Endorsed by the European Oncology Nursing Society

What side effects can I expect from chemotherapy?

What side effects can I expect from chemotherapy? image

Chemotherapy is used to treat different forms of cancer. It works by either killing the cancer cells or slowing their growth to prevent them from multiplying further.1 However, chemotherapy does not only affect cancer cells, it can also kill or slow the growth of healthy cells in the body, leading to side effects.1

Not everyone who undergoes chemotherapy will experience serious side effects;2 some patients may experience very few, some may not experience any.2 Whether or not you experience them is, for most types of chemotherapy, not related to the effectiveness of the treatment received.3

Possible side effects and ways to manage them3,4

One of the most common side effects of chemotherapy is a condition called neutropenia. The other most common side effects experienced by patients undergoing chemotherapy, and strategies for managing them, are listed below. The list is not exhaustive, and you should talk with your doctor if you have questions or concerns about your specific treatment and the potential side effects.


Chemotherapy may decrease the number of red blood cells circulating in your system, a condition known as anaemia.5

Red blood cells are critical to the distribution of oxygen throughout your body, so anaemia may result in tiredness, headaches, dizziness, and shortness of breath.6

Ways to manage anaemia include:

  • Balance rest with activity7
  • Eat foods high in protein and iron, such as meat, eggs, and spinach7
  • Ask your doctor about specialised medical treatment; you may need a blood transfusion or medication7

Loss of appetite

Chemotherapy might cause you to lose your appetite, both by causing nausea and vomiting and by altering your sense of taste and smell.8

If you have lost your appetite, it is important to:

  • Drink plenty of liquids to avoid becoming dehydrated8
  • Eat 5 or 6 small, nutritious meals every day instead of 3 large meals8
  • Be active; short daily walks may help increase your appetite8

Bleeding and/or bruising

Chemotherapy can lower the number of platelets circulating in your blood, which will increase your risk of bleeding or bruising.9

To minimise this risk:

  • Do not take over-the-counter medications such as ibuprofen or aspirin, as they can increase your risk of bleeding9
  • Avoid alcohol9
  • Brush teeth gently with a soft toothbrush to avoid damaging the gums, and do not use dental floss as it can cause bleeding9
  • Take extra care when using knives or other sharp objects9

Constipation and diarrhoea

Cancer therapies may result in either constipation or diarrhoea.10,11

If you have constipation, it is important to:

  • Eat high-fibre foods; for example, add bran to breakfast cereal or a smoothie10
  • Drink at least 8 cups of liquid every day10
  • Take gentle exercise, for example, a 15- to 30-minute daily walk10

If you have diarrhoea, it is important to:

  • Drink 8 to 12 cups of water, fruit juice, or clear soup every day to avoid dehydration12
  • Eat 6 to 8 small, nutritious meals every day instead of 3 large meals11
  • Eat foods containing potassium and sodium, such as bananas11,12


Oedema is a condition in which fluid builds up in body tissues, which results in swelling, particularly in your feet and legs.13

Steps you can take to feel more comfortable and lessen oedema-related swelling include:

  • Wear comfortable clothing and shoes13
  • Cut out salty foods, such as potato crisps, bacon, and tinned soup13
  • Take short walks to improve your circulation13
  • Take medication to promote urination (diuretics), as prescribed by your doctor13

Tiredness and fatigue

In general, chemotherapy will result in an overall loss of energy; some patients may experience severe fatigue.14

You can help alleviate tiredness and fatigue by doing the following:

  • Plan your daily routine to allow time to rest, and prioritise your daily activities to tackle the most important tasks when you feel your best14
  • Get regular exercise; start slowly (by walking or cycling for 15 minutes a day), and then gradually increase the amount of time you exercise each day5,15
  • Avoid caffeine and alcohol14,15
  • Ask for an appointment with a dietician to learn about foods that help you to increase your energy, for example, foods high in protein or calories14
  • Join a support group and meet with a counsellor or mental-health professional who can help you cope with your thoughts and feelings5,14

Hair loss

Chemotherapy also affects the cells responsible for hair growth, so hair loss (alopecia) is a frequent side effect of chemotherapy.

