Brain Tumor Chemotherapy FAQs

Chemotherapy is the use of drugs to kill and slow the growth of cancer cells. In general, chemotherapy is most effective on cells that are rapidly dividing, like tumor cells. However, chemotherapy drugs do not discriminate between healthy and cancerous cells. Most normal cells are not sensitive to the effects of chemotherapy, but some cell types that grow rapidly (like blood cells or hair follicle cells) may be affected. This results in common, temporary side effects like low blood counts and hair loss.

Chemotherapy is used alone, in a combination, or with radiation therapy, to treat tumors.

Most high-risk brain tumors, like glioblastoma, are treated with chemotherapy and radiation therapy following surgery. This is followed by several months of taking chemotherapy. However, chemotherapy is included in the treatment plan for most adult brain tumors.

Depending on the type of drug, chemotherapy can be administered through a variety of methods:

• Orally, as a pill or liquid
• Intravenously, by injection into a blood vessel
• Intrathecally, by injection into the cerebrospinal fluid for more direct access to the brain

Most likely, you will not need to stay in the hospital for chemotherapy, since most drugs can be taken at home, or administered as an outpatient procedure in the doctor’s office or clinic. However, this depends on the specific drugs used, as well as your diagnosis and overall health. In some cases, a short hospital stay may be necessary.

Likewise, the exact treatment dose and schedule also depends on your diagnosis and overall health, as well as the specific drug(s) being given. Many times, chemotherapy will be given on an intermittent schedule to allow for recovery time. For example, you may have daily treatment for the first 5 days of each 28-day treatment cycle, over the course of months. Regardless, your neuro-oncologist will discuss the exact chemotherapy dose and schedule that is best for you.

Many people feel fine for the first few hours after chemotherapy. A reaction may occur about four to six hours later; or possibly until 12 - 48 hours after treatment. Some people experience almost all of the side effects described below, while others experience almost none.

Your well-being is very important to us, and we have many options to help you deal with side effects. For example, your doctor may prescribe additional medications, like anti-nausea drugs, to minimize your nausea and make you feel more comfortable. There is a delicate balance between the benefits of chemotherapy and the harm of possible side effects. Please tell your doctor if you feel that the harm outweighs the benefit.

Most side effects are temporary and will cease after treatment is complete. Some of the most common side effects are:

• Nausea and vomiting
• Increased risk of infection
• Flu-like symptoms
• Fatigue
• Hair loss
• Changes in appetite or taste
• Diarrhea or constipation
• Mouth sores
• Neuropathy (tingling, numbness, or pain, most commonly in fingers or toes)
• Menopausal symptoms

Seek emergency help and contact your health care provider immediately (day or night) if you experience the following:

• Fever of 100.4°F (38°C) or higher (possible sign of infection)
• Rash or hives (possible sign of allergic reaction)
• Difficulty breathing, shortness of breath, throat closing up (possible sign of allergic reaction)

Many patients can continue with normal activities, like going to work or school, while on chemotherapy. However, depending on the severity of the side effects, you may have to limit some activities. For example, fatigue is a common side effect that may make it difficult to work for a full day. You may consider decreasing your hours or taking frequent breaks to make sure you get the appropriate amount of rest.

Your health care team will monitor your progress through regular exams, blood tests, and scans. Your doctors will keep you updated on how well your treatment is going, and answer any questions about specific test results.

General Advice

• Get plenty of rest
• Eat healthy foods – like fresh and organic fruits and vegetables – unless specifically instructed by your doctor
• Get exercise and fresh air, if your doctor allows it and it can be done safely
• Continue enjoying your interests and hobbies, for your emotional wellbeing
• Contact your health care team if you have any questions

Nausea

• Unless otherwise directed, eat a small light meal prior to chemotherapy appointments
• Eat small, frequent meals
• Try not to skip meals
• Generally, starches like rice, bread, potatoes, cereals, and puddings are well tolerated (but eat what appeals to you)
• Drink plenty of fluids (e.g. water, herbal teas, sports drinks, diluted juice, not soda)
• Avoid unappealing smells
• Freeze meals so you don’t have to cook, or have family/friends do the cooking
• If prescribed by your doctor, take anti-nausea medication
• For UCSF patients, schedule a free appointment with our dieticians (call 415-885-3693) to get specific advice on dealing with nausea

Fever

• If you have a fever of 100.4°F (38°C) or higher, contact your doctor immediately. If you cannot reach your doctor or nurse, go to an emergency room.
• Keep a thermometer handy and know how to use it properly:
  • Do not eat/drink/smoke for 10 minutes before taking your temperature
  • Leave the thermometer under your tongue for 3 minutes

Infection

• Wash your hands frequently
• Avoid crowds, or people with colds
• Contact your doctor if you develop a cough, sore throat, or pain/burning when you urinate
• Do not eat raw foods (e.g. sushi, sashimi, caesar salad, milkshakes with raw egg) until you complete chemotherapy and your blood counts resume adequate levels
• Thoroughly wash fruits and vegetables
• Wash hands and cutting boards well after food preparation
• Tell your doctor before going to the dentist
• Avoid rectal intercourse, tampons, douches, enemas, and rectal thermometers

Flu-like Symptoms

• Flu-like symptoms (muscle aches, pains) may occur around the third day of treatment
• Take over-the-counter medications like Tylenol or Advil
• If necessary, contact your doctor for stronger medication

Changes in Appetite or Taste

During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to odors. Don't worry if you don't have an appetite the first few days or a week following chemotherapy; it is not unusual. As you feel better, your appetite will improve.

