• Side Effects:

    Nausea

    Many types of chemotherapy can cause nausea and vomiting. This may last for the day of treatment only or for several days after treatment.

    How to manage this symptom

    • Use your anti-nausea medication as directed by your provider. If it is not helping with your nausea, contact your provider as there are many medications that you can use.
    • Eat 5 to 6 small meals or snacks rather than 3 large meals during the day.
    • Do not force yourself to eat when you are nauseated.
    • Pick foods that have been soothing for you when you have experienced nausea in the past (bland foods, crackers, ginger ale).
    • Do not eat your favorite foods while you are nauseated.
    • Avoid foods that are fatty, fried, very spicy or very sweet when you are nauseated.
    • Avoid strong scented food.
    • Eat foods that are room temperature or cold if the smells from hot food increase your nausea.
    • Have someone else prepare your food if possible.
    • Distract yourself with activities you enjoy.

    When to call your health-care provider

    • If you are nauseated and your anti-nausea medication is not working.
    • If you are vomiting and unable to keep anything down for more than 12 hours.
    • If there is blood or particles that look like coffee grounds in your emesis (vomit).

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    Fatigue

    Fatigue is a feeling of tiredness that can interfere with your normal daily activities. It is common in people receiving treatment for their brain tumor to experience fatigue. There are multiple reasons people experience fatigue while undergoing treatment. These include the tumor itself and/ or the treatments both chemotherapy and radiation which can cause fatigue. Low red blood-cell counts, anemia, can cause fatigue. Poor sleep and poor nutrition can also be factors in fatigue.

    How to manage this symptom

    • Rest is important but too much rest can make you more fatigued. Do not nap for more than an hour.
    • Exercise can improve your fatigue. Keep active by starting slow and gradually increasing your activities.
    • Eat a well-balanced diet with protein and carbohydrates. Make sure you drink a moderate amount of fluids.
    • Relax and decrease stress. Try using meditation, prayer, yoga or guided imagery to help.
    • Conserve your energy by spreading your activities throughout the day. Plan rest breaks and have others help you with household chores and errands. Don’t push yourself to do more than you can manage.
    • Restore your energy by doing activities that you enjoy and make you feel good.
    • Talk with your health care provider about your fatigue

    When to call your health-care provider

    If the patient has a change in their level of consciousness and are difficult to arouse, call your health care provider right away.

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    Appetite Changes

    Appetite changes may happen due to treatment. You may lose your appetite because of nausea, fatigue or depression. You may experience taste changes due to the chemotherapy or medications you are on.

    How to manage these symptoms

    • Eat small meals five to six times a day rather than three large meals.
    • Eat foods high in calories, protein and carbohydrates
    • Butter or oils added to food
    • Cottage cheese, cream cheese muffins, croissants
    • Cream soups or soups with lentils, dried peas or beans
    • Custards, frozen yogurt, ice cream
    • Nuts, seeds and wheat germ
    • Instant breakfast drinks, whole milk, milkshakes, smoothies
    • Liquid meal replacements
    • Peanut butter
    • Beef, chicken, fish
    • Eggs
    • Powdered milk added to foods like pudding, milkshakes
    • Drink milkshakes, smoothies, soup or juice if you do not feel like eating solid foods
    • Limit your fluids right before and during a meal as too much liquid can cause you to feel full
    • Try new and attractively prepared foods to help make a meal more appetizing.
    • Have family or friend help you prepare snacks and meals so you have them handy.
    • Keep active. This can help stimulate your appetite and decrease constipation.
    • If you are experiencing a metallic taste, use plastic forks and spoons and avoid cooking foods in metal pots and pans
    • Cold foods are usually better tolerated than warm or hot foods when your taste is altered

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    Constipation

    Constipation is present when bowel movements become less frequent and stools are hard and dry, becoming difficult to pass. It may make you feel bloated or nauseous. You may feel gassy or have stomach cramps. Constipation can be caused by a side effect of the chemotherapy you are taking or other medications such as pain medication or anti-nausea medication which you are taking.

    How to manage this symptom

    • Eat small frequent meals rather than three large meals
    • Eat low fiber foods. Here are some examples:
    • Chicken, Turkey (without the skin)
    • Potatoes without the skin
    • Bananas
    • Fish
    • White bread
    • Canned fruit (peaches, pears, applesauce)
    • Eggs
    • White rice
    • Clear fruit juice
    • Noodles
    • Asparagus
    • Vegetable juice
    • Cottage cheese
    • Gelatin
    • Saltine crackers
    • Sherbet or sorbet
    • Yogurt (plain or vanilla)
    • Angel food cake
    • Avoid greasy or spicy foods
    • Increase your fluids
    • Avoid drinks that include caffeine, alcohol or milk/ milk products

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    Low Blood Counts

    The bone marrow produces the blood cells that circulate in the arteries, veins and capillaries. White blood cell levels and platelet levels may drop temporarily after each dose of chemotherapy. At the lowest point (called the “nadir”), patients may have an increased risk for infection (with low white blood cells) or bleeding (with low platelets). A low red blood cell count (anemia) is not common with most types of chemotherapy used to treat gliomas. Most of the time patients do not have symptoms related to the presence of low counts. Blood counts are measured by performing a CBC (Complete Blood Count). A CBC may be taken at different times within the chemotherapy cycle and usually within one to two days prior to administration of chemotherapy. The results will help the provider decide if it is safe to give the chemotherapy.

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    Infection

    Common signs of infection include fever (oral temperature over 100.5 degrees), chills, sore throat, shortness of breath, new or worsening cough, abdominal pain, and pain or burning with urination.

    Tips to help prevent infection:

    • Hand washing. Wash your hands frequently particularly after using the bathroom, before cooking or eating, and after touching animals. Have your family wash their hands frequently.
    • Carry hand sanitizer for when you are not near soap and water.
    • Maintain good oral care.
    • Try to avoid people who are sick.
    • Discuss getting the flu shot with your health care provider.

    If your white blood-cell counts become too low (neutropenia) your health care team will give you specific instructions on how to prevent infection and what to do if you are having sign of infection while your counts are low.

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    Bleeding

    Common signs of bleeding include easy bruising of the skin, tiny spots of hemorrhage under the skin (petechia) which look like little red spots, nose bleeds, and bleeding of the gums with brushing teeth.

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