Chemotherapy Side Effects

Anemia

Anemia is when you have too few red blood cells to carry the oxygen your body needs. Your heart works harder, which can make it feel like your heart is pounding or beating very fast. Anemia can also make you feel short of breath, weak, dizzy, faint or very tired.

Some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells.

Ways to manage:
  • Get plenty of rest. Try to sleep at least 8 hours each night. You might also want to take 1 to 2 short naps (1 hour or less) during the day.
  • Limit your activities. This means doing only the activities that are most important to you. For example, you might go to work but not clean the house. Or you might order take-out food instead of cooking dinner.
  • Accept help. When your family or friends offer to help, let them. They can help care for your children, pick up groceries, run errands, drive you to doctor’s visits, or do other chores you feel too tired to do.
  • Eat a well-balanced diet. Choose a diet that contains all the calories and protein your body needs. Calories will help keep your weight up, and extra protein can help repair tissues that have been harmed by cancer treatment.
  • Stand up slowly. You may feel dizzy if you stand up too fast. When you get up from lying down, sit for a minute before you stand.

Your doctor or nurse will check your blood cell count throughout your chemotherapy. You may need a blood transfusion if your red blood cell count falls too low. Your doctor may also prescribe a medicine to speed up the growth of red blood cells or suggest that you take iron or other vitamins.

Appetite Changes

Chemotherapy can cause appetite changes, either because of nausea, a sore mouth and throat, or drugs that cause you to lose your taste for food. Your loss of appetite may last for a day, a few weeks, or even months.

It is important to eat well, even when you have no appetite. Not eating well can lead to weight loss, weakness, and fatigue. Here are some tips to help you:

  • Eat 5 to 6 small meals or snacks each day instead of 3 big meals. Choose foods and drinks that are high in calories and protein.
  • Set a daily schedule for eating your meals and snacks. Eat when it is time to eat, rather than when you feel hungry. You may not feel hungry while you are on chemotherapy, but you still need to eat.
  • Drink milkshakes, smoothies, juice, or soup if you do not feel like eating solid foods. Liquids like these can help provide the protein, vitamins, and calories your body needs.
  • Use plastic forks and spoons. Some types of chemo give you a metal taste in your mouth. Eating with plastic can help decrease the metal taste. Cooking in glass pots and pans can also help.
  • Increase your appetite by doing something active. For instance, you might have more of an appetite if you take a short walk before lunch. Also, be careful not to decrease your appetite by drinking too much liquid before or during meals.
  • Change your routine. This may mean eating in a different place, such as the dining room rather than the kitchen. It can also mean eating with other people instead of eating alone. If you eat alone, you may want to listen to the radio or watch TV. You may also want to vary your diet by trying new foods and recipes.
  • Talk with your doctor, nurse or dietitian. He or she may want you to take extra vitamins or nutrition supplements. If you cannot eat for a long time and are losing weight, you may need to take drugs that increase your appetite or receive nutrition through an IV or feeding tube.

Bleeding

Platelets are cells that make your blood clot when you bleed. Chemotherapy can lower the number of platelets because it affects your bone marrow’s ability to make them. This condition may cause bruises (even when you have not been hit or have not bumped into anything), bleeding from your nose or in your mouth, or a rash of tiny, red dots.

Do:
  • Brush your teeth with a very soft toothbrush. Soften the bristles of your toothbrush by running hot water over them before you brush
  • Blow your nose gently
  • Use an electric shaver instead of a razor
  • Apply gentle but firm pressure to any cuts you get until the bleeding stops
  • Wear shoes all the time, even inside the house or hospital
  • Let your doctor know if you are constipated. He or she may prescribe a stool softener to prevent straining and rectal bleeding when you go to the bathroom.
Do not:
  • Use dental floss or toothpicks
  • Play sports or do other activities during which you could get hurt
  • Use tampons, enemas or suppositories
  • Wear clothes with tight collars, wrists or waistbands
Check with your doctor or nurse before:
  • Drinking beer, wine or other types of alcohol
  • Having sex
  • Taking vitamins, herbs, minerals, dietary supplements, aspirin or other over-the-counter medicines. Some of these products can change how chemotherapy works.

