A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance,

1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
 Chemotherapy

What is chemotherapy?
Chemotherapy (sometimes colloquially called “chemo”) is a type of cancer treatment
that uses powerful drugs to destroy cancer cells. These cancer cells may be around the
original tumour site, or may have spread to other parts of the body. In some cases,
chemotherapy may be used in the treatment of other diseases and disorders as well.

How does chemotherapy work?

In cancer, your body cells keep on dividing until they form a mass of cells that become a
tumour (swelling or a lump). Cancer cells grow and divide at a fast rate. Chemotherapy
works by destroying, shrinking, or controlling the growth of these cells. It is also used to
decrease the discomfort caused by the cancer symptoms.

Since chemotherapy targets dividing cells in the body, at times it affects the healthy
body tissues as well, where the cells are constantly growing and dividing. These include
cells that line your mouth and intestines, and cells that cause hair growth.

How is chemotherapy administered?

Depending on the type of cancer and the drugs prescribed by the doctor, chemotherapy
may be given in one of the following ways:

 By mouth, through pills, tablets, capsules or liquids.

 By injection, either subcutaneous (under the skin) or intramuscular (into a muscle).
 Intravenously (IV), where the drug is injected into a vein for rapid entry into the
bloodstream.
 With creams and gels which can be applied to the skin to treat certain types of skin
cancers.
 Directed towards one area of the body where the tumour is, such as the chest or
abdomen.
 Directed at the cancer or the area where a tumour has been removed during
surgery.

How often will I receive chemotherapy?

Your treatment plan, including how often you will need chemotherapy, will depend on
the kind of cancer you have, the area of body being treated and your response to the
drugs. It may be daily, weekly, monthly and sometimes on and off, so that your body
has a chance to build healthy new cells and regain strength.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
How long is a chemotherapy session?
At The Aga Khan University Hospital, chemotherapy is usually given to patients as part
of our day care services, where the patient comes in the morning and gets discharged
by the evening. In some cases, you may be asked to get admitted overnight, or receive
chemotherapy while you are admitted at the hospital.

What is the treatment process?

Before starting chemotherapy treatment, you will be asked to visit the consulting clinic,
where you will undergo multiple diagnostic tests including complete blood count (CBC),
scans, ultrasound and biopsy. After these tests you will be called again for a follow up.
The results of your investigation will be used in developing your treatment plan.

The process for admission till discharge varies according to the type of admission,
whether it is day-care or inpatient.

Day care admission:

The chemotherapy day care services are offered at the Ibn Zuhr Building, Main Hospital
Campus, The Aga Khan University Hospital, Karachi. The Admission timings for Ibn
Zuhr Building Chemotherapy Unit are:

8 A.M. to 2 P.M. for long chemotherapy infusion and blood transfusion

2 P.M. to 7 P.M. for short chemotherapy and short blood products transfusion.

Before admission: For day care admission, your doctor will give you an Accommodation
Request Form at the clinic. You will be required to confirm your booking for the date
given to you, at the Oncology Day Care Services located on 2 nd Floor of Ibn Zuhr
Building. After the request has been processed, you will be given a date to come in for
the admission.

If you are advised to get a blood test, please have it done a day before admission from
any AKUH collection point, using your medical record (MR) number.

On the day of admission: Reach the ground floor of the Ibn-e-Zuhr building 15 minutes
before your appointment, take a token, and wait for your turn. Your admission will be
processed at the Admission Office on the same, and you will be asked to make your
payments at the nearby cashier. Then you will be directed to go to the second floor for
your treatment.

On arrival at the Oncology Day Care Unit: The nursing staff will check your vitals
including weight and blood pressure and ask for the results of your blood test. He/she
will then take you to your day care bed or couch and advise you on the ward routine.

Treatment: Your doctor will assess you and give directions for your medications. The
doses may vary between one cycle and the other. This will depend on your condition,

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
blood count and the results of other blood tests. Your chemotherapy drugs will be
prepared and dispensed by specialized Pharmacy staff.

