• Try to schedule appointments and fun activities for times when you have the most energy. Using a journal to track changes in your energy levels during and after treatments will help you predict when you feel most tired and when you have more energy.
• Make a list of what you want to do in a day. Put the things that mean the most to you at the top of the list.
• If you don’t have the energy to see friends and family in person, keep in touch with them by telephone or e-mail.
• Limit the number of visitors you see, and ask them to call before they visit.
• Exercise if you can. Being active will relax you and may boost your appetite. Even gentle exercise, such as walking, can help. Ask your healthcare team about what exercises are best for you.
• A balanced diet that includes protein, carbohydrates and fat will help boost your energy.
• Eat when you have the most energy.
• Try to eat small amounts of healthy food throughout the day, even if you don’t feel hungry.
• Schedule a rest period before an important activity.
• Too much rest, as well as too little, can make you feel more tired.
• Keep a regular sleep routine. Make your daytime naps short and save your longest sleep for the night.
• Make sure your bed, pillows and sheets are comfortable.
• If you keep working during your treatment program, ask about getting reduced hours or a flexible work schedule.

• Wash your hands often during the day, especially before eating and after going to the bathroom.
• Carry a small bottle of hand sanitizer with you in case you can’t get to a sink.
• Avoid contact with anyone who has a cold, flu or infectious disease.
• Avoid children recently immunized with “live virus” vaccines, such as chicken pox, polio or measles.
• Check with your healthcare team before having a vaccination or flu shot.
• Clean cuts or scrapes immediately with warm water and soap.
• Don’t tear or cut your cuticles. Use cuticle cream or cuticle remover instead.
• Use an electric shaver instead of a razor to prevent cutting your skin.
• Don’t squeeze or scratch pimples.
• Shower in warm rather than hot water because a hot shower will dry out your skin. Gently pat yourself dry with a towel rather than rubbing briskly.
• Use a moisturizer or oil to soften dry or cracked skin and help it heal. Your healthcare team or a pharmacist can suggest good moisturizers.
• Clean your anal area gently but thoroughly after a bowel movement.
• Be especially careful not to burn yourself.
• If you have cats or birds, ask someone else to clean the litter box or cage.

• a fever over 38°C (100°F)
• white patches or coating in your mouth
• unusual sweating, especially at night
• diarrhea
• a burning feeling when urinating
• a severe cough or sore throat
• chills

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• Avoid contact sports and other activities where injury is likely.
• Use cotton swabs to clean your teeth instead of a toothbrush.
• Don’t floss your teeth.
• Blow your nose very gently.
• Use knives and other sharp tool with extreme caution.
• Wear protective gloves if you are working in the garden or near plants that have thorns.
• Take steps to prevent constipation so that you do not get hemorrhoids or make them bleed.
• Talk to your healthcare team or pharmacist before taking any over-the-counter medications such as pain relievers, cold remedies, vitamins or herbal preparations.

• bruising easily or red spots under the skin
• bleeding from the gums or nose
• bleeding from the bladder or rectum
• for women, vaginal bleeding that is different from a normal menstrual period

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• Wash often to reduce your risk of skin irritation and infections.
• Shower in warm rather than hot water because a hot shower will dry out your skin. Gently pat yourself dry with a towel rather than rubbing briskly.
• Use a moisturizer or oil to soften dry or cracked skin and help it heal. Your healthcare team or a pharmacist can suggest good moisturizers.
• Don’t use any powders, creams, perfumes, aftershave, deodorants, body oils, ointments or lotions on affected skin unless approved by someone on your healthcare team.
• Use an electric shaver rather than a razor to prevent cutting your skin.
• Clean cuts or scrapes immediately with warm water and soap.
• Don’t put anything hot or cold (such as heating pads or ice packs) on affected skin.
• Don’t squeeze or scratch pimples.
• Protect your skin from the sun with clothing or a hat. Sunscreens may irritate affected skin and should only be used on the advice of your healthcare team.
• Protect affected skin areas from rubbing, pressure or irritation. Cotton or silk clothing is less irritating than harsh fabrics, such as wool and corduroy. Avoid tight clothing.

