Side Effect

Management

Diarrhoea (loose and frequent stools) 

• Drink plenty of clear fluids (at least 2 litres or 8 cups every day).
• Eat food that is gentler on the stomach such as porridge or soup. 
• Avoid milk, dairy products, high-fibre food and oily or spicy food. 
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed. 
• If you have mild diarrhoea (less than 4 times a day over your normal) with no fever, take anti-diarrhoea medications (such as loperamide).
• If you have fever, severe diarrhoea (more than 4 times a day) or diarrhoea that does not get better within 24 hours with medication, please proceed to the A&E Department immediately.

Nausea or vomiting 

• Take small and frequent meals, rather than 3 large meals. 
• Avoid foods / smells that may make you feel nauseous, such as oily, fried food or strong-smelling food. 
• Avoid tight-fitting clothes around the waist. 
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed. 

Poor appetite 

• This may be worsened by a change in taste of food and/or nausea.  
• Try different flavours of food and small frequent meals.  
• For poor appetite, try to include nutritional supplements (such as milk supplements) into your diet.

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. 
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed. 
• Inform your doctor if you are eating a lot lesser because of mouth pain.

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

It usually develops within two weeks after starting treatment and will get better after stopping treatment.

Your skin may also become flaky and scaly.

• Avoid direct sunlight during and for 2 months after treatment.  
• Apply sunscreen with an SPF (sun protection factor) of at least 30. Alternatively, wear a hat, long sleeves, and long pants outside on sunny days.
• Apply moisturisers to dry areas.
• You may be prescribed antibiotic cream or oral antibiotics to treat the rashes.  
• Inform your doctor if the acne-like rash becomes widespread and is bothering you.

Nail changes that may affect both fingernails and toenails.

Your nails may:

• Become more brittle and break easily
•  Develop ridges (lines) on the surface, which may give an uneven appearance
• Rarely, nails may come off.

• Try to keep your nails short, clean and dry.
• Avoid contact with harsh chemicals e.g. detergent or dish-washing liquids. Wearing gloves when washing dishes or using detergents can help protect your nails during treatment.
• If you experience pain, redness or swelling around your nails, inform your doctor.

Liver problems  

• Proceed to the A&E department immediately if you experience any: 
  • Dark or tea-coloured urine 
  • Pale or light-coloured stools 
  • Yellowing of skin or eyes 
  • Nausea, vomiting with loss of appetite 
  • Severe abdominal pain 

Lung problems 

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

Drug allergy

Symptoms may include:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

• If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

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.