- Instruct patient to notify health care professional if fever; chills; sore throat; signs of infection; yellowing of skin or eyes; abdominal pain; joint or flank pain; swelling of feet or legs; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patients should be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
- Advise patient to rinse mouth with clear water after eating and drinking and to avoid flossing to minimize stomatitis. Viscous lidocaine may be used if mouth pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
- Discuss with patient the possibility of hair loss. Explore methods of coping.
- Review with patient the need for contraception during therapy.
- Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions.
- Instruct patient not to receive any vaccinations without advice of health care professional.
- Emphasize the importance of routine follow-up lab tests to monitor progress and to check for side effects.
- Topical: Instruct patient in correct application of solution or cream. Emphasize importance of avoiding the eyes; caution should also be used when applying medication near mouth and nose. If patient uses clean finger to self-administer, emphasize importance of washing hands thoroughly after application. Explain that erythema, scaling, and blistering with pruritus and burning sensation are expected. Advise patient to avoid sunlight or ultraviolet light (tanning booths) as much as possible; may increase side effects. Therapy is discontinued when erosion, ulceration, and necrosis occur in 2–6 wk (10–12 wk for basal cell carcinomas). Skin heals 4–8 wk later.