What side effects can I expect from chemotherapy?

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

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

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

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 bananas^11,12

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

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 day^5,15
• Avoid caffeine and alcohol^14,15
• 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 feelings^5,14

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

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

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 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

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 physiotherapy^24,25

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 eggs^26–28
• 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 later^26,27
  • 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

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

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

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