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CHEMOTHERAPY Record Booklet
Please bring this booklet to all hospital appointments and any admission to the
Accident and Emergency Department
Show the booklet to your General Practitioner, Nurse or any other Healthcare
Professional involved in your care when you see them
NAME…………………………………………………………………………………………………
HOSPITAL……………………………………………………………………………………………
HOSPITAL NUMBER ……………………………………………………………………………….
CONSULTANT……………………………………………………………………………………….
CONTENTS
How to contact us
Your chemotherapy details
What is chemotherapy?
Chemotherapy side effects
Effects on your blood
Treatment records and side effects diary
Non chemotherapy drugs record
Information for relatives and friends
Advice to General Practitioners and A&E staff
How to contact us if you have a problem associated with your Chemotherapy
MONDAY TO FRIDAY 9.00 A.M. – 5.00 P.M.
Singleton Hospital 01792 205666 Morriston Hospital 01792 702222
Glangwili Hospital 01267 235151 Prince Philip Hospital 01554 756567
Princess of Wales Hospital 01656 752752 Withybush Hospital 01437 764545
Neath & Port Talbot Hospital 01639 862000
Bronglais Hospital 01970 623131
TELEPHONE AND BLEEP NUMBERS
WARD ……………………………….. Tel: ……………………………………
NURSE SPECIALIST ……………………………… Tel:…………………..Bleep…………..
……………………………….. Tel:…………………..Bleep…………..
CONSULTANT ……………………………….. Tel:………………………………………
………………………………. Tel:………………………………………
WEEKEND AND NIGHT TIME
Tel:……………………………………………………
Tel:…………………………………………………….
Tel:…………………………………………………….
COMMUNITY TEAM
GENERAL PRACTITIONER Tel………………………………………..
DISTRICT NURSE Tel………………………………………..
PALLIATIVE CARE NURSE Tel………………………………………..
OTHER Tel………………………………………..
Your Chemotherapy details and information
CHEMOTHERAPY PROTOCOL………………………………………………..
………………………………………………………………………………………
……………………………………………………………………………………….
DIAGNOSIS ……………………………………………………………………….
TRIAL CODE (If applicable)……………………………………………………...
FREQUENCY OF TREATMENT…………………………………………………
PROPOSED NUMBER OF TREATMENTS……………………………………….
DATE TREATMENT STARTED…………………………………………………..
DRUG SENSITIVITIES……………………………………………………………..
……………………………………………………………………………………….
……………………………………………………………………………………….
CONTRAINDICATED DRUGS DURING TREATMENT………………………
………………………………………………………………………………………..
………………………………………………………………………………………..
BLOOD GROUP ……………………………………………………………………..
SPECIAL BLOOD REQUIREMENTS………………………………………………
VENOUS ACCESS DEVICE…………………………………………………………
CHEMOTHERAPY
What is chemotherapy ?
When we offer you chemotherapy, it means we want to treat your cancer using drug
treatment. There are many different chemotherapy drugs in common use. Sometimes the
drugs are given singly and sometimes in a combination.
The decision about which treatment to offer you will be based on many factors but will mainly
depend on where your cancer is.
How and where will the treatment be given ?
Most chemotherapy is given through a drip into a vein in your arm. Sometimes it may be
necessary to use a semi-permanent line which is inserted into a major vein e.g. Hickman Line,
PICC line or Porta-cath (if you require such a line this will be explained to you in more detail).
Chemotherapy may also be given in other ways – for example as tablets or using portable
pumps. This may make it possible for you to receive your treatment at home.
Many of our treatments can be carried out in the Chemotherapy Daycare Unit but some more
complex treatments must be given as an inpatient.
How will you feel while you are having chemotherapy ?
Some chemotherapy drugs have very few side-effects and you may be able to carry on living a
normal everyday life between visits. Other treatments may be more disruptive. It depends
on the type of chemotherapy you are having – each drug is different.
Some of the more common side-effects of chemotherapy are discussed in the next few pages
but for more specific information about your particular treatment or side effects, please see
the individual fact sheets which your Chemotherapy Nurse will supply. These go into more
detail for each chemotherapy drug you receive.
