Side Effect

Management

Infusion-related reaction

This is usually mild or moderate, but rarely can be more severe. 

• Inform the nurse immediately if you experience any of the following during the infusion:
  • Flu-like symptoms such as fever, chills,  dizziness, headache, and/or feeling flushed
  • Red, warm, and itchy bumps on the skin
  • Swelling of the lips, tongue, or throat
  • Breathlessness, wheezing, cough or sudden difficulty in breathing
  • Chest tightness or pain
• You will be given anti-allergy drugs before the infusion to reduce the chance of this happening. 
• If you do have a reaction, this is usually treated by slowing or stopping the drip until the reaction is over. Future infusions may also be given at a slower rate.

Acne-like rashes (pimples) may appear on the face, upper chest and back.

It usually develops within the first 2 weeks of treatment and will get better after stopping treatment.

Your skin may also become flaky and scaly.

• Avoid direct sunlight during and 2 months after treatment. Apply sunscreen with an SPF (sun protection factor) of at least 30. You may also wear a hat, long sleeves and long pants outside on sunny days.
• Apply moisturiser to dry areas.
• You may be prescribed antibiotic cream or oral antibiotics to treat the rashes. 
• There are rare cases where the skin rash is severe. Proceed to the A&E Department immediately if the rash is painful, blistering, or if it affects a large area of the body.

Nail changes, or inflammation of the skin surrounding a fingernail or toenail may occur.

• Keep your nails trimmed, clean and dry. 
• Avoid contact with harsh chemicals e.g., detergent or dish-washing liquids. 
• Wear gloves when you are doing household chores.
• If you experience pain, redness or swelling around your nails, inform your doctor.

Mouth ulcers or sores 

This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce chances of infection. 
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture cleansing solution overnight. 
• Avoid spicy food and take soft foods e.g. porridge.
• Inform your doctor if you are eating lesser because of mouth pain.

Feeling tired or lack of energy 

• Do not drive or operate machinery if you are feeling tired.  
• Simple exercise such as walking can help to boost your energy. 
• Avoid alcohol as this may cause you to feel more tired and drowsy. 

Muscle aches and/or joint pain

• Mild pain can be relieved by taking Paracetamol. 
• Inform your doctor if the pain is not better.  

Fluid retention (build-up of fluid)

which may cause symptoms such as swelling of feet or lower legs

• For mild leg swelling: Elevate your legs on a stool, cushion or pillow when sitting or sleeping. This may help to improve blood flow and reduce the swelling.
• Proceed to the A&E department immediately for severe symptoms such as difficulty breathing, with cough, puffy eyes or rapid weight gain

Nausea or vomiting

This is usually mild.

• Take small and frequent meals, rather than 3 large meals.
• Avoid smells that increase nausea. 
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

Diarrhoea (loose and frequent stools)

This is usually mild.

• Drink plenty of clear fluids (at least 2 litres or 8 cups every day).
• Eat food that is gentle on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• If you have severe diarrhoea (more than 4 times a day) or diarrhea that does not get better within 24 hours with medication, please see a doctor.

Constipation (hard stools)

This is usually mild.

• Consume more fibre by eating more fruits and vegetables
• Drink enough fluids every day (at least 2 litres) unless otherwise advised by your doctor. 

Lung problems

This is a rare but serious side effect.

• Proceed to the A&E department immediately if you have any new or worsening symptoms of lung problems such as shortness of breath, prolonged dry cough or chest pain.

Eye problems such as dry eyes or eye irritation

• Inform your doctor if you experience any blurred vision, double vision, eye pain or redness, or sensitivity to light. 

Exercise

Light exercise is recommended as it helps to improve mobility, balance, and even emotional well-being. Avoid strenuous exercise, and rest when you are feeling tired.

Adequate hydration

Maintain adequate hydration with 2 to 3 litres of fluids per day unless you have been informed by your doctor to restrict fluids. This will decrease your chances of getting constipation and prevent dehydration.

Medical and dental treatment

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

Seek support if you feel overwhelmed

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.