Many surveys have shown that patients and their family members believe that nausea and vomiting occur with all types of chemotherapy. More than 20 years ago that was true, and it was difficult to control the symptoms. Today, doctors do a much better job of preventing and easing these symptoms.

Generally, if there's more than a 10 percent risk of causing nausea or vomiting with chemotherapy, patients are given anti-nausea medicines — also known as anti-emetics — as a preventive. When it comes to nausea and vomiting, we know that younger people are more at risk than older people, and that women are at a slightly greater risk than men.

Certain drugs commonly cause nausea and vomiting, including:

• Cisplatin (Platinol and others)
• Doxorubicin (Adriamycin and others)
• Cyclophosphamide (Cytoxan)

Doctors have used these standard chemotherapies for many years.

There are many options available to help you manage nausea and vomiting. Talk with your doctor about which one is best for you. In general, anti-nausea medicines are given to prevent the problem from occurring in the first place.

The most common form of anti-nausea medication is a combination of dexamethasone (a type of steroid) and a serotonin blocker — a compound that stops the natural substance serotonin from sending a message to the brain that triggers nausea. Serotonin blockers include dolasetron (Anzemet), granisetron (Kytril and others), ondansetron (Zofran and others), and palonosetron (Aloxi).

This combination helps prevent the acute nausea and vomiting that can occur in the first 24 hours after chemotherapy. Doctors usually recommend patients continue using this drug combination for two to three days following treatment to prevent delayed nausea. By taking medication to prevent these different types of nausea, patients can also avoid developing anticipatory nausea — the queasy feeling that can come before chemotherapy.

Aprepitant (Emend) is an anti-emetic drug that can be added to the combination of dexamethasone and a serotonin blocker to protect against both acute and delayed nausea and vomiting. Aprepitant, taken as a capsule, works by counteracting the effects of a chemical produced in the body called "substance P." A related drug, fosaprepitant (Emend for Injection), gives patients receiving chemotherapy another option for preventing nausea and vomiting. Delivered intravenously, fosaprepitant is converted to aprepitant in the body.

In addition to medical treatments for nausea and vomiting, there are things you can do to ease symptoms, including:

• Eat and drink slowly. Try having small meals throughout the day instead of your usual breakfast, lunch, and dinner.
• Avoid sweet, fried, or fatty foods, as well as foods with strong odors. Eating foods cold or at room temperature can help you avoid strong smells.
• Be sure that you fully understand your doctor's and nurse's instructions for taking anti-nausea medicines.
• See that you have a sufficient supply of the correct drugs.
• Be sure that you are drinking enough fluids. Ask your nurse or doctor about proper nutrition during this time.
• Find out from your doctor if any other medicines you may be taking require special precautions.

Feeling tired — really tired — can be tied to a number of factors:

• The cancer itself
• Treatment of the disease
• The emotional aspects of coping with cancer and cancer pain
• Anemia (low levels of red blood cells)

If you are experiencing fatigue, you should know that this is a symptom for which you can and should seek help. If your doctor doesn't ask you about fatigue, be sure to bring it up. That's the best way to find and treat the cause.

To determine whether there is an underlying physical cause, your doctor will order a blood test to find out if your red blood cell count is abnormally low (anemic). If you are anemic, there are many treatment options available. Be sure to take only treatments prescribed by your doctor. Don't try to treat yourself with over-the-counter medicines for "iron-poor blood." These drugs have not proven to be helpful.

These tips can help you reduce your fatigue:

• Take several short naps or breaks in a comfortable chair rather than in bed.
• Take short walks or do some light exercise if possible.
• Try easier or shorter versions of the activities you enjoy.
• Ask your family or friends to help you with tasks you find difficult or taxing.
• Save your energy for things you find most important.
• Talk to an oncology social worker or oncology nurse. These professionals can also help you manage fatigue. They can work with you to address any emotional or practical concerns that may be causing symptoms and help you develop strategies for coping.

