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Chemotherapy
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Chemotherapy and You

Coping With Side Effects

If you have questions about side effects, you are not alone. Before chemotherapy starts, most people are concerned about whether they will have side effects and, if so, what they will be like. Once treatments begin, people who have side effects want to know the best ways to cope with them. This section will answer some of your questions.

If you are reading this section before you start chemotherapy, you may feel overwhelmed by the wide range of side effects it describes. But remember: Every person doesn't get every side effect, and some people get few, if any. In addition, the severity of side effects varies greatly from person to person. Whether you have a particular side effect, and how severe it will be, depends on the kind of chemotherapy you get and how your body reacts. Be sure to talk to your doctor and nurse about which side effects are most likely to occur with your chemotherapy, how long they might last, how serious they might be, and when you should seek medical attention for them.

What Causes Side Effects?

Because cancer cells grow and divide rapidly, anticancer drugs are made to kill fast-growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. When it does, side effects may result. The fast growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract, reproductive system, and hair follicles. Anticancer drugs also can damage cells of the heart, kidney, bladder, lungs, and nervous system. The most common side effects of chemotherapy include nausea and vomiting, hair loss, and fatigue. Other common side effects include an increased chance of bleeding, getting an infection, or developing anemia. (See Fatigue/Anemia.) These side effects result from changes in blood cells during chemotherapy.

How Long Do Side Effects Last?

Most normal cells recover quickly when chemotherapy is over, so most side effects gradually disappear after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over some side effects and regain energy varies from person to person. How soon you will feel better depends on many factors, including your overall health and the kinds of drugs you have been taking.

While many side effects go away fairly rapidly, certain ones may take months or years to disappear completely. Sometimes the side effects can last a lifetime, as when chemotherapy causes permanent damage to the heart, lungs, kidneys, or reproductive organs. And certain types of chemotherapy occasionally may cause delayed effects, such as a second cancer, that show up many years later.

It is important to remember that many people have no long-term problems due to chemotherapy. It also is reassuring to know that doctors are making great progress in preventing some of chemotherapy's more serious side effects. For instance, they are using many new drugs and techniques that increase chemotherapy's powerful effects on cancer cells while decreasing its harmful effects on the body's healthy cells.

The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment's ability to destroy cancer. People getting chemotherapy sometimes become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor. It may be that your medication or treatment schedule can be changed. Or your doctor may be able to suggest ways to reduce side effects or make them easier to tolerate. Remember though, your doctor will not ask you to continue treatments unless the expected benefits outweigh any problems you might have.

Below you will find suggestions for dealing with some of the more common side effects of chemotherapy.

Nausea and Vomiting

Chemotherapy can cause nausea and vomiting by affecting the stomach, the area of the brain that controls vomiting, or both. This reaction to chemotherapy varies from person to person and from drug to drug. For example, some people never vomit or feel nauseous. Others feel mildly nauseated most of the time, while some become severely nauseated for a limited time during or after a treatment. Their symptoms may start soon after a treatment or hours later. They may feel sick for just a few hours or for about a day. Be sure to tell your doctor or nurse if you are very nauseated and/or have vomited for more than a day or if your nausea is so bad that you cannot even keep liquids down.

Nausea and vomiting almost always can be controlled or at least lessened. If you experience this side effect, your doctor can choose from a range of drugs known as antiemetics, which help curb nausea and vomiting. Different drugs work for different people, and it may be necessary to use more than one drug to get relief. Don't give up. Continue to work with your doctor and nurse to find the drug or drugs that work best for you.

