ALOPECIA/HAIR LOSS ORAL CHEMOTHERAPY EDUCATION Hair loss, or alopecia, is often thought of with chemotherapy, but not all anti-cancer drugs cause this side effect. Hair loss can refer to hair thinning that is not noticeable to others, to complete hair loss. Alopecia can be the loss of hair anywhere on the body, including the head, the eyebrows, arm or facial hair. If an oral anti-cancer drug has a side effect of alopecia, it will usually cause mild hair thinning and not complete hair loss. To minimize hair loss, brush your hair gently, and avoid permanents (“perms”) or dyes in your hair. Your healthcare team or cancer support group can help you find wigs if you’d like to use one, and scarves can be a good option. Biotin is a supplement commonly used to support hair health. If you are interested in alternative supplements, ask your healthcare team to be sure the supplement does not interact with your treatment. Lost hair will usually grow back after cancer treatment has stopped, but it may look different when it grows back. It might be a different color, be curly rather than straight or have a new look or feel. Resource: https://hopescarves.org Additional instructions Examples of Medications That May Cause Alopecia (not intended to be an exhaustive list) Minimal risk () ibrutinib, venetoclax, olaparib, enzalutamide, abiraterone, alectinib Mild risk () imatinib, capecitabine, dasatinib, sunitinib, anastrozole, osimertinib, everolimus, tamoxifen Moderate risk (10%– 35%) nilotinib, cabozantinib, palbociclib, letrozole, exemestane, lenvatinib High risk (> 50%) temozolomide, vismodegib Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved.

CATEGORIZING “CHEMO” ORAL CHEMOTHERAPY EDUCATION CATEGORIZING “CHEMO” ORAL CHEMOTHERAPY EDUCATION There are more than 200 different medications for cancer. Many people call all of these “chemo,” but there are actually many different types. You may hear some of the following terms: All of these types of medications have a place in cancer treatment, and some medications fall into more than one of the categories above. The best treatment depends on cancer type, stage, and other factors. You may be treated with one type of medication, or multiple types combined. For more information, talk to your healthcare team or go to www.cancer.gov/about cancer/treatment/types. Type of Treatment Description Examples Chemotherapy (other names: chemo) • Kills fast growing cells, including cancer cells • Has been a key part of cancer treatment since the 1940s • 5 fluorouracil (5 FU®) • Capecitabine (Xeloda®) • Carboplatin (Paraplatin®) • Doxorubicin (Adriamycin®) • Paclitaxel (Taxol®) Hormone therapy (other names: hormonal therapy, endocrine therapy) • Acts on hormones in the body to slow or stop cancer growth • Used to treat breast, prostate, and neuroendocrine tumors • Bicalutamide (Casodex®) • Letrozole (Femara®) • Leuprolide (Lupron®, Eligard®) • Octreotide (Sandostatin®) • Tamoxifen (Nolvadex®) Targeted therapy (other names: tyrosine kinase inhibitor, kinase inhibitor, small molecule inhibitor) • Stops cancer growth by targeting its growth pathway • Developed based on a better understanding of cancer and why it grows • Bevacizumab (Avastin®) • Imatinib (Gleevec®) • Palbociclib (Ibrance®) • Rituximab (Rituxan®) • Trastuzumab (Herceptin®) • Venetoclax (Venclexta®) Immunotherapy (other names: immune therapy) • Helps your immune system to fight cancer • Atezolizumab (Tecentriq®) • Nivolumab (Opdivo®) • Pembrolizumab (Keytruda®) • Tisagenlecleucel (Kymriah®) Radionuclides • Kills cancer cells with radiation • Similar to other types of radiation, but administered as a medication • Radium 223 (Xofigo®) • Lutetium Lu 177 dotatate (Lutathera®) CATEGORIZING “CHEMO” ORAL CHEMOTHERAPY EDUCATION Additional instructions

