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
- Hair Loss
- Low Red Blood Cells (Anemia)
- Low White Blood Cells (neutropenia)
- Bone Pain with Neulasta
- Low Platelets or Bleeding
- Mouth and Throat Changes
- Nausea and Vomiting
- Skin and Nail Changes
- Urinary 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.
- Eat 5-6 small, light meals or snacks instead of 3 large, heavy meals per day
- Schedule meal and/or snack times to remind you to eat, as you may not feel hungry
- Use plastic forks and/or spoons to reduce metallic taste
- Eat meals with family or friends when possible
- Increase activity
- Limit fluid intake just prior to meals to avoid satiety
- Consider your needs and adjust foods accordingly, such as:
- Soft, bland foods for mouth pain
- Bland, cool foods for nausea (warm foods have stronger smells)
- Clear liquids or B.R.A.T. diet for diarrhea
- Minimal prep time for patients with fatigue
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 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.
- Check with your doctor before using fiber supplements, laxatives, stool softeners, or enemas. Do not use suppositories, enemas, or anything that must be inserted into the rectum if your white blood cells or your platelets are low.
- Call your doctor if you have not had a bowel movement in greater than 3 days.
- Notify your doctor immediately if you have constipation that is associated with abdominal pain and vomiting.
- Keep a record of your bowel movements to ensure you are having a bowel movement every 2-3 days.
- Stay hydrated.
- Be active.
- High-fiber diet.
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.
- Drink 8-12 cups of room temperature, non-carbonated clear liquids daily (water, Gatorade, ginger ale)
- Graduated diet
- Clear liquids (popsicles, jello, broth)
- BRAT diet (Bananas, Rice, Applesauce, Toast)
- If tolerated, may advance to regular diet
- Avoid foods high in fiber, sugar, fat, and caffeine, as well as milk products, while you are having diarrhea
- Increase your intake of foods high in sodium and potassium
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.
- Plan short naps during the day
- Get at least 8 hours of sleep at night
- Maintain adequate nutrition and hydration
- Find ways to decrease stress
- Delegate tasks
- Consider an abbreviated work schedule if possible
- Don’t overdo it!
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.
- Buy a wig while you still have hair (many insurance companies will cover the cost of a wig with a prescription from your doctor)
- Cut your hair short or shave your head
- Use mild shampoos and be gentle when washing your hair
- Do not use items that can harm your scalp (curling irons, hair dryers, dyes, perms)
After hair loss:
- Protect your scalp- wear sunscreen and/or a hat
- Stay warm- wear a turban, scarf, or hat
- Try a satin pillowcase- this causes less friction against a sensitive scalp
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.
- It is very important for you or your partner to avoid becoming pregnant while you are on chemotherapy. Chemotherapy drugs can be harmful to the baby, especially in the first three months of pregnancy.
- Always use protection. In women, birth control in combination with condoms can be used. If you, or your partner, have breast cancer, a diaphragm and condoms should be used. Men should always use condoms.
- If you are having difficulty with vaginal dryness, ask your doctor about medications that can be used to make intimacy more comfortable and to help avoid infections.
- Coping with hot flashes:
- Dress in layers
- Stay active
- Reduce stress
- Ask your doctor about medications that can help with hot flashes
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.
- Tell your doctor if you may want to have children in the future before starting treatment. There are programs available that can preserve a woman’s eggs or a man’s sperm so that pregnancy can be an option after treatment is complete.
- Avoid pregnancy during chemotherapy treatment, as the medications used can be harmful to the baby and cause birth defects.
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.
- Limit activities- ask family/friends for help
- Rest when your body tells you to
- Eat a balanced diet, drink plenty of fluids
- Stand up/move slowly to avoid dizziness/falls
Contact your doctor if you have any of the following symptoms:
- Chest Pain (emergency room)
- Shortness of breath (emergency room)
- Dizziness or feeling faint
- Fatigue prevents you from doing your usual daily activities
- Fast or pounding heartbeat
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.
- Wash your hands often with soap and warm water
- Use hand sanitizer and/or sanitizer wipes when in public places
- Stay away from people who are sick
- Stay out of large crowds, particularly in enclosed spaces
- Good mouth care- this is the dirtiest part of the body!
- Good skin care
- Be gentle- PAT, do not rub or scratch
- Use moisturizer regularly
- Clean cuts/scrapes right away
- Avoid cuts/nicks- electric razor, do not trim cuticles
- Food safety
- Do not eat raw or undercooked meat, seafood, or eggs
- Wash fresh fruits and vegetables before eating
- Store your food at proper temperature
- Avoid changing litter boxes or cleaning up dog waste, bird cages, or fish tanks
- Do not get a flu shot or other vaccines without asking your doctor first
Call your doctor with any of the following symptoms:
- Fever 100.5, chills, or sweats
- Redness or tenderness around central line
- Productive cough
- Sinus pain or pressure
- Painful urination or frequent need to urinate
- Bloody, foul smelling, or cloudy urine
- Redness, swelling
- Stiff neck
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.
