A Guide for Chemotherapy Infusions at Dana-Farber
Copyright © 2020 Dana-Farber Cancer Institute, Inc. All rights reserved. Patient Education. Last revised 11/2024 Overview Your first infusion visit This information will help you and your loved ones understand more about your fist visit to the Infusion Center to receive your cancer and/or other related treatment(s). We know that a cancer diagnosis can be overwhelming. This information is a tool to help you understand your treatment in the Infusion Center and help minimize potential side effects at home. Share this material with family and friends. Table of Contents 1. How to Plan for Your Cancer Treatment 2. What to Expect at Your First Infusion Appointment 3. It Takes Tome to Prepare Your Infusion 4. Treatment Calendar 5. Preventing Falls 6. Safe Driving During Cancer Treatment 7. Speak Up: Your Safety Matters 8. Getting a Peripheral Venous Catheter (IV) 9. What is a Port? 10. References and Resources • Nutrition Services At Dana-Farber • Nutrition from ACS • Supportive Resources • Chemotherapy and You • Contact DFCI This teaching sheet provides information about some possible side effects of the medication prescribed for you, but it may not cover all of them. The side effects you may experience could differ based on the frequency and dosage of treatment, as well as any other medications being taken. It's important to have open discussions with your cancer care team about any side effects that may occur and to ask them any questions you might have. This information is designed to help you understand the medication but should not replace professional medical advice or direct conversations with your health care providers. If you experience any significant health changes during or after treatment, it's crucial to contact your cancer care team immediately. In case of an emergency, call 911.
© Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 12/2022. Page 1 of 2 How to Plan for Your Cancer Treatment This sheet provides some information you should know when you begin chemotherapy (chemo), targeted therapy, hormonal therapy, or immunotherapy. Where will you get cancer treatment? You may receive cancer treatment at home, in an outpatient infusion center, or in the hospital. Your cancer care team will decide the best place for you to receive treatment. Your cancer care team: Phone Numbers: • Weekdays from __ a.m. to __ p.m.: ________________________________________________ • Nights, weekends, and holidays: _______________________________________ How is treatment given? There are many ways to receive cancer treatment, including: • By mouth (liquid, tablet, or capsule) • By injection - a shot into a muscle or under the skin • Topically, as a cream onto the skin • Intravenous (IV), into a vein • Intra-arterial (IA), directly into an artery • Intraperitoneal (IP), directly into a body cavity such as your stomach area New to infusion? Watch our educational video to learn more at www.dana-farber.org/infusion. For an educational videos about oral chemotherapy go to www.dana-farber.org and search for Oral Chemotherapy Animated Series. Before you begin treatment, take these steps: • Check your prescription insurance coverage to make sure it covers your treatment. Talk with DFCI Patient Billing Solutions if you have questions by calling 617-632-3795. • Talk with your doctor or nurse about any sexual health or fertility concerns you may have. • Visit your dentist to have your teeth cleaned and mouth checked. • If you are concerned about hair loss, ask your doctor or nurse if you should think about getting a wig, head covering, or other options. • Talk with your doctor or nurse about the need to explore a flexible work schedule with your employer. For more on taking a medical leave, talk with a social worker or visit www.dana-farber.org/disability Before your first treatment: Doctor: Nurse Practitioner/Physician Assistant: Oncology Nurse Navigator: Other team members:
© Dana-Farber Cancer Institute, Patient and Family Education Committee. Page 2 of 2 HOW TO PLAN FOR YOUR CANCER TREATMENT • Make a list of all the medicines you take, including prescription medicines, vitamins, herbal supplements, and over-the-counter remedies. Always keep this list up-to-date and with you. • Get the over-the-counter medicines that are suggested by your cancer care team (to manage possible side effects of treatment, like constipation or diarrhea). • Fill any prescriptions needed for your treatment. Some treatments require you to take specific medicines before treatment. It is very important that you take these medicines before your first treatment, following instructions from your doctor or nurse. • Drink plenty of fluids. Try to increase your fluid intake to 8 glasses (8 ounces each) of water per day. • Ask a friend or family member to come with you to your appointments. Your illness and treatments may cause you to feel drowsy and weak and affect your ability to drive safely. o Dana-Farber’s visitor policy may change based on public health concerns, like COVID19. Check www.dana-farber.org or talk with your cancer care team for the latest rules. • Talk with your doctor, nurse, or a nutritionist about the best ways to eat a well-balanced diet before, during, and after your treatments. Call Dana-Farber Nutrition Services at 617632-3006 for more information. • Stay active. Exercise has many benefits during treatment. Talk with your cancer care team. Learn more at www.dana-farber.org/exercise. • Stay organized. Set up a system to keep track of your medical bills and care instructions from your cancer care team. • Make a financial plan. Prioritize bills and keep track of your expenses and co-payments. Consider advice from a financial planner and/or tax consultant. Dana-Farber resources: Talk with your cancer care team whenever you have questions or need help. The resources listed here also offer useful support and services: • Zakim Center for Integrative Therapies and Healthy Living: Offers integrative therapies such as exercise classes, yoga, acupuncture, massage therapy, and more. Call 617-632-3322 or visit www.dana-farber.org/zakim. • Social Work: Offers emotional support to you, family and caregivers and can find supportive resources in your local community. Call 617-632-3301 or learn more at www.danafarber.org/socialwork . • Need help with insurance or paying for your care? Learn if you may be eligible for financial assistance. o Call our Patient Billing solutions team 617-632-3795. o Visit www.dana-farber.org/pfa or email patientbillingsolutions@dfci.harvard.edu with difficulty paying for your medical bills. The instructions in this teaching sheet are for informational purposes only. The content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions regarding your medical condition. If you experience any significant change in your health during or after treatment, contact a member of your cancer care team right away.
© Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 6/2020. Page 1 of 2 How to Plan for Cancer Treatment This teaching sheet provides helpful support when you need to begin chemotherapy (chemo) targeted therapy, hormonal therapy, or immunotherapy. Where will you get cancer treatment? You may receive cancer treatment at home, in an outpatient infusion center, or in the hospital. Your cancer care team will decide the best place for you to receive treatment. How is treatment given? There are many ways to receive cancer treatment, including: • Orally, by mouth (liquid, tablet or capsule) • By injection, into the muscle of an arm or leg, or in the abdomen or buttock, or directly into the tumor • As a lotion, over the skin (topically) • Intravenous (IV), through a vein into your bloodstream • Intra-arterial (IA), directly into an artery • Intraperitoneal (IP), directly into a body cavity: bladder, abdomen is most common. Before you begin treatment, take these steps: 1. Check your prescription insurance coverage to see whether it covers your treatment. Talk with your social worker or a financial counselor if you have questions. 2. Talk with your doctor or nurse about any fertility concerns you may have. 3. Visit your dentist to have your teeth cleaned and mouth checked. 4. If you are concerned about hair loss, ask your doctor or nurse if you may want to think about getting a wig or head coverings, and other options. 5. Talk with your doctor or nurse if you need to explore a flexible work schedule with your employer. Before your first treatment: • Make a list of all the medicines you take, including prescriptions, vitamins, herbal supplements, and over-the-counter remedies. Always keep this list up-to-date and with you. • Visit the pharmacy to fill any prescriptions you will need to manage side effects. This includes prescriptions to manage nausea. • Get any over-the-counter medicines that you may need to manage constipation or diarrhea if this pertains to your treatment plan. • Fill any prescriptions needed for your treatment. Some treatments require you to take specific medicines before treatment. It is very important that you take these medicines before your first treatment, following instructions from your doctor or nurse. • Drink plenty of fluids: Try to increase your fluid intake to 6-10 glasses per day, several days before your appointment. What to Expect atYour First Infusion Appointment Find tips on: • What to bring • How your medicines are made • How you may feel during and after • What to expect during the process https://www.dana-farber.org/cancer-care/treatment/chemotherapy/infusion Visit our website to watch a video and learn more about how to prepare for your first infusion appointment at Dana-Farber. Your cancer team will work closely with you to manage your health and help you get the treatment you need.
Chemotherapy and immunotherapy medicines must go through a long process in the pharmacy before the medicine gets to you. This is why patients may have a long wait time before their treatment. This document summarizes how your chemotherapy and immunotherapy is prepared carefully for your safety. Here is a closer look at how it works: © Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 6/2022. Page 1 of 2 5 Pharmacy staff prepares your medicine in a sterile, enclosed workspace called a biological safety cabinet, completing several steps to prepare the complex medicine safely. 3 Two pharmacists review your vital signs, lab results, and medicine orders to make sure they match your doctor’s treatment plan for you. 4 A pharmacist or pharmacy technician gathers the supplies needed to prepare your medicine in a sterile setting called a clean room. 2 Your nurse tells the pharmacist that your medicine orders are approved, and the pharmacy can start to prepare them. 1 Your doctor writes orders for your medicine. Your nurse reviews the orders to make sure all is correct. It Takes Time to Prepare Your Infusion
The information in this document includes some but not necessarily all of the possible side effects of this medication. The side effects listed in this teaching sheet may not be the same ones you experience. Your side effects may be different depending on how often you receive treatment (your schedule) and how much you receive each time (your dosage). Side effects may also vary if you are taking other medications. Please speak with your doctor or nurse if you have questions about possible side effects you may experience. This document should not take the place of conversations with members of your health care team. 6 The finished medicine is thoroughly checked by a pharmacist to make sure it was prepared correctly. 7 Pharmacy staff deliver completed medicines for the nurses to pick up when they are ready to give them to you. Can my chemotherapy and/or immunotherapy be made in advance? Some medicines are safe to prepare in advance and when possible, they are made ahead of time. Other medicines need to be given shortly after they are made. At Dana-Farber, pharmacy staff are part of a large cancer care team looking out for your safety. Learn more about infusion at dana-farber.org/chemotherapy If you are participating in a research study, there may be additional steps before your orders can be processed. Your study team will let you know an estimated time frame. Why is it so time consuming? • Your medicine is made-to-order for you. This means your chemo or immunotherapy is prepared based on factors that may include your weight, height, current vital signs, lab tests, and cancer type. • There are many steps and safety checks involved to ensure each medicine is made properly. To make sure that your medicine is made exactly as prescribed, a specially trained pharmacy team checks every medicine that leaves the clean room. • Many different pharmacy staff review each medicine order that is prepared in the clean room. • Most medicines require many steps in the biological safety cabinet; including scanning to make sure the correct ingredients were selected and many steps to customize the medicine just for you. • Once the medicine has been prepared, a pharmacist checks each one for the correct dose of the correct medicine, as well as the solution, bag type, and tubing to give the medicines as ordered by your doctor. HOW CHEMO AND IMMUNOTHERAPY IS MADE © Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 6/2022. Page 2 of 2