Sores inside the mouth and on the mucous lining of the throat and digestive tract can result from radiation treatments and from some types of chemotherapy. Mucositis can be a serious problem because it can cause pain and infections, making it difficult to eat, drink, and swallow.

Once treatment ends, mouth sores do disappear. But before they fade, it's important that you work closely with your health care team to manage this side effect of cancer treatment.

One of the key things you can to manage mucositis is to take good care of your mouth and keep it clean. Here are some tips:

• Visit your dentist before treatment. A small problem could turn into a large one if mouth sores develop later on.
• Choose the softest bristle brush for brushing your teeth.
• If toothpaste irritates your mouth, use a mixture of ½ teaspoon salt with 4 cups water.
• Gargling may also help. Use a solution made up of 1 quart plain water, ½ teaspoon table salt, and ½ teaspoon baking soda.
• Drink plenty of fluids.

Some options for soothing mouth pain include:

• Ice chips or Popsicles.
• Ibuprofen (such as Motrin) or acetaminophen (such as Tylenol) for mild pain.
• Over-the-counter anesthetics, such as Anbesol or Orajel. Let your doctor know if you are using them, especially if he or she prescribes a lidocaine-based mouthwash.
• Gelclair — an oral gel designed to coat and soothe mouth sores by forming a protective barrier in the mouth. This is available by prescription only.
• If you are receiving high-dose chemotherapy followed by bone marrow transplant for a blood cancer, the drug palifermin (Kepivance) may be prescribed. Palifermin, given intravenously, has been shown to protect the lining of the mouth, reducing severe mucositis. The safety and effectiveness of this drug for people with other types of cancer are not yet known.
• Opiates, a class of drugs that includes morphine, may also be prescribed to help you cope with mouth pain. If so, don't resist taking these stronger drugs for severe pain. It's important to manage pain because it can affect your quality of life and even slow progress toward better health. If swallowing pills is difficult, severe pain can be treated with intravenous drugs. And when your pain is controlled, you will be better able to eat and drink fluids.

Some people on chemotherapy experience numbness or tingling in their hands and feet, what doctors call peripheral neuropathy. Symptoms related to neuropathy and other types of nerve damage can include:

• Difficulty picking up objects or buttoning clothing
• Problems with balance
• Difficulty walking
• Jaw pain
• Hearing loss

These symptoms can build over time. Some people don't notice them until they have had several chemotherapy treatments.

It's important to tell your doctor as soon as possible if you experience these types of side effects. He or she may want to adjust some of your medicines or chemotherapy and may want to see if there is another reason for the problem that can be treated.

Often, nerve damage is temporary; it will usually get better, but it can take time. That's because the nerve fibers re-grow very slowly — less than a millimeter (1/25 of an inch) per day. In the meantime, take extra caution when handling hot, sharp, or dangerous objects. And use handrails on stairs and in the tub or shower.

As we mentioned earlier, chemotherapy can lower the levels of infection-fighting white blood cells, a condition known as neutropenia. Of special concern for cancer patients is their levels of neutrophils, the most abundant of the three types of white blood cells. These cells contain tiny packets filled with potent chemicals called enzymes that can destroy bacteria when the chemicals are released.

Bacteria are the most common source of infection for patients receiving chemotherapy. The normal number of white blood cells in one microliter of blood (a tiny droplet, one millionth of a liter) is between 4,000 and 11,000; the risk of infection is greatest when the neutrophil count drops to 1,000 or fewer. If your neutrophil count dips below this number, the only symptoms you might experience are chills, fever, or sweats.

If you are feeling unwell in any way after receiving chemotherapy, it's vital to take your temperature. Temperatures from 99°F (37.2°C) to 100°F (37.8°C) are fairly common. But if your temperature rises to 100.5°F (38.1°C) or above, call your doctor or nurse immediately. Fever may be your only sign of an infection. Unless fever is treated promptly, infections can become life-threatening. Make sure you have a good thermometer that is easy to use and read (the digital ones are fine). Also, be sure to have your doctor's telephone number in case there is a problem.

