Side Effects of Chemotherapy

The effects of chemotherapy will be different for each patient. What one patient may tolerate, another cannot. The types and intensity of chemo side effects will depend on the location and stage of the cancer and the overall health of the patient. Researchers are continuously developing new drugs and different ways to administer current drugs in order to reduce side effects. Some common side effects of chemotherapy include:

Table of Contents

Appetite Changes

Chemotherapy may affect your appetite, or your desire to eat or drink. Factors causing poor appetite may be nausea, mouth or throat pain, fatigue, or depression. Some chemotherapy drugs can also affect the way certain foods taste.

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If initial interventions such as those above do not work for you, talk to your doctor about a possible consultation with a dietician or the use of appetite stimulants.

Constipation

Constipation is when bowel movements become less frequent and stools are hard, dry, and difficult to pass. Under normal circumstances, you should have a soft bowel movement about every 2-3 days. When you are constipated, you may feel bloated or nauseated. You may also belch, pass gas, or have stomach cramps and or pressure in your rectum. Many drugs used in the treatment of your cancer may cause constipation, including chemotherapy, pain medicine, and nausea medicine. Constipation can also be caused by inactivity, dehydration, or a low fiber diet.

If you are regularly taking pain medications, talk with your doctor about a bowel maintenance regimen.

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Diarrhea

Diarrhea is defined as frequent bowel movements that may be loose or watery. Chemotherapy may cause diarrhea due to its effects on the lining of your digestive tract. Diarrhea can also be caused by an infection or medications you are on, such as antibiotics and/or medicines used to treat constipation. It is important to let your doctor know if you are having more than 3 loose, watery stools in a 24 hour period, or if you have diarrhea associated with abdominal pain or cramping. Do not take ANY medications for new symptoms of diarrhea without first contacting your Nurse Navigator or Physician.

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Fatigue

Fatigue is often described as weakness, lack of energy, or feeling heavy or slow. It can occur in varying intensities, from mild to severe. Fatigue is one of the most common side effects of chemotherapy. It can be caused or worsened by many factors, such as: anemia, poor nutrition, dehydration, lack of exercise, shortness of breath, infection, over-exertion, lack of sleep, or medications. Chemotherapy-induced fatigue is not always relieved with rest.

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Hair Loss

Hair loss, also known as alopecia, is when some or all of your hair falls out as a result of damage to the cells that cause hair growth while undergoing chemotherapy. This can happen to hair anywhere on your body, including your face (eyebrows and eyelashes), arms, legs, and pubic area. Hair loss generally begins about 2-3 weeks after starting chemotherapy, and it takes about one week for all hair to fall out. You may notice some scalp tenderness just before the hair begins to come out. Your hair will almost always grow back within 2-3 months. Often, when your hair comes back, it may have a different color or texture.

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After hair loss:

Intimacy

Chemotherapy can lead to sexual changes in men and women which may impact intimate relationships. In women chemotherapy may damage the ovaries, leading to decreased hormone levels or even early menopause. Symptoms of decreased hormone production or menopause may include hot flashes, vaginal dryness, irritability, irregular or no menstrual periods, bladder or vaginal infections, or a decreased interest in sex. Symptoms for men may include inability to reach climax, impotence, or a decreased interest in sex.

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Infertility

Certain types of chemotherapy can cause infertility due to damage to the ovaries in women, or damage to the sperm in men. This means that you or your partner may not be able to become pregnant, and this may last the rest of your life. Not all treatments cause infertility.

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Low Red Blood Cells (Anemia)

Anemia is when you have too few red blood cells to carry the oxygen your body needs. This can make your heart work harder, causing it to “pound” or beat faster than usual. You may feel very tired, short of breath, or dizzy. Many types of chemotherapy can make it harder for your bone marrow to make new red blood cells, putting chemotherapy patients at risk for anemia. Your doctor will check your blood counts to evaluate for low red blood cells.

