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Patients Against Lymphoma

 

Support or Side Effects or Chemotherapy

Treatment Support

Last update: 11/12/2016

TOPICS

Tips for Getting Through Treatment 
|
Stem Cell Transplants: Patient Tips and Questions to Ask

About Treatment | Ask Your Doctor About | Nausea tips | Food Tips for Managing Nausea and Maintaining Oral Health 
About Therapy and Blood Counts | Diet for Immune SuppressedConstipation | Details and News |
Related Resources and In the News |
First Rituxan Day - a checklist  |  Related Topics

About Treatment  

See also our printable version: PDF (tri-fold, 2 pages)

The goal of treatment is to kill the cancer cells while minimizing damage to normal cells. 

There are three basic goals of therapy.

o      To manage the lymphoma as needed with minimal toxicity 
(management intent)

o      To achieve a durable remission or possible cure 
(curative intent)

o      To relieve symptoms or to address a tumor that is dangerous or impacting on your quality of life (palliative intent) ...
also called best supportive care.

 

It’s important to understand and agree with the intent or goal of therapy;  the most appropriate goal depending on many factors, including the type of lymphoma, its aggressiveness, where it presents, your treatment history, age, performance and other factors.

Treatments may be systemic - delivering drugs into the blood to reach cancer cells anywhere in the body, or localized - to treat a specific area of the body.  

Almost all treatment agents are selective to some degree. That is, they are designed to affect the targeted cells (cancer cells) more than the normal cells. For example, many chemotherapy drugs affect rapidly dividing cells and will therefore damage mainly cancer cells, but also some normal cells that divide rapidly.  

The experience of cancer treatment can vary a lot. Some will experience little discomfort and be able to continue work and family activities with little disruption.  But sometimes the experience of treatment requires close monitoring and extensive after care.

Additionally, the following factors can influence the treatment experience and the outcomes:

o       Your age and health status

o       The treatment agents

o       The unique sensitivities you may have to treatments

o       How closely you follow doctor’s instructions

o       How honestly and promptly you report problems

Try to be positive about the chosen treatment.  Sometimes your anxiety about treatment can disrupt life more than the therapy, and can make recovery more challenging than it need be. 

Learn what you can do to manage or prevent side effects and complications (the focus of what follows), so that you will have the best chance to have a great outcome.   



Tips for Getting Through Cancer Treatment

Keep physically active - and continue to exercise within your limits  

Avoid taking herbs and vitamin supplements without consulting with your oncologist.

Avoid prolonged sun exposure. (A yearly skin check is also recommended.)

Avoid very hot baths to decrease the risk of Hand/Foot Syndrome and infection.  See also Hand-Foot Syndrome - Chemocarer

Avoid uncooked foods; and thoroughly wash vegetables and fruits, including the skins - when your blood cell counts are low.

Record any side effects and share with your doctor.  We don't all react to the same drugs in the same way and sometimes protocols have to be changed or modified based on individual reactions.

Maintain hydration

o       Drink plenty of water daily to keep tissues hydrated, reduce constipation, and to help remove toxins from your bladder, liver and kidneys.

o       For each cup of coffee, tea, cola drink, or cocoa, take an extra cup of water. Chocolate also requires extra water.

o       Avoid alcohol because it's also dehydrating and adds unnecessary toxicity.

Ask your doctor about laxatives and stool softeners if needed.  
 
See also Fighting Constipation below

Have available small portions of food and drink,
which require little or no preparation: broth-based soups, canned fruit, crackers, fruit juice …

Treatment may increase the need for sources of digestible protein.

Minimizing risks of oral complications:

o       Avoid sticky, crunchy foods; and foods that are hot, spicy, or high in acid, like citrus fruits and juices.

o       To help with swallowing, soften your food with gravy, sauces, broth, yogurt, or other liquids.

o       Avoid toothpicks and tobacco products.

o       When your mouth hurts, call or fax your doctor or nurse.

o       Use extra-soft toothbrush after meals and at bedtime. Soften in warm water.

o       Use a fluoride toothpaste; avoid mouthwashes that contain alcohol.

o       Gently floss your teeth daily. Avoid areas that are bleeding or sore. 
If your blood counts are low check with doctor or nurse before flossing.

o       Rinse several times daily with solution of 
1/4 teaspoon baking soda and  1/8 teaspoon salt in one cup of warm water.  
Follow with a plain water rinse.

o       Suck on ice cubes to relieve sores - be sure that the water is pure (boil if from a well).

o       Discuss with your doctor or dentist about your dentures that don't fit.

Constipation management:

o       Contact your doctor if it persists or worsens.  

o       Keep hydrated (drink water) and avoid caffeine.

o       Include fiber in your meals (such as whole grains). 

o       Get regular exercise (such as walking).

Nausea management:

o       Avoid foods that are high in fat, which tend to remain in the stomach longer than other foods and may contribute to nausea.

o       Chew slowly, take small bites, sip liquids with meals; avoid offending foods and odors - breath through your mouth when needed. 

o       Try smaller, more-frequent meals.

Diarrhea management:
Uncontrolled diarrhea can lead to fluid depletion, electrolyte imbalance, skin damage, and even death if it persists too long. 

The following was adapted from Diarrhea in Cancer  ACS

Take medicine for diarrhea as prescribed. 
- inform your doctor if the meds are not helping because changing the prescription can make all the difference.
- keep track of the amount and frequency of bowel movements.

Try
-eating small amounts of foods that are easy to digest such as rice, bananas, applesauce, yogurt, mashed potatoes, low-fat cottage cheese, and dry toast.
- clear liquid diet (one that includes water, weak tea, apple juice, peach or apricot nectar, clear broth, Popsicles, and gelatin with no solids added) as soon as diarrhea starts or when you feel that it’s going to start.


Include
-foods that are high in potassium (such as bananas, potatoes, apricots, and sports drinks like Gatorade® or Powerade®). Potassium is an important mineral that you may lose if you have diarrhea.

Avoid
- acidic drinks, such as tomato juice, citrus juices, and fizzy soft drinks.
- milk or milk products if they seem to make diarrhea worse.
- greasy foods, bran, raw fruits and vegetables, and caffeine.
- pastries, candies, rich desserts, jellies, preserves, and nuts.
- alcohol or use tobacco.
- very hot or spicy foods.

After movements
-
clean your anal area with a mild soap after each bowel movement, rinse well with warm water, and pat dry. Or use baby wipes to clean yourself.
- apply a water-repellent ointment, such as A&D Ointment® or petroleum jelly, to the anal area.
- sitting in a tub of warm water or a sitz bath may help reduce anal discomfort.

Related resources

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Cancer and diarrhea   MedlinePlus
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Diarrhea in Cancer  ACS
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A randomized trial of yogurt for prevention of antibiotic-associated diarrhea.
Dig Dis Sci. 2003 Oct;48(10):2077-82. PMID: 14627358 | Related articles 

Reduce your risk of infection while your blood counts are low: 

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Ask your doctor about growth factors (Neupogen® and Leukine®)
that may help granulocytes to recover more quickly to reduce your risk of infection while on treatment.
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Avoid touching your eyes, nose, mouth, ears, etc.
without first washing your hands with warm soapy water.
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 Be aware of sources of contamination: public places,
raw foods, cutting boards, plates, dish towels, door knobs, counter tops, and sponges.
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Use separate cutting boards for fresh produce and raw meat.

Use
separate dish towels when handling raw meat; use disposable types. 
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See also Tips on self-administration of subcutaneous injections  such as for Neulasta or Neupogen.

 

Being around kids during treatment? 

See patient-to-patient advice
 

Try Relaxation techniques during treatment, such as mediation, prayer, walking, and dance.
 

Get Adequate rest, take naps as needed.

See also:  Nausea tips | Food Tips for Managing Nausea and Maintaining Oral Health

Getting Ready

Preparations - getting ready for treatment: 
 

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Ask about ways to help with the administration of therapies, such as ports
 

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Let neighbors, family, and friends help with your everyday preparations and tasks.

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Notify employees, family, and friends that you will need to be careful to avoid infections.
 

