Chemotherapy – risks and side effects

Anticancer drugs are designed to kill fast-growing cancer cells, but some healthy cells also grow and divide quickly, and chemotherapy can affect them, causing side effects.

The cells most likely affected are blood cells, cells in the digestive tract, reproductive system , hair follicles, heart, kidney, bladder, lungs and nervous system.

The most common side effects of chemotherapy include:

Fatigue
Hair loss
Nausea and vomiting

Topic Index

How long do chemotherapy side effects last?

Low platelet count

Low red blood count

Low white blood count and infection

Sexuality and reproductive issues

Anxiety

Anxiety is a feeling of distress, fear or uneasiness. There are several different types of anxiety disorders, but they all have the common symptoms of excessive, irrational fear and dread. If left untreated, anxiety disorders can grow progressively worse, making it difficult to function in everyday life. Some symptoms of generalized anxiety include:

trembling
insomnia
feeling of a loss of control
racing pulse
difficulty breathing
dizziness
muscle aches

Talk with your doctor or nurse if you are having any of these symptoms or problems.

Tips for dealing with anxiety

Realize that anxiety is a normal reaction to a cancer diagnosis and treatment.
Talk with your doctor or nurse about what you are feeling for direction in managing your symptoms.
Get enough sleep, and exercise daily if you are able.
Try relaxation techniques, such as yoga, meditation, and deep breathing.
Join a cancer support group.
Keep a cancer treatment journal. When possible, take action to resolve those matters that you can control.
Communicate your thoughts and feelings with loved ones.

Constipation

Constipation is the difficulty in passing stools, a decrease in the normal frequency of your bowel movements or the passage of hard, dry stools.

Constipation can be accompanied by nausea, gas related pain or pressure in your stomach. It can be caused by anything that slows movement through the intestines, including some chemotherapy drugs, some antiemetics and pain medications, lack of physical activity and decreased fluid intake and/or poor nutrition.

Constipation can sometimes be a symptom of other problems. An unexpected change in bowel habits or symptoms should be reported to your doctor or nurse. Here are some tips for dealing with and preventing constipation

Drink at least eight, 8-ounce glasses of fluid (water, juices, sports drink, or gelatin) each day; drink fluids between meal-times when possible.
Avoid caffeinated beverages
Drink hot liquids
Adequate diet
Eat at regular times each day
Eat or drink foods or fluids that have helped relieve constipation in the past
Eat food high in fiber such as raw fruits and vegetables with skins and peels on (after they have been washed), bran, whole grain breads and cereals, or whole prunes. Talk with your doctor, nurse or dietician if you have no appetite, problems chewing or swallowing, feel full quickly or are on a low fiber/low-residue diet before eating these foods.
Add Activity or exercise into your daily routine

Call your doctor or nurse immediately if you have any of the following symptoms

Constipation is unrelieved
Pain in your stomach
Blood in your stool
Fever higher than 100.5 degrees Fahrenheit by mouth
You are not able to pass gas
Nausea or vomiting (throwing up) along with constipation
If your stomach looks swollen and/or feels hard to touch
If you have not had a bowel movement in three days despite following the above instructions

Decreased Appetite

Chemotherapy may affect your appetite in different ways. Food may taste different; sour and bitter tastes may be more intense, and sweet food may taste bland. You may even have a metallic taste in your mouth. Radiation therapy can affect your taste buds, making food tasteless. Taste changes may last 2 to 3 months or longer after treatment ends.

You may have a feeling of being full without eating much or any food at all. You may also have less of a desire to eat if you’re experiencing feelings of anxiety or depression.

Tips for dealing with decreased appetite

Rinse your mouth with water or salt water before eating; brush your teeth after meals, at bedtime and as needed for comfort.
Eat 5 or 6 small meals and snacks each day
Drink fluids between meals.
Try nutritional supplements, such as liquid meal replacements
Ask family or friends to help you with cooking and shopping.
Chew ginger or mint to decrease a metallic taste in your mouth.
Add flavorings to your food, or suck on sugarless hard candies or mints.
Eat sweet or tart food.
Use plastic utensils if you have a metallic taste in your mouth.
Eat chilled or frozen foods and fluids.
Avoid unpleasant odors.

Depression

Depression is a persistent feeling of sadness that interferes with your ability to complete daily activities.

