Some patients do not experience any nutritional challenges during their treatments. Some experience a few minor issues and a small group will need significant nutritional support or guidance. Depending on your needs, dietary recommendations will be made to best ensure your nutritional health.  Dietitians are available and your practice will have a variety of resources to help you improve your diet to help you heal after treatment and restore your body to a healthful state. Weight loss during cancer treatment due to poor diet, nausea, and/or diarrhea is not a good way to restore a healthy body weight even if one is overweight before treatment started. Cancer, and the methods used to treat cancer, can be debilitating and weight loss under these conditions can result in feeling weak and tired. Weight loss that occurs during treatment while consuming a nutrient-dense diet is acceptable. This will help your body rebuild to a healthful state.

There are many diets or nutritional lifestyles that people may gravitate to throughout their life, and there certainly is a tendency to make radical changes to diet and nutrition once a cancer diagnosis is made. Many individuals are passionate about their nutritional lifestyles, be it vegan, macrobiotic, gluten free, vegetarian, primal, extra low-fat, fat-free or lactose free. Some of these nutritional lifestyles are necessary due to allergies or other medical conditions.  Many times these nutritional lifestyles are self- selected. During cancer treatment and into cancer survivorship, it will be important to ensure that regardless the type of diet you feel most comfortable ingesting, it needs to be nutrient-dense containing a variety of protein sources, fruits, and vegetables. We are happy to assist you in discussion of your overall diet and help you find assistance within the cancer center or elsewhere for more specific discussions about nutritional your needs now and in the future.

A few general nutritional rules you may consider

• Anything that is bought fresh will have more available nutrients than canned, boxed or bagged food. Fresh food has fewer preservatives.
• Consider purchasing local and organic fresh foods if available.
• Consider purchasing a high-speed blender to make shakes and smoothies from fresh ingredients as opposed to purchase of pre-made supplements.
• Eating fun food like candy, sweets and fast foods will not hurt you in small amounts but provides little nutritional benefits.

Food Recommendations for the Day of Chemotherapy

Eat lightly on your chemotherapy day. Eat small portions, slowly. Avoid fatty, greasy or spicy foods. If dairy upsets you, avoid dairy.  If there are foods that have never agreed with you, do not eat them before or during treatment.  Before you leave for your treatment, eat light, bland foods.

Examples of good choices are:

• Fresh fruit and cottage cheese

• Greek yogurt

• Poached egg and whole wheat or spelt toast

• Chicken and rice soup plus one-half turkey sandwich

• Brown rice

• Whole wheat or spelt bread with almond butter

It is very important is to maintain hydration. If you feel well during treatment, eat small, bland, light meals like those above. You might enjoy mints or hard candy like lemon drops or ginger drops to help with unpleasant tastes. If you worry about taking in lots of sugar, try chewing gum instead. If you don’t feel like eating during chemotherapy you don’t have to, but be sure to always maintain good hydration with water or a low-sugar/electrolyte sport drink. A key to knowing that you are adequately hydrated is if you are able to pass urine at least 4 times a day and the urine is pale yellow in color.

Diet for Two to Three Days Post-Chemotherapy

• Drink small amounts of fluid frequently. Drink at least ten cups per day of non-caffeinated, non-alcoholic liquids to remain hydrated and to remove the by-products of chemotherapy.
• Drink a variety of fluids. Do not drink only water. Include clear soups like chicken broth, bouillon or miso soup, sparkling water, probiotic drinks, coconut water, Gatorade G2, popsicles (home-made are best) and low-sugar sherbet. Water gives fluid; soups give salt (sodium); juices, coconut water and Gatorade contain potassium.  Acid juices like orange juice can be irritating to your already sensitive stomach and are a bit sugary.
• Eat small meals and eat frequently throughout the day rather than three large meals. Take only sips of fluid with meals. Drinking large amounts of fluid with meals may cause feelings of fullness and bloating. If you feel full, then you might not eat the calories you need.
• Eat lower fat, bland foods that still are nutrient dense. Fast foods, processed foods, greasy and spicy foods can irritate the stomach and cause nausea. 
• Eat cool foods that have little aroma or odor. Hot foods often have stronger odors.
• Rest after eating. If you have problems with nausea or heartburn, relax in a reclined position with your head up. Focus on deep, natural breathing and wear loose clothing.
• Take anti-nausea medications as recommended by your physician. If you feel nauseated, don’t wait to take your anti-nausea medication. Take it right away.
• Don’t worry if you don’t feel like eating solid foods. It is most important to take fluids. Drink small amounts of beverages every 15 to 20 minutes as tolerated. Avoid eating your favorite foods for the first few days after chemotherapy to avoid a permanent dislike of these foods due to potential chemotherapy related nausea and vomiting.
• Do not assume that an episode of nausea was caused by the food you ate most recently. You may eliminate food from your diet that is nutritious and easy to digest because you assume it caused the nausea. The nausea is caused by the treatment you are receiving.

