleasant side-effect but thankfully there are drugs called anti-emetics that work really well in controlling feelings of sickness or being sick. If you are prescribed these drugs you should take them as often as your doctor tells you too, even if you don’t feel sick, because this stops the nausea from returning. If the nausea is new or gets worse while taking the anti-sickness drugs you should let your doctor know straight away.

Chemotherapy and radiotherapy can cause you to lose your appetite or change the things you like to eat. This can lead to poor nutrition which in turn can lead to fatigue and susceptibility to infection.  You can read more about eating well in the Diet and Nutrition section.

Mucositis

Chemotherapy can also cause a condition called mucositis that gives you a sore mouth. Cleaning your teeth at least three times a day with a soft toothbrush and avoiding mouthwashes that contain alcohol can reduce the symptoms of mucositis. Your doctor may prescribe a special mouthwash for you. You should also avoid alcoholic drinks and smoking as these activities will make the mucositis worse.

Why am I feeling so sleepy?
During your treatment you may experience chronic fatigue. This means exhaustion that doesn’t get any better, no matter how much sleep you have. This can be especially tough for a young person, as you see your friends in the prime of life while you seem to have been put on hold.  There are lots of reasons for fatigue and it really can interfere with everyday activities. Biological causes behind fatigue can include anaemia, lack of sleep, poor nutrition or infection.

Alongside these biological causes are psychological causes of fatigue such as depression. The important message here is that there are ways of combating chronic fatigue, whether they are transfusions that reduce anaemia, counselling to ease depression or advice from the hospital dietitian. Studies have shown that gentle aerobic exercise can alleviate symptoms and encourage better moods in people who have chronic fatigue that persists both during and after the completion of treatment.

Why do I get more infections now?
As if your body hasn’t taken enough of a battering from your treatment, you are also more likely to get infections. This is because chemotherapy will cause neutropenia which is a lack of infection-fighting white blood cells.

This condition leads to a reduced immune protection, especially against bacteria and fungi.  For this reason, diet and food preparation are very important. You may need to have special menus or a ‘clean diet’ to help minimise the risk of infection. Speak to the hospital dietician or your specialist for more advice.

If you are neutropenic, you must let your doctor or nurses know immediately if you:

• Have a temperature of 38oC or higher
• Feel generally unwell
• Have a sore throat or a cough
• Have diarrhoea
• Have unusual vaginal discharge or itching
• Are uncertain about anything, or if anything is worrying you.

Some drug therapies can be given to reduce the severity of infection but it is very important that you are sensible about monitoring your temperature, as these drugs cannot prevent infections.  Drugs that stimulate the production of white blood cells are sometimes used to try and prevent infection.
You might think these precautions seem rather extreme but an infection that would make someone with a healthy blood count feel a little off-colour can be life threatening for a neutropenic patient. Your care team will advise you about how to avoid infections. You should take precautions such as regular hand washing and avoiding friends or relatives who have an infection.

Females only
You may be administered medication in order to prevent menstruation during chemotherapy. It is important not to lose blood during treatment as you may need a blood transfusion if you do. Your doctor will advise you if this is necessary.