DIETARY SUPPLEMENTS ORAL CHEMOTHERAPY EDUCATION What Are Dietary Supplements? Dietary supplements are products that contain a “dietary ingredient.” Dietary ingredients include vitamins, minerals, amino acids, and herbs/spices or botanicals (e.g., fish oil, turmeric, St. John’s Wort, etc.). Lack of Regulations and Studies Federal law does not require dietary supplements to be proven safe before they are marketed, unlike prescription medications. Also, dietary supplements do not need Food and Drug Administration (FDA) approval to be sold to customers. Because of this, there are very few studies on how safe dietary supplements are or how well they work. Health Claims Claims made by a dietary supplement on labeling or in advertisements may not be accurate or truthful. Examples of such claims are that supplements can prevent, treat, or cure diseases. USP Verification The United States Pharmacopeia (USP) is an organization that ensures supplements are made using high-quality ingredients. When selecting a product, look for the “USP Verified Mark” on the label. It is important to note that USP does not evaluate products for how well they work or their safety. Alternatives to Dietary Supplements Non-drug methods such as acupuncture, yoga, and meditation may help to manage symptoms of cancer and chemotherapy. How Can I Safely Use Dietary Supplements? Talk to your care team before starting any supplements. Once you and your care team determine that a dietary supplement is safe to take, keep track of any signs and symptoms you notice after use and report them to your care team. Supplement Spotlight o Maca: Maca is used in traditional medicine to improve stamina and sexual function. However, few studies have been done in humans. Potential side effects of maca include bleeding and high testosterone levels. Patients with hormone-sensitive cancers, such as breast, ovarian, testicular, and prostate, should avoid its use. o Cannabidiol (CBD): CBD has been promoted as an alternative treatment for cancer and chemotherapy-related side effects, yet there is little research on CBD and its use in patients with cancer. Some studies have shown that CBD may interfere with how your body processes anti-cancer drugs, so it is important to talk to your care team first if you are thinking about using CBD. . o St. John’s Wort: St. John’s Wort may help with depression, tiredness, and premenstrual syndrome (PMS). Potential side effects include headache, nausea, dry mouth, and stomach upset. St. John’s Wort may interfere with how your body processes anti-cancer drugs, so it is important to talk to your care team first if you are thinking about taking this. DIETARY SUPPLEMENTS ORAL CHEMOTHERAPY EDUCATION Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved. * This is not a full list of drugs that can interact with the supplements listed. + There are many types of mushroom supplements not listed here. Talk to your care team if you are interested in any type of mushroom supplement. Recommended Resource National Institutes of Health Office of Dietary Supplements (https://ods.od.nih.gov) Additional Instructions Common Dietary Supplement and Oral Chemotherapy Drug Interactions Cannabidiol (CBD) Increased risk of treatment toxicity Ginseng Increased risk of liver damage Green tea/green tea extract Decreased effectiveness of treatment Maca Decreased effectiveness of treatment Mushroom (Turkey Tail, Reishi, Maiitake+) Increased risk of treatment toxicity; can also decrease blood sugars in patients on medications for diabetes St. John’s Wort Decreased effectiveness of treatment Turmeric Increased risk of treatment toxicity and increased risk of bleeding Vitamin A Increased risk of treatment toxicity Vitamin E Increased risk of treatment toxicity Vitamin D3 Increased risk of treatment toxicity Vitamin C Decreased effectiveness of treatment

EDEMA MANAGEMENT ORAL CHEMOTHERAPY EDUCATION Edema, also called swelling, can be caused by different types of cancer treatments and other non-cancer conditions. Edema may look or feel different for each person. Some examples include: o Swelling in the feet, ankles, or legs o Swelling in the hands or arms o Swelling in the face or abdomen o Skin changes—puffy, shiny, or looking dented after being pressed o Shortness of breath There are many ways to treat edema. Your care provider may prescribe medication to treat edema, but there are also many ways to lessen edema through diet and activity. Ways to prevent or lessen edema: o Wear loose clothing and shoes that aren’t too tight. o Prop up the swollen body part as high as comfortable when resting. o Move the part of your body where edema is present. o Limit salt in your diet. Avoid processed foods (e.g., canned soup), foods high in salt (e.g., chips, bacon, ham), and adding salt to your food. Check food labels for sodium content. o Maintain proper water intake. • Drink 6 to 8 “8 oz” glasses of water or other non-caffeinated beverages per day, unless otherwise instructed by your healthcare team. • Ask your care provider if limiting your fluid intake is needed. o Ask your care provider if magnesium supplements may be good for you. o Ask your care provider if compression stockings may be good for you. Contact your care provider if you have recently had surgery and think your swelling may be related to lymphedema (swelling from changes in lymph node drainage) or if you experience any of the following: o Changes in your heartbeat o Sudden worsening of swelling o Have not passed urine for a day or more o A change in the look of the swelling (red, hot, or one-sided) o Gained more than five pounds in a week Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved.