You can also try the following ideas:

• Avoid big meals so your stomach won't feel too full. Eat small meals throughout the day, instead of one, two, or three large meals.
• Drink liquids at least an hour before or after mealtime, instead of with your meals.
• Eat and drink slowly.
• Stay away from sweet, fried, or fatty foods.
• Eat foods cold or at room temperature so you won't be bothered by strong smells.
• Chew your food well for easier digestion.
• If nausea is a problem in the morning, try eating dry foods like cereal, toast, or crackers before getting up. (Don't try this if you have mouth or throat sores or are troubled by a lack of saliva.)
• Drink cool, clear, unsweetened fruit juices, such as apple or grape juice or light-colored sodas such as ginger ale, that have lost their fizz.
• Suck on ice cubes, mints, or tart candies. (Don't use tart candies if you have mouth or throat sores.)
• Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
• Prepare and freeze meals in advance for days when you don't feel like cooking.
• Rest in a chair after eating, but don't lie flat for at least 2 hours after you've finished your meal.
• Wear loose-fitting clothes.
• Breathe deeply and slowly when you feel nauseated.
• Distract yourself by chatting with friends or family members, listening to music, or watching a movie or TV show.
• Use relaxation techniques. (See Relieving Stress.)
• Avoid eating for at least a few hours before treatment if nausea usually occurs during chemotherapy.

Hair Loss

Hair loss (alopecia) is a common side effect of chemotherapy, but it doesn't always happen. Your doctor can tell you whether hair loss is likely to occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or fall out entirely. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. In some cases, hair may grow back in a different color or texture.

Hair loss can occur on all parts of the body, not just the head. Facial hair, arm and leg hair, underarm hair, and pubic hair all may be affected.

Hair loss usually doesn't happen right away; more often, it begins after a few treatments. At that point, hair may fall out gradually or in clumps. Any hair that is still growing may become dull and dry.

To care for your scalp and hair during chemotherapy:

• Use mild shampoos.
• Use soft hair brushes.
• Use low heat when drying your hair.
• Don't use brush rollers to set your hair.
• Don't dye your hair or get a permanent.
• Have your hair cut short. A shorter style will make your hair look thicker and fuller. It also will make hair loss easier to manage if it occurs.
• Use a sunscreen, sunblock, hat, or scarf to protect your scalp from the sun if you lose a lot of the hair on your head.

Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or hair pieces. Others leave their head uncovered. Still others switch back and forth, depending on whether they are in public or at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.

Here are some tips if you choose to cover your head:

• Get your wig or hairpiece before you lose a lot of hair. That way, you can match your natural color and current hair. You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients. Someone even may come to your home to help you. You also can buy a wig or hair piece through a catalog or by phone. Call the American Cancer society for more information. (See Resources.)
• Consider borrowing a wig or hairpiece, rather than buying one. Check with the local chapter of the American Cancer Society or with the social work department at your hospital.
• Remember that a hairpiece needed because of cancer treatment is a tax-deductible expense and may be at least partially covered by your health insurance. Be sure to check your policy.

Losing hair from your head, face, or body can be hard to accept. It's common-and perfectly all right-to feel angry or depressed about this loss. Talking about your feelings can help.

Fatigue/Anemia

Chemotherapy can reduce the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues don't get enough oxygen to do their work. This condition is called anemia.

Anemia can make you feel very weak and tired. Other symptoms of anemia include dizziness, chills, or shortness of breath. Be sure to report any of these symptoms to your doctor.

Your doctor will check your blood cell count often during your treatment. If your red count falls too low, you may need a blood transfusion to increase the number of red blood cells in your body.

Here are some things you can do to help yourself feel better if you develop anemia:

• Get plenty of rest. Sleep more at night and take naps during the day if you can.
• Limit your activities: Do only the things that are most important to you.
• Don't be afraid to get help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving.
• Eat a well balanced diet.
• When sitting or lying down, get up slowly. This will help prevent dizziness.

Infection

Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the bone marrow and decrease its ability to produce white blood cells, the cells that fight many types of infections. An infection can begin in almost any part of your body, including your mouth, skin, lungs, urinary tract, rectum, and reproductive tract.

Your doctor will check your blood cell count often while you are getting chemotherapy. Your doctor also may add colony stimulating factors to your treatment to keep your blood count from getting too far below normal. In spite of these extra steps, however, your white blood cell count still may drop. If this happens, your doctor may postpone treatment or give you a lower dose of drugs for a while.

