What side effects are possible?

The side effects that you might experience from chemotherapy depend on the drugs you receive and how they affect you. Most side effects stay relatively steady throughout the treatment course. Ask your specialist or nurse what to expect and how to deal with it.

Most side effects are only temporary, they are not experienced between treatments and usually disappear shortly after the treatment stops. However, some side effects are permanent. Ask your specialist if you are likely to get any permanent effects. 

Listed below are the more common side effects and ways that can help you deal with them. You probably won't get all of them, but tell your doctor or nurse about any that you do, as they need to know how you are coping with the drugs. They may be able to help control the side effects, or they may want to change the treatment to try to avoid them.

Chemotherapy mainly affects parts of the body where normal cells rapidly divide and grow. These include the lining of the mouth, skin and hair, the digestive system, the testes and the bone marrow.

Changes to bone marrow

Bone marrow is the spongy tissue that fills the hollow cavities of many of the flat bones of the body. It produces new blood cells. The effect of chemotherapy is to reduce the number of blood cells produced by the bone marrow.

Effects of chemotherapy on blood cells

White cells: Essential for fighting infections.
Chemotherapy: You will be at increased risk of infection – have not enough white cells to fight bacteria.

• If your temperature is 38 degrees or more, or you feel unwell even with a normal temperature, call your cancer doctor or nurse.
• Other signs of infection include swelling, redness, or pain. Don’t ‘wait to see what happens’. Follow the advice of your medical team.
• You may need to go to hospital for intravenous antibiotics.

Red cells: Contain the red iron-rich pigment haemoglobin to carry oxygen around the body.
Chemotherapy: You may feel tired, low in energy, dizzy, light-headed, and breathless – all symptoms of anaemia.

• Let your cancer doctor or nurse know if you have any of these symptoms. You may need a blood transfusion.
• Conserve your energy where you can. Talk to your doctor or nurse about ways to manage fatigue.

Platelets: Help the blood to clot and prevent bleeding.
Chemotherapy: You will be at increased risk of bleeding, and will bruise easily.

• Contact your cancer doctor or nurse immediately if you have any unexplained bleeding or bruising.
• You may need a platelet transfusion.

Infection and fever

A fever can be a sign that your body has an infection. Fevers can also cause other problems, such as chills, shivering and headaches.  It is important, therefore, to investigate the cause of infection and to treat it appropriately.

It is also possible to have an infection but to not have a fever, just to feel unwell. In either case, contact your doctor immediately.

If fever develops (if your temperature is 38 degrees or over) or you feel unwell, even with a normal temperature, don't wait to see what happens - take action quickly. Contact your cancer doctor or nurse and follow the advice given.

Myths about fever

Be careful not to believe these myths about fever:
1. ‘Fevers come and go – it’s best just to let them run their course.’ FALSE.
Fevers are always an indication that something is wrong, and should be treated and reported. If they get too high, they can lead to dehydration and seizures. When someone is undergoing chemotherapy or radiation therapy, fevers often indicate infection, which is serious and requires medical attention.

2. ‘Fevers help burn up whatever is wrong.’ FALSE.
High fevers do not destroy bacteria that cause infection. This is why your doctor or healthcare team will treat both the fever and the possible infection – if your white blood cell count is low, your body will not be able to fight off the infection on its own.

Feeling tired

Fatigue/tiredness is a very common side effect of chemotherapy.  If you do get tired, try to take things easier. Only do as much as you feel comfortable doing. Try to plan rest times in your day. Also try to ensure you are drinking plenty of fluids, eating well and having some form of physical activity. This will help you cope better with the treatment.

Don't be afraid to ask for some help. Family, whanau, friends and neighbours may be happy to have the chance to help you - tell them how they can help.

If you're not sleeping well, tell your doctor or nurse. They may be able to suggest ways to help, or prescribe sleeping tablets or a mild relaxant.

Feeling sick or vomiting

Not everyone feels sick after chemotherapy and anti-sickness medication has greatly improved over the past decade. If you do feel sick you'll find that it usually occurs several hours after treatment and may last for a few hours.

Anti-nausea medication is frequently given to prevent sickness occurring. It is important to take your medication for nausea exactly as prescribed. Check with your doctor or nurse if you can drive while on this medication. If nausea or vomiting persists longer than 24 hours, contact your doctor.

If you feel sick, try some of these ideas:

• if you feel sick before treatments, eat lightly before each treatment
• eat smaller amounts more often
• eat slowly and chew well to help you digest your food better
• eat your main meal at the time of the day when you feel best
• try not to eat fatty things
• eat dry toast or crackers - they often help
• drink clear, cool and unsweetened drinks like apple juice
• don't do anything too strenuous after a meal, but try not to lie down for at least two hours after a meal
• try breathing deeply through your mouth whenever you feel like being sick
• if cooking or cooking smells make you feel sick, ask others to cook for you, or prepare meals between treatments and freeze them
• ask the nurse or hospital social worker where you can learn relaxation or meditation methods.

Not wanting to eat

You may have no problems with your appetite during treatment, or you may not feel like eating at all. Your sense of taste may change. This change can last for the duration of chemotherapy but will then return to normal once chemotherapy stops.