Fluid Guidelines

  Vary the types of liquids you drink. Do not drink diet beverages if you have not been able to eat any solid food. Even if you are diabetic you need to take in calories and water.

Options include:

• Water
• Bouillon – an excellent source of salt
• Miso soup – an excellent source of salt
• Chicken broth – an excellent source of salt and natural fat
• Coconut water – an excellent source of natural potassium
• Natural fruit juices – best if homemade (fresh squeezed) for fructose

Sample Menu for treatment day:

Breakfast:   Whole wheat or spelt toast and almond butter, poached egg, fresh spinach or kale and tea

Snack:        Protein bar or shake

Lunch:        Broth, turkey slices, slice of avocado, almond milk ice cream and tea

Snack:        Probiotic drink, water, protein bar, fruit slices with almond butter

Dinner:       Chicken and rice soup, baked chicken or turkey breast, fish, shitake noodles with vegetable

Snack:        Popsicle, watermelon

Throughout the day 

Drink nutritious liquids like low-sugar juice, sparkling water, smoothies, and Gatorade G2.

*Eating is an important part of your treatment for cancer. Chemo and radiation put stress on your body, so you will need extra protein to stay strong during and after treatment. Your appetite may not be what it was before the treatment. It is vital to continue to eat even if you do not always feel like it. We suggest you eat smaller, more frequent meals throughout the day. 

 Frequently Asked Questions

Question: What if I am already on a physician-recommended diet?

Answer: You should discuss this with your physician. He/she may wish you to continue on this diet while you are being treated or prefer that you stop while you are receiving treatment. The patients who most often need to continue on their previous diets are diabetics and patients with pre-existing digestive problems.

Question: Can I continue to take the vitamin, mineral and herbal supplements that I took before treatment?

Answer: Nutritional supplements are another matter that you should discuss with your doctor. Some supplements, particularly herbal supplements, can interfere with the treatments that you receive in our facility. A trusted website for information about such items can be found at: www.msk.org/cancer-care/treatments/symptoms-management/integrative-medicine/herbs/search

 Question: What are the most common diet-related problems during cancer therapy?

Answer: The most common problems are constipation or diarrhea. Patients taking certain medications and/or receiving chemotherapy might experience nausea or vomiting. Patients that receive head and neck radiation or radiation to part of the intestinal tract may develop other issues.  These can lead to difficulty tolerating certain foods.

*Should any of these problems affect you, they need to be addressed individually. If you experience any of the intestinal problems mentioned above please inform your nurse or doctor.

Your practice may have an in-office dispensary. This allows patients to pick up prescriptions in the office – no extra stops on the way home, no long waits for mail orders, and your practice works to resolve any co-pay issues if they arise.

Some patients may take several medications – prescribed by other doctors with the prescriptions filled at other pharmacies. It’s hard to remember each one when you come in for an appointment. But your care team will need a complete and accurate list so they are more informed on how to manage your cancer treatment and can assist in working out a proper schedule.

Did you know that some medicines, such as anti-fungals or anti-depressants, can make chemotherapy less effective? Make sure you let your doctor know if you are taking any of these. Other medicines can cause similar side effects as chemotherapies, making both harder to take. Some drugs may actually enhance effectiveness. There are herbal medicines – even some foods – that change the way your body absorbs and uses drugs. All of this can be managed as long as we are aware of what you are taking. 