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• Moisturize your hands and feet liberally and often, especially in the creases of skin. Your healthcare team or a pharmacist can suggest good moisturizers.
• Don’t rub too vigorously when applying moisturizers.
• Wear loose-fitting cotton socks or gloves at bedtime to increase the absorption of moisturizer.
• Avoid hot water. Wash your hands, bathe and shower in warm or cool water.
• Avoid activities that cause pressure or rubbing on the skin of your hands and feet, such as vigorous washing, clapping, gripping tools or appliances, typing, playing musical instruments, driving or vigorous exercises.
• Sit or lie on padded surfaces, such as chairs or mattresses, when possible and elevate your legs with cushions.
• To prevent your legs from rubbing together during sleep, place a pillow between your knees or wear soft pajamas.
• Keep your hands and feet uncovered when possible.
• Wear loose-fitting clothes and comfortable, well-ventilated shoes with cushioned soles.
• Avoid direct sunlight, and use an SPF 15 or higher sunscreen on exposed skin.
• Avoid tight dressings and adhesive tape, if possible.
• If redness and discomfort develop, cooling the affected area, such as by soaking it in cool water, may help.

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• Sip water or suck on ice chips.
• Suck on sugarless hard candy or chew sugarless gum.
• Drink 2–3 L (8–12 cups) of liquids a day. Juices, slushies, soups, milk, popsicles, gelatin, pudding, yogurt and ice cream are good sources of liquids.
• Take a sports bottle filled with your favourite liquid everywhere you go.
• Eat soft foods that are cool or at room temperature. Avoid foods that crumble in your mouth, such as muffins, crackers and rice.
• Add broth, soup, sauces, gravy, creams, butter or margarine to foods. Have prepared gravy ready to add to meat, potatoes and vegetables.
• Keep your mouth clean by using a soft-bristle toothbrush and rinsing your mouth before and after you eat.
• Sip on club soda to loosen thick saliva.
• Avoid alcohol and tobacco.
• Use a lanolin-based lip balm or use plain lanolin.
• If your eyes are dry and you wear contact lenses, you may want to stop wearing them during your treatment program.

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• Use a cool-air vaporizer or humidifier to keep the air in your room moist.
• Use extra pillows to raise your head and upper body while you are resting or sleeping.
• Pace yourself and plan activities with rest periods if you’re feeling short of breath.
• Drink plenty of fluids.
• Don’t go outside on hot, humid days or on very cold days.
• Wear light, loose-fitting clothing. Avoid anything tight around your neck, such as ties or shirt collars.

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• Consider having your teeth cleaned and any cavities repaired before your treatment program starts.
• Have your dentist contact your healthcare team before doing any dental work. Depending on the timing, you may be more at risk for infection and bleeding.
• Follow the dentist’s instructions on gentle ways of cleaning your teeth four times a day.
• Use a very mild toothpaste.
• Ask your healthcare team if it’s OK for you to floss.
• Clean your toothbrush well after each use.
• Use a mouthwash with baking soda, not alcohol. Mouthwashes that contain alcohol will sting or make your mouth feel dry.
• If you have dentures, remove them often to give your gums a rest.

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• Keep your teeth and gums healthy. Your family doctor or dentist can suggest gentle ways of cleaning your teeth. Flossing may not be recommended if your mouth is very sore or your blood counts are low.
• If you have dentures, remove them often to give your gums a rest.
• Use a straw to prevent liquids from coming into too much contact with your mouth.
• Avoid tart, salty or acidic fruits and juices, such as orange and grapefruit. Try fruit nectars like pear, peach or apricot instead.
• Avoid spicy foods that may irritate your mouth.
• Do not smoke or drink alcohol.
• Rinse your mouth often with club soda or mixture of 5 ml (1 tsp) baking soda to 250 ml (1 cup) water.
• Don’t use mouthwashes that contain alcohol.