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Make preparations (lists, shopping, complete responsibilities) to minimize what you will have to do when treatment starts. 
 

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Prepare a journal of your activities, body functions, symptoms and side effects; bring to your doctor's appointment. Write down your questions. Set goals.
 

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Prepare your favorite music and reading to help you relax.
 

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NEW Oncolink: Home Safety for Patients Receiving Chemotherapy

Handling Body Waste, Handling Trash or Laundry, Handling Spills, Sexual Contact,
Safety for My Family

 

About Therapy and Blood Counts

Many therapies can lead to decrease blood cell counts (cytopenias):

o       Fatigue from low red blood cells (Anemia)

o       Increased risk of bleeding from low platelets (Thrombocytopenia)

o       Increased risk of infection from low granulocyte levels (Granulocytopenia)

And from low lymphocytes and neutrophils counts (Lymphopenia and Neutropenia).  Also known as low White Blood Counts or WBC.

These risks will decrease as your blood counts return to more normal levels.

Tips on self-administration of subcutaneous injections  such as for Neulasta or Neupogen.

Ask your doctor

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 For readable information about each of the drugs you will receive. 

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What symptoms or side effects are expected, and which require:

  Immediate attention?   
 
See also When to Call Your Doctor or 911  
and Symptoms Checklist PDF

Or a call the next day?

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How you can contact her or him?

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If drugs to control nausea will be needed? 

If nausea medicines are needed, please provide a prescription several days prior to the first treatment. 
(Prior approval may be required by your insurance company.)

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Ask about ways to help with the administration of therapies, such as ports

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Ask about dietary and prescription guidelines, such as any foods or drugs to avoid when receiving treatment.

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Talk to your doctor or nurse about dental problems and
chronic infections; address before treatment if possible.

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Talk to your doctor or nurse about drug administration options.

For background on risks to your veins from temporary IVs see PAL
including how to assess your individual risk.

Provide a list for your doctor of allergies you may have, 
along with a list medications and supplements you take, including over-the-counter types.  

 

Updates and Details

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Nutrition and Food Safety Tips

Also see Diet recommendation for Immunosuppressed for details about safe and unsafe foods.
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Nutrition for the Person With Cancer During Treatment ACS
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During and after chemotherapy your body will need to repairFoods that are rich in protein supply your body with amino acids, which help to build, repair, and maintain cells and muscle tissue, to heal wounds, and to support the immune system.
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An excellent guide for low microbial diet: roswellp ark.org PDF 
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Potential Uptake of Escherichia coli O157:H7 from Organic Manure into Crisphead Lettuceo
nlm.nih.gov
 
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Avoid Vitamin D  and Calcium?
Be aware that in patients with advanced lymphomas and during treatment that these high doses of these supplements may increase the risk of hypercalcemia - a metabolic imbalance resulting from too much calcium in the blood. 

Hypercalcemia is associated with lymphomas and can also be a side effect of chemotherapy.

"Some patients with sarcoidosis, tuberculosis, or lymphoma become hypercalcemic in response to any increase in vitamin D nutrition (122, 134, 135). For these persons, it may be prudent to avoid any dietary or environmental sources of vitamin D." www.ajcn. org/cgi/content/ full/69/5/ 842
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Avoid hot baths 
See Hand/Foot Syndrome  | And to avoid risk of infection:  cancer.gov

HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents  

Comment:  When you think about it, the doses of chemotherapy agents are carefully calculated to achieve blood levels within the therapeutic window (to be effective with acceptable toxicity).  It may be that a hot bath will raise the temperature of blood in your skin and extremities, which could increase drug accumulations in those areas and reduce blood flow to other areas. When you self-prescribe and experiment with the treatment script with the goal of optimizing therapy it's possible to do more harm than good.   
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Exercise?
Studies show that moderate (not strenuous) exercise during treatment can 
have many benefits.  Please consult your doctor for guidance on activities appropriate to your
performance level and special risks you may have.
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Exercise to Stay Active  cancer.org/docroot 

Find out how much activity is healthy during treatment and create an exercise program that's right for you.
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"It has been shown that exercise such as riding a bike or walking can maintain a patient's strength and endurance while undergoing therapy."  rch.unimelb.edu

Benefits may include: 
" Shorter duration of low neutrophil and platelet counts 
   Decreased risk of upper respiratory tract infections (urti's)
   Decreased pain severity | Decreased anxiety and depression | Improved mood"
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Prepare a Journal (Dave writes): 

Get a binder, to keep your: questions, answers, lab results, receipts,
important information; take it to all appointments.