Your in-office dispensary will have what you need to get you through your cancer treatment– the supportive care medicines that might be needed for diarrhea, nausea, constipation, as well as steroids, hormone therapies and oral chemotherapies. They can provide the medications, fully explain how to take them, at what times, with or without food, and what to do if you miss a dose. It’s very important you take the medications correctly or they might not work as well as they should. 

If you decide to be treated with chemotherapy, we encourage you to visit your practice for an informational session where you will learn about the drugs you will receive and any side effects you may experience. You will have the opportunity to ask as many questions as you want and be asked to sign a consent form to show that you understand. Chemotherapy can be used in conjunction with other therapies to treat cancer or ease the symptoms of cancer. The type of treatment you receive and how often will depend upon your specific situation, which you will discuss with your doctor. The various methods in which chemotherapy is administered are:

• Orally (pills, capsules, or liquids that are swallowed)
• Intravenous or IV (administrated directly into a vein)
• Injection
• Creams

If you are receiving chemotherapy to treat your cancer, you must take special precautions to prevent the chemotherapy from coming into accidental contact with others. Your treatment plan may require you to take oral medications or have a chemotherapy pump at home. Your doctor will provide clear instructions on how to take your medication as well as how to store them. Be sure to follow the instructions of your doctor and call the practice if you have any questions. This information is to inform you and your family how to avoid exposure from chemotherapy and how to handle the waste from the chemotherapy in your home. 

Chemotherapy drugs are hazardous. Equipment or items that come into contact with the medicines such as syringes and needles are considered contaminated. Regardless of how the medicines are taken, chemotherapy remains in your body for many hours and sometimes days after treatment. Your body eliminates the chemotherapy in urine and stool. Traces of chemotherapy also may be present in other bodily fluids such as vomit. 

Please keep oral chemotherapy medications out of the reach of children. These medications need to be stored away from other family medications. 

Disposal of hazardous drugs

If you are discontinued from oral chemotherapy, please bring the unused medications back to your practice for proper disposal. Please do not dispose of these medications on your own. 

Bodily waste

You may use the toilet (septic tank or sewer as usual). For 48 hours after receiving chemotherapy, flush the toilet with the lid closed.  Always, be sure to wash your hands thoroughly with soap and water, and wash your skin if urine or stool get on it. Pregnant women should avoid direct contact with chemotherapy and/or contaminated waste. 

Laundry

Wash your clothing or linen normally unless they become soiled with chemotherapy. If that happens, put on gloves and handle the laundry carefully to avoid getting the drug on your hands. Immediately place the contaminated laundry in the washer and wash as usual. Do not wash other items with the chemotherapy-soiled items. If you do not have a washer, place soiled items in a bag until they can be washed. 

Skin care

Chemotherapy spilled on skin may cause irritation. If this happens, wash the area thoroughly with mild soap and water, and then pat dry. If irritation redness lasts more than one hour call your practice. To prevent chemotherapy from being absorbed into the skin, wear gloves when working with chemotherapy equipment or waste. 

Eye care

If any chemotherapy splashes into your eyes, flush them with water for 10 to 15 minutes first, then notify your doctor. 

Frequently Asked Questions:

Family and friends

Question: Is it safe for family members to have contact with me during chemotherapy?

Answer: Yes, eating together, enjoying favorite activities, hugging and kissing are all safe.

Question: Is it safe for my family to use the same toilet as I do?

Answer: Yes, sharing is safe. Close the lid and flush after each use.

Bodily fluids

Question: What if I use a bedpan, urinal or commode?

Answer: Your caregiver should wear gloves when emptying body wastes. Rinse the container with water after each use and wash it with soap and water atleast once per day.

Question: What if I vomit?

Answer: Your caregiver should wear gloves when emptying the basin. Rinse the container with water after each use, and wash it with soap and water at least once per day.

Question: Is it safe to be sexually active during my treatment?Answer: Be sure to ask your doctor or nurse this question. It is possible that traces of chemotherapy may be present in vaginal fluid or semen for up to 48 hours after treatment. The most conservative recommendation is to use barrier protection during sexual activity for 48 hours post-treatment. Special precautions may be necessary.