It affects all hair: not just the hair on your head but also body hair, eyebrows, and eyelashes.4,16,17

There are several ways to manage or cope with hair loss:

  • Treat your hair gently, using a hairbrush with soft bristles or a wide-tooth comb16
  • Avoid products that may irritate your scalp, such as hair gels, dryers, or irons16
  • If you have long hair it might help to have it cut shorter before it starts to fall out, to minimise the impact of hair loss, or you might want to shave your head completely to avoid a patchy effect16
  • If you plan to buy a wig, you may want to purchase one while you still have hair, to match your own hair colour as precisely as possible16
  • Comfortable scarves or turbans are good, stylish alternatives for those who do not want to wear a wig16
  • Wearing a “cold cap” during or after chemotherapy can prevent hair loss; ask your nurse or doctor about this possibility17

Hair often grows back 2–3 months after chemotherapy has ended.16 At first, it may look different to the way it used to look, and may even have changed colour, but over time it may look much the same as before you started treatment.16


This condition occurs when the lymph system is damaged or blocked, and fluid retention can cause swelling in your arms, legs, head, or neck.18

The following may help lessen the swelling:

  • Wear compression garments around the affected area or areas19
  • Exercise to keep body fluids moving, especially in those places where lymphoedema has developed19
    • Ask your doctor or nurse what exercises are best for you

Memory or concentration problems

You may experience problems with memory and concentration during chemotherapy or after chemotherapy has ended.19

Some people only experience minor problems, while others have greater difficulty.19

If you are experiencing problems with concentration and memory, try the following:

  • Perform the most important tasks at the time of day you feel your best19
  • Make sure you get enough sleep, and schedule plenty of rest moments into your day; short naps of less than 1 hour can also help, but longer naps during the day might make it difficult to sleep at night19
  • Take regular exercise, which may help decrease stress and help you feel more alert19
  • Write things down, and make lists of important information such as names and phone numbers19

Mouth or throat problems

Chemotherapy may cause changes in the way you taste or smell things, cause pain or swelling in the mouth, or result in increased sensitivity to hot or cold foods.20

There are several ways to manage (or in some cases, avoid) these symptoms:

  • Schedule a dental check-up prior to starting chemotherapy, and inform your dentist about your upcoming treatment20
    • Any necessary dental work can then be done prior to starting therapy20
  • Check your mouth every day for sores or spots, and rinse your mouth with a combination of warm water, baking soda, and salt20
  • Use a soft toothbrush when brushing your teeth to help prevent sores or wounds from developing and avoid using dental floss20
  • If you have a sore throat or mouth, eat foods that are soft and easy to swallow; avoid foods that may irritate your mouth, such as foods that are salty, crunchy, spicy, or sugary20
  • If you have a dry mouth, make sure you drink plenty of fluids to prevent tooth decay and mouth infections20

Nausea and vomiting

Nausea and vomiting are common side effects of chemotherapy.21

If you are experiencing nausea and vomiting try the following:

  • Ask your doctor for an anti-nausea medication22
  • Prevent dehydration by drinking plenty of fluids, such as mineral water, fruit juice, ginger ale, or tea22
  • Avoid greasy, fried, sweet, or spicy foods; if the smell of food makes you feel sick, try eating cold food, or wait until warm food cools down before eating it22
  • Wait at least 1 hour after treatment before eating; some people also find that eating a small snack prior to treatment helps with nausea, although this may not work for everyone22

Nerve problems

Chemotherapy may cause nerve damage, affecting the way you feel pain, cold, heat, and pressure (sensory nerves).23

Other nerves that may be affected include nerves to muscles that help you move (motor nerves), and nerves that control blood pressure, digestion, heart rate, temperature, and urination (autonomic nerves).23