Factors that can increase your likelihood of becoming depressed include:

your physical condition
poorly controlled pain
personal history and/or a family history of depression
certain medications

The symptoms of depression include:

Depressed mood for most of the day and feeling like this on most days
Loss of pleasure and interest in most activities
Nervousness or sluggishness
Restlessness
Fatigue
Changes in eating and sleeping habits
Feeling of guilt, worthlessness and hopelessness
Difficulty concentrating and making decisions
Thoughts of suicide or hurting yourself or others. If you experience thoughts of suicide or hurting yourself or others, it’s important to tell someone – a family member or friend, your doctor or nurse – immediately.

If you experience any of these symptoms consistently for a 2-week period, you should talk with your doctor or nurse.

How to get help for depression

Talk with your doctor or nurse; they can put you in touch with a counselor, social worker or other health care professional
Get enough sleep and try to exercise daily
Join a cancer support group
Try relaxation techniques

Diarrhea

Chemotherapy can damage the cells In your gastrointestinal tract and cause loose, watery, bowel movements. Diarrhea can lead to poor appetite, weight loss, weakness and dehydration. Diarrhea can become life-threatening if it is not brought under control.

Diarrhea may be relieved by restricting what you eat, drinking plenty of fluids and by using an anti-diarrhea medication.

Tips for dealing with diarrhea:

Call your doctor or nurse immediately if you have a fever higher than 100.5 degrees Fahrenheit by mouth, severe stomach cramps or bloody stools with diarrhea.
General instructions for over the counter anti-diarrhea medication: Begin taking Imodium® (loperamide) 2 tablets (4 mg) with first sign of diarrhea, then 1 tablet (2 mg) after each loose bowel movement up to 8 tablets in a 24 hour period.

Instructions for Imodium® intense (physician ordered) over the counter anti-diarrhea medication - Follow these instructions only if your doctor or nurse directs you:

Begin taking Imodium® (loperamide) as follows at the first sign of diarrhea – Take 2 tablets (4 mg) immediately, followed by 1 tablet (2 mg) every 2 hours during the day, and 2 tablets (4 mg) every 4 hours during the night until you have no diarrhea for 12 hours
Set your alarm to wake up during the night to take your dose on schedule
Call your doctor or nurse if diarrhea continues for 12 hours
Eat smaller amounts of food throughout the day.
Drink at least six to eight 8-ounce glasses of fluids every day to prevent dehydration. This includes water, sports drinks, juice, or clear broth.
Eat lower-fiber foods, such as white bread, rice, eggs, potatoes, cooked fish, chicken without skin, and creamed cereals.
Avoid high-fiber foods, like fresh fruit (except bananas and apples), whole grains, beans, popcorn, nuts, and vegetables.
Limit your intake of sugar substitutes such as Sorbitol.
Avoid very hot or cold food or beverages.
Avoid milk, milk products, and other beverages or foods that irritate your stomach, such as spicy, fried or fatty food.
Avoid caffeinated drinks.
You may drink carbonated beverages if you leave them open for at least 10 minutes before drinking.

Dry Skin and Rashes

Minor skin problems are a common side effect of cancer treatments, including dry, itchy skin and skin rashes. A skin rash can indicate an allergic reaction to therapy. Ask your doctor or nurse if there are creams and other special skin care products available to help decrease rashes caused by chemotherapy treatments.

Tips For Dealing With Dry Skin And Rashes

Use mild soaps and cleansers.
Dry skin carefully after bathing. Pat your skin dry, do not rub it.
Moisturize skin frequently.
Expose the affected skin to the air as much as possible, but avoid exposure to the sun.
If your skin itches, try not to scratch. Call your doctor or nurse for anti-itching baths and/or lotions. Your doctor may prescribe medication and/or ointments to treat your skin rashes.

Extreme Tiredness (Fatigue)

Fatigue is common among cancer patients. It’s important that you do not ignore it. Symptoms of fatigue are sometimes vague and may include:

Low energy level and an increased need to rest after normal activity.
Overall weakness with a heavy feeling in your arms and legs.
Difficulty completing daily activities.
Difficulty concentrating or thinking clearly.