• Fever of 100.4o F (38o C) or higher if you are taking chemotherapy. • Chills, any unusual bleeding. • Watery diarrhea, blood or mucous in your stool, abdominal pain. o Do NOT take any medicines for diarrhea without first talking to your team. • Nausea or vomiting not controlled with medicine. • Pain not controlled with medicine. Sun Mon Tues Wed Thurs Fri Sat Treatment Calendar © Dana-Farber Cancer Institute, Patient and Family Education Committee. Revised 8/2022. Page 1 of 1 How to contact your cancer team: • Longwood and Chestnut Hill: 617-632-3000 • Other location: After business hours you can page your doctor using the numbers above. Month/Year: • Facial flushing, facial swelling, itching, or hives. • Skin that is red, raw, or blistered. • New lightheadedness or dizziness. • New confusion. • New shortness of breath or new cough. • New changes to eyesight. • New or worsening headache. • New blisters or sores in the mouth or genital area. Call 911 if you have chest pain or heart palpitations. Call your cancer care team right away if you have the following: Other:
© 2023 Dana-Farber Cancer Institute, Patient and Family Education Committee. Revised 11/2023. Page 1 of 2 Why are some cancer patients more likely to fall? People with cancer may be at a higher likelihood for falls than the general population due to the side effects of certain cancer-related treatments. Your cancer treatment might cause: • Peripheral neuropathy, or an increased tingling, burning and loss of feeling in your fingers, feet, and legs. Peripheral neuropathy can make it easier to fall and harder to hold onto railings. • Vision changes that can make it harder to see where you’re moving, changes in depth perception, or tripping hazards in your path. • Increased tiredness (or fatigue) from cancer treatments or from changes in blood counts. • Generalized weakness caused by changes that the cancer may be having on your body, or by your treatment. It is common to be more tired or feel like it’s harder to move your arms and legs, which can make you more likely to fall. • Dehydration as a side effect of nausea and diarrhea sometimes caused by cancer treatment. This can lead to feeling dizzy and lightheaded, increasing your risk for falls. o To offset dehydration, your care team may tell you to drink more fluids. This is important but may also increase your risk for falls by increasing the number of times you need to walk to a bathroom. Tell a member of your cancer care team right away if: • You fell in the past month. • You feel unsteady. • You feel dizzy. • You have difficulty getting up from a sitting position. • You have difficulty seeing or hearing. • You have new feelings of weakness, or heaviness in your legs and feet. How can I prevent myself from falling at the clinic or hospital? • Wear shoes with good support and laces, straps, or buckles. Do not wear sandals or shoes which lack heels. Do not wear sandals (such as Crocs or flipflops). • Bring your walker or cane with you everywhere you go. • If you’re at Dana-Farber and leave your walker or cane at home, tell your cancer care team. • If you’re having trouble walking, ask a staff member for help. • Wheelchairs are available to any patient to use when at the clinic or hospital. • Be mindful that the seating and bathrooms in the clinics may be unfamiliar to you. The toilets may be higher or lower than what you’re used to at home. • Never lean on an IV pole or use it for support. Preventing Falls
PREVENTING FALLS © 2023 Dana-Farber Cancer Institute, Patient and Family Education Committee. Page 2 of 2 • Ask your care team to review your medications each time you’re prescribed a new drug to see if it may make you more likely to fall. • If you feel faint or if you have been given medicine that may make you sleepy or lightheaded, use the nurse call lights when you need to get out of your chair or go to the toilet. • Keep your belongings where you can easily reach them. • If you use eyeglasses, hearing aids, or other devices, bring them everywhere you go. • Tell a staff member if you notice something that could cause a fall, such as a spill, slippery area, torn carpet, or uneven floor. How can I prevent myself from falling in the clinic or hospital bathroom? • Stay near the nurse call lights that are in all exam rooms and infusion areas. • Keep your belongings where you can easily reach them. • Choose safety over modesty. Discuss how staff can be mindful of your modesty while staying to assist you in the bathroom to prevent falling. How can I prevent myself from falling at home? Home improvements • Remove clutter and tripping hazards from walking areas, like: o Throw rugs o Papers, books, shoes, boxes, etc. on the floor o Wires or cords o Objects on stairs o Unsteady steps, stepstools, or railings • Add railings to stairs and grab bars in bathrooms. • Improve lighting in your home, especially near stairs and on your path from bedroom to bathroom. • Use a wheelchair when you need to travel long distances. • Do not use a stepstool or ladder unless you have someone help you. Lifestyle changes • Exercise regularly if your doctor says it’s OK. This can help improve your balance and strength. • Get your vision checked every year and update your prescription glasses when needed. • Don’t wear loose clothing that may cause you to trip. • If you wear shoes at home, wear shoes with good support and laces, straps, or buckles. Do not wear sandals or shoes which lack heels. Do not wear sandals (such as Crocs or flipflops). • If you normally go barefoot or wear socks at home, wear socks with grips on the bottom. This teaching sheet is for informational purposes only. The content is not intended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions regarding your medical condition. If you experience any major change(s) in your health during or after treatment, contact a member of your cancer care team right away.