Tips:

Contact your doctor if you have any of the following symptoms:

Low White Blood Cells (neutropenia)

White blood cells help your body defend itself from infection. Some types of chemotherapy affect your body’s ability to make white blood cells, which can cause them to become low after treatment. This is called neutropenia. Your doctor will check your blood counts during your chemotherapy treatment to evaluate for low white blood cells. It is important to avoid infections while your white blood cells are low. If you have a fever higher than 100.5, hard shaking chills, or other signs of infection, contact your physician as soon as possible. Your doctor may give you a shot to help bring your white blood cells back up more quickly after a chemotherapy treatment, called Neulasta or Neupogen. It is important to remember that even if you get one of these shots, your white blood cells still may drop, so infection precautions still apply.

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Call your doctor with any of the following symptoms:

Bone Pain with Neulasta

Your doctor may prescribe an injection the day following your chemotherapy called Neulasta in order to prevent your white blood cells from becoming extremely low. This medication is given as a one-time injection in the back of your arm or in your abdomen. Neulasta has a very common side effect of bone pain. Because your large bones (sternum, ribs, pelvis, femurs) are bone marrow production sites, you may notice some achiness in these areas for up to 5 days following a Neulasta injection.

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Low Platelets or Bleeding

Platelets are the blood cells that make your blood clot to stop bleeding. Chemotherapy can affect your body’s ability to make platelets, causing them to become low after a treatment. This is called thrombocytopenia. When your platelets are low, you may bruise easily or bleed from your nose or in your mouth/gums. You may also develop a rash of tiny bright red dots called petechiae. Your doctor will check your blood counts during your treatment to evaluate for low platelets.

Tips:

Call your doctor if you have any of the following symptoms:

Mouth and Throat Changes

Many types of chemotherapy target fast-growing cells, which helps to fight your cancer. This can attack normal fast-growing cells too, such as the ones that line your mouth, throat, and lips. Teeth, gums, and the glands that make saliva can also be affected. Common problems with the mouth and throat may include:

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If you have mouth pain, ulcers, or white patches in your mouth, call the office. Sometimes this is an indication that your blood counts may be low. Special combination mouthwashes are available by prescription that may help treat the pain so that you can eat or drink.

Nausea and Vomiting

Nausea is when you feel sick at your stomach, vomiting is when you throw up. Dry heaves can occur when your body tries to vomit, but your stomach is empty. Some types of chemotherapy (not all) may cause nausea and/or vomiting. This can occur as early as the same day of your treatment, and as late as several days later.

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Neuropathy

Some types of chemotherapy can cause damage to your nervous system. This can cause numbness, tingling, or pain, most often affecting the hands and/or feet. This is called neuropathy. Other types of neuropathy can cause cold sensations, balance issues, hearing loss, or gastrointestinal difficulties such as constipation or heartburn. Most commonly, neuropathy improves within a year of stopping chemotherapy. There are some chemotherapy drugs, however, that can cause neuropathy long term, even lifelong. It is important to let your doctor know if you experience any form of neuropathy. There are medications available to help with neuropathy that is uncomfortable, and your chemotherapy dose may need to be adjusted to prevent worsening of your symptoms.

Let your doctor know if you have any pre-existing neuropathy (like diabetes) before you start your treatment.

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Skin and Nail Changes

Some types of chemotherapy can cause damage to the fast growing cells in your skin and nails. These changes may be distressing due to the changes in your appearance, but keep in mind that most are temporary and do not require treatment other than good hygiene.

Minor skin changes can include:

Major skin changes, however, should be treated right away to avoid life-long damage. Examples of major skin changes include:

Tips:

Call your doctor if you have one or more of the following symptoms:

Urinary Changes

Certain types of chemotherapy can damage cells in the kidney or bladder. It is important to drink plenty of fluids if you are getting chemotherapy that may damage the kidneys or bladder, starting the day before chemotherapy and in the days following. Some chemotherapy drugs may change the color of your urine. Your doctor or nurse will let you know if you are receiving one of these drugs so that you will know what to expect.

Tips:

Call your doctor if you have one or more of the following symptoms: