Common chemotherapy side effects and how to manage them

If your cancer care team has recommended chemotherapy as part of your cancer treatment, you may be concerned because you know chemotherapy has potential side effects—some mild and some severe, some short-term and some long-lasting.

Not everyone experiences every side effect. Some people may have just a few. Some may have many side effects, but none severe. Others may experience debilitating side effects and serious, long-term complications such as heart or nerve damage.

Your cancer care team is careful to prescribe the right amount of chemotherapy to be effective while keeping side effects to a minimum. You may undergo more than one chemotherapy treatment.

Chemotherapy drugs are designed to kill fast-growing cancer cells. However, as these powerful drugs travel throughout the body, they also destroy normal, healthy cells, which may cause side effects.

The normal cells that chemotherapy drugs are most likely to damage are:

• Hair follicles
• Cells that form blood, found in bone marrow
• Cells in the digestive tract, starting in the mouth
• Cells in the reproductive system

You may find that some side effects come and go surprisingly quickly. But it may take months for you to completely get over other side effects. Some side effects subside between treatments and some, especially serious ones, may last the rest of your life.

Common reactions such as nausea or vomiting and fatigue may start as soon as the first treatment. Others, such as a second cancer, may not appear for many months or years.

Don’t get discouraged. There’s lots that you and your cancer treatment team may do to prevent and reduce side effects of chemotherapy when you work together.

Knowing as much as possible about the different side effects and what to expect may put you more in control and at ease.

Fatigue: A feeling of utter exhaustion, or fatigue, is the most common side effect of chemotherapy. Scientists don’t fully understand why chemotherapy causes extra fatigue in cancer patients, but they suspect it’s the body’s response to having to work harder to rid itself of the toxic substances left behind. Chemotherapy also may wreak havoc on sleep patterns, making it hard for you to get the healing rest you need.

Many patients seem to experience the most chemo-induced fatigue midway through their treatments. Fatigue seems to decrease when treatments stop, but it may take months after the last treatment until you feel like yourself again.

To help manage fatigue:

• Get regular exercise. This may sound counterintuitive, but even light activity for a short period of time may help combat fatigue. Choose an exercise you enjoy and slowly increase the amount of time you spend doing it. A good goal: three to five hours of moderate activity (like walking) each week. Performing exercises such as yoga and tai chi, and combining movement (stretching, balancing, controlled breathing) with activities like meditation may help reduce fatigue.
• Establish a routine. Make a schedule for your day. Skip activities that aren’t really important. Do you have more energy in the morning after sleeping? Or after lunch? Plan those activities that require you to have the most energy for those times.
• Adopt healthy sleep habits. Establishing a nighttime routine may help you sleep better. Naps are OK, as long as they don’t last more than an hour. Keep your bedroom quiet and dark—and avoid distractions such as noise and the TV.
• Work with your care team. Make sure your care team is aware of your fatigue. They may help look for other factors that may be contributing to it such as anemia, depression or troublesome pain.

Hair loss (alopecia): Some chemotherapy drugs may cause your hair to thin, and others cause it to fall out. You may lose the hair not only on your head, including eyebrows and eyelashes, but also on your arms, legs and pubic area.

Some patients find cooling caps reduce their risk of hair loss, but others find them to be uncomfortable and cause headaches.

Some ways to manage hair loss:

• Be proactive. Cut it short or shave your head before your hair starts to fall out.
• Cover your head. Some people buy wigs or wear scarves. Ask your health-care team to help determine whether a wig would be covered by your insurance. The American Cancer Society has a program, Tender Loving Care, that helps provide wigs, hats and scarves.
• Be gentle. You may not lose as much hair if you’re extra-kind to your head—don’t brush too often or pull too hard or use blow dryers and curling irons. Avoid perms and dyes, especially when your hair starts to grow back.

Nausea and vomiting: Certain drugs are more likely to cause nausea and vomiting than others, including those that target cancers of the gastrointestinal tract, liver and brain.

These factors also may increase your risk of nausea and vomiting:

• You’re female
• You’re younger
• You had morning sickness and motion sickness during pregnancy
• You’ve received chemotherapy before
• You’re prone to vomiting when you’re feeling ill
• You don’t drink alcohol or drink very little

You may start feeling nauseated and vomit within the first 24 hours of treatment, especially if it’s administered through an intravenous (IV) infusion. That’s because drugs given intravenously are absorbed faster. You also may experience nausea and vomiting as many as a few days after your latest treatment.

Anticipating treatment or the smells may make some people nauseous and vomit as well.

Tips for managing nausea and vomiting include:

• Pre-treat. Ask your care team for anti-nausea medicines, specifically those shown to work best for your treatment. Start them before your first session and continue taking them until treatment is complete. Ginger may be helpful when used along with your other anti-nausea treatments or for certain chemotherapy regimens.
• Practice relaxation techniques. Meditation, breathing exercises and progressive muscle relaxation (where you tense and relax muscles) have been shown to reduce nausea and vomiting.
• Don’t let your stomach be empty. Having an empty stomach may cause you to feel nauseated. Eat small meals and snacks throughout the day. Sipping clear liquids (cold, not hot) such as ginger ale, tea and broth may help. Suck on ice chips or chips made from freezing juice. Go for bland food such as toast and crackers.