Remember, having treatment-related tiredness doesn’t mean that your cancer is getting worse, but may be caused by many other factors, including:

Chemotherapy
Unrelieved pain
Depression
Lack of exercise
Side effects of other medications
Sleep disturbances
Anxiety
Low thyroid gland function
Not getting proper nutrition
Other medical problems

Tips for dealing with fatigue

Prioritize your activities to conserve energy.
Exercise daily, if possible.
Try to eat a balanced diet.
Try to maintain a normal sleep routine.
Try relaxation techniques before bedtime, such as taking a hot bath, listening to music, meditating, praying or using guided imagery.

Hair Loss (Alopecia)

Hair loss (alopecia) can be a side effect of certain chemotherapy drugs.

Hair loss usually begins 2 to 3 weeks after chemotherapy treatment starts. The amount of hair you lose depends on the chemotherapy you receive. The good news is that your hair will grow back. Hair usually starts to grow back 1 to 2 months after chemotherapy ends.

It can be difficult to prepare yourself for the loss of your hair. It’s OK to allow yourself to grieve the loss of your hair. Encourage family members, especially children, to express their thoughts and feelings about your hair loss. Remember, losing your hair does not change who you are as a person.

Tips for dealing with hair loss:

Get a short haircut before you begin treatment. It may help make your adjustment to hair loss easier.
Shop for a wig before your hair is gone, especially if you wish to match your natural color. Some insurance companies cover the cost of a wig.
Be gentle with your hair. Use mild shampoos and soft hair brushes. Avoid chemicals including permanent waves, bleach, peroxide or hair dye.
Remember to cover your head or use sunscreen (with an SPF of at least 15) on your scalp.
Shaving your head before your hair starts to fall out can give you a sense of control.
Try other head coverings
Accessorize your makeup or jewelry

Hot Flashes

Hot flashes are caused by hormonal changes that interfere with your body’s ability to lower its temperature.

Chemotherapy can cause sudden menopause that can bring on hot flashes. Hormonal (anti estrogen) treatment of breast cancer can also cause hot flashes.

Men who are being treated with hormonal therapy for prostate cancer can also experience hot flashes.

Tips For Dealing With Hot Flashes:

Dress in layers of cotton clothing.
Keep your home or workplace at a cool temperature.
Keep ice water or cool beverages available.
Take a cool shower.
Try deep-breathing exercises.
Talk with your doctor about vitamins and/or medications that may help decrease and/or control these symptoms

How long do chemotherapy side effects last?

How soon you will feel better depends on many things, including your general health and the kinds of chemotherapy you have been taking.

Some side effects go away fairly quickly and others may take months or years to disappear completely. Sometimes side effects can last a lifetime.

Low Platelet Count (Thrombocytopenia)

Platelets are cells in your blood that stop bleeding by plugging damaged blood vessels and helping the blood to clot. People with low levels of platelets bleed more easily and are prone to bruising.

Certain types of chemotherapy drugs can damage the bone marrow so that it does not make enough platelets. Thrombocytopenia caused by chemotherapy is usually temporary.

Call your doctor or nurse immediately if you notice any of the following:

Easy, heavy, or prolonged bleeding
New, pinpoint, red, flat spots anywhere on your body
Persistent nose bleeds
Blood in vomit
Bloody or black stools
Increased bruising of skin
Unusually heavy menstrual bleeding
Headaches

Tips for dealing with low platelet count:

Do not take aspirin, aspirin-containing products or ibuprofen unless approved by your doctor.
Do not use rectal or vaginal suppositories.
Use stool softeners to prevent straining with bowel movements.
Avoid activities, such as sports, that can cause you to fall or develop bumps or bruises.
Do not have sexual intercourse.
Use a soft-bristle toothbrush.
Use an electric razor instead of a blade razor.

Low Red Blood Cell Count (Anemia)

Anemia is a decrease in the number of red blood cells and amount of hemoglobin, a protein that helps your blood carry oxygen. Anemia results in your blood being unable to carry oxygen throughout your body. Cancer-related anemia can be caused by chemotherapy, radiation therapy, iron deficiency, bleeding, the cancer itself or a combination of these or other things.