Doctors use antibiotics to treat infections. Although most people think of antibiotics as pills, intravenous antibiotics are often recommended for patients receiving chemotherapy. Using intravenous antibiotics knocks out infections until the white blood cell count returns to normal.

Depending on a number of things, including the type of chemotherapy you receive, another approach is to take white blood cell growth factors. In some patients, these medicines can reduce the risk of getting infections. Growth factors stimulate the bone marrow to replenish blood cells affected by chemotherapy.

Commonly used white blood cell growth factors include filgrastim (Neupogen) and pegfilgrastim (Neulasta). Both of these drugs have to be given by injection. Your doctor or nurse can train you or a caregiver to administer this injection at home if you prefer. Pegfilgrastim may be given just once, a day or two after chemotherapy.

You can lower your risk of infection by taking these simple steps:

• Wash your hands frequently with soap and water, especially after using the toilet and before eating.
• Clean cuts and scrapes right away. Use an antiseptic and keep wounds clean and dry until they heal.
• Carry alcohol-based sanitizers, such as Purell, with you in case you don't have access to soap and water.
• Be extra careful not to nick or cut yourself when using a razor, knife, or scissors.
• Wear protective gloves when gardening or cleaning up.
• Avoid contact with cat litter boxes, bird cages, and fish tanks.

Defined as two or more loose stools per day, diarrhea may be caused by some types of chemotherapy, including:

• Irinotecan (Camptosar and others)
• 5-fluorouracil (5-FU)
• Erlotinib (Tarceva)
• Gefitinib (Iressa)

There are many things you can do to help control diarrhea. If diarrhea persists, especially large and frequent stools, you should report it to your doctor or nurse.

If you are experiencing diarrhea, it is very important to drink plenty of fluids. If you are getting behind in fluids, make sure that your doctor or nurse knows about the problem you are having with diarrhea.

You can also increase your intake of drinks such as Gatorade or Pedialyte, an over-the-counter solution made for infants that can be used by adults as well. These drinks provide electrolytes — the body's salts that must stay in balance in order for cells to work properly. Occasionally, intravenous fluids are needed if the diarrhea is especially severe.

Many foods can nourish you without contributing to diarrhea. Here are some suggestions for making healthy choices:

Note: Foods marked with an asterisk (*) are high in soluble fiber, which solidifies stool but contributes to the amount of stool. Choose them when the volume of stool is manageable.

Over-the-counter medicines and prescription treatments are available for diarrhea, but you should only use them if they are necessary.

The most recommended over-the-counter medicine for diarrhea is Imodium AD. But you should remember that this used to be a prescription medicine and can be quite powerful. In general, if the diarrhea is bad enough for you to need a medicine, including an over-the-counter one, you should discuss the diarrhea and treatment with your doctor or nurse.

Your doctor may need to prescribe something stronger, such as diphenoxylate and atropine (Lomotil and others). Like all drugs, these products can interact with other drugs you may be taking, such as opiate pain relievers. If your doctor prescribes Lomotil, be sure to tell him or her about any existing conditions you may have, such as heart disease or breathing or thyroid problems; taking this drug can make these problems worse.

For severe, unrelenting diarrhea that does not respond to these oral medications, your doctor may consider giving you injections of octreotide (Sandostatin). Although this drug has not been approved specifically for diarrhea caused by chemotherapy or radiation treatments, your doctor may choose to prescribe it "off label."

Defined as fewer than three bowel movements a week (although fewer than four or five may be a reduced number for some people), this symptom can be caused by:

• Certain chemotherapy drugs, including vinorelbine (Navelbine), vincristine (Oncovin and others), and temozolomide (Temodar)
• Inactivity
• Low fluid intake
• Low intake of dietary fiber
• Anti-nausea medications
• Opiate pain medications

In cases of severe constipation, liquid can seep around a blockage, which some patients mistake for diarrhea. They may take an antidiarrheal medication, making the problem worse. With prolonged constipation, other symptoms, such as confusion and retaining urine, can occur.