The complete process from your assessment, doctor’s order entry and pharmacy
medication preparation may take up to 3 to 3.5 hours. The process time may seem long,
but rest assured that this is to ensure your safety for the correct drug infusion. You will
be administered the chemotherapy drugs once the preparation is complete.

Discharge: When the chemotherapy treatment is over, the nurse will explain how to take
your home medications and give you your next appointment or another Accommodation
Request Form.

Your attendant will receive a consolidated bill from the reception and, if needed, will be
asked to pay the remaining amount at the cashier on the ground floor.

Please note if you get sick or face any other issue, you may be taken to the Emergency
Department or the inpatient unit.

Inpatient admission:

Before admission: Your doctor will generate an electronic Accommodation Request for
your admission. Your bed allocation will be managed by the Admission Office as per its
availability in the unit.

If your doctor prescribes a blood test, it can be done at any AKUH collection point a day
before the admission using your medical record (MR) number.

On the day of the admission: You will receive a call from the Admission Office, once
your bed is allocated. After allocation of the bed, you will be asked to come to the
Admission Office to complete formalities of admission. Then you will be directed
towards your allocated unit with your admission sheet (yellow sheet). You will need to
show this to the unit receptionist, who will then ask the designated staff to take you to
your assigned bed.

On arrival at the ward: The nursing staff will check your vitals including weight and blood
pressure. You will then be taken to your bed, given orientation of the unit and asked to
change into the hospital clothing.

You will be asked for the results of your blood test. If these have not been done, they
will be carried out at this stage.

Treatment: Depending on your condition, vitals and test results, your doctor will direct
the pharmacy to prepare your chemotherapy drugs. This process takes about 2-3 hours;
and the pharmacy prepares chemotherapies only till 4 P.M. If there is a delay, your
chemotherapy may need to be processed and initiated the next day. To avoid delays,
you are requested to get you blood work done a day prior to your admission, from any
AKUH Lab Collection Point, using your medical record (MR) number.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
Discharge: When the chemotherapy treatment and prescribed monitoring is over, your
doctor will forward instructions for your discharge. Your nurse will explain to you your
take home medications and give you the required educational material. He/she will also
inform you about the date of your follow up with the doctor. In the meanwhile, your
attendant will be asked to pay the bill at the Patient Business Services Department.

How will I know if my chemotherapy is working?

To monitor the effects of chemotherapy your doctor will conduct physical exams and
medical tests, such as blood tests and x-rays, at specific intervals after your sessions to
compare the results with previous results of the same type. This will help gauge how
well your body is responding to the treatment.

Contrary to popular beliefs, side effects are not a measure of chemotherapy success or
failure. Severe side effects do not mean that chemotherapy is working well. Similarly, an
absence of side effects does not mean that the chemotherapy is not working.

What will happen if I miss my scheduled chemotherapy?

It is recommended to not skip chemotherapy treatment sessions, and in ideal situation,
the cycle should only be broken if cleared by your doctors. They may change your
schedule in some situations because of the side effects you may be experiencing. If
there are any changes to your schedule, your healthcare team will discuss these with
you.

What will I feel during chemotherapy?

Dealing with cancer and chemotherapy can be an emotionally draining and stressful
time for you. You may feel frustrated, helpless, lonely, anxious, depressed, afraid and
angry. Know that is it normal to have such feelings during this time and you are not
along in this struggle.

How can I cope with my feelings during chemotherapy?

Everyone is different and has a different way of coping. The following are some ways
which can help you cope better:

 Seek emotional support: Talk to a close friend, family member or a fellow cancer
patient, to help share what you are feeling.

