Side Effect

Management

Fluid retention 

Swelling of ankles and legs due to fluid build-up

You may notice some painless swelling at the lower legs or unusual weight gain.

• Avoid standing for long periods. 
• For mild leg swelling, elevating legs on a foot stool, cushion or pillow may help to improve blood flow and reduce the swelling.
• For severe symptoms such as difficulty breathing, with cough, puffy eyes or rapid weight gain, proceed to the A&E department immediately.

Nausea or vomiting 

• Take small and frequent meals.
• Avoid foods / smells that may make you feel nauseous, such as oily, fried 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.

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.

Constipation (difficulty in passing stool)

• Increase fibre intake by taking more fruits and vegetables (at least 2 servings daily) 
• Drink enough fluids every day (at least 2 litres) unless otherwise advised by your doctor.  
• Your doctor may prescribe medications to help relieve or prevent constipation. Take these as instructed.

Poor appetite 

• Try different flavours of food and small frequent meals.
• For poor appetite, try to include nutritional supplements (such as milk supplements) into your diet. 

Feeling tired or lack of energy 

• Do not drive or operate machinery if you are feeling tired.
• Eat well and get enough sleep. Prioritize tasks to ensure you make the best use of your energy.
• 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.  
  • Do not take Paracetamol if you are having a fever at the same time. 
• Taking regular warm baths may help.
• Inform your doctor if the pain is not better.

Skin rash

• Avoid hot showers. Use cool or lukewarm water to bathe.
• Apply a moisturizer to areas with dry skin.
• Avoid staying out under the sun. Use sunscreen with Sun Protection Factor (SPF) of at least 30 and covered clothing when you are out in the sun.
• Please see a doctor immediately if the rashes are painful, blistering, or affect a large area of the body.

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 38 °C 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 red blood cell count

This may cause you to feel tired more easily and have paler skin

• 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 

Lung problems 

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

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 stomach pain 
• Keep your doctor informed about any supplements or over-the-counter medications that you take. 

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.