To help protect yourself, you can take the following precautions:

  • Reduce your chance of falling by removing rugs or other obstacles that may cause you to trip23
  • Get up slowly after sitting or lying down, especially if you are feeling dizzy23
  • Install railings on walls and in the bathroom so you can hold onto them for balance, and place an anti-slip mat in the shower or bath23
  • Protect yourself from burns in the kitchen by using potholders, and handle knives and other sharp objects with care23
  • Wear shoes both indoors and outdoors to protect your feet;23 check your arms, hands, legs, and feet for cuts every day23
  • If it is cold, wear warm clothing to protect your hands and feet23
  • Slow down, and allow yourself extra time to do things23


Cancer and chemotherapy can cause pain.24

Pain is not something you “just have to put up with”; it can interfere with your recovery process by disturbing sleep, suppressing your immune system, and affecting your mood.24 Pain control is an important part of your treatment plan.24

Ways to manage your pain include:

  • Keep track of your pain by writing in a “log book”24
    • Record where the pain is located, what activities cause the pain, and when the pain starts
    • Rate the pain on a scale of 1 to 10, and note what makes the pain better or worse
    • Bring your “log book” to your next doctor’s appointment24
  • Take any prescribed pain medication as indicated
    • Do not wait until the pain becomes unbearable to take your medication, and do not stop taking your pain medication unless instructed to do so by your doctor
    • Tell your doctor or nurse if your pain medication no longer seems to be helping or seems to be wearing off too quickly24
  • Talk to a pain specialist24
  • Talk to your doctor or nurse about massage therapy, acupuncture, biofeedback, hypnosis, or physiotherapy24,25

Sexual and fertility problems (males and females)

Sexual relationships and fertility are important topics, and before you begin chemotherapy you will need to understand how chemotherapy could affect your fertility and sex life.26,27

In men, chemotherapy may lower testosterone levels and sexual interest;26 in women, chemotherapy can result in premature menopause and, possibly, infertility.27

It is important that you make informed decisions with regard to the impact of chemotherapy on sexuality and fertility.

  • Confirm with your doctor or nurse that it is okay for you to be sexually active during chemotherapy26
  • Males should use condoms during the treatment period, as some traces of the medication may still be found in semen26
  • Females should use birth control during chemotherapy and for at least 6 months after chemotherapy treatment has ended, as chemotherapy drugs may damage their eggs26–28
  • Discuss potential fertility problems with your doctor before you begin chemotherapy, and if treatment is likely to result in infertility, explore the options that are available should you want to have children later26,27
    • Males may be able to preserve sperm using methods such as cryopreservation (sperm banking) or testicular sperm extraction26
    • Females may be able to preserve eggs using methods such as ovarian tissue banking, or egg banking27

Skin and nail changes

Chemotherapy can damage fast-growing skin and nail cells, resulting in dry, itchy, and peeling skin (pruritus) and damaged nails.29

Take the following precautions to prevent infection, protect your skin, and reduce itching:

  • Use mild soaps that are gentle on your skin29
    • Ask your doctor or nurse to recommend suitable lotions and soaps, and ask which products you should avoid
  • Protect your skin by using lotions or antibiotics as recommended by your nurse or doctor26
  • Avoid shaving areas that are sore29
  • When outdoors, wear sunscreen and lip balm, and wear loose-fitting clothing and a hat with a wide brim to protect yourself from the sun29
  • To avoid dry, itchy skin
    • Take showers or baths in lukewarm water and apply lotion to the skin while it is still slightly damp29
    • Keep your home cool and humid29
    • Refrain from using cosmetic products containing alcohol or perfume29
  • Eat a healthy diet and drink plenty of fluids to help keep your skin moist29
  • Help protect your nails by wearing gloves when you do the washing up, work in the garden, or clean the house; keep your nails trimmed short29

Sleep-related problems

Studies have shown that as many as 50% of patients undergoing chemotherapy have sleep-related problems, which can be due to stress, treatment side-effects, or long hospital stays.30