 Join a support group: You can also join a support group for people with cancer. Such
meetings are attended by people going through or have survived the same ordeal as
you and by listening to their stories and sharing yours you may feel that you are not
alone.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
 At the Aga Khan University Hospital, there are multiple support groups which you
can join:

 Children’s Cancer (Paediatric Oncology) Support Group (oncology@aku.edu)

 Head and Neck Cancer Support Group (oncology@aku.edu)

 “I Will Stay Beautiful”, Women’s Cancer Support Group (oncology@aku.edu)

 Find ways to help yourself relax: This may include engaging in your hobbies, or
listening to music. You can also choose to pray or meditate, or simply rest to help
put your mind to ease.

 Be active: Exercises such as walking, riding a bike, and doing yoga can help you
feel energetic. You can also choose to remain fully engaged in your professional
activities or take up volunteer roles to keep yourself engaged. Being active can help
divert your thoughts and make you feel lively. However, talk to your doctor or nurse
before starting any exercise or physically exhausting routines.

 Put your life in control: Step back and look at your daily life to note things which you
can control. Set a daily schedule and try to accomplish whatever you can on the list.
Keeping up with your appointments, making positive changes in your lifestyle and
staying informed about your treatment can help you feel positive and in control.

What side effects should I expect during chemotherapy?

Side effects are undesirable and adverse secondary effects resulting from taking a drug.
During chemotherapy you may experience a number of these undesirable effects.
These will depend on the type and amount of chemotherapy you are being administered
and how your body responds to it.

It is very important to understand the difference between the side effects of

chemotherapy and the symptoms of cancer. Therefore, before you start chemotherapy,
talk to your doctor or nurse about the side effects to expect.

How long do these side effects last?

The duration of your side effects depends on your overall health and the kind of
chemotherapy you receive. After chemotherapy, most side effects go away. At times,
the treatment may cause long-term side effects including permanent damage to the
heart, lungs, nerves, kidneys, or reproductive organs. Ask your doctor or nurse about
chances of having long-term side effects.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
What are the common side effects of chemotherapy?
Some common side effects of chemotherapy are fatigue, nausea, vomiting, decreased
blood cell count, hair loss, mouth sores and pain.

How can I cope with these side effects?

There are different ways to cope with the side effects of chemotherapy. While some
side effects can be managed with medication, there are some that can be managed by
medical counselling. Make sure to let your doctor or nurse know about any changes you
notice as these may be signs of your treatment’s side effects.

A few ways to cope with the side effects of chemotherapy are:

1. Fatigue: Patients receiving chemotherapy usually complain of constantly feeling

tired. Fatigue during cancer can be a result of the treatment or the cancer itself. At
times the fatigue experienced can be due to anaemia or deficiency of red blood cells
in your body. Healthy red blood cells may get destroyed during chemotherapy and
having a decreased number of red blood cells to carry the oxygen around the body,
makes the heart work harder and makes you feel short of breath, weak, dizzy, faint,
or very tired.

Ways to manage:

 Get plenty of rest: Try to sleep for at least 8 hours each night. Take short naps of
1 to 2 hours during the day.

 Limit your activities: Engage only in important activities. For example you might
go to work but not clean the house. You can order food from outside instead of
cooking dinner at home. However, while ordering, make sure that the food is
cooked hygienically and meets your health requirements.

 Accept help: When your family or friends offer help, say yes to them. They can
help and care for your children, pick up groceries, drive you to doctor’s visits or
help with other daily chores.

 Eat a well-balanced diet: Choose a diet that contains all the calories and protein
your body needs. Calories will help keep your weight up, and extra protein can
help repair tissues that are damaged during cancer treatment.

 Do light exercises: Build in light exercises in your routine throughout the week.
Exercises can enhance the blood flow carrying oxygen and nutrients to muscle
tissue, improving their ability to produce more energy and help you feel more
energetic.

 Stand up slowly: You may feel dizzy if you stand up too fast. When you get up
from lying down, sit for a minute before you stand.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
  Medications: If your fatigue is a result of anaemia, you may be prescribed
medications to stimulate your bone marrow to produce more red blood cells. You
may also be given blood transfusions.

Call your doctor or nurse if:

 Your level of fatigue increases or you are not able to do your usual activities.
 You feel dizzy or feel like fainting.
 You feel short of breath.
 It feels like your heart is pounding or beating very fast.