Here are some things you can do to help prevent constipation:

• Eat plenty of dietary fiber. Grains, beans, and vegetables such as cauliflower or broccoli are good sources of fiber.
• Drink plenty of fluids.
• Make light exercise a part of your everyday schedule.

It's very important to use only gentle, stimulating laxatives if you're constipated. Stool softeners such as docusate sodium (Colace and others), although helpful, are not enough. Pharmacies carry a number of different laxatives that are available without a prescription such as Senokot, bisacodyl (Correctol, Dulcolax, and others), magnesium hydroxide (milk of magnesia), Metamucil and MiraLAX.

The best thing to do is to prevent constipation through diet, exercise, and careful use of laxatives. Prescription pain medicines may be one of the biggest reasons people with cancer experience constipation. But your doctor can prescribe a special schedule of laxatives along with your pain medication so that you can still benefit from pain relief and avoid constipation.

Not all anti-cancer medicines cause hair loss; your doctor or nurse can tell you whether you might be affected. Hair loss is often one of the more trying aspects of cancer treatment. When hair falls out, it can affect self-image and quality of life. But there are ways to cope with this side effect.

Everyone's experience is different, so it's important to talk with your doctor or nurse about how your particular treatment affects hair loss. Depending on the treatment, hair loss may start anywhere from seven to 21 days after the first chemotherapy session. Hair starts to grow back after you are finished with treatment. It may have a different texture or color, but these changes are usually not permanent.

Generally, when they lose their hair, most people want to wear some kind of head covering, whether it's a scarf, turban, hat, or wig. Some insurance plans cover part of the cost. Organizations such as CancerCare can also provide suggestions for obtaining a wig.

If you choose to wear a wig, consider buying one before all of your hair falls out. This way, you will have a good match to your own hair color. Having a wig ahead of time will also help you feel more prepared. You can have your wig professionally fitted and styled by a full-service wig salon. Some of these salons even specialize in hair loss from chemotherapy.

A. This is a judgment call. You and your doctor have to weigh the risks and benefits of your treatment. The decision will depend on how severe your symptoms are, where you are in the course of your treatment, how responsive your tumor has been to chemotherapy, the current goals of treatment, and whether there are effective drugs that do not cause nerve damage that could be substituted.

However, even if you stop using a medicine today, you will probably continue to have symptoms for some time. And because nerve damage is cumulative, the symptoms may get worse before they get better. Talk with your doctor or nurse about medications, as well as techniques such as relaxation exercises and acupuncture, which may help ease discomfort.

A. Sometimes, people can have a great benefit from chemotherapy without having a lot of side effects or possibly even any side effects. An important goal is to prevent side effects, and it sounds as though you and your doctors have been able to do that. Not having side effects might be due to other factors as well. For example, every drug affects each person differently, and at different stages of treatment. And some chemotherapy drugs are known to cause less severe side effects than others.

A. There are many different organisms that can cause infection. That is why a broad-spectrum antibiotic is usually prescribed to treat infection. Doctors see different patterns of infection in different geographic regions. These patterns affect which medicines are given to treat infections and prevent them from becoming worse.

A. If you are having memory problems and trouble focusing on tasks, finding words, or managing daily activities, you are not alone. Patients often notice these changes during chemotherapy treatment. But most people find that within a year of finishing treatment, these symptoms have either greatly improved or disappeared altogether.

Researchers are still uncertain about the exact causes of chemobrain. But a number of conditions that may lead to these symptoms can be treated effectively: low blood cell counts, depression, anxiety, and fatigue among them. Tell your doctor if you're having any of the symptoms of chemobrain. Sometimes, simply changing a prescription can make a real difference in how you feel, since some medications can also make you less alert.