Chemotherapy: tips for managing side effects | Cancer Council

The most important effect of chemotherapy is that it kills cancer cells. However, chemotherapy can also affect normal cells that rapidly divide and grow, such as those in the bone marrow, digestive tract, skin, hair and reproductive organs. When the normal cells are damaged, this can cause side effects.

This chapter discusses the most common side effects people experience and offers suggestions to help manage them.

• It is natural to worry about side effects. However, whether or not you experience side effects, and how severe they are, depends on the type of drugs you?ve been prescribed and how you react individually from one treatment period to the next.

• Side effects vary greatly. Some people will have no side effects, others will experience a range. If you have side effects, they will usually start during the first few weeks of treatment.

• Most side effects are temporary and can be managed. They tend to gradually disappear once treatment has stopped.

You should talk to your doctor or nurse before your treatment begins about the side effects you should watch out for or report, and who to contact out of hours if you have immediate concerns.

If the side effects impact on your appearance and self-esteem, you may find it helpful to attend a free Look Good...Feel Better program, which teaches you about using skin care, hats, wigs and cosmetics.

Chemotherapy diary

It can be useful to record information about your chemotherapy treatment in one place so you recall details about any side effects you?re experiencing and what helped to reduce them. Some people like to write down notes. Other people choose to record things another way ? for example, by using their smartphone.

Share the information you record with your doctors and nurses so that they can give you suggestions for dealing with side effects or adjust your treatment, if appropriate.

Feeling tired and lacking energy (fatigue) is the most common ? and often, debilitating ? side effect of chemotherapy. Fatigue can include feeling exhausted, drowsy, confused or impatient. You may have a heavy feeling in your limbs, or find it difficult to do daily activities.

Fatigue can appear suddenly and rest may not relieve it. You might still feel tired for weeks or months after a treatment cycle ends.

Tips?

• Save your energy. Help your body recover by doing less and resting more.

• Let people help you. Family, friends and neighbours often want to assist but may feel unsure about what to do. They could help with shopping, child-care, driving or housework.

• If you are employed, consider whether you could take some time off, reduce your hours or work from home during or after chemotherapy. Some workplaces might allow you to work flexibly around your treatment.

• If there is a time during the day when you tend to feel most energetic, try to plan activities during this time.

• Do light exercise, such as walking. If you have a normal exercise routine and you feel up to it, ask your doctor if you can exercise.

• Don?t start any new exercise activities until you have recovered from treatment.

• Try to get more sleep at night and take naps during the day if you can.

• If you aren?t sleeping well, tell your health care team. Only take sleeping pills that are recommended or prescribed by your doctor.

• Some people benefit from doing relaxation or meditation exercises.

• Try to eat a healthy, well- balanced diet with plenty of fruits and vegetables.

• If you have a poor appetite, nausea or vomiting, see below or read the Food and Cancer information.

• Check with your doctor whether your fatigue is related to low red blood cells (anaemia) so that this can be treated.

It is common for your appetite to change when you are going through chemotherapy. Sometimes you may not feel hungry, or you may not enjoy the foods you used to like. Some treatments temporarily change the taste of foods.

Chemotherapy may make you feel sick (nauseous) or vomit. Not everyone feels sick during or after chemotherapy, but if nausea affects you, it usually starts a few hours after treatment. Nausea may last for many hours and be accompanied by vomiting or retching.

Anti-nausea or anti-vomiting medication can help. This medicine can be taken before, during or after treatment. It may be available as:

• injections ??usually given before chemotherapy
• tablets ??can be taken regularly at home
• wafers ??dissolved under or on top of the tongue
• suppositories ??placed in the rectum where they dissolve
• liquids ??added to the chemotherapy.

Your medical oncologist will tell you if the drugs you are given are likely to cause nausea and vomiting. You may be prescribed medication in advance so you don?t experience the side effects, or so they are reduced. It may take some time before you find a medication that works for you, so let your nurse or doctor know?if you still have nausea after a few days taking the medication or if you have vomited for more than 24 hours.

Trying to eat as well as possible will help you recover sooner and cope better with the treatment and its side effects.

Tips

• Eat a light meal before your treatment (e.g. soup and dry biscuits or toast), and drink as much fluid as possible.

• Sip small amounts of liquid often, rather than trying to drink a lot at once. Sucking on ice cubes, ice-blocks ?or jellies can also help to increase your fluid intake.

• If your stomach is upset, try drinking fizzy drinks such as soda water or dry ginger ale.

• If you wake up feeling sick, eat a dry biscuit or a slice of toast rather than skipping food altogether or forcing yourself to have a full meal.

• Breathe deeply and gently through your mouth if you feel like you?re going to vomit.

• If you are nauseous or have vomited a lot, try to keep your fluids up so that you don?t get dehydrated. If you aren?t able to keep fluids down, contact your doctor immediately.

• Avoid strong odours and cooking smells.

• Eat and drink slowly. Chew your food well to make it easier to digest.

• Prepare meals between treatments and freeze them for the days you don?t feel like cooking.

• Be flexible about your meals. Try to eat when you are hungry, and don?t delay eating when you feel like it.

• Eat small, frequent snacks instead of large meals.

• If the taste of certain types of food has changed, don?t force yourself to eat them. Your sense of taste should return to normal after treatment ends, but it may take several weeks.

• Speak to the hospital dietitian for advice about eating.

• Call Cancer Council Helpline 13 11 20 for free information about eating healthily during and after treatment.

Many people having chemotherapy worry about hair loss. Some people lose all their hair quickly, others lose it after several treatments, and others may only lose a little hair or none at all.

• Whether or not you lose your hair depends on the drugs you receive. Some drugs don?t cause this side effect. Ask your doctor if this is a possible side effect and discuss how you can prepare for it.
• When hair loss does occur, it usually starts 2?3 weeks after the first treatment and grows back when chemotherapy is completed. Your scalp may feel hot, itchy, tender or tingly before and while your hair is falling out. Some people find that the skin on their head is very sensitive, and they may develop pimples on their scalp.
• Although losing head hair is most common, you may also lose hair from your eyebrows, eyelashes, arms, legs, chest and pubic region.
• It takes 4?12 months to grow back a full head of hair. When your hair first grows back, it may be a different colour or curly (even if you have always had straight hair). In time your hair usually returns to its normal condition.
• Many people find losing their hair very difficult. You may feel that hair makes up a part of your overall image and its loss can make you feel physically unattractive, vulnerable or sad. It?s natural to feel this way. Talking to your medical team may be helpful.

Tips

• Keep your hair and scalp very clean.

• Use a mild shampoo like baby shampoo. If you want to use lotion on your head, use sorbolene. Check with your nurse before using any other hair or skin care products.

• Comb or brush your hair gently using a large comb or hairbrush with soft bristles.

• Wear a light cotton turban or beanie to bed if you are cold at night, or to collect hair.

• Use a cotton, polyester or satin pillowcase, as nylon can irritate your scalp.

• If you prefer to leave your head bare, protect it against sunburn and the cold.

• Make an appointment? with a hairdresser who can make your hair look as good as possible even if it is thin or patchy.

• Avoid perms and dyes, and limit the use of hair dryers, rollers and harsh products.

• If your eyelashes fall out, wear glasses or sunglasses to protect your eyes from the sun and dust while outside.

• Tell your nurse or doctor if the skin on your scalp is very sensitive, or if you have a lot of discomfort ?and itchiness.
• Wear a wig, toupee, hat, scarf or turban. Do whatever feels the most comfortable and gives you the most confidence.

• Some hospitals or treatment centres have a wig library where you can borrow a wig if you need one. Ask your doctor or nurse for more information.

• If you want to purchase a wig and you have private health insurance, check with your fund to see if you are eligible for a rebate.

• Call Cancer Council Helpline 13 11 20 for assistance in finding a wig library or shop.

Your skin may darken, peel or become dry and itchy when you are having chemotherapy. It is also likely to be more sensitive to the sun. Protect your skin from the sun ? especially between 10am and 3pm ? by wearing high-protection sunscreen (SPF 30+), a hat and protective clothing. This advice applies to everyone, but it is even more important for people having chemotherapy.

Tips

• Shower using a moisturising soap or sorbolene cream as a soap replacement.

• After showering, gently pat your skin dry with a towel. Try not to rub your skin too hard.

• Use a moisturising lotion or cream containing the ingredient urea to stop the dryness.