Anemia makes you feel tired. If you are anemic, you may also have the following symptoms:

Difficulty thinking
Dizziness and weakness
Shortness of breath with mild activity
Pale skin
Rapid heartbeat
Feeling cold all the time
Loss of sex drive
Depression

Call your doctor if you have:

Shortness of breath or chest pain
Dizziness when you get up from lying or sitting down
Paler skin than normal
Extreme tiredness that is not helped by sleep OR you have been too tired to get out of bed for the past 24 hours
Felt confused or cannot think clearly

Tips for dealing with anemia

Eat small, balanced meals every 2 to 3 hours. The best sources of iron are beef and other meats. Additional sources of iron include beans, lentils, iron-fortified cereals and dark green, leafy vegetables. Foods containing vitamin C, such as citrus fruits, help increase iron absorption.
Stay as active as you can. At least 10 to 30 minutes daily of light exercise can ease tiredness.
Take short naps, but do not let them interfere with your nighttime sleep.
Take your time getting up from a lying or sitting position. Getting up too fast can make you dizzy and cause you to fall.

Low White Blood Count (Neutropenia) and Infection

Chemotherapy may lower your infection-fighting white blood cells (neutrophils) – a condition known as neutropenia.

When your blood counts are low, you may be at higher risk of getting an infection.

Your doctor can tell if you have neutropenia by ordering a complete blood count (CBC). Your risk depends on:

How low your white blood count falls
How long your white blood count is low
Which type of low white blood cell count you have
Other medications you may be taking (Check with your doctor or nurse before getting immunization shots.)

Tips for preventing infection:

Drink 2 to 3 quarts of fluids each day.
Eat a balanced diet
Cook eggs, fish, and meat
Wash all food before you eat it
Clean any cuts with soap and water and apply an antibiotic ointment
Do not use tampons
Wash your hands frequently with warm, soapy water, especially before eating and after using the bathroom
Take a warm bath or shower daily. Pat your skin dry
Rinse your mouth often and brush teeth with a soft toothbrush after eating. (Check with your doctor before having dental work done.)
Ask family or friends to clean up after pets for you
Avoid adults who have shingles or children who have chicken pox or measles
Avoid constipation
Avoid crowds and stay aware from people who are sick with colds, flu, or other infections you can catch
Do not cut or tear your nail cuticles
Do not have sexual intercourse
Do not use rectal or vaginal suppositories
Wear gloves to wash dishes or to garden

Tips for dealing with neutropenia and infection:

Have all blood tests (lab work) done as ordered.
Check your temperature if you feel hot and “sweaty”, cold and “chilled”, or you are not feeling well when your white blood count is low. Call your doctor or nurse immediately if you have any of the following symptoms or problems:
- A fever higher than 100.5 degrees Fahrenheit by mouth
- Shaking chills
- New symptoms of burning, pain or blood when passing urine

Call your doctor or nurse within 24 hours if you experience any of the following:

Diarrhea with fever
New symptoms of coughing along with shortness of breath
Sore mouth or throat
New or unusual vaginal discharge or itching
Redness, swelling, pus, or pain surrounding a cut or wound on your skin

When your white blood cell count is low you may NOT have the usual signs and symptoms of an infection. Therefore, it is very important to be alert to any change in how you feel and report/discuss what you are feeling with your doctor or nurse.

Mouth Sores

Chemotherapy can affect the cells in your bone marrow, mouth and throat, making you more susceptible to infection and bleeding. You can prevent infection, improve your appetite and improve comfort by keeping your mouth clean.

Symptoms of mouth sores include:

Mouth dryness, mild burning, discomfort and increased sensitivity to hot and cold foods
Difficulty eating, drinking or swallowing.
Redness, shininess, swelling or sores in the mouth and on the gums, tongue, lips or throat.
White or yellow patches in the mouth or a coating on the tongue.

Tips for preventing mouth sores

Eat a healthy diet
Increase your intake of fluids
Eat foods high in protein
Maintain a well-balanced diet
Prevent trauma to your mouth
Avoid tobacco, alcohol and commercial mouthwashes
Make sure your dentures fit properly
Avoid dental appliances such as a water-pic
Brush your teeth with toothpaste and a soft toothbrush after meals and at bedtime
Rinse your mouth after meals and at bedtime with a rinse prescribed by your doctor or nurse
Remove dentures prior to rinsing
Do not use commercially prepared mouthwashes
Keep your lips moist with A and D® ointment, Vaseline®, K-Y® Jelly, or Chap Stick
Examine your mouth every day
Wash your hands
Remove dentures if present
Use a mirror and a small flashlight to check your lips, tongue, teeth, gums, saliva and the lining of your mouth and throat
Look for redness, opened areas, or yellow or white patches

