Carboplatin and paclitaxel: side effects and what to do

Slightly raised temperature

A slightly raised temperature, otherwise well.

Fever: always an emergency during chemotherapy

A temperature of 38.0°C (100.4°F) or more, even once. Or shivering, chills, or feeling suddenly very unwell.

• Keep a thermometer at home. Check your temperature whenever you feel unwell, hot, cold or shivery.
• Do not take paracetamol before checking: it can hide a fever.
• Wash hands often; avoid crowds and people with colds, cough or chickenpox.
• Eat freshly cooked food; avoid raw salads, cut fruit and street food when counts are low.
• Brush gently, keep cuts clean, and do not squeeze pimples.

• Growth factor injections (G-CSF) may be given after chemotherapy to raise white cells.
• Antibiotics are given by us when needed. Do not start antibiotics from home without telling us.

Mild (grade 1)

Feeling sick and eating a little less than usual, no vomiting.

Moderate (grade 2)

Eating much less than usual, or vomiting 1 to 3 times in a day.

Severe (grade 3 or 4)

Vomiting more than 3 times in 24 hours, or cannot keep down water or medicines, or feeling dizzy.

• Take your anti-sickness tablets on time for the days advised, even if you feel well.
• Eat small, plain meals often: idli, toast, rice, biscuits. Avoid oily, spicy food and strong smells.
• Sip fluids through the day: water, ORS, lemon water, coconut water.
• Ginger tea or lemon may help.
• Sit up for 30 minutes after eating.

• Ondansetron or granisetron, aprepitant, dexamethasone, olanzapine and metoclopramide.
• If you still feel sick, tell us: the medicines can be changed or added for the next cycle.

Mild (grade 1)

Tired, but better with rest.

Moderate (grade 2)

Not better with rest; you cannot do housework, shopping or work as usual.

Severe (grade 3 or 4)

Cannot get out of bed or walk, fainting, dizziness on standing, or tiredness with breathlessness or confusion.

• Gentle exercise, such as a 20 to 30 minute walk most days, helps more than resting all day.
• Plan important things for your better days; accept help with chores.
• Short naps (under 30 minutes), regular sleep times.
• Eat well and drink enough.

• Treating the cause: a blood transfusion or iron for low haemoglobin, thyroid tablets, or help with sleep or low mood.

• Cut hair short before it starts; use a soft brush and mild shampoo.
• Use a scarf, cap or wig; protect the scalp from sun and cold.
• It is normal to feel upset. Talking about it helps.

Mild (grade 1)

Dry skin, mild rash or redness, without pain.

Moderate (grade 2)

Painful redness or peeling of the hands or feet, or a rash over a large area, that affects daily work.

Severe (grade 3 or 4)

Blisters, skin peeling off, a rash with fever, a rash in the mouth or eyes, or a red, hot, swollen area with pus.

• Moisturise twice a day with a fragrance-free cream; urea cream for hands and feet.
• Use sunscreen and cover up in the sun.
• Bathe with lukewarm water and mild soap.
• Avoid tight shoes, hot water and long walks if hands and feet are sore.
• Keep nails short; wear gloves for housework.

• Antibiotic tablets and creams for EGFR rash; steroid creams; a short break or dose change for sore hands and feet.

Mild (grade 1)

Tingling or numbness that does not affect daily tasks.

Moderate (grade 2)

Difficulty with buttons, writing, holding things, or walking feels unsteady.

Severe (grade 3 or 4)

Cannot dress or walk safely, or falls. Or sudden weakness of the legs, numbness around the bottom, or trouble passing urine or stools (this can be pressure on the spinal cord).

• Protect hands and feet: check feet daily for cuts, wear well-fitting footwear, test bath water with your elbow.
• Take care on stairs and in the dark.
• Gentle exercise and physiotherapy help.

• The dose can be lowered or the medicine changed. Medicines such as duloxetine or pregabalin help painful tingling.

Mild (grade 1)

A few small bruises, or gums that bleed a little on brushing and stop.

Severe

Bleeding that does not stop after 10 minutes of pressure, vomiting blood, black or bloody stools, blood in urine, coughing blood, many new tiny red spots on the skin, or a sudden severe headache.

• Use a soft toothbrush and an electric razor.
• Avoid aspirin and painkillers like ibuprofen unless we advise them.
• Avoid injuries and contact sports.
• For a nosebleed: sit up, lean forward and pinch the soft part of the nose for 10 minutes.

• Platelet transfusion if platelets are very low or there is bleeding.