Constipation

Drugs such as chemotherapy and pain medicine can cause constipation. You may have painful bowel movements and feel bloated or nauseous. You may belch, pass a lot of gas, and have stomach cramps.

Ways to manage:
  • Drink at least 8 cups of water or other fluids each day. Many people find that drinking warm or hot fluids, such as coffee and tea, help with constipation. Fruit juices, such as prune juice may also be helpful.
  • Be active every day. You can be active by walking, riding a bike, or doing yoga. If you cannot walk, ask about exercises that you can do in a chair or bed. Talk with your doctor or nurse about ways you can be more active.
  • Ask your doctor, nurse, or dietitian about foods that are high in fiber. Eating highfiber foods and drinking lots of fluids can help soften your stools. Good sources of fiber include whole-grain breads and cereals, dried beans and peas, raw vegetables, fresh and dried fruit, nuts, seeds, and popcorn.

Diarrhea

Chemotherapy can cause diarrhea because it harms healthy cells that line your large and small bowel. It may also speed up your bowels.

Ways to manage:
  • Eat 5 or 6 small meals and snacks each day instead of 3 large meals.
  • Ask your doctor or nurse about foods that are high in salts such as sodium and potassium. Your body can lose these salts when you have diarrhea, and it is important to replace them. Foods that are high in sodium or potassium include bananas, oranges, peach and apricot nectar, and boiled or mashed potatoes.
  • Drink 8 to 12 cups of clear liquids each day. These include water, clear broth, ginger ale, or sports drinks. Drink slowly, and choose drinks that are at room temperature. Let carbonated drinks lose their fizz before you drink them.
  • Eat low-fiber foods. Foods that are high in fiber can make diarrhea worse. Low-fiber foods include bananas, white rice, white toast, and plain or vanilla yogurt.
  • Let your doctor or nurse know if your diarrhea lasts for more than 24 hours or if you have pain and cramping along with diarrhea. Do not take any medicine for diarrhea without first asking your doctor or nurse.

Hair Loss

Some types of chemotherapy damage the cells that cause hair growth. Hair loss can happen anywhere on your body: your head, face, arms, legs, underarms, or the area between your legs. Many people are upset by the loss of their hair and find it the most difficult part of chemotherapy.

Hair loss often starts 2 to 3 weeks after chemotherapy begins. Your scalp may hurt at first. Then you may lose your hair, either a little at a time or in clumps. Almost always, your hair will grow back 2 to 3 months after chemotherapy is over.

Before hair loss:
  • Cut your hair short or shave your head. You might feel more in control of hair loss if you first cut your hair or shave your head. This often makes hair loss easier to manage. If you shave your head, use an electric shaver instead of a razor.
  • If you plan to buy a wig, do so while you still have hair. The best time to choose your wig is before chemotherapy starts. This way, you can match the wig to the color and style of your hair. You might also take it to your hair dresser who can style the wig to look like your own hair. Make sure to choose a wig that feels comfortable and does not hurt your scalp.
  • Ask if your insurance company will pay for a wig. If it will not, you can deduct the cost of your wig as a medical expense on your income tax. Some groups also have free “wig banks.” Your doctor, nurse, or social worker will know if there is a wig bank near you.
  • Be gentle when you wash your hair. Use a mild shampoo, such as a baby shampoo. Dry your hair by patting (not rubbing) it with a soft towel.
After hair loss:
  • Protect your scalp. Your scalp may hurt during and after hair loss. Protect it by wearing a hat, turban, or scarf when you are outside. Try to avoid places that are very hot or very cold. This includes tanning beds and outside in the sun or cold air. And always apply sunscreen or sunblock to protect your scalp.
  • Stay warm. You may feel colder once you lose your hair. Wear a hat, turban, scarf, or wig to help you stay warm.
  • Sleep on a satin pillow case. Satin creates less friction than cotton when you sleep on it. Therefore, you may find satin pillow cases more comfortable.