Storing chemotherapy

Question: How should I store oral chemotherapy at home?

Answer: Store chemotherapy and equipment in a safe place, out of the reach of children and pets. Do not store chemotherapy in the bathroom, as high humidity may damage the drugs. Check medicine labels to see if your chemotherapy should be kept in the refrigerator or away from light. Be sure all medicines are completely labeled.

Disposal of chemotherapy

Question: Is it safe to dispose of chemotherapy in the trash? 

Answer: No. Chemotherapy waste is hazardous and should be disposed of properly. Please visit your practice to dispose of your medications. If you receive IV chemotherapy at home, you should have a special spill kit in case of a chemotherapy spill. Please see question “What should I do if I spill chemotherapy?”

Travel

Question: Can I travel with my chemotherapy?

Answer: Yes. Usually traveling is not a problem; however, because some chemotherapy requires special storage (such refrigeration), you may need to make special arrangements. Check with your nurse, doctor or pharmacist for further instructions. Regardless of your means of travel (airplane, car or other), always seal your chemotherapy drugs in a plastic bag. 

Spills

Question: What do I do if I spill some chemotherapy? 

Answer: You will have a spill kit if you are receiving intravenous chemotherapy at home. In the event of a chemotherapy spill, open the spill kit and put on the supplied gloves. Place a gloved hand inside the pocket of the absorbent towel and absorb the spill. Turn the yellow bag inside out. While still wearing the gloves, clean the spill area with mild soap and water. Remove the gloves, turning them inside out and place all contaminated items inside the yellow spill kit. Remove cover from the adhesive strip and seal the yellow spill kit. Place sealed kit inside provided plastic bag and seal it. Bring sealed spill kit back to the practice for proper disposal. 

Safety Precautions

While receiving chemotherapy and radiation therapy your platelets may be temporarily reduced, causing:

• Bruising: Dark, purple areas under the skin.
• Petechia: Small, pinpoint non-raised, round purple-red spots. 
• Bleeding: Excessive or prolonged opening in the body (mouth, nose, gums, rectum etc.), and from cuts and/or scratches; urine may turn rusty or brown; bowel movements may be very dark or black. 

If your doctor says your platelets are low, protect yourself by:

• Take special care when handling sharp objects such as scissors, knives or pins.
• Maintain integrity of mucous membranes. Drink plenty of fluids. Use stool softeners daily. Avoid hard nose blowing. Humidify the air. Use lotion on your skin. Moisten nose and lips with lubricant. Use water soluble lubricant prior to sexual activity. 
• Avoid aspirin and aspirin containing products. Avoid activities with the potential for bodily injury such as contact sports and the use of power tools. 
• IV sites: Apply firm, gentle pressure for at least five minutes after all the needle sticks to prevent scarring of the vein and to promote clotting. 

Infection Precautions

Treatment with chemotherapy and/or radiation therapy can temporarily reduce your infection fighting blood cells (white cells). By practicing preventative measures, you can contribute to your level of wellness and reduce your risk of infection. 

Report these signs IMMEDIATELY to your care team:

• A fever of 99.5°F or greater
• Shaking and/or chills
• Painful or frequent urination
• A cough or sore throat

Please follow these recommendations to prevent infections: 

• Conserve energy. Listen to your body. Plan for periods or rest and sleep.
• Eat well. Include foods high in nutrients and protein into your diet. Eat fresh fruits and vegetables daily.
• Avoid potential sources of infection, including people with bacterial infections, colds, sore throats, flu, chicken pox, measles and cold sores. Avoid bird, cat and dog feces; do not clean bird cages or kitty litter boxes. 
• Keep your body clean. Bathe daily and wash your hands before eating or preparing food and after using the restroom. Keep your nails clean and clipped short. Perform mouth care daily. Keep lips moist with lubricant. Clean yourself carefully after bowl movements. Ladies, always wipe front to back. 
• Keep your lungs clear. Take deep breaths every hour while awake. Schedule daily exercise.
• Keep your kidneys flushed. Drink eight cups of non-caffeinated liquid daily. 

What are red blood cells?

Red blood cells (RBC) carry oxygen to all parts of the body to give you energy. If the RBC count is low (anemia), you may look pale and tired.