FATIGUE ORAL CHEMOTHERAPY EDUCATION Fatigue is a daily lack of energy or an unusual feeling of whole-body tiredness that does not get better with simple rest or sleep. It is different from feeling tired which normally goes away after you sleep. Fatigue interferes with daily activities and can affect quality of life. What causes fatigue? Fatigue is one of the most common side effects of cancer and its treatments including surgery, chemotherapy, and radiation. Sometimes the exact cause of fatigue cannot be found or fatigue may be related to one or more causes, including: o Anemia—low level of red blood cells o Decreased nutrition levels o Dehydration due to fluid loss or poor fluid intake o Depression or anxiety o Hormone levels that are too high or too low o Lack of exercise o Medications to treat pain or nausea o Pain o Stress o Other medical problems such as heart, lung, kidney, or nerve problems To feel better, do the following: o Manage your activity level to save your energy. • Pace yourself and do tasks when you have the most energy. • Take time to rest in between times when you are more active. o Drink plenty of fluids. • Drink at least 8-10 cups/day or as recommended by your doctor. • Fluids can include water, sports drink, broth, weak decaffeinated teas, clear juices, and gelatin. o Maintain good nutrition. • Eat 5 or 6 snacks or small meals during the day instead of 3 big meals. • Eat plenty of protein including milk, yogurt, eggs, lean meats, fish, and poultry such as chicken or turkey. • Ask your healthcare provider to refer you to a dietitian who can advise you on how many calories you need and provide suggestions. o Regular, moderate exercise is one of the best ways to lessen fatigue. • Moderate exercise is anything that gets your heart beating faster. • Regular means every day, or at least every other day. • Even during cancer treatment, it is safe to continue regular physical activity. o Exercise may include things like walking, riding a bike, swimming, water aerobics, pushing a lawn mower, or gardening unless your healthcare provider has instructed otherwise. o Most importantly, move your whole body for periods that you can tolerate. Even doing laundry or walking to the mailbox may be exercise. Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved. • Try to build up to 150 minutes of moderate activity a week, or exercising for a total of 20 to 30 minutes a day. It does not need to be done all at one time. • The type and amount of your physical activity may change during and after cancer treatment. • Talk to your healthcare provider about your current activity level and types of exercise best for you. What can you do to lower stress? o Aromatherapy o Massage o Music therapy o Yoga Talk to your doctor before trying any new medications, over-the-counter products, herbal products, or supplements for your fatigue. Call your care team if you have: o Fatigue that keeps you from being able to care for yourself o Shortness of breath with very little activity o Pain that you cannot control or does not go away o Difficulty controlling side effects of your treatment, including nausea, vomiting, diarrhea, or loss of appetite o Ongoing or new depression or anxiety Additional instructions

CONSTIPATION ORAL CHEMOTHERAPY EDUCATION Constipation is when your bowel movements happen less often than normal or if your bowel movements are hard or painful to pass. There are things you can do to prevent constipation, including the following: Drink at least 8 glasses of fluid every day, such as water, fruit or vegetable juices, and other clear liquids, like broth, Pedialyte®, or sports drinks. Warm liquids, such as coffee and tea, may help. If you are able, try to stay active every day. Walking is a good form of exercise that is convenient and easy to do. Even short walks around the house can help keep your bowels moving. Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, prunes, nuts, seeds, popcorn, and high fiber cereals. Your doctor may recommend medications to prevent or treat constipation. Take your medication as directed by your care team. Call your care team if you experience any of the following symptoms: You have pain in your stomach. You have not had a bowel movement in more than 2 days. You are unable to pass gas. You have pain in your rectal area. You have a fever over 100.4°F. You are having nausea or vomiting with your constipation. Your stomach looks swollen or feels hard to the touch. Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved

DIARRHEA ORAL CHEMOTHERAPY EDUCATION Diarrhea is when your bowel movements become more frequent and are watery, softer, or looser than normal. To minimize the possibility of diarrhea, do the following: Avoid spicy, greasy, or fried foods. Avoid eating a lot of raw vegetables or fruits. Avoid high fiber foods, such as whole wheat breads, granola, and bran. Avoid gas forming foods, such as cabbage and broccoli. Avoid lactose containing products, such as milk and dairy products. Avoid beverages with caffeine and alcohol. To help you feel better, do the following: Drink plenty of clear fluids, at least 8–10 glasses per day. Examples include water, sports drinks, broth, weak decaffeinated teas, decaffeinated soft drinks, clear juices, and gelatin. Eat bland foods, such as bananas, applesauce, rice, noodles, white bread, toast, and chicken (without the skin). You may take over the counter medication for your diarrhea, as instructed by your healthcare provider, including the following: Loperamide (Imodium®); take 4 mg (2 tablets) for 1 dose, then take 1 tablet by mouth every 4 hours OR 1 tablet by mouth after each loose stool. Do not take more than 8 tablets in 24 hours. Call your care team if you experience any of the following symptoms: You have 4 more than your normal number of bowel movements in 1 day. You have diarrhea or cramps for more than 1 day. Your rectal area is sore or bleeding. You feel dizzy. You have a fever of 100.4°F or higher. Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved

EGFR SKIN RASH ORAL CHEMOTHERAPY EDUCATION EGFR stands for “epidermal growth factor receptor,” which can be targeted by certain cancer therapies. A common side effect of EGFR cancer treatment is an acne like skin rash that can occur mostly on the face, chest, back, arms, and scalp. The rash may have the following characteristics: It may look like acne, but it is not. It may appear red, swollen, crusty, and very dry. It may feel itchy, tender, painful, warm, or burning. It may cause the skin to change color after the rash has gone away. It usually starts and is worse within the first few weeks of treatment. It will go away after the treatment is stopped, but not right away. To lessen the severity of the rash, do the following: Avoid direct sunlight on the skin by applying PABA free SPF 30 sunblock and lip balm, and wear protective hats and clothing in the sunlight. Do not use tanning beds. Avoid products with perfumes, alcohol, benzoyl peroxide, or salicylic acid (anti acne products) because they can increase skin dryness and cause further irritation. Cleanse your skin regularly with a mild soap, such as Basis® or Cetaphil®, to keep the area from becoming infected. Limit showers with hot water because it can dry the skin. Instead, take short showers with warm water. After bathing, pat your skin dry, and while it is still a little damp, apply a non fragrance body cream. To treat the rash, your doctor may prescribe the following: A steroid cream to apply temporarily An antibiotic gel to apply to the affected area An antibiotic to take by mouth to help treat infection caused by the rash Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved.FEDRATINIB ORAL CHEMOTHERAPY EDUCATION EGFR SKIN RASH ORAL CHEMOTHERAPY EDUCATION Call your care team if you experience any of the following symptoms: The rash becomes itchy, tender, or painful or looks infected (red, warm to touch). The rash is affecting your ability to carry out your normal daily activities. The appearance of the rash is bothering you. The rash continues to spread despite current treatment. Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved

HAND FOOT REACTION ORAL CHEMOTHERAPY EDUCATION Hand foot reaction (sometimes referred to as hand foot syndrome) describes a common side effect of certain oral anticancer therapies (e.g., capecitabine, sunitinib, cabozantinib) affecting the palms of the hand and/or bottoms of the feet. Hand foot reaction may cause the following: Redness Tingling Numbness Swelling Cracking of the skin Thickening of the skin at pressure points (similar to calluses) Pain while on the feet or while using hands for everyday tasks Hand foot reaction typically starts after a few weeks of treatment. It will go away after treatment is stopped, but not right away. What can you do to lessen the severity of hand foot reaction? Regularly apply a moisturizing cream. • Udder Cream and Bag Balm are two commonly used products. Urea cream (10%–20%) is helpful to use on thickened skin. Wear well fitted shoes as well as socks to avoid excess rubbing on the feet. Use gloves when working with your hands. Avoid exposure to heat (including hot water) on hands and feet. Wear SPF 30 or higher daily, or wear long sleeved shirts and pants. Pat your skin dry after washing hands and feet instead of rubbing with a towel. Call your care team if you experience any of the following symptoms: You notice blistering of the hands and/or feet. You notice that it is painful to do everyday tasks with the hands and/or feet. Additional instructions

HEARTBURN ORAL CHEMOTHERAPY EDUCATION Heartburn is often described as a burning sensation in the stomach or lower chest that rises toward the neck and occasionally to the back. If you are currently taking heartburn medications (prescription or over the counter), please check with your healthcare team about whether these can be continued, as they may interact with your anticancer medications. Common heartburn medications include the following: Proton pump inhibitors (PPI): omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®) H2 blockers: famotidine (Pepcid®), ranitidine (Zantac®) Antacids: calcium carbonate (Tums®), sodium bicarbonate (Alka Seltzer®) Heartburn may be managed without medications by doing the following: Avoiding certain foods, such as chocolate, spicy foods, high fat foods, carbonated beverages, and peppermint Avoiding tobacco, alcohol, and caffeine Losing weight if you have had recent weight gain or are overweight Elevating your head and upper body in bed if symptoms are at night or while lying down Avoiding wearing tight fitting clothes Your care team may recommend certain medications to help relieve or lessen your heartburn. Take these medications as directed by your care team. Your care team may also ask that you take your heartburn medication and your anticancer medication at separate times. If you are not able to stop taking your heartburn medications and you are taking an interacting medication, your care team may recommend that you take your anticancer medication with 8–12 oz of seltzer water/club soda, or some other acidic beverage, which may help with absorption of your anticancer medication. Call your care team if you experience any of the following symptoms: Severe or new heartburn symptoms Bloody or black tarry stools Persistent vomiting Unexplained weight loss Difficulty swallowing Additional instructions

MANAGING HORMONAL SIDE EFFECTS/MENOPAUSAL SYMPTOMS ORAL CHEMOTHERAPY EDUCATION Menopause happens naturally with age when a woman’s ovaries make less estrogen. Some chemotherapy treatments can damage a woman’s ovaries causing symptoms of menopause to occur. Symptoms of menopause may continue even after chemotherapy treatment is completed. Some types of breast cancer are affected by the hormones estrogen and progesterone. Treatments that stop these hormones from helping breast cancer cells grow are called “hormone therapy” or “endocrine therapy.” Side effects of hormone therapy can be like the symptoms of menopause, which are caused by low levels of estrogen. Possible Side Effect Management Hot flashes (sudden sweating and feelings of warmth) Things you can do to make hot flashes less bothersome include: • Wear loose fitting clothing, dress in layers. • Stay hydrated with cool liquids. • Avoid alcohol, caffeine and foods that are hot or spicy. • Sleep in a cool room on cotton sheets. • Participate in mild, regular exercise. • Carry a portable fan. • Keep a personal hot flash diary to record the number, how often, how severe, and the timing of hot flashes so you can identify and avoid the personal triggers that cause your hot flashes. • Inform your care provider if your hot flashes are bothersome as there may be medications that can help. Vaginal dryness Vaginal moisturizers are used on a regular basis to maintain vaginal moisture and health of tissue. They can be used any time and several times a week for overall vaginal health and comfort. Natural oil moisturizers may be applied with the fingertip to the outside or inside vaginal area. • Coconut oil • Olive oil • Vitamin E—comes as a suppository, oil, or capsule. To use the capsule, break it open and apply the oil to the vagina with your fingertip. Commercial moisturizers can be found in the feminine hygiene section of your drug store. Most are inserted into the vagina using an applicator. • Replens™ • Hyalo Gyn® • Luvena® Vaginal lubricants are used during sexual activity to help you feel more comfortable. Natural oil lubricants can be used inside or outside of your vagina. Do not use oil based lubricants if you are using a latex condom. • Vitamin E Water based lubricants can be found at your drug store or online and include brands such as: Astroglide®, KY Jelly®, Aquagel®, Sliquid®, Good Clean Love®, Aloe Cadabra®, Luvena®, Yes® Silicone based lubricants include Pjur®, PINK™, Astroglide® Silicone * Always use a water or silicone based lubricant if you are using a latex condom. * Never use Vaseline as a vaginal lubricant as it can increase the chance and severity of vaginal yeast infections. Vaginal hormones or estrogen creams are available. Discuss with your oncologist to see if this therapy is right for you. Continued on the next page Additional instructions Bone thinning • Include plenty of calcium in your diet. Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones and sardines. • Include physical activity in your daily routine. Weight bearing activities such as walking, jogging and climbing stairs can help build strong bones and slow bone loss. • Take a Calcium and Vit D supplement as recommended by your doctor. • Do not smoke. • Avoid drinking more than one alcoholic drink per day for women, 2 drinks/day for men. Muscle or joint pain or weakness • Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. • Stay as active as possible, but know that it is okay to rest as needed, too. • Tell your care provider if pain interferes with your activity. If the pain or weakness bothers you, ask your provider how you may ease this discomfort. • Take only pain medication that has been prescribed or recommended by your care provider. Hair thinning • Avoid hairstyles that pull on hair. • Avoid high heat hair styling tools. • Use a soft brush with natural fibers. • For more information on hair loss refer to the “alopecia” supplemental side effect sheet. Fluid retention • Do not stand for long periods of time. • Keep your legs elevated when sitting or lying down. • Avoid eating salty foods, which can increase swelling. • Avoid wearing tight-fitting clothing and shoes. • Weigh yourself daily. • Contact your care provider if you notice any of the following: o Swelling in the hands, feet, or legs o Shortness of breath o Weight gain of five pounds or more in a week o If you have swelling after you had lymph nodes removed you may experience lymphedema. Notify your doctor. Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved.

NAUSEA AND VOMITING ORAL CHEMOTHERAPY EDUCATION Nausea and vomiting can be a side effect of cancer treatment and may include having an upset stomach, feeling queasy, and vomiting. To prevent nausea or to feel better, do the following: Eat 5 or 6 small meals during the day instead of 3 big meals. Eat before you get too hungry. An empty stomach can make nausea worse. Eat foods that are easy on the stomach, such as dry cereal, white toast, and crackers, without liquids first thing in the morning. Try lemon, lime, or other tart flavored foods. Sip on fluids throughout the day, like water, juice, broth, and semi flat soda. Avoid strong odors and smells. If you are vomiting, do the following: Stop eating. Once you stop vomiting, start back on food slowly, beginning with clear liquids, then try mild foods, such as gelatin, bananas, rice, and toast. Your doctor can prescribe medications to help relieve or lessen your nausea or vomiting. Take your medication as directed by your doctor or nurse. Take your anti nausea medicine as soon as you start to feel nauseous. This is the best way to prevent vomiting. Sometimes you can take more than 1 medication to prevent or treat nausea. If needed, you can take these medications on a consistent schedule or 30 minutes before taking your cancer treatment to better control nausea. Call your care team if you experience any of the following symptoms: The anti nausea medicine you are taking is not working and you are experiencing nausea or vomiting. You are unable to drink fluids for more than 1 day due to ongoing nausea or vomiting. Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved.FEDRATINIB ORAL CHEMOTHERAPY EDUCATION NAUSEA AND VOMITING ORAL CHEMOTHERAPY EDUCATION Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2020. All rights reserved