Infection

Some types of chemotherapy make it harder for your bone marrow to produce new white blood cells to help your body fight infection. Therefore, it is important to avoid infections during your cancer treatment.

Your doctor or nurse will check your white blood cell count throughout your treatment. If chemotherapy is likely to make your white blood cell count very low, you may get medicine to raise your white blood cell count and lower your risk of infection.

  • Wash your hands often with soap and water.
    Be sure to wash your hands before cooking and eating, and after you use the bathroom, blow your nose, cough, sneeze, or touch animals. Carry hand sanitizer for times when you are not near soap and water.
  • Watch for signs of infection around your catheter.
    Signs include drainage, redness, swelling, or soreness.
  • Take good care of your mouth.
    Brush your teeth after meals and before you go to bed. Use a very soft toothbrush. Use a mouth rinse that does not contain alcohol. Check with your doctor or nurse before going to the dentist.
  • Take good care of your skin.
    Do not squeeze or scratch pimples. Use lotion to soften and heal dry, cracked skin. Dry yourself after a bath or shower by gently patting (not rubbing) your skin.
  • Be careful around animals.
    Do not clean your cat’s litter box, pick up dog waste or clean bird cages or fish tanks. Be sure to wash your hands after touching pets and other animals.
  • Do not get a flu shot or other type of vaccine without first asking your doctor or nurse. Some vaccines contain a live virus, which you should not be exposed to.
Signs of infection include:
  • Fever of 100.5°F or higher
  • Redness
  • Swelling
  • Rash
  • Chills
  • Cough
  • Earache
  • Headache
  • Stiff neck
  • Bloody or cloudy urine
  • Painful or frequent need to urinate
  • Sinus pain or pressure

Infertility

Some types of chemotherapy can cause infertility by damaging the ovaries or causing early menopause in women, or by damaging sperm in men. Whether or not you become infertile depends on the type of chemotherapy you get, your age, and whether you have other health problems.

Before treatment, talk with your doctor or nurse about:
  • Whether you want to have children. Before you start chemotherapy, let your doctor or nurse know if you might want to get pregnant in the future. He or she may talk with you about ways to preserve your eggs to use after treatment ends or refer you to a fertility specialist.
  • Birth control. It is very important that you or your partner not get pregnant while getting chemotherapy. These drugs can hurt the fetus, especially in the first 3 months of pregnancy.
  • Pregnancy. If you are female, your doctor or nurse may ask you to take a pregnancy test before you start chemotherapy. If you are pregnant, your doctor or nurse will talk with you about other treatment options.

Mouth & Throat Changes

Some types of chemotherapy harm fast-growing cells, such as those that line your mouth, throat, and lips. This can affect your teeth, gums, the lining of your mouth, and the glands that make saliva. Most mouth problems go away a few days after chemotherapy is over.

Mouth and throat problems may include:
  • Dry mouth (having little or no saliva)
  • Changes in taste and smell (such as when food tastes like metal or chalk, has no taste, or does not taste or smell like it used to)
  • Infections of your gums, teeth, or tongue
  • Increased sensitivity to hot or cold foods
  • Mouth sores that cause trouble eating
Ways to manage:
  • Visit a dentist at least 2 weeks before starting chemotherapy. It is important to have your mouth as healthy as possible. This means getting all your dental work done before chemotherapy starts. If you cannot go to the dentist before chemotherapy starts, ask your doctor or nurse when it is safe to go. Be sure to tell your dentist that you have cancer and about your treatment plan.
  • Check your mouth and tongue every day. This way, you can see or feel problems (such as mouth sores, white spots, or infections) as soon as they start. Inform your doctor or nurse about these problems right away.
  • Keep your mouth moist. You can keep your mouth moist by sipping water throughout the day, sucking on ice chips or sugar-free hard candy, or chewing sugar-free gum. Ask your doctor or nurse about saliva substitutes if your mouth is always dry.
  • Clean your mouth, teeth, gums, and tongue.
  • Brush your teeth, gums, and tongue after each meal and at bedtime.
  • Use an extra-soft toothbrush. You can make the bristles even softer by rinsing your toothbrush in hot water before you brush.
  • If brushing is painful, try cleaning your teeth with cotton swabs.
  • Use a fluoride toothpaste or special fluoride gel that your dentist prescribes.
  • Do not use mouthwash that has alcohol. Instead, rinse your mouth 3 to 4 times a day with a solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup of warm water. Follow this with a plain water rinse.
  • Gently floss your teeth every day. If your gums bleed or hurt, avoid those areas but floss your other teeth. Ask your doctor or nurse about flossing if your platelet count is low.
  • If you wear dentures, make sure they fit well and keep them clean. Also, limit the length of time that you wear them.
Stay away from things that can hurt, scrape, or burn your mouth, such as:
  • Sharp or crunchy foods, such as crackers and potato or corn chips
  • Spicy foods, such as hot sauce, curry dishes, salsa, and chili
  • Citrus fruits or juices such as orange, lemon, and grapefruit
  • Food and drinks that have a lot of sugar, such as candy or soda
  • Beer, wine, and other types of alcohol
  • Toothpicks or other sharp objects
  • Tobacco products, including cigarettes, pipes, cigars, and chewing tobacco