© Dana-Farber Cancer Institute, Patient and Family Education Committee. 7/2022 Page 1 of 1 Safe Driving During Cancer Treatment Why is safe driving important? At Dana-Farber Cancer Institute, we strive to provide you with the safest possible medical care. We also care about your safety before and after your visits. As a patient, you may find that you feel weaker and less alert than usual. Your medications, your illness, and your treatments may cause you to feel drowsy or weak and affect your ability to drive safely. Controlled substances and the law Controlled substances are drugs, such as opioids, that are controlled by law. Opioids are often prescribed to control pain. They include medicines such as: morphine sulfate, oxycodone, hydromorphone (Dilaudid®), and the fentanyl patch (Duragesic®). Your doctor may prescribe other controlled substances, such as anti-anxiety drugs like lorazepam (Ativan®). These medicines may increase the effects of alcohol. Massachusetts and New Hampshire laws do not allow driving while under the influence of controlled substances, even with a doctor’s prescription. Therefore, you should have another person drive you. (If you live in a different state, please check the state laws.) In fact, during cancer treatment, it is always a good idea to have another person accompany you to your appointments, because you may not know how you are going to feel. Other concerns Alertness, good vision, finding the brake pedal quickly in an emergency, turning your head and neck to see traffic, and adjusting rearview and side mirrors are all required for safe driving. Illness, stress, tiredness, depression, anxiety, or side effects of medicine can affect your ability to react quickly and drive safely. Ask if any of the medicines you are taking can make you sleepy or confused. Talk to your cancer care team about your condition and your medicines before you drive. Other options for transportation If you can’t use public transit or a driving service, please call Social Services at 617-632-3301. For more information about safe driving • Massachusetts Registry of Motor Vehicles, Medical Affairs Bureau www.mass.gov/orgs/massachusetts-registry-of-motor-vehicles • New Hampshire Bureau of Driver Licensing, 603-227-4020 www.nh.gov/safety/divisions/dmv Patients and families CAN help ensure safe care: Check your medications; Ask questions; and Notify your team of any concerns. Talk with your doctor or pharmacist if you have questions. This document is for informational purposes only. The content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Thank you for choosing us as partners in your health care. Please help us make sure that you get the best and safest care possible Patient Family Relations 617-632-3417 jointcommission.org Show Identification For your safety, please be sure that your health care providers check your name and date of birth before any test or treatment. Speak up if staff don’t wear an ID badge, introduce themselves, or explain how they will be part of your care. dana-farber.org Open Communication For your safety, please be sure you and your health care providers agree on any procedure, surgery, or plan of care. Ask about your test results. Do not assume that no news is good news. Speak up if you do not understand something. Update Medicine Lists For your safety, please carry a list of all medicines you take, including prescriptions, over-the-counter drugs, vitamins, herbs, and supplements. Speak up if a medicine looks unfamiliar or if you have questions. Prevent Infections For your safety, please get the vaccines you need. All staff and visitors should clean their hands often to prevent spreading germs. Speak up if someone does not wash his or her hands. Wear a mask if you are sick so you don’t infect others. Report Safety Concerns For your safety, please let us know if something makes you worry or feel unsafe. Keep personal items close. Speak up if you see something that could make you fall, so we can clean the area. Use your call light if you need any help. Speak Up: Your Safety Matters!
© Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 3/2024. Page 1 of 1 Getting a Peripheral Venous Catheter (IV) What is a peripheral venous catheter? Pronounced (peh-RIH-feh-rul VEE-nus KA-theh-ter) • A peripheral venous catheter is a small, flexible tube that a nurse will place into a vein in your arm or hand. Many people call it an IV (intravenous) line. Why do I need an IV? You will usually need an IV to get chemotherapy, fluids, other medicines, or blood products. What happens when I get an IV? • Before choosing a vein, the nurse will talk to you about any past injuries, planned or past surgeries, or medical devices you may have to help choose the safest vein to use. • Usually, the nurse will try to place your IV in one of the veins in your forearm. It is important for your nurse to start with veins closer to the end of your arm. • Your nurse will try not to place your IV in the bend of your elbow or wrist to prevent movement that could lead to irritation. • After finding the best vein, the nurse will clean the area. • Then, the nurse will use a special needle with clear, plastic tubing around it called a cannula. The needle will be inserted into your vein and then removed, leaving only the plastic cannula inside the vein. What if the nurse has a hard time finding a good vein? Sometimes, it can be hard to put your IV into a vein. • If, after 4 total tries, your nurses cannot place the IV, they will work with your cancer care team to find another option, such as a long-lasting type of IV. How do I prepare for my appointment? Keeping your veins healthy can make it easier to get your IV. The best ways to do this are: • Drink more water/ non-caffeinated fluids the days before your appointment. (Not the morning of appointment) • Dress warmly • Wear loose, comfy clothing Remember If you do not get your IV treatment after the IV is placed, ask your care team to remove your IV before you leave Dana-Farber. If you leave with your IV by mistake, do not try to remove it yourself. Contact your care team for instructions. Call your care team if you notice any redness or swelling around the IV site after your visit. This teaching sheet is for informational purposes only. The content is not intended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions regarding your medical condition. If you experience any major change(s) in your health during or after treatment, contact a member of your cancer care team right away.