What is hemoglobin?

The hemoglobin (HGB) in your red blood cells carries oxygen. If your HGB is very low (8.0 gm or less), your doctor may want you to have a blood transfusion. Sometimes hemoglobin can be low because you are iron deficient due to poor nutrition or blood losses. Make sure that your blood is checked for anemia after cancer surgery. 

What are platelets? 

Platelets (PLT) help stop bleeding by clotting the blood. Platelets are white-yellow in color. The normal count is 150,000 to 450,000. During and after chemotherapy your platelets may be very low. When the platelet counts drops to be less than 50,000, you may notice more bleeding when you get cut. You may bruise easily or have nose bleeds. If your platelet count is less than 20,000 and there are signs of bleeding, you may need a platelet transfusion. Platelet counts less than 10,000 may require platelet transfusion because you can bleed without injury. 

Some signs of low platelet count: 

• Bruising easily.
• Small red-purple dots on the skin (petechia).
• Blood in urine or vomit.
• Black (like tar) or bright red bowel movements.
• Bleeding from the gums, mouth, nose, vagina or rectum. Women may have heavier periods than usual. 

If you notice any of these, please call your doctor or care team as soon as possible. 

If you experience a nosebleed:

• Sit up and lean forward.
• Squeeze your nose tightly.
• Put ice in a washcloth and place it on your nose. 
• Pediatric strength Afrin may help stop a minor nosebleed but use it sparingly. 

When receiving chemotherapy, you should avoid the following if you know your platelets go low: 

• Aspirin or NSAIDS (Advil, Motrin, Ibuprofen, Aleve). 
• Rough sports.
• Rectal thermometers, enemas or suppositories without permission from the doctor.
• Unsafe situations that can result in a fall or injury. 

What are white blood cells?

White blood cells (WBC) fight infection. The normal count is 4,000-10,000. During and after chemotherapy, your count may be low.  The white blood cells that fight infection first are the neutrophils, or “segs”. Young neutrophils are called “bands”. 

What are neutrophils?

A kind of white blood cell, neutrophils (segs and bands) help your body fight infection. They are your first line of defense against bacterial infections. 

What is an absolute neutrophil count? 

Absolute neutrophil count (ANC) measures the amount of infection-fighting WBCs.

How to measure the absolute neutrophil count: 

(Example: Segs=45% Bands=7%  WBC=3.4)

1. WBC multiply by 1,000…(3.4 x 1,000=3,400)
2. Add segs + band…(45+7=52%)
3. Multiply WBC x percentage…(3,400 x 0.52 = 1,768)

What is neutropenia?

Neutropenia usually occurs when the white blood cell count (WBC) drops below 4.0, and the absolute neutrophil count (ANC) is below 1,000. Severe neutropenia is when the ANC is less than 500. 

What happens when you have neutropenia? 

If you have a low white blood cell count, you are at a higher risk for getting a spontaneous infection. The risk of infection increases as the WBC count decreases because white blood-cells-neutrophils, lymphocytes, monocytes, eosinophils and basophils-function to protect the body from infection. 

How do you know if you have an infection?

If you have neutropenia (low WBC count), your body will not have enough neutrophils to fight infection, so you may not see the usual signs of infection. A temperature elevation or fever is the most obvious sign of infection if you are neutropenic. Here are some possible signs you may have an infection:

• Temperature greater than 99.5°F or 37.5°C (If you have difficulty reading a thermometer, let your doctor or nurse know). 
• Burning, hesitancy, or difficulty emptying bladder when urinating.
• Sore throat or difficulty swallowing. Red or white patches in your mouth. 
• Cough-with or without sputum (phlegm).
• Reddened or painful sores with or without pus. 
• Shaking, chills or sweating.
• Burning or pain in your rectum.
• Redness or drainage from a surgical site or mediport site.
• Drainage from an eye or an ear.
• Flu-like symptoms-aching joints, headache and fatigue.
• Redness of skin that is advancing up an arm or leg. 

*Immediately report these symptoms to your care team!