Nervous System Changes

Chemotherapy can cause damage to your nervous system. Many nervous system problems get better within a year of when you finish chemotherapy, but some may last the rest of your life.

Symptoms may include:
  • Tingling, burning, weakness, or numbness in your hands or feet
  • Feeling colder than normal
  • Pain when walking
  • Weak, sore, tired, or achy muscles
  • Being clumsy and losing your balance
  • Trouble picking up objects or buttoning your clothes
  • Shaking or trembling
  • Hearing loss
  • Stomach pain, such as constipation or heartburn
  • Fatigue
  • Confusion and memory problems
  • Dizziness
  • Depression
Ways to manage:
  • Let your doctor or nurse know right away if you notice any nervous system changes. It is important to treat these problems as soon as possible.
  • Be careful when handling knives, scissors, and other sharp or dangerous objects.
  • Avoid falling. Walk slowly, hold onto handrails when using the stairs, and put no-slip bath mats in your bathtub or shower. Make sure there are no area rugs or cords to trip over.
  • Always wear sneakers, tennis shoes or other footwear with rubber soles.
  • Check the temperature of your bath water with a thermometer. This will keep you from getting burned by water that is too hot.
  • Wear gloves when working in the garden, cooking, or washing dishes.
  • Steady yourself when you walk by using a cane or other device.
  • Talk to your doctor or nurse if you notice memory problems, feel confused, or are depressed.

Other Side Effects

Flu-like symptoms

Some types of chemotherapy can make you feel like you have the flu. Symptoms may last from 1 to 3 days. An infection or the cancer itself can also cause them. Let your doctor or nurse know if you have any of these symptoms.

Fluid retention

Fluid retention can be caused by chemotherapy, hormone changes, or your cancer. It can cause your face, hands, feet, or stomach to feel swollen and puffy. Sometimes fluid builds up around your lungs and heart and can cause coughing, shortness of breath, or an irregular heartbeat. Fluid can also build up in the lower part of your belly, which can cause bloating.

You and your doctor or nurse can help manage fluid retention by:
  • Weighing yourself at the same time each day, using the same scale. Let your doctor or nurse know if you gain weight quickly.
  • Avoiding table salt or salty foods
  • Limiting the liquids you drink
  • If you retain a lot of fluid, your doctor may prescribe medicine to get rid of the extra fluid.
Eye changes
  • Trouble wearing contact lenses. Some types of chemotherapy can bother your eyes and make wearing contact lenses painful. Ask your doctor or nurse if you can wear contact lenses while getting chemotherapy.
  • Blurry vision. Some types of chemotherapy can clog your tear ducts, which can cause blurry vision.
  • Watery eyes. Sometimes, chemotherapy can seep out in your tears, which can cause your eyes to water more than usual.
    If your vision gets blurry or your eyes water more than usual, tell your doctor or nurse.