Changes to your appetite can be because of your treatment, your cancer or just because of the whole experience of having cancer and being treated for it.

Whatever your experience, do try to eat as well as possible during your treatment to maintain your energy levels and avoid weight loss. If you don't feel like eating, try different foods until you find foods that you want to eat.

Eat smaller amounts more often, or try drinking special liquid supplement foods that you can get from your pharmacist. Even when you are unable to eat very much it is important to drink plenty of clear fluids.

Your hospital may have its own diet information for cancer patients. You can also talk to the hospital or community dietitian for advice about what to eat.

Weight gain

Some people gain weight during chemotherapy. Talk to a dietitian if this becomes a problem for you. Any weight gained during chemotherapy can be due to medication, but usually comes off when treatment stops.

Hair loss

Some people don't lose their hair, while others lose all their head and body hair. Whether this happens to you depends on what drugs you are given. Ask your specialist if you are likely to lose your hair.

Your hair may start to fall out two to three weeks after the first treatment or it may not fall out for quite a while. Your scalp may feel hot or itchy just before it starts to fall out. You might want to wear a hairnet at night to catch all the hairs, or use a mini vacuum to clean the hairs from your pillow.

Your hair will grow back again when your treatment stops. It takes between four and 12 months to grow back a full head of hair. It is possible your new hair may be a different texture or colour. Your scalp may be quite itchy as your hair grows back. Frequent shampooing can help.

Many people find losing their head hair very upsetting. Try to remember that it will grow back. Until it does, you might want to wear a wig. It's a good idea to get a wig fitted before you start losing your hair, so that it matches as closely as possible your style and colour. You may want to get your hair cut shorter so that it fits better under a wig. Spend some time choosing one that suits you.

The Government helps pay the cost of a wig. You must get a certificate from your doctor that states you are entitled to a wig. Some people don't bother with a wig. They stay bald or cover up with a scarf or hat. What you do is up to you.

There is no medical reason why you have to cover up your head. However, your scalp will be more sensitive to the sun than normal, so you should wear a hat or a high protection sunscreen (SPF 30+) on your scalp when you're in the sun. In the winter your head may feel much colder than it normally would.

Sore or dry mouth or throat

Chemotherapy drugs can give you a sore mouth or mouth ulcers. The cells that make up the lining of your mouth replace themselves very frequently, and so the drugs start acting on them quickly.

It is important to keep your teeth, gums and mouth very clean during your treatment to help stop infections. The nurses can show you how to do this. Use a very soft toothbrush or a cotton bud for your teeth and gums, and avoid vigorous or rough brushing.

If your mouth is very sore or if you get ulcers or thrush (a white coating in the mouth), see your doctor or nurse straightaway for advice on treatment.

Use a mouthwash regularly. Don't use a commercial one because they can be too drying and make your mouth more painful. Ask your doctor or nurse for advice or you can make one yourself by mixing 1 tsp of salt and 1 tsp of baking soda (sodium bicarbonate) in 4 cups of warm water. Use it three times a day after meals or as often as you need to. Your specialist may give you a special liquid mouthwash.

Eat soft foods and have lots to drink. Don't have anything with a high acid level such as grapefruit, tomatoes or oranges and avoid spicy foods and spirits. Use a lip salve or ointment on your lips if they are dry.

If your mouth or throat is dry and you have trouble swallowing, try some of these ideas:

• suck on ice blocks
• drink lots of liquids
• moisten foods with butter
• dunk dry biscuits in tea
• blend foods and eat soups and ice creams
• ask your dentist, doctor or nurse about artificial saliva
• don't smoke.

Itchy skin and other skin problems

Your skin may redden, peel or become dry and itchy. You might get drying and cracking of the fingers around the nails. Your nails may become coloured, brittle and ridged. You may get some acne. Tell your doctor about any skin problems. Use a lotion or cream to stop the dryness. Ask your doctor for something to help if these suggestions don't work.

Your skin may go red or thicken where the injection or the drip goes in. If this happens, tell your doctor or nurse immediately

It's especially important to cover up your skin and use a high protection sunscreen (SPF 30+) in the sun when having chemotherapy.

Bowel problems

If you have bowel problems, try the following suggestions. If problems persist, tell your doctor.

If you get diarrhoea:

• drink between meals to replace lost fluids
• eat small frequent meals
• avoid seeds, pips and skins in fruit, vegetables and grains
• avoid cow's milk. Lactose (milk sugar) in milk can cause cramping pains and diarrhoea. Mild cheese and yoghurt are low in lactose and can be eaten.

If you are constipated:

• drink at least six to eight cups of fluid (1500ml) each day
• eat regular meals. Don't miss breakfast
• add extra fibre to your food. For example, add wheat bran flakes to your breakfast cereal or use it in cooking.

Related topics

What is chemotherapy? See Chemotherapy

What about food and cancer treatment? For advice about your diet, see Eating well when you have cancer

What about sex if you have cancer? For information on how sexual practices may be affected, see Cancer and sex

Original material provided by the Cancer Society of New Zealand, 2006. Reviewed by everybody, September 2008.