• Try different foods until you find some with a texture you can swallow. Foods with a smooth texture, such as mashed potatoes, may be good.
• Use a blender or food processor to chop up foods that are too hard to chew. Add fruit or vegetable juices, broth or milk to blend the foods together.
• Thicken liquids to make them easier to swallow. Gelatin, puréed vegetables or fruits, instant potatoes, cornstarch and infant rice cereal are good thickeners.
• Dip dry, crisp foods, such as biscuits, into milk, coffee or tea to make them softer.
• Make sure your diet includes plenty of liquids every day so you stay well hydrated. In addition to water, good sources of liquids are juices, soups, milk, popsicles, gelatin, pudding, yogurt and ice cream.
• Make every mouthful count by choosing foods and drinks that are high in protein and high in calories.

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• Serve foods cold or at room temperature to reduce strong tastes and smells.
• Try new foods or beverages you don’t usually eat.
• Extra seasonings may make foods taste better to you. Unless you have a sore mouth, tart flavours from lemons, vinegar and pickled foods may also help.
• If foods taste bland, try taking alternate bites of different foods within a meal.
• If foods taste too salty or bitter, add sugar.
• If foods taste too sweet, add a pinch of salt.
• Use plastic cutlery and glass cooking pots if foods taste metallic.
• Chew sugarless gum or suck on sugarless lemon candies or mints to get rid of unpleasant tastes that remain after eating.
• Rinse your mouth before and after eating to help clear your taste buds. Club soda or a mixture of 2 ml (½ tsp) salt and 250 ml (1 cup) water may help.

When you lose your appetite:

• Eat small meals every two hours.
• Eat in pleasant surroundings and with other people.
• Eat your biggest meal whenever you feel the most hungry.
• Have snacks on hand for when you are hungry but don’t have the energy to prepare a meal.
• Drink fluids between meals instead of with meals to avoid filling up too quickly.
• Eat and drink high-protein, high-calorie foods to make sure every mouthful counts.
• Gentle exercise, such as a walk, before meals will increase your appetite.
• Don’t try to eat your favourite foods when you feel nauseous or you might associate these foods with feeling sick in the future.

When you feel hungry and are gaining weight:

Eat smaller portions and plan your meals around vegetables, fruit and grain products, with fish, legumes, nuts and seeds as alternatives to meat.

• Replace some high-fat snack foods and baked goods with lower-fat choices, such as vegetables and fruit, low-fat yogurt, low-fat crackers and air-popped or low-fat microwave popcorn.
• Keep in mind that table fats like butter, margarine, mayonnaise, and salad dressing are high in fat. Choose low-fat or fat-free brands when you can and look for non-hydrogenated margarines.
• Drink milk and eat yogurt and cottage cheese that contain no more than 2% milk fat. Try lower-fat cheeses.
• Don’t skip meals or you may over-eat later.
• Be as physically active as you can.
• Talk to your healthcare team or dietitian if you want to lose weight for health or other reasons. They may suggest you wait until your treatment is finished.

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• Ask your healthcare team for clear instructions on how to take your anti-nausea medication.
• Nibble on crackers, toast, dry cereals, bread sticks or other dry foods as soon as you wake up and every few hours through the day.
• Don’t try to eat if you are vomiting. Instead, try to drink or sip cool liquids to replace the fluid you have lost.
• Cool liquids may be easier to drink than hot or very cold liquids.
• Suck on ice chips or hard candy if there is a bad taste in your mouth.
• Eat smaller meals more often through the day.
• Eat bland foods rather than overly sweet, greasy, fried or spicy foods and foods that have a strong odour.
• If the smell of food makes you queasy, try cold meals, such as sandwiches and salad plates.
• Don’t try to eat in a room that is warm or that has cooking odours or other smells.
• Let someone else do the cooking, if possible, and leave the room while they prepare the food.
• Rinse your mouth with club soda before and after meals.
• Don’t lie down for at least an hour after eating.
• Breathe slowly and deeply through your mouth.
• Do not use alcohol.
• If you have dentures, remove them on treatment days. objects in your mouth can sometimes make you feel like vomiting.