• Eat what appeals to you during this time
• Eat foods that are warm rather than hot
• Avoid places where food is being cooked, like kitchens
• Avoid smells that are unappealing
• Try to drink 8-10 glasses of water per day
• Contact your health care team if you’re experiencing reflux (when food backs up into your esophagus)
• For UCSF patients, schedule a free appointment with our dieticians (call 415-885-3693) to get specific recommendations for maintaining healthy nutrition

Constipation

To help prevent constipation, drink 8-10 glasses of fluid per day.

• If recommended by your doctor, take stool softener (not a laxative)
• Stay as active as you can, since consistent exercise can reduce constipation
• If you can tolerate them, try high-fiber foods such as prunes, fruits, and vegetables

Diarrhea

• If you have more than 3-4 watery stools in 24 hours, call your doctor or nurse
• If you have blood in your stool, call your doctor or nurse
• Do NOT use over-the-counter anti-diarrhea medications (e.g. Immodium), unless advised to do so by your doctor
• Stay hydrated by drinking 8-10 glasses of non-caffeinated fluids per day
• If you rectum is sore, use soft toilet paper and A&D ointment (used for diaper rash on infants) or Anusol, which can help numb the rectum and soothe soreness

Mouth Sores

Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed. Let your doctor know about mouth sores early on, before it limits your eating.

• Brush your teeth with a soft toothbrush, three times daily
• Rinse your mouth with a solution of one teaspoon baking soda and one teaspoon of salt, diluted in a glass of lukewarm water, 3-4 times daily.
• Most commercial mouthwashes contain alcohol. You can ask your healthcare provider about mouthwashes that are not irritating to your mouth
• Ulcer-ease is a commercial product that may provide temporary relief from sores

Neuropathy

Neuropathy can sometimes be caused by chemotherapy. This may be experienced as tingling, burning, numbness, or pain, usually at your fingers or toes. Other signs might include a loss of balance, or a feeling of not knowing where a body part is positioned without looking at it.

Tell your doctor about any symptoms that you experience. Early detection and treatment are the best way to control your symptoms and prevent further nerve damage.

• Tight shoes and socks can worsen pain and tingling, and may lead to sores that won't heal
• Wear soft, loose cotton socks and padded shoes
• If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice per day
• Massage your hands and feet (or have someone do it for you) to improve circulation, stimulate nerves, and temporarily relieve pain

Menopausal Symptoms

For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause.

If your periods continue during treatment, they are likely to change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause. If you experience any of the following menopausal-like symptoms, talk to your doctor or nurse to get information and treatment: hot flashes, decreased libido, vaginal dryness, mood changes, or sleeping disturbances.

• Eat soy products or take vitamin E (400 units only) to reduce hot flashes
• Your doctor may recommend prescription medications for hot flashes.
• Wear light cotton pajamas to help prevent overheating when sleeping 
• Use vaginal moisturizers on a regular basis or other water-based lubricants as needed, especially during and before sexual activity
• Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication
• Contact your health care team to get more information

Hair Loss

Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect. Most chemotherapy drugs used to treat brain tumors do not cause hair loss.

Most often, hair loss begins about two to three weeks after starting chemotherapy. Some people will lose relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you most comfortable.

Your hair will begin to grow back after you stop chemotherapy. It usually takes from two to three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its original texture after some time.

• Before possible hair loss, some people like to cut their hair short. The hair loss won't be quite so shocking if there is less hair to lose.
• It may not be necessary to buy a real wig. Synthetic wigs can look as good and are less expensive, easier to care for, less heavy, and may be more comfortable to wear.
• If you decide to buy a wig, try to get one while you still have your own hair, so you can better match color and style
• You may want to ask your doctor for a prescription for a “cranial prosthesis” (i.e. a wig), since some insurance companies only pay for the wig with a prescription for a cranial prosthesis
• When buying a wig, take a friend for emotional support and maybe even a laugh!
• Put a towel over your pillow so that clean up in the morning will be easier while you are shedding your hair 
• Buy a drain catch for your shower. Other people choose to shave their head hair when hair loss begins.
• Find more information, including about donated wigs, at our Friend to Friend Gift Shop and Cancer Resource Center.

Emotional and Practical Support

To varying degrees, all people with tumors struggle with the challenges of coping and adjusting to these life changes. We recognize that having a brain tumor has an impact not only on you, but also on your family and loved ones. At UCSF, we have a number of programs to support you and your caregivers through this process, from support groups to individual counseling and learning workshops. Please learn more about our support services:

• UCSF Neuro-Oncology Gordon Murray Caregiver Program
• The Ida and Joseph Friend Cancer Resource Center
• UCSF Benioff Children’s Hospital Patient and Family Support Services