Copyright © 2021 Dana-Farber Cancer Institute, Inc. All Rights Reserved. Patient Education. Last revised 06/2024. Page 1 of 2 What Is a “Port”? Brand name: Port-A Cath® What is a port? A port is a small device used to draw blood and receive treatments. You might hear staff call it by its brand name, Port-A-Cath. Many people have a port instead of an IV in the arm. A port is placed during an outpatient procedure. It is usually inserted under the skin of the upper chest or arm. A port consists of a raised disc. It is about the size of a large grape with a flexible tube, called a catheter. The catheter is inserted into a vein and placed under the skin. Once the skin heals, the area will have a small bump. There are many types of ports. Your cancer care team will choose the type of port that is best for your treatment. A Port This picture shows a port inside a patient’s body without a needle inserted. It also shows a needle inserted into the port for a blood draw. Why might you need a port? • You need many infusions or blood draws. A port puts less stress on your arm veins than an IV. When using an IV, your arm veins become overused and hard to find. As a result, you could have multiple IV sticks per visit and a port could reduce this risk. • The medicine you need could irritate small veins in the arm or it may need to be given over a few days through a pump. • Some ports are used by radiology for some imaging tests. You might be able to receive an injection of dye for a scan through the port.
WHAT IS A “PORT”? BRAND NAME: PORT-A CATH How is a port used? • Your nurse will put a special needle into your port, through your skin. This it is called a “port access.” You may feel a pinch or pressure. • Before a port is accessed, your nurse will clean the skin around the port to remove any germs. • Each time the port is accessed and before it can be used, the nurse will use a syringe to pull blood into the tubing. This ensures the port is usable. If the nurse cannot see blood, they may need to put medicine in the tubing. If the medicine doesn’t work, you may need an x-ray to check on the port’s location. • If your port is usable and remains accessed, your nurse will cover it with a dressing. • While receiving medicines through the port, you should not feel anything. Some people report tasting or smelling the IV fluid when the nurse flushes. • While receiving medicines through the port, pain, redness or feeling wetness are reasons to call the nurse to look at the port area more closely. • When treatment is complete, the nurse will flush the port with a sodium-chloride solution and apply a small dressing. • When the port is not being used, it will need to be flushed again, every 12 weeks. Caring for your port After you have a port placed, you will get instructions that explain how to care for the port dressing and when you can resume activities. If the port does not have the needle in it, there is no day-to-day care. Tips to remember After your port is placed, you will get a port identification card or key ring card. • Always keep your port ID card or key ring card with you. • If your port was placed at a facility outside the Dana-Farber network, if possible, get a copy of your “procedure note.” This will help speed up your care. • Security systems, such as airport metal detectors, may detect the metal in your port. If this occurs, show your port identification card. You can also get a letter from your doctor to provide airport security. • When using MRI machines and similar imaging scanners always have your clinician check the guidelines for your specific port especially before having an MRI or similar imaging scan. • Wear a button-down shirt and loose-fitting layers when you come to the clinic or hospital. Port removal Once your treatment is completed and your cancer team determines you no longer need a port, you will need another surgical day procedure to remove the port. The instructions in this teaching sheet are for informational purposes only. The content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions regarding your medical condition. If you experience any significant change in your health during or after treatment, contact a member of your cancer care team right away. Copyright © 2021 Dana-Farber Cancer Institute, Inc. All Rights Reserved. Patient Education. Last revised 06/2024. Page 2 of 2
© Dana-Farber Cancer Institute, Patient and Family Education Committee. Last revised 7/2021. Edited 08/2022 Page 1 of 1 Nutrition Services at Dana‐Farber Your nutrition is a vital part of your cancer treatment and survivorship. At Dana‐Farber, our registered and licensed dietitian/nutritionists give one‐to‐one consults and programs for people with cancer. They are experts in cancer nutrition and can help you make healthy eating choices based on your needs. For recipe ideas and more guidance, visit www.dana‐farber.org/nutrition. During treatment: Our nutritionists can help you handle side effects, such as: • Nausea • Vomiting • Loss of appetite • Taste changes • Bowel problems • Weight changes • Malnutrition Our nutritionists also help you develop specialized diets and teach on topics, such as: • Tube feedings • IV nutrition • Food allergies or sensitivities • Antioxidants, phytonutrients, vitamins, herbs, and other supplements • Whole food, plant‐based diets After treatment: Our nutritionists are trained in integrative therapies and offer support through cancer survivorship. Appointments: To meet with a nutritionist, ask your cancer care team to book a visit for you or call the office at your center, listed below. Depending on your location: • Dana-Farber Cancer Institute Longwood Medical Area: 617-632-3006 • Dana-Farber Cancer Institute Chestnut Hill: 617-632-3006 • Dana-Farber Cancer Institute - Merrimack Valley: 978-620-2020 • Dana-Farber Brigham Cancer Center at Milford Regional Medical Center: 774-448-3746 • Dana-Farber Brigham Cancer Center in clinical affiliation with South Shore Health: 781-624-4789 • Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center: 617-789-2903 • Dana-Farber Cancer Institute - Foxborough: 508-543-1700 • Dana-Farber/New Hampshire Oncology-Hematology (Londonderry): 603-552-9100
Nutrition for the Person With Cancer During Treatment