SOME OF THE MOST COMMON SIDE EFFECTS OF CHEMOTHERAPY
Nausea and vomiting (feeling and being sick)
Not all chemotherapy drugs will make you feel or be sick. When we use the ones that do, we
always give anti-sickness drugs to try to prevent the problem. Improvements in these drugs
over the last few years means that many patients do not feel sick at all, or only have minor
problems. If you are given anti-sickness tablets to take for a few days after your treatment,
do make sure you take them as prescribed. It’s much better to prevent sickness before it
starts.
If despite this you do feel sick after chemotherapy, let us or your GP (family doctor) know.
We can usually try different anti-sickness drugs to help. You could also try ‘sea bands’.
These are elastic wrist bracelets which you can buy from your local chemist. They have a
small plastic’ bobble’ which presses on your anti-sickness accupressure point.
Hair Loss
Many chemotherapy drugs do not cause hair loss but others cause hair thinning or even
complete hair loss. Again, it all depends on which chemotherapy drugs you are having. Your
doctor and nurses will be able to tell you how likely hair loss is with your treatment. If it
happens, hair loss will usually start about 2-3 weeks after the first treatment. It is
important to say that the hair always grows back after the chemotherapy stops.
For some people, the thought of losing their hair temporarily is very upsetting. If your
chemotherapy is likely to cause hair loss, we will be able to arrange a wig fitting for you.
Some patients use scarves, turbans or colourful hats to help cope until their hair comes back.
Sometimes we can try and reduce hair loss by using ‘scalp cooling’. This means wearing a cold
pack on your head for roughly 2-3 hours at the time of treatment. This is only effective for
some chemotherapy and may not be advisable in some cancers. Ask your Chemotherapy Nurse
for more details.
Tiredness
Probably the most common side-effect of chemotherapy is tiredness. Again, this affects
some people more than it does others. If you do feel tired or lethargic, try to balance
getting plenty of rest with making sure you carry on with some of your usual activities. Do
what you feel up to. There are few restrictions on work, sport or social and sexual activities,
though it is common to feel less enthusiastic about these than usual.
Fertility
It is important that you do not become pregnant or father a child whilst on chemotherapy as
the drugs may damage your unborn child. Chemotherapy often makes you temporarily
infertile but this can be unpredictable, so it is very important that you continue to use
contraception. Sometimes the infertility is permanent. If you are concerned about this ask
about sperm storage and egg conservation before treatment starts. Women who are still
having periods may notice changes in their normal pattern. Sometimes the periods stop or
there may be less blood loss.
Please do not hesitate to discuss these issues with your Consultant or Chemotherapy Nurse.
Taste changes
Patients often tell us that chemotherapy gives them a strange taste in the mouth.
Sometimes food may seem tasteless and it is quite common for tea and coffee to taste
different. This is usually temporary and your taste should return.
Sore mouth
Chemotherapy can make your mouth more sensitive and it may become sore or infected.
Some people find that they have mouth ulcers. Regular brushing with a soft toothbrush and
fluoride toothpaste after meals and before going to bed is very important and is the best way
to prevent infection.
We often give patients mouthwashes to use to prevent soreness and infection.
However, if your mouth does become sore, please discuss with your doctor or nurse. It might
also be a good idea to go for a check up at your dentist before you start your chemotherapy.
Altered Bowel Habit
Chemotherapy may affect your bowels, so your normal bowel habits may alter – for example
you may get diarrhoea or constipation. Please tell your doctor or nurse if this becomes a
problem – don’t suffer in silence as it is usually very easy to resolve !
Some chemotherapy drugs may occasionally cause severe diarrhoea which can make you very
unwell if not treated. If this applies to you, you will be given specific instructions and a supply
of tablets to take should this occur.
Appetite
There are few restrictions on what you can eat and drink whilst on chemotherapy. A ‘little of
what you fancy’ when you fancy it is always a good policy. Alcohol is generally also allowed –
in moderation ! But do check with your pharmacist or nurse first.
Haematology patients should avoid unpasteurised dairy products and take away food and some
patients may be asked to follow a ‘clean food diet’. You will be given this information
separately.
Phlebitis (sore veins)
Some drugs have to be injected very carefully into your veins otherwise they may cause
damage to your skin. This is why the nurse takes such care with the injections. You may
experience some discomfort and hardening of a vein which has been used but if you develop
severe pain and redness at an injection site contact the Chemotherapy Nurse.
THE EFFECTS OF CHEMOTHERAPY ON YOUR BLOOD
One thing that all chemotherapy drugs have in common is they tend to lower your resistance
to infections. This is because they lower your blood count – especially your white blood count.