• Don’t take any over-the-counter medicines for diarrhea without first talking to your healthcare team.
• Eat small meals and snacks often throughout the day.
• Don’t eat greasy, fried, spicy or very sweet foods.
• Eat low-fibre foods, such as white bread and pasta, refined cereals, cooked fruit and vegetables, meat, poultry and fish.
• Don’t eat prunes, rhubarb, papaya and other foods that are natural laxatives.
• Avoid the artificial sweetener Sorbitol, which acts like a laxative.
• Limit foods that contain caffeine, such as coffee, tea, chocolate and colas.
• Switch to low-lactose milk or a soy beverage if milk makes your diarrhea worse.
• Keep well hydrated by drinking plenty of non-carbonated, caffeine-free fluids, such as water, juice, sports drinks and clear broth.
• Eat salty foods, such as soups, crackers, pretzels and sports drinks, to replace lost sodium.
• Eat high-potassium foods, such as fruit juices, sports drinks, potatoes and bananas, to replace lost potassium.

• Drink plenty of liquids—at least 8–10 glasses a day.
• Try something hot, such as tea or soup, about a half hour before your usual bowel movement.
• Eat high-fibre foods, such as whole grain breads, cereals, dried beans, peas and lentils.
• Add wheat bran, wheat germ, bran flakes or flaxseeds to cereals, casseroles, potatoes, pasta, rice, sauces, yogurt and soups.
• Eat plenty of fresh, frozen, canned or cooked vegetables and fruits. Aim for a minimum of five servings a day.
• Eat foods that act as natural laxatives, such as prunes, rhubarb and papaya.
• Get some exercise, such as walking, every day.
• Don’t use laxatives without the permission of your physician.

When to call your healthcare team:

If you experience any of the following symptoms, your constipation may have become a serious and you should contact your healthcare team:

• severe abdominal pain
• nausea with vomiting
• blood in the stool
• no stool for 5 days
• no passage of gas rectally
• small amounts of liquid stool with abdominal bloating, gas pain, nausea or vomiting.

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• Drink plenty of fluids during the day to ensure a regular flow of urine.
• Empty your bladder frequently.
• Don’t drink anything for a few hours before going to bed if your sleep is being interrupted by having to urinate.
• Avoid caffeine and carbonated beverages.
• Don’t drink alcohol without the permission of your healthcare team.
• Sit in warm water for a few minutes to soothe irritated areas.

When to call your healthcare team:

The following symptoms may indicate a bladder, kidney or urinary tract infection:

• a burning feeling during urination
• a reddish colour or blood in the urine
• an unpleasant odour to the urine
• being unable to urinate
• needing to urinate often
• feeling the need to urinate right away
• a fever or chills (especially when accompanied by shaking)

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• Drink plenty of fluids during the day to ensure a regular flow of urine.
• Empty your bladder frequently.
• Don’t drink anything for a few hours before going to bed if your sleep is being interrupted by having to urinate.
• Don’t drink alcohol without the permission of your healthcare team.

When to call your healthcare team:


The following symptoms may indicate a bladder, kidney or urinary tract infection:

• a burning feeling during urination
• a reddish colour or blood in the urine
• an unpleasant odour to the urine
• being unable to urinate
• needing to urinate often
• feeling the need to urinate right away
• a fever or chills (especially when accompanied by shaking)

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• Use sharp, hot, cold or other dangerous objects with extreme caution if your fingers are numb.
• Move slowly and use handrails when you go up and down stairs if your muscle strength or balance is affected.

• Limit your use of salt in cooking.
• Put a shaker of herb seasonings or pepper on the dinner table and remove the salt shaker.
• Eat fewer salty foods, such as chips, prepared foods, luncheon meats and pickles.
• Elevate your legs if your feet are swollen.

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• You can reduce the chance for infection with meticulous skin and nail care, which will minimize bacterial and fungal growth.
• Use your unaffected arm for injections, IVs and blood samples, if possible.
• Don’t lift heavy objects with the affected arm.
• Immediately treat any injuries to the affected limb with first aid or at a walk-in clinic.
• Women should shave their underarms with an electric razor.
• Swimming, walking, bicycling, light yoga and similar exercises may improve lymph movement.

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• Protect your ears from cold and wind.
• Ask your healthcare team if medications might relieve your earaches.