• Dust cornflour over the itchy parts of your skin.

• Wear loose, non-restricting clothing. Choose cotton fabric instead of rough wool or synthetic fibres.

• Wash your clothing in mild detergent for people with sensitive skin.

• Stop shaving or waxing until your skin is completely healed.

• If your skin becomes red or sore in the area where the intravenous device went in, tell your doctor or nurse immediately.

Some chemotherapy drugs, pain relief medicines and anti-nausea drugs can cause constipation or diarrhoea. Tell your doctor or nurse if your bowel habits have changed.

After a bout of constipation or diarrhoea, eat a balanced diet with fresh fruits, vegetables, wholegrain bread and pasta.

Constipation

?

• Eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables, nuts and legumes (e.g. baked beans or lentils).
• Sometimes drinking fruit juice can help ease constipation. Try prune, apple or pear juice.
• Drink plenty of other fluids, both warm and cold, to help loosen the bowels.
• Do some light exercise, such as walking.
• Don?t use enemas or suppositories. They are not recommended for people having chemotherapy.
• If you have constipation for more than a couple of days, let your doctor or nurse know. They may change your medication or give you other medication to relieve it.

Diarrhoea

• Choose bland foods such as clear broth or boiled rice. Avoid spicy foods, wholegrain products, fatty or fried foods, rich gravies and sauces, and raw fruits or vegetables with skins or seeds.
• Limit alcohol, fruit juice, soft drinks, strong tea or coffee and dairy products, as these may further stimulate the bowel.
• Drink water to help replace the fluids lost through diarrhoea.
• Diarrhoea can usually be treated at home with over-the-counter medication. Talk to your doctor or pharmacist.
• If the diarrhoea becomes severe, it can cause dehydration and you may need to be admitted to hospital.

Some chemotherapy drugs can cause mouth sores such as ulcers or infections. This is more likely if you have had or are having radiation to the head, neck or chest, or if you have dental or gum problems.

If you notice any change in your mouth or throat, such as sores, ulcers or thickened saliva, or if you find it difficult to swallow, contact your doctor. You should also discuss any dental problems with your doctor before seeing the dentist. If you need any dental work, tell your dentist you are having chemotherapy.

Tips

• Use a soft toothbrush to clean your teeth twice a day.

• Don?t use commercial mouthwashes containing alcohol as they may dry out or irritate your mouth. Instead, try homemade mouthwash (1 tsp bicarbonate of soda or salt in a glass of warm water) at least four times a day. This helps keep your mouth clean, while the salt mouthwash helps heal mouth sores.

• Sip fluids, especially water, and eat moist foods such as casseroles or soups if you have a dry mouth. Moisten foods with butter and sauces.

• Try sucking on ice while you?re having intravenous chemotherapy to reduce mouth ulcers.

• Blend foods to make them easier to eat.

• Nourishing drinks such as milkshakes, smoothies and supplements add extra energy to your diet and feel soothing.

• Avoid very hot foods, and spicy, acidic or coarse foods, (e.g. nuts or grains), as these can aggravate mouth sores.

• Don?t smoke or drink alcohol, as this irritates tissue in the mouth.

Some people say they have trouble thinking clearly after chemotherapy. This is called cognitive impairment or, sometimes, ?chemo brain?. You may find that it takes you more time to process information, or you may experience short-term memory loss or have trouble concentrating for long periods.

There is some evidence that self-help techniques such as relaxation, exercise and memory games can be beneficial. You can also try focusing on activities that don?t require too much concentration. For example, you might choose to read magazines with short articles instead of books with several characters or complex storylines. Tell your doctor if this issue is affecting your day-to-day life.

Tips?

• Use a calendar to keep track of tasks, appointments, social commitments, birthdays, etc.

• Write down things you have to remember. For example, make to-do lists or write down where you parked the car.

• Learn something new, take up a new hobby, or do crosswords, ?word or number puzzles.

• Plan activities to do things that require more concentration when you are fresher, such as in the morning.

• Get plenty of sleep. Deep sleep is important for memory and concentration.

• Do light exercise each day as this may help you to clear your mind and sleep better.

• Talk to others about how you?re feeling ? for example, your partner or colleagues ? to prevent misunderstandings and frustration.