When your white count is lower than normal, it is very important to try to prevent infections by taking the following steps:

• Wash your hands often during the day. Be sure to wash them extra well before you eat and before and after you use the bathroom.
• Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories. (See Constipation.)
• Stay away from people who have diseases you can catch, such as a cold, the flu, measles, or chickenpox. Also try to avoid crowds.
• Stay away from children who recently have received immunizations, such as vaccines for polio, measles, mumps and rubella (German measles).
• Don't cut or tear the cuticles of your nails.
• Be careful not to cut or nick yourself when using scissors, needles, or knives.
• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
• Use a soft toothbrush that won't hurt your gums.
• Don't squeeze or scratch pimples.
• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Don't rub.
• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
• Clean cuts and scrapes right away with warm water, soap, and an antiseptic.
• Wear protective gloves when gardening or cleaning up after animals and others, especially small children.
• Do not get any immunization shots without checking first with your doctor to see if it's all right.

Most infections come from the bacteria normally found on the skin and in the intestines and genital tract. In some cases, the cause of an infection may not be known. When your white blood cell count is low, your body may not be able to fight off infections. So, even if you take extra care, you still may get an infection.

Be alert to the signs that you might have an infection and check your body regularly for its signs, paying special attention to your eyes, nose, mouth, and genital and rectal areas. The symptoms of infection include:

• Fever over 100 degrees F.
• Chills.
• Sweating.
• Loose bowels. (This also can be a side effect of chemotherapy.)
• A burning feeling when you urinate.
• A severe cough or sore throat.
• Unusual vaginal discharge or itching.
• Redness, swelling, or tenderness, especially around a wound, sore, pimple, or intravenous catheter site.

Report any signs of infection to your doctor right away. This is especially important when your white blood cell count is low. If you have a fever, don't use aspirin, acetaminophen, or any other medicine to bring your temperature down without first checking with your doctor.

Blood Clotting Problems

Anticancer drugs can affect the bone marrow's ability to make platelets, the blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even from a minor injury.

Be sure to let your doctor know if you have unexpected bruising, small red spots under the skin, reddish or pinkish urine, or black or bloody bowel movements. Also report any bleeding from your gums or nose. Your doctor will check your platelet count often while you are having chemotherapy. If your platelet count falls too low, the doctor may give you a transfusion to build up the count.

Here are some ways to avoid problems if your platelet count is low:

• Don't take any medicine without first checking with your doctor or nurse. This includes aspirin or aspirin-free pain relievers, including acetaminophen, ibuprofen, and any other medicines you can buy without a prescription. These drugs may affect platelet function.
• Don't drink any alcoholic beverages unless your doctor says it's all right.
• Use a very soft toothbrush to clean your teeth.
• Clean your nose by blowing gently into a soft tissue.
• Take care not to cut or nick yourself when using scissors, needles, knives, or tools.
• Be careful not to burn yourself when ironing or cooking. Use a padded glove when you reach into the oven.
• Avoid contact sports and other activities that might result in injury.

Mouth, Gum, and Throat Problems

Good oral care is important during cancer treatment. Anticancer drugs can cause sores in the mouth and throat. They also can make these tissues dry and irritated or cause them to bleed. In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Because infections can be hard to fight during chemotherapy and can lead to serious problems, it's important to take every possible step to prevent them.

Here are some suggestions for keeping your mouth, gums, and throat healthy:

• If possible, see your dentist before you start chemotherapy to have your teeth cleaned and to take care of any problems such as cavities, abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay.
• Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch; brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special type of toothbrush and/or toothpaste if your gums are very sensitive.
• Rinse your toothbrush well after each use and store it in a dry place.
• Avoid commercial mouthwashes that contain a large amount of salt or alcohol. Ask your doctor or nurse about a mild mouthwash that you might use.

If you develop sores in your mouth, be sure to contact your doctor or nurse because you may need medical treatment. If the sores are painful or keep you from eating, you also can try these ideas:

• Ask your doctor if there is anything you can apply directly to the sores. You also may ask your doctor to prescribe a medicine you can use to ease the pain.
• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat.
• Choose soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat.
• Avoid irritating, acidic foods, such as tomatoes, citrus fruit, and fruit juice (orange, grapefruit, and lemon); spicy or salty foods; and rough, coarse, or dry foods such as raw vegetables, granola, and toast.