2. Nausea and Vomiting: Some types of chemotherapy can cause nausea, vomiting or
both. Nausea and vomiting can occur during chemotherapy, or many hours or days
later. You will most likely feel better on the days you do not get chemotherapy.

Ways to manage:

 Anti-nausea drugs: Your doctor can prescribe drugs to help prevent nausea
during and after chemotherapy. Be sure to take these drugs as suggested and let
your doctor or nurse know if they do not work.

 Plan when it is best for you to eat and drink: Some people feel better when they
eat a light meal or snack before chemotherapy. Other people feel better when
they have chemotherapy on an empty stomach. After treatment, wait for at least
1 hour before you eat or drink.

 Eat small meals and snacks: Instead of having 3 large meals each day, have 5 or
6 small meals and snacks throughout the day. Do not drink lots of fluids before or
during meals. Also, do not lie down right after you eat.

 Stay away from foods and drinks with strong smells: These may include coffee,
fish, onions, garlic and foods that are being cooked.

 Relax before your treatment: You may feel less nauseous if you relax before
each chemotherapy treatment. Meditate, practice deep breathing exercises or
imagine peaceful scenes or experiences. You can also indulge in quiet hobbies
such as reading or listening to music.

3. Hair Loss: During chemotherapy you may experience hair loss from the head, face,
arms, legs, underarms, or the pubic area, as the treatment affects the growth of
healthy hair cells. Hair loss often starts 2 to 3 weeks after chemotherapy begins.
Your hair will grow back about 3 to 6 months after your chemotherapy is over,
although the regrowth maybe thinner and different in texture.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
 To manage hair loss you can take certain measures before starting the
chemotherapy treatment and after the treatment ends.

Before hair loss:

 Be gentle to your hair: Avoid using chemicals, including dyes, colour or bleach,
and let your hair air-dry as much as possible. Use a mild shampoo, such as baby
shampoo, during wash. Dry your hair by patting (not rubbing) with a soft towel.

 Cut your hair short or shave your head: You might feel more in control of hair
loss if you first cut your hair or shave your head. While shaving your head, use
an electric shaver instead of a razor.

 The best time to choose your wig is before chemotherapy starts: You can match
the wig to the colour and style of your hair. Make sure that you choose a wig that
feels comfortable and does not hurt your scalp.

After hair loss:

 Protect your scalp: Your scalp may hurt during and after hair loss. Protect it by
wearing a hat or scarf when you are outside. Try to avoid places that are very hot
or very cold, and always apply sunscreen or sun block to protect the scalp.

 Cover your head: You can choose to wear a hat or a scarf to cover the loss of
hair and even include it as part of your new wardrobe.

 Talk about your feelings: Many people feel angry, depressed or embarrassed
about hair loss. If you are worried or upset, you should talk about these feelings
with a doctor, nurse, family member, close friend or someone who has
experienced hair loss.

4. Mouth and Throat Changes: Some types of chemotherapy harm fast-growing cells,
such as those that line your mouth, throat and lips. This can affect your teeth, gums,
the lining of your mouth, and the glands that make saliva.

Mouth and throat problems may include dry mouth (having little or no saliva),
changes in taste and smell (such as food tasting like metal or chalk or not smelling
like it used to), infections of your gums, teeth, or tongue, increased sensitivity to hot
or cold foods, mouth sores and trouble eating due to mouth sores. Most mouth
problems go away a few days after chemotherapy is over.

Ways to manage:

 Visit a dentist before starting treatment: Visit a dentist at least 2 weeks before
you start treatment. Get a copy of the report from your dentist and share it with
your doctor or nurse.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
  Check your mouth and tongue every day: Check your mouth regularly to see or
feel problems (such as mouth sores, white spots, or infections) as soon as they
start. Inform your doctor or nurse about these problems as soon as you notice
them. Your doctor may prescribe medicines to help relieve discomfort.