When you have fewer white blood cells than usual your body is less able to fight infections.
This does not mean that you need to isolate yourself from other people, though it is sensible
to avoid close contact with those who have obvious coughs, colds, flu and so on. It does mean
that you should take it seriously if you develop an infection.
What should you do if you get an infection ?
If you develop any of the following while you are on chemotherapy – and for four weeks
afterwards – you should ring us for advice immediately using the contact numbers at the
front of this booklet:
A temperature (above 38ºC on one occasion or above 37.5ºC on two occasions
taken half an hour apart)
A sore throat
A chesty cough
A stomach bug or upset stomach
A urine infection (cystitis)
Feeling generally unwell, achy or flu-like
Redness or discharge around a Hickman or other central line
Shivery episodes after flushing a Hickman or other central line
DON’T DELAY!
It is very important to act straight away. Always contact us first using the telephone
numbers at the front of this booklet. We may ask you to see your GP.
Other effects of a low blood count
Chemotherapy can also lower your ‘platelet count’. Platelets are blood cells which help clot
your blood. With most chemotherapy low platelets are unlikely to cause a problem, but if you
have any unusual bleeding or bruising please let us know.
Sometimes chemotherapy can also lower your red blood count. This tends to happen slowly
over the course of several treatments. A low red count can make you feel tired and short of
breath. From time to time we offer patients blood transfusions to correct a low red cell
count.
Blood tests during chemotherapy
We will always ask you to have a blood test before going ahead with each treatment to make
sure your blood has recovered after the last chemotherapy. Sometimes it is worth having
these blood tests done a day ahead at your local hospital as this will save you having to wait
for the results on the day of treatment. Your doctor or Chemotherapy Nurse will discuss
this with you.
(Please read the information sheet about your treatment for more specific potential side
effects)
SAFETY AND HYGIENE
Chemotherapy drugs can affect normal cells in the body as well as those cells they are meant
to kill. Because of this we ask you to take some simple hygiene precautions to limit exposure
for anyone handling them. This is especially important if relatives or carers will be handling
your drugs. Pregnant women should avoid handling them altogether.
Chemotherapy drugs will normally have a sticker on the container saying ‘cytotoxic agent –
handle with care’ or something similar.
Chemotherapy tablets and capsules
If you are taking tablets or capsules, do not touch them directly if at all possible
but tip them gently from the bottle onto a spoon or medicine measure.
Swallow tablets and capsules whole with plenty of water and DO NOT CHEW OR
CRUSH unless specifically told to do so.
Be careful how you store and dispose of any containers. Store them well out of
the reach of children in a cool, dry cupboard unless told otherwise by your
pharmacist.
Any unused drug should be returned to the hospital Pharmacy or your local
chemist for safe disposal. Empty containers can also be returned to the
Pharmacy or put carefully into the household rubbish bin.
Always wash your hands after handling any chemotherapy drugs.
Injections and Pumps
If you are having chemotherapy by injection at home, the nurse looking after you
will make sure that any hazardous material is disposed of carefully. However, if
you have a spillage of drug, for example, from a pump, follow the advice given
below.
What to do if your chemotherapy leaks
It is very unlikely that your chemotherapy will leak whilst you are wearing your
pump
If you notice a leak, find an empty plastic bag such as a carrier bag
If you have any disposable plastic or household rubber gloves available, wear
these.
Sit down
If you have a Hickman line, close the clamp
If you have a Paragon pump, close the clamp on the line
If you have a Walkmed pump, switch it off
Wrap the pump and the bum bag in the plastic bag
DO NOT detach the line from your catheter unless you have been shown how to
do so
Contact the Chemotherapy Unit for advice.
If the chemotherapy has come into contact with your skin, wash the area with
plenty of soap and water, immediately.
If the chemotherapy gets onto your clothes, they should be washed thoroughly
straight away. Use your washing machine or handwash with soap and plenty of
water.
Always wash your hands after dealing with chemotherapy, even if you have worn
gloves.
