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
  • Shortness of breath , wheezing, cough or sudden difficulty breathing
  • Chest tightness or pain
• You may be given anti-allergy medications 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.

Decrease in white blood cell count. 

This may increase your chances of getting an infection.

• To reduce risk of infection: 
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet. 
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary. 
  • Eat freshly cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection such as fever of 38ºC and above, chills, bad sore throat, pain when you pass urine or have mouth sores or wounds that do not heal. 
  • Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection.

Decrease in platelet count. 

Low platelet levels can increase your chance of bleeding.

• To reduce risk of bleeding: 
  • Be careful when using sharp objects such as scissors or knives. 
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding. 
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop

Decrease in red blood cell count (anaemia)

As your red blood cells help to carry oxygen to the different parts of your body, this may cause you to feel tired more easily.

• Proceed to the A&E department immediately if you have:
  • Unusual giddiness or light-headedness that does not go away
  • Severe shortness of breath or rapid breathing
  • A fast heartbeat while resting

Nausea or vomiting

• Take small and frequent meals, rather than 3 large meals. ·
• Avoid smells that trigger 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.

Mouth ulcers or sores 

due to inflammation of the inner lining of your mouth. 

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 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 or drinking a lot lesser because of mouth pain.

Red or pinkish discolouration of the urine

• This is harmless and is expected as it is the colour of Liposomal Doxorubicin.
• The discolouration will last for one to two days after chemotherapy.

Hand-foot syndrome

• Palms of the hand and soles of the feet may become numb, sore, swollen, red or painful
• Nail beds may darken
• Skin may become dry or itchy

• Moisturize your hands and feet daily. Wear socks or soft bedroom slippers at home to avoid slipping.
• Avoid tight-fitting shoes.
• Inform your doctor if blisters, severe pain or ulcers affect your normal daily activities.

Hair thinning

This is a temporary side effect. 

• Your hair will grow back a few weeks after you have stopped treatment.
• Your hair colour and texture may change.

Heart problems

• You may require tests to check how well your heart is working before, during and sometimes after treatment. 
• Proceed to the A&E department immediately if you experience shortness of breath, difficulty breathing, tightness in chest, chest pain, fast or irregular heartbeat or sudden swelling of legs.

Risk of secondary cancer 

This refers to developing a new cancer, sometimes during treatment or years after treatment.

• This occurs very rarely. Please discuss with your doctor if you have concerns. 

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.