Always take your nausea meds as early as prescribed, if you have
optional nausea pills, err on the overly cautious side.

Chemo day, take a little backpack with: book, non-smelly-bland munchies,
water or drinks, binder, and a copy of your chemo dosages (check the
bags). The first day is long, nervous and boring.  You should have a
designated driver.

Never eat your favorite foods when nausea is probable.

If you get tired, take a nap, then take a walk.
1 hour nap = 1/2 hour walk.
Keep active, avoid the temptation to cocoon.

If ANYTHING seems to change, ask your onc.  (Mine got tired of saying
"it goes with the territory", but I didn't need the extra stress caused
by worrying over stuff.)

Many people go through CHOP+R with very minor bad side effects, don't
believe the TV sensationalized stereotypes.

If you have hair 10" or longer, cut it and donate to kids with cancer at
www.locksoflove.org
 
You are going to lose it, and it makes a good story when you don't want
to tell somebody about the chemo.

Keep a sense of humor.

Dave (originally posted on nhl-follic support list)

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Fight treatment-related Nausea:  

Informing your health care provider is also extremely important so that your symptoms
can be monitored and prescribed medications can be modified if necessary.

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Ask your doctor to provide a prescription several days prior to the first chemo treatment. 
 
Prior approval may be required by their insurance company. Delays - 
and unnecessary suffering - can be avoided with sufficient advance notice.
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Ask your doctor about medication that can dramatically control nausea, such as Zofran, Kytril, and Emend.
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Avoid foods that are high in fat, which tend to remain in the stomach longer than 
other foods and may contribute to nausea.
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Avoid odors that offend you.
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Breath through your mouth when feeling nauseous. 
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Try smaller, more-frequent meals to help to minimize nausea. 
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Complementary practices that may help control nausea and vomiting:
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Acupuncture and Ginger  
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Resources:
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Ginger Eases Nausea From Chemo healthday.com 

Participants were randomized to receive either a placebo or one of three doses of ginger supplement: 0.5 grams, 1 gram or 1.5 grams for three days before the start of chemo and three days after for the next two cycles. All also received traditional antiemetic drugs on the first day of treatment.
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Managing Nausea and Vomiting 
ccn.aacnjournals.org
  | cancerbackup.org.uk | thedietchannel.com 
Also see Nausea Shopping List
Also see Nausea side effects for information about therapies that can control nausea.
 
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Oral Health - especially important during and prior to chemotherapy

Important: See your dentist as early as possible before chemotherapy begins. If you have already started chemotherapy and didn’t go to a dentist, see one as soon as possible, and notify him or her that you are receiving treatment. 
See Oral and Dental Management Prior to Cancer Therapy cancer.gov
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Avoid foods that are: 
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Sharp, crunchy, which can scrape or cut your mouth (hard nuts, brittle candy)
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Hot, spicy, or high in acid, like citrus fruits and juices, which can irritate your mouth
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Sugary and can cause cavities
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Choose foods that are:
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nutritious,  easy to chew and swallow
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soft and moist (soups, cooked cereals, mashed potatoes, and scrambled eggs)
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If you have trouble swallowing, soften your food with gravy, sauces, broth, yogurt, or other liquids.
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Chew slowly, take small bites, sip liquids with meals.
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Also avoid toothpicks, tobacco products, alcoholic drinks.
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When your mouth hurts, call or fax your doctor or nurse.
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Oral hygiene: How to clean your mouth, tongue, and gums.
Prevention of oral mucositis - evidence-based best practices oralcancerfoundation.org  pdf 
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Use extra-soft toothbrush after every meal and at bedtime. Soften brush in warm water.
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Use a fluoride toothpaste.
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Avoid  mouthwashes that contain  alcohol.
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Gently floss your teeth daily. Avoid  areas that are bleeding or sore. If blood counts are low check with doctor or nurse before flossing.
bullet
Rinse several times daily with solution of
1/4 teaspoon baking soda and 
1/8 teaspoon salt in one cup of warm water. 
Follow with a plain water rinse.
bullet
Suck on ice cubes to relieve sores - 
be sure that the water is pure (boil if from a well).
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Discuss with your doctor or dentist about your dentures that don't fit.
Adapted from:  Chemotherapy and Your Mouth - NIDCR