1 What’s Inside Diet and nutrition during cancer treatment 4 Diet and nutrients 4 How cancer and cancer treatment can affect nutrition 9 Before treatment 10 Make plans 11 During treatment 12 Eat well 12 Tips to increase calories and protein 13 Don’t forget about physical activity 14 Managing common eating problems caused by cancer treatments 14 Loss of appetite 15 Constipation 16 Diarrhea 17 Mouth dryness or thick saliva 18 Mouth sores 20 Dental and gum issues 21 Nausea and vomiting 22 Swallowing problems 24 Taste and smell changes 25 Weight changes 27 Dehydration 28
2 T p n A ( d a t a m b C f For people with weakened immune systems 29 After treatment 32 Tips for healthy eating after cancer 32
3 Eating the right kinds of foods before, during, and after cancer treatment can help you feel better and stay stronger. This information is not meant to replace the advice of a medical professional. If you have any questions or concerns about your nutritional needs, you should talk to a doctor, nurse, or dietitian. A registered dietitian (RD) or a registered dietitian nutritionist (RDN) can be one of your best sources of information about your diet and what to eat during cancer treatment. Some dietitians are board-certified specialists in oncology nutrition and have the letters “CSO” after their names. If you’re going to meet with a dietitian, be sure to write down your questions before your meeting so you won’t forget anything. It is also a good idea to bring someone with you to help remember what is being said. Contact the Academy of Nutrition and Dietetics at eatright.org for more information or to find a dietitian 9 2 2
4 Diet and nutrition during cancer treatment Good nutrition is important for everyone, but even more so when you have cancer. The nutrition needs of people with cancer during treatment depend on the type of cancer they have, which treatments they get, and what side effects they have. Your cancer care team can help you identify your nutrition goals and plan ways to help you meet them. Eating well while you are being treated for cancer may help you: • Feel better • Keep up your strength and energy • Maintain your weight and your body’s store of nutrients • Better tolerate treatment side effects • Lower your risk of infection • Heal and recover Diet and nutrients Eating well means eating a variety of foods to get the nutrients your body needs. These nutrients include proteins, fats, carbohydrates, water, vitamins, and minerals. Proteins Everyone needs protein for growth, to repair body tissue, and to keep the immune system healthy. When your body doesn’t get enough protein from the foods you eat, it might use the protein stored in your muscles. When this happens, it may take you lo p e in T c G le li P d F F d a Y o c f M o
5 r r longer to heal and recover. People with cancer often need more protein than usual. After surgery or other treatment for cancer, extra protein is usually needed to heal tissues and help fight infection. There are two types of protein: animal proteins and proteins that comes from plants. Good sources of healthy animal proteins include fish, poultry, lean meat, eggs, and low-fat dairy products. Everyone should limit the amount of red and processed meat they eat. Plant-based proteins are foods like nuts and nut butters, seeds, dried beans, peas and lentils, and soy foods. Fats Fats and oils are sources of energy for the body. The body breaks down fats and uses them to store energy, insulate body tissues, and transport some types of vitamins through the blood. You may have heard that some fats are better for you than others. When thinking about the effects of fats on your heart and cholesterol level, choose monounsaturated and polyunsaturated fats over saturated fats or trans fats. Monounsaturated fats are found mainly in vegetable oils like olive, canola, and peanut oils.
6 Polyunsaturated fats are found mainly in vegetable oils like safflower, sunflower, corn, and flaxseed. They are also the main fats found in seafood. Saturated fats are mainly found in animal sources like meat and poultry, whole or reduced-fat milk, cheese, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are saturated. Saturated fats can raise cholesterol and increase your risk for heart disease. Trans fats are formed when vegetable oils are processed into solids, such as margarine or shortening. These fats are being removed from the food supply, but may still be found in snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. Trans fats are also found naturally in some animal products, like full-fat dairy products. For health, avoid processed food that contain trans fats. Carbohydrates Carbohydrates are the body’s major source of energy. Carbohydrates fuel the body for physical activity and proper organ function. The best sources of carbohydrates – fruits, vegetables, and whole grains – also supply needed fiber, vitamins and minerals, and phytonutrients to the body’s cells. (Phytonutrients are healthy, natural substances found in plantbased foods.) Whole grains or foods made from them have all naturally occurring nutrients of the entire grain seed. Whole grains are found in cereals, breads, and flours. Some whole grains, such as q o F a o s O s W A fl b it s t in s fl y V T it a t
7 quinoa, brown rice, or barley, can be used as side dishes or part of an entrée. Fiber is the part of plant foods that the body can’t digest. There are two types of fiber. Insoluble fiber helps to move food waste out of the body quickly, and soluble fiber binds with water in the stool to help keep stool soft. Other sources of carbohydrates include bread, potatoes, rice, spaghetti, pasta, cereals, corn, peas, and beans. Water All body cells need water to function. If you don’t take in enough fluids or if you lose fluids through vomiting or diarrhea, you can become dehydrated (your body doesn’t have as much fluid as it should). You get water from the foods you eat, but a person should also drink about eight 8-ounce glasses of fluids each day to be sure that all the body cells get the fluids they need. To help increase your fluid intake, include hydrating drinks like juices, sports drinks, and caffeine-free liquids. Keep in mind that all fluids (soups, milk, even ice cream and gelatin) count toward your fluid goals. Vitamins and minerals The body needs small amounts of vitamins and minerals to help it function properly. Most are found naturally in foods. They are also sold as pill and liquid supplements. They help the body use the energy (calories) found in foods.
