Chemotherapy involves the use of powerful, cytotoxic drugs designed to destroy rapidly dividing cancer cells. These agents are highly effective but come with inherent risks to the patient undergoing treatment and to the caregivers and family members around them. Chemotherapy precautions are a defined set of safety measures taken to minimize these risks. Adherence to these guidelines protects the patient from internal risks, such as infection, and shields others from external exposure to the drugs or their active metabolites. These protective actions are an integrated part of the treatment plan, ensuring safety throughout therapy and recovery.
Preventing Caregiver and Household Exposure
Chemotherapy drugs are metabolized by the body, and their active components are excreted primarily through bodily fluids, including urine, feces, sweat, and vomit. Exposure to these contaminated fluids can pose a health risk to caregivers, potentially causing skin irritation. Precautions are necessary for 48 to 72 hours following the last dose of chemotherapy, as this is the timeframe when the highest concentration of drug metabolites is excreted.
Caregivers must use disposable gloves when handling the patient’s bodily waste, soiled laundry, or contaminated items. After handling waste, the gloves should be immediately discarded into a sealed plastic bag, followed by thorough hand washing. To minimize splashing, men should sit to urinate, and the toilet lid must be closed before flushing.
If using a low-volume flush toilet, it should be flushed twice after each use to ensure all waste is cleared. Clothing, bedding, or absorbent undergarments soiled with bodily fluids must be segregated. These items should be machine-washed separately in hot water using regular detergent. They should never be washed by hand.
Proper disposal of contaminated materials is important. Used disposable items, such as pads or diapers, should be sealed in a plastic bag before being placed in the regular trash. Caregivers handling oral chemotherapy medication should wear gloves. Contaminated sharps, such as needles or syringes, must be disposed of in a designated, puncture-proof container and returned to the clinic for proper disposal.
Managing Severe Infection Risk
Chemotherapy suppresses the production of white blood cells in the bone marrow, a condition called myelosuppression. This reduction in neutrophils leads to neutropenia, which increases the risk of severe infection. Preventing infection is a primary focus of patient precautions, particularly seven to twelve days after treatment when the neutrophil count is lowest.
Rigorous hand hygiene is the most effective defense against pathogens for the patient and all visitors. Hand washing should be performed frequently, especially before eating and after using the restroom. Patients should avoid crowds and close contact with anyone who shows signs of illness.
Food safety requires careful attention to avoid pathogens that could cause foodborne illness. All meat, fish, and eggs must be fully cooked, and unpasteurized dairy products should be avoided entirely. Raw fruits and vegetables must be thoroughly washed or peeled before consumption.
Patients should avoid activities that involve contact with soil, such as gardening, unless wearing thick, protective gloves. When handling pet waste, caregivers must wear gloves to avoid contact with bacteria or fungi. The patient should avoid direct contact with pet litter boxes or feces.
Precautions for Physical Side Effects
Chemotherapy can damage rapidly dividing cells, leading to physical side effects that require specific preventative measures. Damage to bone marrow cells can lead to thrombocytopenia (a low platelet count), which impairs the blood’s ability to clot. To prevent injury and bleeding, patients should use a soft-bristled toothbrush and switch to an electric razor.
Patients should avoid activities that carry a risk of cuts, falls, or bruising. Over-the-counter medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), can increase the risk of bleeding and should only be taken if directed by the oncology team.
Skin cells are often affected, resulting in dryness, irritation, and increased sensitivity to the sun. Skin should be kept moisturized using mild, unscented lotions to prevent cracking. Due to photosensitivity, patients must use sun protection, such as sunscreen with an SPF of at least 15, and wear protective clothing when outdoors.
The mucous membranes lining the mouth are susceptible to damage, which can cause mucositis (painful mouth sores). Maintaining meticulous oral hygiene is necessary to prevent infection. This involves regular rinsing with solutions recommended by the care team, often saline or baking soda rinses, while avoiding commercial mouthwashes that contain alcohol. Patients should also avoid hot, spicy, or acidic foods that could irritate the mouth lining.
When to Seek Immediate Medical Attention
Prompt action is necessary when acute symptoms occur, as chemotherapy-related complications can escalate rapidly. The most serious warning sign is a fever, which may be the only indication of a severe infection in a neutropenic patient. Patients must contact their oncology team immediately or go to the emergency room if they register a single oral temperature of 100.4°F (38°C) or higher.
Immediate medical attention is required for any signs of uncontrolled bleeding. This includes persistent nosebleeds, blood in the urine, vomit, or stools, or excessive bruising. Other symptoms that warrant an urgent call include new chest pain, severe shortness of breath, or a sudden change in mental status. The inability to swallow or keep down prescribed medications or fluids due to persistent nausea or vomiting is also a cause for immediate concern.
Caregivers must be prepared for the management of a significant chemotherapy drug spill at home. If a spill occurs, all people should be moved away immediately, and the caregiver should put on gloves. The spill should be contained with paper towels, moving from the outside edge inward. The contaminated towels and gloves must be double-bagged in sealed plastic bags for proper disposal according to the care team’s instructions.