ACNEIFORM RASH CANCER TREATMENT EDUCATION Page 1 What is acneiform rash? • Acneiform rash (also called acne-like rash) looks like acne, with raised red bumps, redness, and irritation. • Despite the similar appearance, it should not be treated with acne medications. • It most often occurs on the face, chest, back, arms, and scalp. What should I know about acneiform rash? • It is a common side effect of a type of medication called an EGFR (epidermal growth factor receptor) blocker. • The acne-like rash often starts within the first 2–4 weeks of treatment. • At first it may feel warm, tender, or like a burning sensation. It may then turn red and feel swollen. • Eventually you may experience raised bumps, sometimes called papules or pustules, that crust over and become very dry, itchy, or painful. • Severe acneiform rash may lead to infection if not properly managed. • Your skin may also be more prone to sunburn. • Acneiform rash can change your appearance, which may lead to changes in body image and feeling uncomfortable or depressed. What puts me at risk of experiencing acneiform rash? • Being male may increase the risk for acneiform rash. • The rash is typically worse with higher doses of EGFR blockers. • Developing an acneiform rash may mean that your cancer might respond better to the treatment you are receiving. How is acneiform rash identified/evaluated/diagnosed? • Acneiform rash may present after beginning treatment with an EGFR blocker and may appear as papules and/or pustules. • The acneiform rash may be tender and itchy. What can I do to prevent acneiform rash or manage it once it appears? • Do: • Use a daily moisturizing cream on skin at least 2 times daily. • Use sunscreen of at least SPF 30 when outside and avoid prolonged direct sun exposure. • Gently clean skin with mild soap and warm water and pat to dry. • Ask your care team if they recommend: • An over-the-counter steroid cream to be used on the skin • An antihistamine to help with itching • Avoid: • Long hot showers that can irritate and dry out skin. • Lotions that contain alcohol or fragrance. • Using benzoyl peroxide or retinoid cream because this does not help acneiform rash and may add to the irritation. ACNEIFORM RASH CANCER TREATMENT EDUCATION Page 2 What might my care team provide to help? • To help prevent severe acneiform rash, your care team may prescribe: • Certain antibiotics to take by mouth • Additional topical steroids or antibiotic creams to apply directly to the affected areas of the skin • Before starting treatment with an EGFR blocker, your care team should carefully look over your skin and note any areas that already show any signs of bumps, redness, or tenderness. • At each visit after starting treatment, this should be repeated to note any signs of skin changes. • You should also carefully examine your skin each day to look for early signs of changes. When should I call my care team? • At the first signs of a rash that looks like acne after starting treatment with an EGFR blocker. • If any areas of rash show signs of drainage, pus, or open sores. • If your rash becomes so severe that it limits your ability to do your normal daily activities or sleep at night. • If your rash is causing you to feel depressed. How can I tell if my acneiform rash is getting better? • It may take up to 4 weeks for the rash to improve. Signs of improvement include: • Decreased redness and tenderness. • Bumps start to dry and crust over. • You may still see discoloration where the rash used to be. What questions should I ask my care team about acneiform rash? • Is it helpful for me to track my symptoms? What do you recommend? • Do any of my other medical conditions increase my chance of experiencing acne-like rash? • Do you recommend any changes to my medications to help prevent or control acne-like rash? • What lifestyle changes do you recommend to manage my acne-like rash? • What are my options if acne-like rash cannot be controlled while I am receiving cancer treatment? Where can I find out more information about acneiform rash? Hair, Skin, and Nail Problems | American Cancer Society • https://www.cancer.org/cancer/managing-cancer/side-effects/hair-skin-nails.html Skin Reactions to Targeted Therapy and Immunotherapy | Cancer.Net • https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/ skin-reactions-targeted-therapy-and-immunotherapy Skin and Nail Changes During Cancer Treatment | National Cancer Institute • https://www.cancer.gov/about-cancer/treatment/side-effects/skin-nail-changes ACNEIFORM RASH CANCER TREATMENT EDUCATION Page 3 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 Cancer Treatment Education sheet. This summarized information represents a brief summary of supportive care information and other resources. This Cancer Treatment Education sheet 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 Cancer Treatment Education sheet 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: Cancer Treatment Education 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 Oral Chemotherapy Education (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 © 2023 by NCODA. All rights reserved.