Tips for dealing with mouth sores

Rinse your mouth every 2 hours with a salt water solution
Ask your doctor or nurse to prescribe medication(s) to numb the mouth or throat and to promote healing of ulcers
Eat bland, soft foods
Try eating foods that are served cold or at room temperature
Eat foods that have been processed in a blender or drink liquid nutritional supplements, if swallowing is difficult
Drink at least 2 to 3 quarts of liquid a day unless your doctor or nurse instructs you otherwise
Drink through a straw
Avoid rough, salty, acidic, hot, spicy and other irritating foods

Call your doctor or nurse immediately if:

You are not able to eat or drink
Your mouth or throat pain is not controlled
You develop yellow of white patches in your mouth
You have a temperature of 100.5 degrees Fahrenheit by mouth or higher

Nausea and Vomiting (Throwing Up)

There are medications that your doctor can prescribe to prevent, lessen, or relieve the nausea and vomiting associated with chemotherapy. These medications are called anti-nausea drugs or antiemetics. Some of these medications are given before chemotherapy treatments in the hospital or clinic, but you may also be given prescriptions to take at home.

Tips for dealing with nausea and vomiting:

Eat small, frequent meals.
Eat and drink slowly and chew food thoroughly.
Eat soft, bland foods; such as toast, crackers or breadsticks.
Eat and drink food/fluids that are cold or room temperature.
Do not let yourself get hungry. Have snacks available.
Have other people cook for you whenever possible. Smells may bring on nausea and vomiting. Sometimes it helps to have food prepared outside the home or eat out.
Avoid very spicy or acidic foods; fatty fried or greasy foods; very sweet foods; dairy products.
Drink at least six to eight 8-ounce glasses of non-caffeine fluids each day. This includes water, fruit juice, decaffeinated soda (e.g. Sprite, 7-Up, ginger-ale, sports drinks, etc.), broth, gelatin, pudding, ice cream, etc.
Rest after eating to help your digestion, but do not lie flat for 2 hours after eating.
Call your doctor or nurse if your nausea or vomiting does not get better by the next day.

Nerve Side Effects (Peripheral Neuropathy)

Chemotherapy may cause tingling, burning, weakness, or numbness in the hands and/or feet. Other symptoms include:

loss of balance
clumsiness
difficulty picking up objects
walking problems
jaw pain
hearing loss
stomach pain
constipation

Peripheral neuropathy can range from mild to severe and may occur during treatment or after all of your treatment has been completed.

Most nerve side effects usually improve or decrease once you have completed chemotherapy, though some may be permanent.

Diabetes, alcohol abuse, and use of other chemotherapy agents can increase your risk of developing nerve side effects.

Tips for dealing with nerve side effects:

Avoid very hot or very cold temperatures. Take lukewarm baths. Do not use heating pads
Wear sturdy shoes or slippers that fit well at all times to protect your feet. Avoid floppy, loose, or tight shoes. Do not go barefoot
Wear gloves when doing work with your hands
Wear warm boots and gloves in cold weather
Use potholders
Remove throw rugs or other objects in your home that might make you trip
Use a cane or walker if you are unsteady on your feet

Pain

Pain may be a side effect of a cancer treatment, caused by surgery or the cancer itself. There are effective treatments for pain control. Often, medicines are used in combination with other treatments for best pain relief.

Tips for dealing with pain:

Keep a diary or journal of your pain
Call your doctor or nurse if you have new pain or pain that is not controlled by your pain medication within 24 hours
Take your pain medication as prescribed.
Do not let the fear of addiction cause you to not take your pain medication as prescribed

Sexuality and Reproductive Issues

Cancer treatment can cause physical, hormonal and emotional changes that affect your sexual drive and raise issues of fertility. Don't let your treatment related fatigue, surgical pain or other side effects take away from nurturing your relationship with your partner.

There are many ways to handle the potential reproductive issues you may have at this time.

Dealing with sexuality and reproductive issues

Bring your partner with you to doctor or nurse appointments.
Talk openly with your doctor or nurse about your concerns.
Talk with your partner about your hopes, concerns, fears and needs.
Practice birth control during treatment.
Discuss sperm banking, egg retrieval or embryo freezing with your doctor before starting treatment.
If you are experiencing hormonal changes from treatment (hot flashes, vaginal dryness, or inability to achieve an erection) talk with your doctor about treatment to manage these side effects.