You can minimize the risk of infection

Although you cannot prevent an infection, you can minimize the risk. Here are some suggestions:

• Avoid people with contagious illnesses or colds. Do not share food, beverage glasses, bottles or cans, and always use your own utensils. 
• Avoid crowds and confined spaces, especially in the winter. Avoid sitting with someone that appears to have a cold or other symptoms of a contagious illness. 
• Wash your hands with soap before preparing or eating food and after using the bathroom. Have visitors wash their hands as well. 
• Wash down areas in your home that are used by multiple individuals like doorknobs, faucets, and refrigerator doors.
• Don’t provide direct care for pets. Don’t change litter boxes or clean bird cages. 
• Use your own wash cloth and towel. Do not share pillows and change your pillow case at least twice per week. 
• Unless told otherwise, drink at least 8 cups of non-caffeinated liquid daily. 
• Protect your skin from cuts and burns. Wear shoes or slippers to prevent cuts on your feet. Wear gloves in the garden. If you have had breast surgery, consider wearing rubber gloves when washing dishes.  
• Avoiding straining to have bowel movements. Don’t use enemas or takes suppositories without permission from your physician.
• Obtain a digital thermometer and take your temperature under the arm. NEVER take a rectal temperature. Know your baseline temperature.
• If you need dental work, consult with your doctor before making arrangements. 
• Eat a well-balanced diet. Wash fruits and vegetables with warm water. Avoid eating foods from carts or unknown sources.
• Ask your doctor if vaccines are safe for you and your family.
• Ask your children’s school to alert you of any infectious disease outbreaks. Notify your doctor within 72 hours if anyone at home is exposed. 
• Always check with your doctor before taking any new medications. 

• Internally (the tumor is treated from inside the body)
• Externally (high-energy directed from outside the body aimed at the tumor)
• Systematically (radioactive drugs are given orally or given via IV)

Simulation

If it is determined that you will have radiation treatments, you may be scheduled to return for a simulation/CT scan. The simulation process can take 45 minutes to one hour.  The tumor’s location is marked on your skin with a small tattoo to help aim the radiation beam. In some cases, they will make a special “mold” or “mask” to help place you in the exact treatment position every time. After this session is completed, an appointment will be scheduled and may take several days. The reason for the waiting period is so the doctor and dosimetrist have enough time to plan your radiation treatment.  

Your Radiation Team

Your radiation therapy department may consist of the following staff members:

• Radiation Oncologist  

 The doctor who will be involved in all aspects of your radiation treatments.

• Nurse Practitioner and Physician Assistant

The physician assistant and nurse practitioner will assist the radiation oncologists with your clinical needs. 

• Registered Nurse        

The nurse will be involved in preparing you for radiation treatments and will give you instructions about radiation therapy, skin care, nutrition, side effects and other matters.

• Radiation Therapist

The radiation therapist will complete your initial simulation/CT scan and will deliver radiation treatment daily using the linear accelerator. The therapist will greet you each day you come for treatment.

• Dosimetrist

The dosimetrist will generate and customize radiation dose distributions unique to you and in accordance with the doctor’s orders.

• Physicist

The physicist will do  quality assurance testing on the treatment machines, and double-check all of the calculations for treatment.

Radiation Therapy (Daily Treatments)

You will have measurements, images and marks on your first day. After that, the radiation therapists will work with you on scheduling a permanent time for your daily treatments. Plan to allot at least 15 to 30 minutes daily for your treatment.

Weekly Doctor Visits 

You will be seen by a radiation oncologist or physician assistant at least once a week. This is routine even if you are feeling well. Your radiation oncologist (you may see several during your course of treatment) will assess your treatment and adjust if necessary. if you feel you are experiencing problems or side effects associated with your treatment, please approach your care team so that this information can be assessed and you can be referred to your doctor if necessary. 

Nursing Instructions

After you have been under treatment for a few days, the nurse will schedule some extra time to go over instructions for caring for your skin in the treatment area. The nurse will also talk to you about nutritional needs and pain control, and will care for you throughout your treatments.

Safety Precautions

While receiving chemotherapy and radiation therapy your platelets may be temporarily reduced, causing:

• Bruising: Dark, purple areas under the skin.
• Petechaia: Small, pinpoint non-raised, round purple-red spots. 
• Bleeding: Excessive or prolonged opening in the body (mouth, nose, gums, rectum etc.), and from cuts and/or scratches; urine may turn rusty or brown; bowel movements may be very dark or black. 