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• Try to figure out what makes you feel anxious. Talking to someone who has had a cancer experience similar to yours may help you cope with anxiety and reduce your fears.
• Decide how much you’d like to know about your cancer. Some people become anxious if they have too little information; others feel better not knowing everything.
• Keeping a journal or diary may help you release anxiety and other thoughts and feelings. Record your positive feelings as well—you can return to them when you’re feeling low.
• Keep track of new strengths you discover in yourself and those around you. You may find new reasons to appreciate your family and your life.
• Share your worries and concerns with your healthcare team, your family doctor, family or friends. Try not to keep your feelings bottled up inside.
• You may find contact with pets, especially dogs or cats, to be soothing.
• Look to your spiritual faith for comfort.
• Learn and practise some meditation or relaxation exercises.
• Eat well and be as physically active as possible.
• Reduce your intake of caffeine (coffee, tea and cola) by switching to decaffeinated drinks.

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• Try to figure out why you feel down. Sometimes talking to someone who has had a cancer experience similar to yours can help you cope with depression and reduce your fears.
• Share your worries and concerns with your healthcare team, your family doctor, family or friends. Try not to keep your feelings bottled up inside.
• You may find contact with pets, especially dogs or cats, to be soothing.
• Look to your spiritual faith for comfort.
• Eat well and be as physically active as possible.

When to call your healthcare team:

If you have any of the following possible signs of depression, call your healthcare team. They may recommend a medication to relieve depression or therapy to help you during treatment.

• trouble sleeping
• no interest in eating
• overeating
• crying a lot
• feeling hopeless
• thoughts of harming yourself

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• Go to bed and get up at the same time every day.
• Relax before bedtime. Try reading, listening to books on tape, writing in a journal, having a bath or doing some easy stretches.
• Avoid alcohol, caffeine and smoking for several hours before bedtime.
• Make sure your bed, pillows and sheets are comfortable.
• Block outside light with blinds or drapes, if needed.
• Use earplugs if noise is keeping you awake.
• Make sure that your room is at a comfortable temperature for sleeping.
• Don’t stay in bed tossing and turning when you have trouble falling asleep. Get up and go into another room. Read or watch TV until you feel sleepy enough to return to your bed.

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• Plan activities where you need to concentrate more for the times of the day when you are most rested.
• Keep track of things by making lists.
• Ask a family member or friend to help you to remember by listening, taking notes and asking questions at appointments.

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• Talk to your doctor about banking your sperm, a procedure that freezes sperm for future use, before your treatment starts.
• Use a condom during sexual intercourse for the first few days after treatment because some chemotherapy drugs can be carried in the sperm.
• Use a reliable method of birth control during treatment. Your sperm may be altered by your cancer treatments, and it is important not to fertilize an egg with them. Talk to your healthcare team about what method is right for you and your partner, and how long to continue to use it.

Women:

• It’s important to practise birth control during chemotherapy. Although pregnancy may be possible during treatment, it’s not a good idea because the cancer treatments can be harmful to a developing fetus.
• If you are pregnant when your cancer is discovered, it may be possible to delay chemotherapy treatment until after the baby is born. If you need treatment sooner, your healthcare team may suggest waiting until after the 12th week of pregnancy. In some cases, you might need to think about ending the pregnancy.

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• Wear light clothing in layers that can be removed.
• Avoid caffeine and alcohol.
• Get as much exercise as possible.

Vaginal symptoms:

• Use a water-based vaginal lubricant during sex. Don’t use petroleum jelly, which increases the risk of infection.
• Ask your pharmacist about vaginal gels that help with dryness.
• Ask your doctor about an estrogen ring, estrogen cream or vitamin E vaginal suppository to relieve dryness.
• Wear cotton underwear and pantyhose with a ventilated cotton lining.
• Don’t wear tight slacks or shorts.

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• Try to share your feelings with your partner. If talking to each other about sex or cancer is difficult, a counsellor may be able to help.
• Tell your partner if you have any fears about resuming sexual activity.
• Let your partner know when you’re ready to have sex,  what level of intensity is appropriate and if they should do anything differently.
• Talk to your partner about their own worries, which may be about hurting you or appearing too eager.
• Plan ahead. Choosing the right time for sex can help you avoid problems of fatigue and pain.
• Hugging, touching, holding and cuddling may become more important, while sexual intercourse may become less important.

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