8 If you’re thinking of taking a vitamin or supplement, be sure to discuss this with your cancer care team first. Some can be harmful, especially when taken in large doses. In fact, large doses of some vitamins and minerals may make cancer treatments less effective. Antioxidants Antioxidants are substances that protect cells from damage caused by the process of oxidation during metabolism. They include vitamins A, C, and E; selenium and zinc; other phytonutrients, including carotenoids and flavonoids; and some enzymes. Antioxidants are naturally found in fruits, vegetables, and other foods. If you are thinking of taking antioxidants as supplements, talk to your cancer care team first. Phytonutrients Phytonutrients or phytochemicals are natural substances found in plants; it is what makes them colorful. Just like antioxidants, it is best to eat foods that contain them rather than taking supplements. Herbs People have used herbs in foods as medicine for thousands of years to help manage disease with mixed results. Today, herbs are found in many dietary products and supplements, like pills, liquid extracts, teas, and ointments. Many of these products are safe to use, but others can cause harmful side effects. Some can even interfere with your cancer treatments prescribed by your doctor. If you’re thinking about using products containing herbs, always talk with your cancer care team or dietitian first. S M s ( t s b p F m T o o H c C h D h e
9 , d Safety considerations Many people believe that if they find a pill or supplement in stores, it’s safe and it works. The Food and Drug Administration (FDA) has rules to help make sure that supplements contain the ingredients listed on the label. But information about the supplement’s safety and its effects on the body are not required by the FDA rules. The FDA does not make manufacturers of these products print possible side effects on their labels. And the FDA can’t pull a dietary supplement or herbal product from the market unless they have proof that the product is unsafe. Tell your cancer care team about any over-the-counter products or supplements you are using or are thinking about using. Some other safety tips: • Check the product labels for both the quantity and concentration of active ingredients in each product. • Stop taking the product and call your cancer care team right away if you have problems like wheezing, itching, numbness, tingling in your limbs, or any other new side effects. How cancer and cancer treatment can affect nutrition Choosing and eating nutritious foods during cancer treatment can help you manage your energy levels, feel better, and stay stronger. Depending on the type of treatment, people with cancer can have different side effects. Some of the more common side effects that can affect eating are:
10 • Loss of appetite • Constipation • Diarrhea • Mouth dryness or thick saliva • Mouth sores and pain • Dental and gum problems • Nausea and vomiting • Swallowing problems • Taste and smell changes • Weight changes • Dehydration • Feeling very tired (fatigue) • Anxiety or depression Visit cancer.org/sideeffects for more information on cancerrelated side effects. Before treatment Until you start treatment, you won’t know what, if any, side effects you may have or how you will feel. Although every individual’s experience may be different, there are several steps to take to be prepared for changes to your diet or appetite due to cancer treatment: M T L a a b w r H t
11 Make plans Talk to your cancer care team about the things that worry you. Learn as much as you can about the cancer, your treatment plan, and how you might feel during treatment. You might meet with a dietitian to assess and monitor your diet and nutritional status before, during, and after treatment. Planning how you’ll cope with possible side effects can make you feel more in control and ready for changes if they come. Here are some tips to help you prep your kitchen before treatment begins: • Stock your pantry and freezer with your favorite foods so you won’t need to shop as often. - Include foods you know you can eat even when you’re sick. - If you need help with food costs, some government programs may be able to help. Examples of these programs include Supplemental Nutrition Assistance Program (SNAP) and Meals on Wheels. To ask about SNAP by phone, call your state or local health department or social services department, or call 1-800-221-5689 to get the local number. Call 1- 888-998-6325 or visit the Meals on Wheels website at mealsonwheelsamerica.org for more information about their program. • Cook in advance, and freeze foods in meal-sized portions. • Talk to your friends or family members about ways they can help with shopping and cooking, or ask a friend or family member to take over those jobs for you. Be sure to tell them if there are certain foods or spices you might have trouble eating.