The following steps may help you sleep better:

  • Talk to your doctor about possible treatment to help alleviate side effects such as bladder or gastrointestinal problems, which interrupt sleep30
  • Ask your doctor about cognitive behavioural therapy (also known as CBT), which many people find helps them relax and promotes positive thoughts and beliefs about sleep30
  • Follow a routine: go to bed only when you feel sleepy, and get up again if you cannot fall asleep, returning only when you are sleepy again30
  • Avoid drinking or eating too much before bedtime; try not to exercise in the hours prior to bedtime27
  • Ask your doctor if prescription sleep medication might be helpful for you30

Urinary and bladder problems

Chemotherapy may damage the cells in the kidney and bladder, increasing the chance of bladder infections.27

Changes in the urine, such as to the colour or smell, are normal.31

To help prevent bladder infections:

  • Drink at least 8 cups of fluids every day and avoid caffeine, alcoholic drinks, smoking, and spicy foods, all of which can aggravate bladder problems31
  • Ask your doctor or nurse about how you can lower your risk of developing a bladder infection; advice often includes to urinate more frequently, to wear loose-fitting trousers and cotton underwear, and to take showers instead of baths31

Feel free to ask your doctor or nurse about the possible side effects of chemotherapy, the best course of action to prevent or lessen the symptoms, and what types of supportive care are available.25,32 Be sure to inform your doctor or nurse about any side effects you may experience so they can help you manage or treat them.2



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  2. National Cancer Institute. Side effects. Accessed November 2015.
  3. Cancer.Net. Side effects of chemotherapy Accessed November 2015.
  4. NHS. Side effects of chemotherapy. Accessed November 2015.
  5. Cancer.Net. Fatigue. Accessed November 2014.
  6. National Cancer Institue. Anemia. Accessed November 2015.
  7. National Cancer Institute.Managing chemotherapy side effects. Accessed November 2015.
  8. National Cancer Institute. Appetite loss. Accessed November 2015.
  9. National Cancer Institute. Bleeding and bruising (thrombocytopenia). Accessed November 2015.
  10. National Cancer Institute. Constipation. Accessed November 2015.
  11. National Cancer Institute. Diarrhea. Accessed 13 November, 2015.
  12. NHS. Diarrhea - treatment. Accessed November 2015.
  13. National Cancer Institute. Edema. Accessed November 2015.
  14. National Cancer Institute. Fatigue. Accessed November 2015.
  15. NHS. Self-help tips to fight fatigue. Accessed November 2015.
  16. National Cancer Institute. Hair loss (alopecia). Accessed November 2015.
  17. Cancer.Net. Hair Loss or alopecia. Accessed November 2015.
  18. National Cancer Institute. Lymphedema. Accessed November 2015.
  19. National Cancer Institute. Memory or concentration problems. Accessed November 2015.
  20. National Cancer Institute. Mouth or throat problems. Accessed November 2015.
  21. Macmillan. Possible side effects of chemotherapy. Accessed November 2015.
  22. National Cancer Institute. Nausea and vomiting. Accessed November 2015.
  23. National Cancer Institute. Nerve problems (peripheral neuropathy). Accessed November 2015.
  24. National Cancer Institute. Pain. Accessed November 2015.
  25. Macmillan. Complementary therapies. Accessed November 2015.
  26. National Cancer Institute. Sexual and fertility problems (men). Accessed November 2015.
  27. National Cancer Institute. Sexual and fertility problems (women). Accessed November 2015.
  28. Breastcancer.Org. Fertility after chemotherapy. Accessed November 2015
  29. National Cancer Institute. Skin and nail changes. Accessed November 2015.
  30. National Cancer Institute. Sleep problems. Accessed November 2015.
  31. National Cancer Institute. Urinary and bladder problems. Accessed November 2015.
  32. MacMillan. Side effect and symptoms. Accessed November 2015.