If mouth dryness bothers you or makes it hard for you to eat, try these tips:

• Ask your doctor if you should use an artificial saliva product to moisten your mouth.
• Drink plenty of liquids.
• Suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum.
• Moisten dry foods with butter, margarine, gravy, sauces, or broth.
• Dunk crisp, dry foods in mild liquids.
• Eat soft and pureed foods like those listed above.
• Use lip balm if your lips become dry.

Diarrhea

When chemotherapy affects the cells lining the intestine, the result can be diarrhea (loose stools). If you have diarrhea that continues for more than 24 hours, or if you have pain and cramping along with the diarrhea, call your doctor. In severe cases, the doctor may prescribe an antidiarrheal medicine. However, you should not take any over-the-counter antidiarrheal medicines without asking your doctor first.

You also can try these ideas to help control diarrhea:

• Eat smaller amounts of food, but eat more often.
• Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit. Eat low fiber foods instead. Low-fiber foods include white bread, white rice or noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins, cottage cheese, yogurt, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken or turkey without the skin, and fish.
• Avoid coffee, tea, alcohol, and sweets. Stay away from fried, greasy, or highly spiced foods, too. They are irritating and can cause diarrhea and cramping.
• Avoid milk and milk products if they make your diarrhea worse.
• Unless your doctor has told you otherwise, eat more potassium-rich foods because diarrhea can cause you to lose this important mineral. Bananas, oranges, potatoes, and peach and apricot nectars are good sources of potassium.
• Drink plenty of fluids to replace those you have lost through diarrhea. Mild, clear liquids, such as apple juice, water, weak tea, clear broth, or ginger ale, are best. Drink them slowly, and make sure they are at room temperature. Let carbonated drinks lose their fizz before you drink them.
• If your diarrhea is severe, it is important to let your doctor know. Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. As you feel better, gradually add the low-fiber foods listed above. A clear liquid diet doesn't provide all the nutrients you need, so don't follow one for more than 3 to 5 days.
• If your diarrhea is very severe, you may need to get intravenous fluids to replace the water and nutrients you have lost.

Constipation

Some people who get chemotherapy become constipated because of the drugs they are taking. Others may become constipated because they are less active or less nourished than usual. Tell your doctor if you have not had a bowel movement for more than a day or two. You may need to take a laxative or stool softener or use an enema, but don't use these remedies unless you have checked with your doctor, especially if your white blood cell count is low.

You also can try these ideas to deal with constipation:

• Drink plenty of fluids to help loosen the bowels. Warm and hot fluids work especially well.
• Eat a lot of high-fiber foods. High-fiber foods include bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.
• Get some exercise. Simply getting out for a walk can help, as can a more structured exercise program. Be sure to check with your doctor before becoming more active.

Nerve and Muscle Effects

Your nervous system affects just about all your body's organs and tissues. So it's not surprising that when chemotherapy affects the cells of the nervous system-as the drugs sometimes do-a wide range of side effects can result. For example, certain drugs can cause peripheral neuropathy, a condition that may make you feel a tingling, burning, weakness, or numbness in the hands and/or feet. Other nerve related symptoms include loss of balance, clumsiness, difficulty picking up objects and buttoning clothing, walking problems, jaw pain, hearing loss, stomach pain, and constipation. In addition to affecting the nerves, certain anticancer drugs also can affect the muscles and make them weak, tired, or sore.

In some cases, nerve and muscle effects-though annoying-may not be serious. In other cases, nerve and muscle symptoms may indicate serious problems that need medical attention. Be sure to report any suspected nerve or muscle symptoms to your doctor.

Caution and common sense can help you deal with nerve and muscle problems. For example, if your fingers become numb, be very careful when grasping objects that are sharp, hot, or otherwise dangerous. If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs and using bathmats in the bathtub or shower. Do not wear slippery shoes.