 Keep your mouth moist: You can keep your mouth moist by sipping water
throughout the day, or sucking on ice chips

 Rinse your mouth: You can also rinse your mouth with a mixture of baking soda,
salt and warm water, every few hours. However, before doing this, consult with
your doctor or nurse first.

 Clean your mouth, teeth, gums and tongue: Brush your teeth, gums and tongue
after each meal and at bedtime. Use an extra-soft toothbrush. If brushing is
painful, try cleaning your teeth with cotton swabs. Use a fluoride toothpaste or
special fluoride gel after consulting with your doctor. If you wear dentures, make
sure they fit well and kept clean.

 Eat soft, bland foods: Choose foods that are moist, soft, and easy to chew or
swallow. These include cooked cereals and mashed potatoes. Take small bites,
chew slowly, and sip liquids while you eat. Soften food with sauces, yogurt or
other liquids. Eat foods that are cool or at room temperature.

 Stay away from things that can hurt or burn your mouth: Avoid sharp or crunchy
foods, such as crackers and potato or corn chips. Do not include spicy foods,
such as hot sauce, curry and chilli in your diet. Other foods that should be
avoided include citrus fruits or juices (such as orange, lemon and grapefruit),
food and drinks that have a lot of sugar (such as candy or soda), beer, wine and
other types of alcohol and tobacco products, including cigarettes, pipes and
cigars.

 Medicines: Ask for pain medicine if your mouth or throat is sore.

5. Constipation:
Chemotherapy drugs and pain medicines can cause constipation.

Ways to manage:

 Keep a record of your bowel movements: Show this record to your doctor or
nurse and talk about it. By doing this you will be able to identify whether you are
suffering from constipation or not.

 Drink at least 8 glasses of water or other fluids each day: Many people find that
drinking warm or hot fluids, such as coffee and tea, helps in easing constipation.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
  Be active every day: You can be active by walking, riding a bike or doing yoga. If
you cannot walk, ask your doctor about exercises that you can do in a chair or in
the bed.

 Ask your doctor, nurse, or dietician about foods that are high in fibre: Eating high-
fibre foods and drinking lots of fluids can help soften your stools. Good sources
of fibre include whole-grain breads and cereals, dried beans and peas, raw
vegetables, fresh and dried fruit, nuts, seeds and popcorn.

 Let your doctor or nurse know if you have not had a bowel movement in 2 days:
Your doctor may suggest a fibre supplement, laxative, stool softener or enema.
Do not use these treatments without asking your doctor or nurse first.

6. Diarrhoea: Chemotherapy can also cause diarrhoea as it harms healthy cells that
line your large and small intestines.

Ways to manage:

 Divide meals: Eat 5 or 6 small meals and snacks each day instead of 3 large
meals.

 Ask your doctor or nurse about foods that are high in salts such as sodium and
potassium: Your body can lose these salts when you have diarrhoea and it is
important to replace them. Foods that are high in sodium or potassium include
bananas, oranges, peach and apricot nectar, and boiled or mashed potatoes.

 Drink 8 to 12 cups of clear liquids each day: These include water and other
drinks recommended by your doctor or nurse. Drink slowly, and choose to have
drinks at room temperature. Add extra water if your drinks make you thirsty or
nauseous.

 Eat low-fibre foods: Foods that are high in fibre can make diarrhoea worse. Low-
fibre foods include bananas, white rice, white toast, and plain or vanilla yogurt.

 Let your doctor or nurse know if your diarrhoea lasts more than 24 hours or if you
have pain and cramping along with diarrhoea: Your doctor may prescribe a
medicine to control the diarrhoea. You may also need intravenous (IV) fluids to
replace the water and nutrients. Do not take any medicine for diarrhoea without
first asking your doctor or nurse.