If your doctor says your platelets are low, protect yourself by:

• Take special care when handling sharp objects such as scissors, knives or pins.
• Maintain integrity of mucous membranes. Drink plenty of fluids. Use stool softeners daily. Avoid hard nose blowing. Humidify the air. Use lotion on your skin. Moisten nose and lips with lubricant. Use water soluble lubricant prior to sexual activity. 
• Avoid aspirin and aspirin containing products. Avoid activities with the potential for bodily injury such as contact sports and the use of power tools. 
• IV sites: Apply firm, gentle pressure for at least five minutes after all the needle sticks to prevent scarring of the vein and to promote clotting. 

• Open your mouth wide and look for areas of redness, swelling, tenderness, coating on the tongue, or white patches. Report issues to your doctor. Please call your doctor if you notice blisters, sores, or open areas on your lips or in your mouth.
• Brush your tongue with a soft toothbrush within 30 minutes after each meal and at bedtime. Also brush tongue to remove any debris.
• If you normally floss, continue to do so once per day. Floss gently and use un-waxed dental floss. Stop if there is pain or bleeding. Do not floss if your doctor tells you that your platelet count or white blood cell count is low.
• Rinse your mouth after meals and at bedtime with a salt water solution, (which you can make by adding 1 teaspoon of salt to 2 cups of water). If you would prefer, you can use a baking soda solution: 1 teaspoon of baking soda to 2 cups of water. 
• If you wear dentures, remove them at night to give your gums a rest. Always keep the dentures in water to prevent warping. Do not wear dentures if they do not fit properly, have rough spots on them, or cause painful areas in your mouth. Call your dentist to have them checked. 
• Do not use commercial mouthwashes. Many mouthwashes contain alcohol which is drying and irritating to sensitive tissues in your mouth. 
• Drink lots of fluids: at least 8 cups of liquid daily if possible. Keep your mouth moist. If you do not like water, drink fruit juices, warm or cool teas and/or non-carbonated beverages. 
• If you have taste changes and/or metallic taste in your mouth, chew sugarless gum or suck on sugarless, fruit-flavored candy. This will stimulate the flow of saliva and reduce bad tastes. Frequent mouth care, especially before eating, will also diminish the unpleasant taste in your mouth. 
• If your mouth is becoming red or slightly sore, run your soft toothbrush under hot water to make it softer before using or buy a child’s soft toothbrush. Stop brushing if it becomes too painful. 
• For increasing discomfort, rinse your mouth every two hours. 

Here are other suggestions you may find helpful:

• Keep your lips moist by applying moisturizer or lip balm every two hours. 
• When your mouth is sore, avoid hot(temperature), spicy, acidic, (orange juice, grapefruit, tomatoes, or lemon) or coarse rough foods. Try soft, cool or liquid foods like smoothies, cold soups, ice cream frozen yogurt, sherbet, popsicles, soft eggs, or protein drinks. 
• Your doctor may prescribe a special mouthwash that has medicine to fight virus and fungus and is numbing to help with pain. Some doctors suggest using Peridex. 
• Avoid alcohol and tobacco.

It is important to continue this routine for at least two weeks after your last treatment.And again, please contact your care team if you have increasing pain or redness or the appearance of sores in your mouth or on your lips. 

• Treatment/intervention: These trials explore new medicines, different combinations of medicines or a different sequence of therapy.
• Observational: These studies follow patients receiving standard treatments by collecting de-identified data. There is no change in treatment because of the study.
• Translational: These studies collect blood or tissue samples, sometimes with de-identified data, to explore how differences in genetics affect diagnosis, treatment and response. There is no change in treatment because of the study. 

Cancer trials are done in phases, and each phase answers a separate research question:

• Phase I: Researchers determine dosage, range and identify any side effects
• Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety
• Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely
• Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug’s effect in various populations and any side effects associated with long-term use

Taking part of a clinical trial does not prevent you from any other medical treatment you may need. You are free to leave the study at any for any reason.