Some chemotherapy drugs affect the bone marrow, which is the soft and spongy material inside the bones. The bone marrow makes three types of blood cells:

• red blood cells ??carry oxygen throughout the body
• white blood cells ??fight infection
• platelets ??help blood to clot and prevent bruising.

The bone marrow?s job is to maintain normal levels of blood cells (your blood count) to keep you fit and healthy. When chemotherapy affects the bone marrow, your blood count is reduced. The count may fall with each treatment. This can cause problems such as anaemia, infections and bleeding problems, depending on the type of blood cell affected.

Your health care team will do regular blood tests to make sure your blood cells return to normal levels before your next treatment.

Anaemia

• A low red blood cell count is called anaemia.
• This can make you feel tired, lethargic, dizzy or breathless.
• You may need a blood transfusion to build up your red blood cells and treat the anaemia.
• Eating a nourishing diet with foods rich in iron and B vitamins is also important if you are anaemic. Wholegrain breads and cereals, lean meat and green leafy vegetables are good sources of iron and vitamin B.

Infections

If white blood cell numbers drop during chemotherapy treatment, it can make colds and flu harder to shake off. Scratches and cuts may get infected easily or take longer to heal.

See your doctor if you are unwell ? even if you just have a cold. Sometimes doctors recommend taking antibiotics as a precaution against infection. If you are having chemotherapy in winter, check with your doctor about having the flu vaccine.

You may have an injection of granulocyte-colony stimulating factor (G-CSF) after chemotherapy if your doctor thinks it will be useful for you. It increases the number of neutrophils, which are a type of white blood cell that help protect against infection. If G-CSF is given, your doctor or nurse will speak to you about possible side effects. Some people may experience bone pain or tenderness at the injection site or show signs of an allergic reaction.

When to contact your doctor

Contact your doctor urgently if any of the following occur:

• chills or sweats
• a temperature of 38?C or more
• persistent or severe vomiting
• severe abdominal pain, constipation or diarrhoea
• unusual bleeding
• tenderness, redness or swelling around the site of the intravenous chemotherapy device
• any serious unexpected side effects or sudden deterioration in health.

Also, contact your GP or treating specialist if you experience:

• sweating, especially at night
• sore throat
• mouth ulcers
• burning or stinging on passing urine
• easy bruising.

Tips

• Keep a thermometer at home to check your temperature.

• Some people having chemotherapy prefer to avoid crowded places such as shopping centres or public pools to reduce the risk of picking up an infection. This is not always practical, so use your commonsense.

• Wash your hands with soap and water before preparing food and eating, and after using the toilet.

• Use separate boards and utensils for raw and cooked foods, and clean thoroughly with hot, soapy water.

• Leftover food should be stored in airtight containers in the fridge as soon as possible.

• Store raw and cooked foods separately.

• Try to eat freshly cooked or freshly prepared foods.

• Don?t eat food or drinks past their use-by or best before dates.

• Wash fruits and vegetables well, or peel where possible.

• Avoid pre-made sandwiches, salads and takeaway foods; soft cheeses; raw or rare fish, meat and eggs; unpasteurised dairy products and soft-serve ice-creams.

• Avoid people who are unwell, especially if they have the flu, conjunctivitis, measles, mumps, a cold sore or chickenpox.

Bleeding problems

A decrease in platelets can cause you to bleed for longer than normal after minor cuts or scrapes, or to bruise more easily. You may need a platelet transfusion if they are low.

Tips

• Be careful when using scissors, needles, knives or razors. Small cuts or nicks can harbour germs where an infection can start.

• Use an electric razor to minimise the chance of nicking yourself.

• Use a soft toothbrush to avoid irritating your gums.

• Wear thick gloves when gardening to avoid injury, and to prevent infection from soil, which contains bacteria.

• If you bleed, apply pressure for about 10 minutes and bandage, if appropriate.

Some drugs can cause tingling and loss of sensation in your fingers and/or toes, and muscle weakness in your legs. If this happens, tell your doctor or nurse before your next treatment.

Your treatment may need to be changed or the problem carefully monitored.

Some chemotherapy drugs can affect your hearing.

• You may lose some of your ability to hear high-pitched sounds.
• It can also cause a continuous ringing noise in the ears known as tinnitus.
• Let your doctor know if you notice any change in your hearing.

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