See also Mucositis - Chemotherapy Problems and Solutions .cancersupportivecare.com
 

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Fighting constipation 

Also see Bowel & Bladder in the Side Effects section.

In the News

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Science Based Medicine: Constipation Myths and Facts

TIPS

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CHOP-R / CVP-R / Bendamustine-R: Patient Tips and Questions to Ask
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Ask your doctor about laxatives and stool softeners.
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Drink plenty of liquids
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Eat foods with fiber content, such as celery and cooked whole grains.
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Keep active.
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Also see for guidance on constipation: http://cancer.about.com

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When to call your doctor or nurse - general guidelines 

We have moved this topic to an new page

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Resources and Research 

In the News

* The Medical News:  Tips to avoid foodborne illness http://bit.ly/1fQme1O

 

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TOOLS - look up information about drugs you will be taking PAL
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Mucositis - Chemotherapy Problems and Solutions .cancersupportivecare.com
 
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Antioxidants during chemotherapy?
TOPIC SEARCH: PubMed Antioxidants with chemotherapy?  -
 Unknown - error on the side of not taking.
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NCI
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Coping with Side Effects  Cancer.gov
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Chemotherapy and You: A Guide to Self-Help During Cancer Treatment  NCI.gov | cancer.gov  pdf
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NCI Guidance: Chemotherapy and You  Cancer.gov | PDF
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NCI Guidance: Radiotherapy and You  Cancer.gov | PDF
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NCI Radiation Therapy Fact Sheet Series  Cancer.gov
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Oral and Dental Management Prior to Cancer Therapy cancer.gov
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Nutrition related
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Nutrition and Cancer THREE STAGES:   cancerNutrition.com
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Building Up diet  CancerBACUP 
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Eating problems  CancerBACUP
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"Eating Well Through Cancer" by Holly Clegg  Amazon.com

Focuses on cancer and nutrition with a mainstream approach. 
Recipes were selected to ease symptoms while undergoing treatment and to maintain 
a healthier lifestyle. (We have no affiliations with the authors)
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A healthy guide to eating CancerBACUP 
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Nutrition and Cancer THREE STAGES:   cancerNutrition.com
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Life after High Dose Treatment and Stem Cell Support  CancerBACUP
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Suggestions for conserving energy  CancerLynx 
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Understanding chemotherapy and side effects:
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Dealing with ill-effects of Chemo  CancerLynx
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General Management Guidelines for Chemotherapy  www.dent.ohio-state.edu pdf 
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International Journal of Experimental and Clinical Chemotherapy  karger.com
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Understanding Drug Therapy and Managing Side Effects  leukemia-lymphoma.org  pdf
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Understanding Chemotherapy  CancerBACUP booklet series
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Understanding Adriamycin Chemotherapy Western General Hospital, Edinburgh

Related topics:

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First Rituxan Day a checklist
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CHOP-R Tips
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BC Cancer For the Patient http://bit.ly/9KJ3ny
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By Patient Tips for CHOP+R
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Questions for Your Doctor
bullet When to Call Your Doctor or 911 
 
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Fight Nausea
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Nausea Shopping List
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Fight Constipation
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Related Resources and Research News
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Diet for Immune Suppressed
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Oral Health during therapy
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Managing Side Effects
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About ports and blood draws: 
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radiologyinfo.org  
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emedicinehealth.com  
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PICC lines 
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Blood Draw and I.V. Tips

 

 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright © 2004,  All Rights Reserved.