Effects on Skin and Nails

You may have minor skin problems while you are having chemotherapy. Possible side effects include redness, itching, peeling, dryness, and acne. Your nails may become darkened, brittle, or cracked. They also may develop vertical lines or bands.

You will be able to take care of most of these problems yourself. If you develop acne, try to keep your face clean and dry and use over-the-counter medicated creams or soaps. For itching, apply corn starch as you would a dusting powder. To help avoid dryness, take quick showers or sponge baths rather than long, hot baths. Apply cream and lotion while your skin is still moist and avoid perfume, cologne, or aftershave lotion that contains alcohol. You can strengthen your nails with the remedies sold for this purpose, but be alert to signs of a worsening problem because these products can be irritating to some people. Protect your nails by wearing gloves when washing dishes, gardening, or performing other work around the house. Get further advice from your doctor if these skin and nail problems don't respond to your efforts. Be sure to let your doctor know if you have redness, pain, or changes around the cuticles.

Certain anticancer drugs, when given intravenously, may produce a fairly dramatic darkening of the skin all along the vein. Some people use makeup to cover the area, but this can become difficult and time-consuming if several veins are affected, which sometimes happens. The darkened areas usually will fade on their own a few months after treatment ends.

Exposure to the sun may increase the effects some anticancer drugs have on your skin. Check with your doctor or nurse about using a sunscreen lotion with a skin protection factor of 15 to protect against the sun's effects. They may even suggest that you avoid being in direct sunlight or that you use a product, such as zinc oxide, that blocks the sun's rays completely. Long-sleeve cotton shirts, hats, and pants also will block the sun.

Some people who have had radiation therapy develop "radiation recall" during their chemotherapy. During or shortly after certain anticancer drugs are given, the skin over the area that was treated with radiation turns red-a shade anywhere from light to very bright-and may itch or burn. This reaction may last hours or even days. You can soothe the itching and burning by putting a cool, wet compress over the affected area. Radiation recall reactions should be reported to your doctor or nurse.

Most skin problems are not serious, but a few demand immediate attention. For example, certain drugs given intravenously can cause serious and permanent tissue damage if they leak out of the vein. Tell your doctor or nurse right away if you feel any burning or pain when you are getting IV drugs. These symptoms don't always mean there's a problem, but they always must be checked out at once.

You should also let your doctor or nurse know right away if you develop sudden or severe itching, if your skin breaks out in a rash or hives, or if you have wheezing or any other trouble breathing. These symptoms may mean you are having an allergic reaction that may need to be treated at once.

Kidney and Bladder Effects

Some anticancer drugs can irritate the bladder or cause temporary or permanent damage to the kidneys. Be sure to ask your doctor if your anticancer drugs are among the ones that have this effect, and notify the doctor if you have any symptoms that might indicate a problem. Signs to watch for include:

• Pain or burning when you urinate.
• Frequent urination.
• A feeling that you must urinate right away ("urgency").
• Reddish or bloody urine.
• Fever.
• Chills.

In general, it's a good idea to drink plenty of fluids to ensure good urine flow and help prevent problems; this is especially important if your drugs are among those that affect the kidney and bladder. Water, juice, coffee, tea, soup, soft drinks, broth, ice cream, soup, popsicles, and gelatin are all considered fluids. Your doctor will let you know if you must increase your fluid intake.

You also should be aware that some anticancer drugs cause the urine to change color (orange, red, or yellow) or to take on a strong or medicine-like odor. For a short time, the color and odor of semen may be affected as well. Check with your doctor to see if the drugs you are taking have this effect.

Flu-Like Syndrome

Some people report feeling as though they have the flu a few hours to a few days after chemotherapy. Flu-like symptoms-muscle aches, headache, tiredness, nausea, slight fever, chills, and poor appetite- may last from 1 to 3 days. These symptoms also can be caused by an infection or by the cancer itself, so it's important to check with your doctor if you have flu-like symptoms.

Fluid Retention

Your body may retain fluid when you are having chemotherapy. This may be due to hormonal changes from your therapy, to the drugs themselves, or to your cancer. Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen. You may need to avoid table salt and foods with a high sodium content. If the problem is severe, your doctor may prescribe diuretics, medicine to help your body get rid of excess fluids. However, don't take any over-the-counter diuretics without asking your doctor first.