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea
(feeling sick) None
Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Too sick to
take fluids
Vomiting
(being sick)
None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10
episodes in
24 hours
> 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for
more than 2
days; feeling
bloated
Bowels not
opened for
more than 4
days; in pain
Diarrhoea None Less than two days More than
two days Intolerable
Bloody or
admitted to
hospital
Mouth Normal Sore Ulcers, but
eating
Taking liquids
only
Cannot eat or
drink
Hair No change Minimal loss Patchy loss Complete
loss
Tiredness;
energy levels None
Experiencing
symptoms but
maintaining normal
activity
Rest for less
than half of
each day
Rest for
more than
half of each
day
Bedbound
Nerves and
weakness Normal
Tingling/Numbness
(T/N)
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other
Please state:
Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea
(feeling sick) None
Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
TREATMENT RECORD
Date……………………
Results
Hb Regime
WBC
Plts
Neuts Cycle No.
Chemotherapy (IV) Chemotherapy (oral)
Other medication
Special instructions/comments
Blood tests needed before next treatment
Test Date Place of test Form
Next chemotherapy due
SIDE EFFECTS DIARY – Please circle
Type None Mild Moderate Severe Very severe
Nausea None Eating almost as
normal
Can eat but
much less
than normal
Not really
able to eat
Vomiting None 1 episode in 24
hours
2-5 episodes
in 24 hours
6-10 episodes
in 24 hours > 10 episodes
Constipation None Bowels opened
almost as normal
Bowels
opening but
much less
than normal
Bowels not
opened for >2
days; feeling
bloated
Bowels not
opened > 4
days; in pain
Diarrhoea None Less than two
days
More than
two days Intolerable
Bloody, or in
hospital
Mouth Normal Sore Ulcers, but
eating
Eating liquids
only Cannot eat
Hair No change Minimal loss Patchy loss Complete loss
Tiredness;
energy levels None
Symptoms; normal
activity
Rest less
than half of
each day
Rest more
than half of
each day
Bedbound
Nerves and
weakness Normal
Tingling/numbness
T/N
Severe T/N
or mild
weakness
Intolerable
T/N or
marked
weakness
Pain None Mild Moderate Severe Intolerable
Other Mild Moderate Severe Very severe
INFORMATION FOR RELATIVES AND FRIENDS
Family and friends often want to help and support you. You may like to share this booklet and
other information concerning your treatment with them.
It will be helpful if close family or friends know the effect of chemotherapy on your blood
and what action to take if you get an infection.
You may find it useful to have practical help with shopping, housework, visits to the hospital
or collecting the children from school. You could ask one person to co-ordinate help and
telephone calls to see how you are feeling.
Don’t be afraid to identify times when you want quiet time or days when you don’t feel well
enough for visits and phone calls.
If you are feeling isolated or finding it difficult to cope, talk to the nursing staff so that
professional support can be organised if necessary.
We have BACUP booklets specific to different cancers that you may like to read before or
during your treatment. There are also booklets of a more general nature (e.g.)
coping with hair loss
diet and the cancer patient
who can ever understand ?
talking about your cancer
sexuality and cancer
Concerns and Suggestions
Your views and comments help us to improve the service we offer. Our aim is to provide a
high standard of care for all our patients.
If you have any concerns about your care or treatment, please let us know immediately. You
can talk to your nurse or the department sister. Most concerns can be addressed straight
away. You can also speak to a doctor if you have any problems.
If you have any concerns which you feel have not been addressed you can always ask to speak
to your consultant or ask staff for details of the Trust’s complaints procedure.
ADVICE TO GENERAL PRACTITIONERS AND A&E STAFF
This is for you to show to your GP or the A & E Staff if you develop an infection while you are
on chemotherapy.
Dear Doctor
This patient has been undergoing chemotherapy treatment at:
………………………………………………………………………………………………………………………………………………………………………..
The chemotherapy is likely to cause a low white cell count – particularly neutropenia. If the
patient consults you regarding any form of infection while they are receiving chemotherapy
we advise that an URGENT SAME DAY full blood count should be carried out and that the
following guidelines be considered:
if Neutrophils <1.0 x 109/l and the patient is febrile (>38ºC on one occasion or
>37.50C on two occasions taken half an hour apart), admit to hospital for IV
antibiotics
if Neutrophils >1.0 x 109/l and the patient is febrile but well consider oral
antibiotics after clinical assessment
if neutrophils >1.0 x 109/l and the patient is febrile and clinically unwell
please liaise with the appropriate consultant team (see front of booklet).
…………………………………………………………………………………………………………………………………………….
Please do not hesitate to contact us for advice. Ring the Hospital switchboard and ask for
the Registrar – see the front of this booklet to identify the appropriate Consultant Team.
During office hours, if the Registrar is not available ask for one of the Chemotherapy Nurses.