Some types of chemotherapy make it harder for your bone marrow to produce new white blood cells. White blood cells help your body fight infection. Therefore, it is important to avoid infections, since chemotherapy decreases the number of your white blood cells.

There are many types of white blood cells. One type is called neutrophil. When your neutrophil count is low, it is called neutropenia. Your doctor or nurse may do blood tests to find out whether you have neutropenia.

It is important to watch for signs of infection when you have neutropenia. Check for fever at least once a day, or as often as your doctor or nurse tells you to. You may find it best to use a digital thermometer. Call your doctor or nurse if your temperature is 100.5°F or higher.

• Your doctor or nurse will check your white blood cell count throughout your treatment. If chemotherapy is likely to make your white blood cell count very low, you may get medicine to raise your white blood cell count and lower your risk of infection.
• Wash your hands often with soap and water. Be sure to wash your hands before cooking and eating, and after you use the bathroom, blow your nose, cough, sneeze, or touch animals. Carry hand sanitizer for times when you are not near soap and water.
• Use sanitizing wipes to clean surfaces and items that you touch. This includes public telephones, ATM machines, doorknobs, and other common items.
• Be gentle and thorough when you wipe yourself after a bowel movement. Instead of toilet paper, use a baby wipe or squirt of water from a spray bottle to clean yourself. Let your doctor or nurse know if your rectal area is sore or bleeds or if you have hemorrhoids.
• Stay away from people who are sick. This includes people with colds, flu, measles, or chicken pox. You also need to stay away from children who just had a “live virus” vaccine for chicken pox or polio. Call your doctor, nurse, or local health department if you have any questions.
• Stay away from crowds. Try not to be around a lot of people. For instance, plan to go shopping or to the movies when the stores and theaters are less crowded.

• Be careful not to cut or nick yourself. Do not cut or tear your nail cuticles. Use an electric shaver instead of a razor. And be extra careful when using scissors, needles, or knives.
• Watch for signs of infection around your catheter. Signs include drainage, redness, swelling, or soreness. Let your doctor or nurse know about any changes you notice near your catheter.
• Maintain good mouth care. Brush your teeth after meals and before you go to bed. Use a very soft toothbrush. You can make the bristles even softer by running hot water over them just before you brush. Use a mouth rinse that does not contain alcohol. Check with your doctor or nurse before going to the dentist. (For more about taking care of your mouth, see Mouth and Throat Changes.)
• Take good care of your skin. Do not squeeze or scratch pimples. Use lotion to soften and heal dry, cracked skin. Dry yourself after a bath or shower by gently patting (not rubbing) your skin. (For more information about taking care of your skin, see Skin and Nail Changes.)
• Clean cuts right away. Use warm water, soap, and an antiseptic to clean your cuts. Do this every day until your cut has a scab over it.
• Be careful around animals. Do not clean your cat’s litter box, pick up dog waste, or clean bird cages or fish tanks. Be sure to wash your hands after touching pets and other animals.
• Do not get a flu shot or other type of vaccine without first asking your doctor or nurse. Some vaccines contain a live virus, which you should not be exposed to.
• Keep hot foods hot and cold foods cold. Do not leave leftovers sitting out. Put them in the refrigerator as soon as you are done eating.

• Wash raw vegetables and fruits well before eating them.
• Do not eat raw or undercooked fish, seafood, meat, chicken, or eggs. These may have bacteria that can cause infection.

• Do not have food or drinks that are moldy, spoiled, or past the freshness date.
• Call your doctor right away (even on the weekend or in the middle of the night) if you think you have an infection. Be sure you know how to reach your doctor after office hours and on weekends. Call if you have a fever of 100.5°F or higher, or when you have chills or sweats. Do not take aspirin, acetaminophen (such as Tylenol®), ibuprofen products, or any other drugs that reduce fever without first talking with your doctor or nurse. Other signs of infection include:
  • Redness
  • Swelling
  • Rash
  • Chills
  • Cough
  • Earache
  • Headache
  • Stiff neck
  • Bloody or cloudy urine
  • Painful or frequent need to urinate
  • Sinus pain or pressure

ScienceDaily (Apr. 18, 2007) — Using Chinese herbs either alone or in conjunction with chemotherapy may help protect a breast cancer patient’s bone marrow and immune system, as well as improving the woman’s overall quality of life.

Sixty per cent of women undergoing chemotherapy for breast cancer experience a range of significant short term side effects. These include nausea, vomiting and fatigue, as well as inflammation of the gut lining, decreased numbers of red and white blood cells and decreased numbers of blood platelets.

Chinese medicinal herbs include mixtures of herbal compounds or extracts from herbs, and they are prescribed to counteract the side effects of chemotherapy. This Cochrane Systematic Review set out to see if there is conventional evidence indicating that these medicines are safe and whether there is evidence that the medicines are effective.

The researchers identified seven randomised studies involving 542 patients with breast cancer. By analysing these data, the researchers concluded that there was no evidence that the Chinese medicinal herbal treatment caused harm, and some evidence that it might reduce side effects.

“Further trials are needed before the effects of traditional Chinese medicines for people with breast cancer can be evaluated with any real confidence,” says Assistant Professor Jing Li, who works at the Chinese Cochrane Centre in Chengdu, China.

The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience for the person receiving chemotherapy.

Chemotherapy’s potential effects on the skin and nails:

As each person’s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Chemotherapy can affect both the skin and nails. It may cause an increased sensitivity to the sun as well as redness, rashes, itching, peeling, dryness, or acne. Nails may become darkened, yellow, brittle, or cracked, and may also develop vertical lines or ridges.

Sometimes, chemotherapy causes the skin along the vein to darken, especially in people who have very dark skin. Cosmetics or makeup may be used to cover the darkened area, but this can take a lot of time if more than one vein is affected. After treatment ends, the darkened areas often fade in a few months.

Although some side effects can be self-managed, some conditions require immediate medical attention. If you are receiving intravenous (IV) drugs, be sure that you immediately report any burning or pain to your physician. Sometimes, intravenous drugs can leak out of the vein, potentially causing tissue damage. These symptoms need to be reported to your physician right away.

Other skin and nail symptoms may indicate an allergic reaction. Consult your physician or cancer care team immediately if you develop sudden or severe itching, rash or hives, wheezing, or any other labored breathing.

How can I manage skin and nail problems?

The National Cancer Institute (NCI) recommends the following strategies for reducing skin and nail problems related to chemotherapy:

Acne

• Keep your face clean and dry.
• Discuss with your physician the use of any over-the-counter medicated creams or soaps before using them.

Itching and dryness

• Apply cornstarch like you would using a dusting powder.
• Take quick showers or sponge baths, not long, hot baths. Use a moisturizing soap.
• Apply cream or lotion to your skin while it is still moist.
• Avoid perfume, cologne, or aftershave lotions that contain alcohol.

Nail problems

• Avoid nail-strengthening products as they may bother your skin and nails.
• Wear gloves when doing housework or working in the garden.
• If you note redness, pain, or changes around the cuticles, consult your physician.

Sunlight sensitivity

• Avoid direct sunlight as much as possible, and especially stay out of the sun between the peak hours of 10 a.m. and 4 p.m. when the sun’s rays are the strongest. Even if you have dark skin, protect yourself from the sun.
• Use a sunscreen lotion with a skin protection factor (SPF) of 15 or higher. Zinc oxide, sold over the counter, can block the sun’s rays completely.
• Use a lip balm with a high sun protection factor.
• Wear long-sleeve cotton shirts, pants, and hats with a wide brim (especially if you are experiencing hair loss) to prevent your skin and scalp from sunburn.