Sexual Effects: Physical and Psychological

Chemotherapy may-but does not always- affect sexual organs and functioning in both men and women. The side effects that might occur depend on the drugs used and the person's age and general health.

Men

Chemotherapy drugs may lower the number of sperm cells, reduce their ability to move, or cause other abnormalities. These changes can result in infertility, which may be temporary or permanent. Infertility affects a man's ability to father a child but does not affect his ability to have sexual intercourse.

Because permanent sterility may occur, it's important to discuss this issue with your doctor before you begin chemotherapy. If you wish, you might consider sperm banking, a procedure that freezes sperm for future use.

Men undergoing chemotherapy should use an effective means of birth control with their partners during treatment because of the harmful effects of the drugs on chromosomes. Ask your doctor when you can stop using birth control for this purpose.

Women

Anticancer drugs can damage the ovaries and reduce the amount of hormones they produce. As a result, some women find that their menstrual periods become irregular or stop completely while they are having chemotherapy.

The hormonal effects of chemotherapy also may cause menopause-like symptoms such as hot flashes and itching, burning, or dryness of vaginal tissues. These tissue changes can make intercourse uncomfortable, but the symptoms often can be relieved by using a water-based vaginal lubricant. The tissue changes also can make a woman more likely to get vaginal infections. To help prevent infection, avoid oil-based lubricants such as petroleum jelly, wear cotton underwear and pantyhose with a ventilated cotton lining, and don't wear tight slacks or shorts. Your doctor also may prescribe a vaginal cream or suppository to reduce the chances of infection. If infection does occur, it should be treated right away. (See Infection.)

Damage to the ovaries may result in infertility, the inability to become pregnant. In some cases, the infertility is a temporary condition; in other cases, it may be permanent. Whether infertility occurs, and how long it lasts, depends on many factors, including the type of drug, the dosage given, and the woman's age.

Although pregnancy may be possible during chemotherapy, it still is not advisable because some anticancer drugs may cause birth defects. Doctors advise women of childbearing age-from the teens through the end of menopause-to use birth control throughout their treatment.

If a woman is pregnant when her cancer is discovered, it may be possible to delay chemotherapy until after the baby is born. For a woman who needs treatment sooner, the doctor may suggest starting chemotherapy after the 12th week of pregnancy, when the fetus is beyond the stage of greatest risk. In some cases, termination of the pregnancy may be considered.

Sexuality

Sexual feelings and attitudes vary among people during chemotherapy. Some people find that they feel closer than ever to their partners and have an increased desire for sexual activity. Others experience little or no change in their sexual desire and energy level. Still others find that their sexual interest declines because of the physical and emotional stresses of having cancer and getting chemotherapy. These stresses may include worries about changes in appearance; anxiety about health, family, or finances; or side effects, including fatigue and hormonal changes.

A partner's concerns or fears also can affect the sexual relationship. Some may worry that physical intimacy will harm the person who has cancer; others may fear that they might "catch" the cancer or be affected by the drugs. Many of these issues can be cleared up by talking about misunderstandings. Both you and your partner should feel free to discuss sexual concerns with your doctor, nurse, or other counselor who can give you the information and the reassurance you need.

You and your partner also should try to share your feelings with one another. If it's difficult for you to talk to each other about sex, or cancer, or both, you may want to speak to a counselor who can help you communicate more openly. People who can help include psychiatrists, psychologists, social workers, marriage counselors, sex therapists, and members of the clergy.

If you were comfortable with and enjoyed sexual relations before starting therapy, chances are you will still find pleasure in physical intimacy during your treatment. You may discover, however, that intimacy takes on a new meaning and character. Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important. Remember that what was true before you started chemotherapy remains true now: There is no one "right" way to express your sexuality. It's up to you and your partner to determine together what is pleasurable and satisfying to you both.

The American Cancer Society has two free booklets on sexuality that may be helpful-one for women and one for men. Contact your local unit or the national office for copies. (See Resources.)

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