12 • Talk to your cancer care team about any concerns you have about eating. Ask them what side effects you can expect from treatment and how the side effects can be managed. During treatment Eat well Your body needs a healthy diet to function at its best. This is even more important if you have cancer. In fact, some cancer treatments work better in people who are well-nourished and are getting enough calories and protein. Try these tips: • Don’t be afraid to try new foods. Some things you may never have liked before might taste good during treatment. • Choose different plant-based foods. Try eating beans and peas instead of meat at a few meals each week. • Try to eat more fruits and vegetables every day. Colorful vegetables and fruits and plant-based foods contain many natural health-promoting substances. • Try to stay at a healthy weight and stay physically active. Small weight changes during treatment are normal. • Limit the amount of salt-cured, smoked, and pickled foods you eat. • Limit or avoid red or processed meats. People getting cancer treatment may have problems eating, such as poor appetite; problems chewing, swallowing, or digesting; and feeling very tired from the treatment or cancer. All of these issues can affect their nutritional status. T I o t
13 m h Tips to increase calories and protein If you are losing weight or having trouble getting enough calories or protein due to the side effects of treatment, here are some tips that might help: • Eat several small meals and snacks throughout the day, rather than 3 large meals. • Eat your favorite foods at any time of the day. For instance, eat breakfast foods for dinner if they appeal to you. • Eat every few hours. Don’t wait until you feel hungry. • Eat your biggest meal when you feel hungriest. For example, if you are most hungry in the morning, make breakfast your biggest meal. • Try to eat high-calorie, high-protein foods at each meal and snack. • Exercise lightly or take a walk before meals to increase your appetite. • Drink high-calorie, high-protein beverages like milk shakes and prepared liquid supplements. • Drink most of your fluids between meals instead of with meals. Drinking fluids with meals can make you feel too full. • Try homemade or prepared nutrition bars and puddings.
14 Visit cancer.org/healthy/eat-healthy-getactive/eat-healthy/find-healthy-recipes.html for ideas on healthy recipes. Don’t forget about physical activity Physical activity has many benefits. It helps you maintain muscle mass, strength, stamina, and bone strength. It also can help reduce anxiety, depression, fatigue, and lymphedema, as well as improve health-related quality of life, bone health, and sleep. Still, it is important for you to check with your cancer care team before starting any exercise program for advice on choosing a program that is safe and effective for you. Managing common eating problems caused by cancer treatments Cancer and cancer treatments can cause side effects that affect how well you can eat and drink. Following are some of the more common problems and tips on how to deal with them. Always tell your cancer care team about any problems you have; the problems can often be treated or kept from getting worse. Your cancer care team can also help you make diet changes to help manage side effects like constipation, weight loss, nausea, or other problems that affect your eating. Ask your cancer c c t t L C h p M y W
15 e care team if they have a dietitian for personalized nutritional counseling. If your cancer center does not have a dietitian, visit the Academy of Nutrition and Dietetics website at eatright.org to conduct a “Find a Nutrition Expert” search. Loss of appetite Cancer and its treatment can cause changes in your eating habits and your desire to eat. Treatment-related side effects like pain, nausea, and constipation can also cause loss of appetite. Managing any problems that cause appetite changes may help you eat better. What to do • Eat several small meals and snacks throughout the day, rather than 3 large meals. • Avoid large amounts of fluids with meals, or take only small sips of fluids to keep from feeling too full. Drink most of your fluids between meals. • Make eating more enjoyable by setting the table with pretty dishes, playing your favorite music, watching TV, or eating with someone. • Be as physically active as you can, as long as your cancer care team says it’s OK. • Keep high-calorie, high-protein snacks on hand, like hardcooked eggs, nuts, nut butters, or canned tuna or chicken.
16 Constipation Being constipated means difficulty having bowel movements or fewer bowel movements a week than normal. What to do • Ask your cancer care team to help you set up a daily bowel care plan. They might suggest over-the-counter products such as stool softeners or fiber supplements. • Try to eat at the same times each day. If possible, try to have a bowel movement at the same time each day. • Drink more fluids, unless instructed otherwise by your cancer care team. • If it’s OK with your cancer care team, eat more high-fiber foods every day, such as whole-grain breads and cereals; fresh raw fruits with skins; fresh raw vegetables; fruit juices; and dates, apricots, raisins, prunes, prune juice, and nuts. • Avoid foods and drinks that cause gas, such as apples, avocados, beans and peas, cabbage, broccoli, milk, and fizzy drinks, until the constipation is gone. • Avoid chewing gum and using straws to drink. Using them can cause gas. • Avoid or cut back on any foods that may cause constipation, such as cheese or eggs. • Always ask your cancer care team before using stool softeners or laxatives. Don’t use enemas or suppositories, unless directed to do so. • Try to move around and be as physically active as you can. D C m c a W
17 Diarrhea Cancer treatments and medicines can cause your bowels to move much more often and become loose. Uncontrolled diarrhea can lead to fluid loss (dehydration), weight loss, poor appetite, and weakness. What to do • Consume plenty of mild, clear, non-carbonated fluids during the day like water, apple juice, clear broth, popsicles, sports drinks, and gelatin. • Eat small, frequent meals and snacks during the day. • Avoid high-fat foods, like fried or greasy food, because they can make diarrhea worse. • Avoid high-fiber foods, which might make diarrhea worse. These include nuts, seeds, whole grains, legumes (beans and peas), dried fruits, and raw fruits and vegetables. • Avoid milk or milk products if they seem to make the diarrhea worse. Yogurt and buttermilk are OK. • Avoid drinks and foods that cause gas, like carbonated drinks, gas-forming vegetables, and chewing gum. • Drink and eat high-sodium (salt) foods like broths, soups, sports drinks, crackers, and pretzels. • Drink and eat high-potassium foods like fruit juices and nectars, sports drinks, potatoes with the skin, and bananas. • Drink at least 1 cup of fluid after each loose bowel movement.
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