- Zyrtec 10mg (generic is fine) by mouth twice daily for 5 days starting the night prior to the injection, to help reduce tenderness”. This is an over-the-counter medication that can be purchased at most pharmacies and/or large retailers.
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.
- Use a soft bristle toothbrush
- Blow your nose gently
- Avoid cuts or nicks
- Use an electric razor
- Apply gentle, firm pressure to cuts or scrapes to stop bleeding if it occurs
- Be gentle with hemorrhoids
- Avoid enemas or suppositories when your platelets are low
- Avoid alcohol while your platelets are low (thins blood)
- Ask your doctor before taking vitamins, supplements, aspirin, herbs, or over the counter medicines while your platelets are low
Call your doctor if you have any of the following symptoms:
- Multiple small, red dots on your skin
- Unusual bruises
- Bleeding that does not stop with firm pressure
- Black or bloody stools
- Bloody or pink urine
- Heavy or prolonged menstrual period
- Severe headache or sleepiness when platelets are low
- Changes in vision when platelets are low
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:
- Dry Mouth
- Mouth sores
- Difficulty eating or drinking due to mouth pain
- Bleeding gums when your counts are low
- Infections of the gums or teeth
- Changes in the way foods taste or smell
- Schedule a dental visit 2 weeks prior to chemotherapy if possible. Inform your dentist if you are undergoing chemotherapy.
- Practice good dental hygiene
- Use a soft bristle toothbrush and baking soda toothpaste recommended
- Brush three times daily, followed by a baking soda and salt water rinse
- Avoid mouthwashes with alcohol, as they may cause discomfort. Try making baking soda mouthwash: ¼ tsp baking soda and 1/8 tsp salt per 1 cup of water
- Ensure that dentures are well-fitting, limit length of wear if needed
- Eat soft, bland foods if you have mouth pain
- Avoid citrus, spicy, sharp/crunchy, or salty foods to avoid further discomfort
- Do not use tobacco or use alcohol if you have mouth pain
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 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.
- Prevent it
- Plan meals and snacks
- Eat small, light meals and snacks
- Stay away from foods/drinks that have strong smells
- Avoid foods/drinks that are very hot or very cold
- Take nausea medicines as prescribed by your physician
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.
- Be careful handling sharp objects (knives, scissors)
- Avoid falls- walk slowly, use handrails, remove trip hazards
- Use a cane or other device to steady yourself when walking if your feet are numb
- Wear shoes with rubber soles and put no-slip mats in your tub or shower
- Use caution when handling hot objects, test the temperature of bath water with a thermometer
- Wear gloves when working in the garden, cleaning, or washing dishes
- Avoid temperature 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:
- Itching, dryness, rashes, and peeling
- Dark veins
- Sensitivity to the sun
- Darkened, yellow, or brittle nails, or nails that loosen or fall off
Major skin changes, however, should be treated right away to avoid life-long damage. Examples of major skin changes include:
- Radiation recall
- Chemotherapy that leaks under the skin from your IV
- Allergic reactions to chemotherapy
- Hand-foot syndrome
- Irritated skin:
- Quick showers instead of long hot showers or baths
- Use a mild, moisturizing soap
- Apply a good cream or lotion while your skin is still damp after washing
- Avoid products containing alcohol (aftershave, perfume, cologne)
- Colloidal oatmeal baths
- Acne :
- Do not use over the counter acne products (too drying)
- Keep your face clean and dry
- Ask your doctor about medicated creams or gels
- Sensitivity to the Sun
- Use sunscreen
- Avoid direct sun between 10 a.m. and 4 p.m.
- Wear a hat with a wide brim, light colored clothing, or long sleeves
- Do not use tanning beds
- Nail Problems:
- Wear gloves when washing dishes, cleaning, or working in the garden
- Use products to make your nails stronger (avoid if irritation occurs)
- Keep cuticles well moisturized
- Radiation Recall
- Protect areas of skin that received radiation from the sun
- Do not use tanning beds
- Cool soaks to painful areas
- Cotton undergarments
Call your doctor if you have one or more of the following symptoms:
- Pain or redness at your IV site during chemotherapy infusion
- Sudden or severe itching, rashes, or hives along with wheezing or shortness of breath, during your chemotherapy infusion
- Develop a new rash, particularly if it is painful
- Cuticles become red, swollen, or painful, or if you notice drainage from around or under your nails
- Blisters, redness, swelling, or cracked skin to the fingertips or palms of your hands or your toes or the soles of your feet
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.
- Your doctor will monitor blood tests regularly that will indicate how well your kidneys are functioning.
- Drink plenty of non-carbonated, caffeine free fluids (water is best)
Call your doctor if you have one or more of the following symptoms:
- Burning or pain with urination
- Frequent or urgent need to urinate
- Not being able to urinate
- Blood in the urine
- Foul smelling or cloudy urine
- Fever and/or chills
- Urine that is orange, red, green, or an unusual color