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

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

CANCER TREATMENT EDUCATION CYTOKINE RELEASE SYNDROME (CRS) What is cytokine release syndrome (CRS)? • Cytokine release syndrome (CRS) is a side effect that can occur after certain types of immune therapy treatments. • These therapies cause T cells to release proteins called cytokines, which gather immune cells to help kill cancer cells. • Cytokines cause inflammation, which is similar to when your body is fighting a severe infection. What should I know about CRS? • For most patients, CRS usually starts within one week after treatment, depending on which type of therapy you receive. It often begins with fever and flu-like symptoms but can worsen quickly and cause serious illness. • Common signs and symptoms of CRS are fever of 100.4 ˚F (38 ˚C) or higher, fatigue, feeling unwell, shortness of breath or low oxygen levels, nausea, vomiting, chills, rapid heartbeat or changes in heart rhythm, rash, headache, muscle and joint aches, changes in kidney function, and low blood pressure. What puts me at risk of experiencing CRS? • CRS is a known side effect of certain types of immune therapy treatments, and your care team will be prepared for CRS if it happens. Your risk for CRS can increase if you have an active infection or have large amounts of cancer in your body. How is CRS diagnosed? • Your care team will monitor your vital signs frequently such as temperature, blood pressure and oxygen levels. • They will perform an examination daily and ask you about your symptoms. • They may also run a variety of tests, including blood tests or imaging tests (e.g., x-rays, CT scans, MRI scans). What are the complications of CRS if my symptoms are not managed? • In mild to moderate cases, CRS will cause uncontrolled fevers, shortness of breath, and low blood pressure if symptoms are not treated. • In severe cases, CRS can cause organ failure and even death. What can I do to prevent or minimize CRS? • Check your temperature regularly or whenever you feel unwell and report any fevers immediately. • Let your doctor know if you experience any signs or symptoms of fever, such as chills, shivering, sweating, or weakness. • Let your doctor know if you experience any signs or symptoms of infection, such as cough, runny nose, sore throat, or diarrhea. • Check your blood pressure regularly or whenever you feel unwell and report low blood pressure readings immediately. • Let your doctor know if you experience any shortness of breath, difficulty breathing, or changes in your heart rhythm. • Avoid taking any over-the-counter pain medications (e.g., acetaminophen [Tylenol®], ibuprofen [Advil®], naproxen [Aleve®]) unless instructed by your doctor. Page 1 CANCER TREATMENT EDUCATION CYTOKINE RELEASE SYNDROME (CRS) What can I do to treat or manage CRS at home? • CRS may need to be treated in the hospital, depending on the severity of your symptoms. • Call your oncologist or go to the emergency department right away if you have any symptoms of CRS, including fever, shortness of breath, or low blood pressure. • Your care team may provide you with a wallet card to remind you of the signs and symptoms of CRS and when to seek immediate medical attention. • You can share this card with any care team provider to inform them of the treatment that you received and when to contact your oncologist. What might my care team provide to help? • Your care team will monitor you closely for fevers, low blood pressure, or shortness of breath. • Treatment for CRS includes fever-lowering medications, IV fluids, or oxygen to control symptoms. • Some patients may need to be treated in the hospital and receive additional medications, such as steroids or medications that help block the effects of cytokines. • For severe cases, patients may need treatment in the intensive care unit. When should I call my care team? Call your care provider or get emergency help right away if you experience any of the following: • Difficulty breathing. • Fever (100.4˚F/38˚C or higher). • Chills or shivering. • Confusion. • Dizziness or lightheadedness. • Shaking or twitching (tremor). • Fast or irregular heartbeat. • Severe fatigue. • Severe nausea, vomiting, or diarrhea. How can I tell if my CRS is getting better? Signs that CRS is getting better include: • Less frequent fevers and lower fever temperatures. • Improved shortness of breath and/or decreased need for oxygen. • Improved or normalized blood pressure readings. What questions should I ask my care team about constipation? • How long will I have to stay at or near a hospital? • Do I need a caregiver? Page 2 CANCER TREATMENT EDUCATION CYTOKINE RELEASE SYNDROME (CRS) • How closely should I be monitored after my treatment? • Is it helpful for me to track my symptoms? What do you recommend? • Who should I contact if I experience any symptoms of CRS or have any questions? • When should I go to the emergency department if I experience any symptoms of CRS? • How will you or my caregiver know I am having symptoms of CRS? • How will you treat CRS? • Are there any medications or activities I should avoid while receiving therapy? • Will I receive a wallet card? What do I need to do with it? 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: Cancer Treatment Education 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 Oral Cancer Treatment Education (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 © 2023 by NCODA. All rights reserved. Page 3

DIARRHEA CANCER TREATMENT EDUCATION Page 1 What is diarrhea? • Diarrhea is when your bowel movements are watery, soft, loose, or become more frequent than usual. • It is a common side effect of cancer and cancer treatments. • If you are receiving immunotherapy to treat your cancer and have diarrhea, contact your care team. What are the symptoms that I might experience if I have diarrhea? • You feel a sense of bloating (fullness in the belly area). • You have cramping or abdominal pain. • You have excess gas. • You are unable to hold in bowel movements. • You may feel more weak and tired than usual. What puts me at risk of experiencing diarrhea? • Certain cancer treatments, including chemotherapy, immunotherapy, targeted therapy, radiation therapy to the belly or pelvic region, surgery to the stomach or intestines, or stem cell or bone marrow transplant. • Certain bowel disorders, such as Crohn’s disease, ulcerative colitis, and irritable bowel syndrome. • Certain medical conditions, such as hyperthyroidism, diabetes, or lactose intolerance. • Anxiety or stress. • Certain types of infections. • Taking certain medications, including antibiotics, laxatives, some blood pressure medications, and antacid medications that contain magnesium. How is diarrhea diagnosed? • Your care team may ask you to describe the following: • When diarrhea first started. • How many episodes of diarrhea you have had in the past 24–48 hours. • The color and consistency (semi-formed, soft, or liquid). • If there is any blood, mucous, or unusual odors. • Any recent dietary changes or new food sensitivities. • Any new medication changes. • Your care team may request the following: • A stool sample to check for infection or blood. • Blood tests to check for related medical conditions. • X-rays or other imaging to look for other causes of diarrhea. DIARRHEA CANCER TREATMENT EDUCATION Page 2 What can happen if my symptoms are not managed? • Dehydration from fluid loss can be caused by diarrhea, which can become serious. Signs of severe dehydration include feeling very weak, feeling very thirsty, dry mouth, feeling dizzy, or decreased urine production. • Skin irritation around the anus can occur, which can result in pain or bleeding when wiping. • Weight loss, malnutrition, and fatigue can occur. • There may be schedule delays, dose reductions, or temporary or permanent stopping of cancer treatment that is causing diarrhea. What can I do to prevent or lessen diarrhea? • Avoid spicy, greasy, or fried foods. • Avoid eating a lot of raw vegetables or fruits. Small amounts of cooked vegetables are OK. • Avoid high-fiber foods, such as whole wheat breads, granola, bran, and seeds. • Avoid gas-forming foods, such as cabbage and broccoli. • Avoid milk and dairy products. • Avoid beverages with caffeine and alcohol. • Avoid artificial sweeteners like sorbitol or xylitol. • Do not smoke cigarettes. • Eat small, frequent meals throughout the day rather than a few large meals. What can I do to treat diarrhea at home? • Drink plenty of clear fluids, at least 6–8 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, white rice, noodles, plain pasta, baked potatoes without the skin, white bread, toast, and chicken or turkey (without the skin). • There are several types of over-the-counter medications to help with diarrhea. Check with your care team for guidance before trying these. • For raw or irritated skin around the anus, gently clean the area well with mild soap and water or baby wipes. Pat the area dry and apply a barrier ointment, such as petroleum jelly or diaper rash cream, to protect your skin. What might my care team provide to help? • Medications may be prescribed to prevent or treat diarrhea. Take these medications as directed. • Your care team may order blood tests to check for dehydration and order IV fluids. DIARRHEA CANCER TREATMENT EDUCATION Page 3 When should I call my care team? • If you are receiving immunotherapy to treat your cancer, notify your care team right away if you experience diarrhea. • 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 anal area is sore or bleeding. • You feel dizzy. • You have a fever of 100.4°F or higher. • You are unable to drink fluids to replace fluid loss from diarrhea. • Your urine (pee) becomes dark yellow in color. • You have pain in your belly area or it becomes swollen. How can I tell if my diarrhea is getting better? • Your diarrhea is improving when your stools are more solid than liquid and you are close to your normal number of bowel movements in one day. What questions should I ask my care team about diarrhea? • Is it helpful for me to track my symptoms? What do you recommend? • Do any of my other medical conditions increase my chance of experiencing diarrhea? • Do any of my medications I take for other conditions contribute to diarrhea? • Do you recommend any changes to my medications to help prevent or control diarrhea? • What lifestyle changes do you recommend to manage my diarrhea? • What are my options if my diarrhea cannot be controlled while I am receiving cancer treatment? Where can I find out more information about diarrhea? What is Diarrhea? | American Cancer Society • https://www.cancer.org/cancer/managing-cancer/side-effects/stool-or-urine-changes/diarrhea.html Diarrhea and Cancer Treatment—Side Effects | National Cancer Institute • https://www.cancer.gov/about-cancer/treatment/side-effects/diarrhea Chemotherapy and You | National Cancer Institute • https://www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf Diarrhea | Cancer.net • https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/ diarrhea DIARRHEA CANCER TREATMENT EDUCATION Page 4 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 Cancer Treatment Education sheet. This summarized information represents a brief summary of supportive care information and other resources. This Cancer Treatment Education sheet 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 Cancer Treatment Education sheet 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: Cancer Treatment Education 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 Oral Chemotherapy Education (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 © 2023 by NCODA. All rights reserved. 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

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.