7. Pain: Some types of chemotherapy cause physical discomfort including burning,

numbness and tingling or shooting pains in your hands and feet. Other side effects
may include mouth sores, headaches, and muscle and stomach pains. Pain can be
caused by the cancer itself or by chemotherapy. Doctors and nurses can guide you
on ways to relieve your pain.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
 Ways to manage:

 Talk about your pain with a doctor, nurse or pharmacist: When discussing your
pain, try and be specific and describe where you feel the pain. Is it all over the
body or in one part? Is it sharp, dull or throbbing? Rate the pain on a scale of 0 to
10. How long does it last? What makes the pain worse or better? Do you take
any medicine for the pain? How often do you need to take it?

 Practice pain control: Discuss with your doctor which medicine you should be
taking and take theses regularly, even when you are not in pain. This is very
important if you have pain most of the time. Do not skip doses of your pain
medicine. Try deep breathing, yoga or other ways to relax. This can help reduce
muscle tension, anxiety and pain. Take the pain medication before it starts.

8. Appetite Changes: Chemotherapy can cause changes in appetite. You may lose
your appetite because of nausea or mouth and throat problems. Appetite loss may
last for a day, a few weeks, or even months. Some cancer treatments cause weight
gain or an increase in your appetite. Always, ask your doctor, nurse or dietician what
types of appetite changes you might expect and what you can do to manage them.

Ways to Manage:

 Instead of 3 big meals, eat 5 to 6 small meals or snacks each day: Choose foods
and drinks that are high in calories and protein.

 Drink milkshakes, juice, or soup if you do not feel like eating solid foods: These
liquids can help provide the protein, vitamins, and calories your body needs.

 Increase your appetite by doing something active: You might be able to build up
an appetite if you take a short walk before lunch.

 Change your routine: Eat in a different place, such as the dining room rather than
the kitchen. You can also choose to eat with other people instead of eating alone.

 Talk to your doctor, nurse, or dietician: You may be prescribed to take extra
vitamins or nutrition supplements (such as high protein). If you cannot eat for a
long time and are losing weight, you may need to take drugs that build up your
appetite. Alternately you may be directed to receive nutrition intravenously or
through a feeding tube.

9. Weakening of the Immune System: White blood cells play an important role in the
immune system: they help fight infection and ward off illness. At times chemotherapy
can lower the count of white blood cells which may increase the risk of infections in
the body. Therefore, it is important to take measures to avoid infections.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
 Ways to manage:

 Maintain good oral care: Your mouth can be the gateway of germs. Visit a dentist
or a dental hygienist before starting your chemotherapy treatment. Brush your
teeth after meals and before going to bed. Use a soft toothbrush and a mouth
wash that does not contain alcohol

 Your doctor or nurse will check your white blood cell count throughout your
treatment: If chemotherapy makes your white blood cell count very low, you may
be prescribed medicines to increase white blood cell count and lower the risk of
infection.

 Wash your hands often with soap and water: Be sure to wash your hands before
cooking and eating, and after using the bathroom, blowing your nose, coughing,
sneezing, or touching animals. Carry a hand sanitizer for times when you may
not have access to soap and water.

 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 have just
had a “live virus” vaccine for chicken pox or polio.

 Stay away from crowds: Try not to be around a lot of people. Plan to go for
shopping or to the movies when the stores and theatres are less crowded.

 Be careful not to cut yourself: Be careful when using scissors, needles, or knives,
and avoid their unnecessary use.

 Take good care of your skin: Do not squeeze or scratch pimples. Use lotion to
soften dry and cracked skin. Dry yourself after a bath or shower by gently patting
(not rubbing) your skin.

 Wash raw vegetables and fruits well before eating them. Scrubbing and properly
washing your fruits and vegetables will stop a lot of harmful bacteria and
chemicals from entering your body.

 Call your doctor right away if you think you have an infection: Call your doctor
immediately if you have a fever of 100.5°F or higher, or if you have chills or
sweats. Do not take aspirin, acetaminophen, ibuprofen products or any other
drugs that reduce fever without discussing 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 and sinus
pain or pressure.