Constipation and diarrhea: Treatment may cause changes in your diet (you’re not drinking as much or eating as much fiber) and activity levels (you’re not moving or exercising as much). These lifestyle changes may also affect your bowel habits.

To reduce constipation:

• Drink lots of fluids. Aim for eight, 8-ounce glasses of fluid each day, unless you have kidney or heart disease.
• Eat more fiber. Fruits and vegetables and whole grain breads and cereals are great sources. Be sure to drink more fluids when eating a high-fiber diet so you don’t make your constipation worse.
• Get moving. The more you move, the better for your abdominal muscles. If you can’t walk, ask about abdominal exercises that are safe to do in a bed or chair.

Check with your care team before taking laxatives for constipation. Using them too often may cause further constipation. Suppositories or enemas may cause bleeding or infections or other side effects in some cancer patients.

Chemotherapy also may cause diarrhea anytime during treatment. How to manage this side effect:

• Watch your diet. Eat frequently—but small amounts each time. Avoid milk and other dairy products, spicy and fatty foods, nuts, seeds and coconut. Don’t drink alcohol, caffeinated drinks (tea, coffee, hot chocolate) or carbonated beverages.
• Add probiotics. Natural yogurt is an excellent source of probiotics, which are live microorganisms that help digestion.
• Drink liquids:. Be sure you’re replenishing fluids, so you don’t get dehydrated. Stick to clear liquids such as chicken broth and ginger ale.
• Ask your care team before taking medicines for diarrhea. They may be able to prescribe the medicine that’s best for you and your drug treatment.

Changes in appetite: You may lose your appetite from nausea and vomiting or from painful mouth sores. You also may lose your desire for food because of all you’re going through.

To manage:

• Eat small amounts. Try sampling small amounts five or six times a day rather than three big meals. Go for foods and drinks that are loaded with protein and calories.
• Eat by the clock. Make a schedule and eat when the clock says it’s time, not just when you’re hungry. You may not feel hungry when you’re receiving chemotherapy.
• Get moving. You may increase your appetite by being active. Consider a short walk before lunch or dinner, or some stretches between meal times.

Mouth sores: Chemotherapy may harm the cells of your mouth, throat and lips because they too are fast-growing. You may develop sores, making it hard to eat.

To manage the sores:

• Keep your mouth moist. Have a glass of water next to you and take small sips throughout the day. You may also try to suck on ice chips, popsicles and/or sugar-free hard candy or chew sugar-free gum.
• Eat foods that are soft, moist and easy to swallow, such as oatmeal, mashed potatoes and scrambled eggs. Puree foods or soften them with gravy and sauces.
• Rinse your mouth. Avoid mouthwash that has alcohol in it. Prepare this rinse instead: a quarter-teaspoon baking soda, 1/8 teaspoon salt and 1 cup warm water. Use the rinse three or four times a day.

Pain: This may come in many different forms, such as headaches, stomachaches or muscle pain. You may experience pain, burning and numbness, especially in your hands and feet, from the cancer as well as the chemotherapy. Pain control is important, and there are many treatments to help you feel better.

To manage:

• Take pain medicine. Ask your care team about prescribing pain medicine, which may be helpful when taken on a set schedule or as needed.
• See a pain specialist. You may request a meeting with a pain or palliative care expert and discuss ways to control your pain.
• Learn to relax. Many patients find that relaxation techniques such as deep breathing or yoga may help reduce muscle pain and tension.

Some chemotherapy drugs have been linked to a number of different second cancers. Your risk of this side effect increases the longer your treatment and the higher the intensity of your dose.

The most likely second cancers from chemotherapy are blood cell cancers: myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML). You may develop one or both. MDS may occur first and then become AML.

Speak with your health-care team about your risk for developing a second cancer from chemotherapy treatment.

Depending on the cancer and chemotherapy treatment, you also may experience some of the following:

• Easy bruising and bleeding
• Anemia (low red blood cell counts)
• Pain when swallowing
• Nerve problems, such as numbness and tingling
• Changes to nails and skin, or excessive dryness
• Kidney problems and bladder changes
• Weight changes
• Memory, concentration and focus problems
• Mood swings
• Changes in libido and sexual function
• Fertility issues

While some chemotherapy side effects are minor and likely to subside, others may be alarming and long-lasting. Alert your cancer care team immediately if you have any of the following:

• High fever (100.5 to 101 degrees Fahrenheit)
• Chills that won’t stop
• Bleeding or unexplained bruising
• Allergic reaction that causes severe itching or trouble swallowing or breathing
• Intense headaches or other unusual pain
• Blood in urine or stool
• Difficulty urinating
• Persistent diarrhea or vomiting