10. Sexual Dysfunction: Some types of chemotherapy can cause sexual changes.
These changes are different for women and men. Whether or not you have sexual
changes during chemotherapy depends on the type of chemotherapy you are

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
receiving, your age, and whether you have any other illnesses. Some problems,
such as loss of interest in sex, are likely to improve once chemotherapy is over.

Problems in women: In women, chemotherapy may damage the ovaries, which can
cause changes in hormone levels. Hormonal changes can lead to problems like
vaginal dryness and early menopause, even though you may be too young to
experience menopause. Other side effects include vaginal discharge or itching,
being too tired to have sex, not being interested in having sex or feeling too worried,
stressed, or depressed to have sex.

Problems in men: In men, chemotherapy can cause changes in hormone levels,

decreased blood supply to the penis, or damage to the nerves that control the penis;
all of which can lead to not being able to get or keep an erection. Other side effects
include not being able to reach climax, being too tired to have sex, not being
interested in having sex or feeling too worried, stressed, or depressed to have sex.

Ways to manage:

For Women:

 Managing birth control: It is very important that you do not get pregnant while
having chemotherapy. Chemotherapy may hurt the foetus, especially in the first 3
months of pregnancy. If you have not yet gone through menopause, talk to your
doctor or nurse about birth control and ways to keep from getting pregnant.

 Being active: This includes walking, riding a bike, or other types of exercise.

 Reducing stress: Try yoga, meditation, or other ways to relax.

For Men:

 Managing birth control it is very important that your spouse or partner does not
get pregnant while you are getting chemotherapy. Chemotherapy can damage
your sperm and cause birth defects. If you are having sex less often, explore
other activities which can make you feel close to each other.

For both Women and Men:

 Discuss with your doctor: Your healthcare professionals will discuss your sexual
health during and after chemotherapy. At every session with your doctor, share
any problems and issues you may encounter.

 Be open and honest with your spouse or partner: Talk about your feelings and
concerns.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
  Explore new ways to show love: You and your spouse or partner may want to
show your love for each other in new ways while you go through chemotherapy.
If you are having sex less often, you may hug each other, bathe together, give
each other massages or try other activities that make you feel close to each
other.

How can I prepare before meeting with my doctor?

Here are some tips to help you prepare for your appointment:

 Make a list of questions before each appointment. Some people keep a “running list”
and write down new questions as they think of them. Make sure to have space on
this list to write down the answers from your doctor or nurse.

 Bring a family member or trusted friend to your medical visits. This person can help
you understand what the doctor or nurse says and talks to you about.

 Ask all your questions. If you do not understand an answer, keep asking until you
do.

 Take notes. You can write them down or use a tape recorder. Later, you can review
your notes and remember what was said.

 Find out how to contact your doctor or nurse in an emergency. This includes who to
call and where to go. Write important phone numbers.

I cannot afford the chemotherapy treatment. Does the hospital offer

financial assistance?
Patients who find that they are unable to pay the full cost of the Hospital's services may
request welfare assistance from our Patient Welfare Officers before receiving any
Hospital services.

Financial Counsellors are available at the Patient Business Service Department (PBSD)
to answer any financial queries patients may have, including treatment costs. The
patient and/ or their immediate relatives will be interviewed and if the family's socio-
economic profile is found to meet the Hospital's Welfare Criteria, they will be assisted in
their treatment cost. If it appears that the patient is eligible for assistance from Zakat,
they will be referred to Patient Behbood Society (PBS) for further confirmation.

By working together, you, your family and your healthcare providers can make the
strongest team in your fight against cancer. We wish you a healthy recovery.

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
Contact Information:
For Consultation Clinic Appointment: 021 111 911 911
For Ibn Zuhr Building Day Care Oncology: 0213 486 1812, 0213 486 1814,
0213 486 1815
For Inpatient Admissions: 0213 486 2002, 0213 486 2003
In case of emergency: 0213 486 4290, 0213 486 4291
Patient Welfare Department: 0213 486 1471, 0213 486 1481,
0213 486 1470

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.