Chemotherapy Side Effects

Chemotherapy drugs can cause side effects, but they don’t have to take over your life.

If you're about to start cancer treatment, talk to your medical team about the possible side effects and how you can feel better.

Fatigue

This is common during chemotherapy. Some people feel just a little low in energy, while others feel wiped out.

Depending on how tired you are, your doctor might give you medicines to treat other side effects that can make you feel tired, like depression, pain, and anemia. Studies have shown these drugs can boost energy in people with cancer.

Aside from taking medicines, you can practice these habits to fight fatigue:

  • Don't try to do everything at once or by yourself. If your family or friends ask what they can do for you, get their help with shopping, cooking, or other chores.
  • Adjust your work schedule if you need to.
  • Eat a healthy diet of fruits, vegetables, whole grains, and lean protein.
  • Exercise, even if it's just a little bit every day.
  • Drink plenty of water.
  • Take short naps if you need to, but not too close to bedtime.

Nausea and Vomiting

These can happen before, during, or after treatment. The good news is that a lot of drugs can ease upset stomach. Your doctor will probably recommend specific ones based on the kind of chemotherapy you’re getting. You might need to try a few nausea medicines before you find the right one for you. Or you might need to take more than one.

Other tips:

  • Eat several small meals throughout the day rather than three big ones.
  • Drink liquids an hour before you eat rather than during the meal.
  • Sip clear liquids all day long.
  • Plan your eating around your chemo. For some people, a snack right before a session helps keep nausea away. Others do better on an empty stomach.

Hair Loss

Chemotherapy can make you lose hair, not just on top of your head but in other places, like your eyebrows and eyelashes.

A tight-fitting cap with a cool gel, called a cooling cap, can reduce hair loss for some people. It makes the blood vessels in your scalp smaller so less of the chemo medicine reaches your hair follicles. Ask your doctor if it might help you.

You also can handle hair loss with a few other changes:

  • Treat your hair and your scalp gently. That means using mild shampoos, soft brushes, and no electric rollers, curling irons, dyes, or perms.
  • Use moisturizing shampoo, conditioner, and cream on your hair before it falls out and later on your scalp. This will help with dryness and itching.
  • Consider wearing wigs, scarves, turbans, or hats to mask your hair loss. You might even want to shave your head before you start treatment.

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Bleeding and Bruising

Chemotherapy kills platelets, which help your blood clot. You have higher chances of bleeding and bruising, even if you haven't bumped yourself.

Platelet transfusions can help. So can injections of drugs that help your body make more blood cells.

To prevent bleeding and bruising:

  • Use an electric shaver instead of a razor.
  • If you need to blow your nose, do it gently.
  • Don't play rough sports.
  • Don't use dental floss or toothpicks, which can make your gums bleed.

Anemia

You might get this blood condition during chemo because some drugs can kill cells that form red blood cells in the bone marrow. It can also be a major cause of fatigue during treatment.

Your doctor might recommend iron supplements, vitamin B12, or folic acid supplements. They may tell you to try a few treatments at once. If your anemia is severe, you could need a blood transfusion. In some cases, your doctor might prescribe drugs that trigger your body to make more red blood cells.

Foods rich in iron such as spinach, red meat, and beans might also help boost your energy.

Infection

Chemo also kills white blood cells, which fight germs. This can make you more likely to get an infection.

Let your doctor know right away if you notice signs of a possible infection such as a fever, a sore throat, a cough, or swollen red skin. They can give you medicines to fight it.

To prevent infections:

Constipation and Diarrhea

Try anti-diarrheal medicines or use laxatives and stool softeners for constipation. You can get them over the counter or by prescription. Always talk to your doctor before you take them.

Other habits can also keep bathroom troubles at bay. For constipation, try high-fiber foods, exercise, and drinking lots of fluids. For diarrhea, low-fiber foods like white rice, oatmeal, and skinless chicken may help.

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Chemo Brain

Some people who get chemo have trouble remembering things, focusing, and concentrating. It’s called "chemo brain" or "chemo fog." To keep yourself on track, try a few of these steps:

  • Stick to a routine.
  • Take notes and use a planner.
  • Cut down on distractions at work and elsewhere.
  • Use a pill box to keep track of your medications.

Mouth and Throat Sores

Painful sores can make it hard to eat, and they can get infected.

Ask your doctor about pain medicines and ointments. If you start having dry mouth, they might recommend treatments to help you make more saliva.

Other tips:

  • Get any dental work done at least 2 weeks before you start chemo.
  • Brush your teeth and tongue after every meal and before bed with a soft toothbrush or cotton swabs.
  • Suck on ice chips right before or during a chemo session.

Nerve Changes

If you have numbness, tingling, weakness, burning, a pins-and-needles feeling, or pain in your hands and feet, it might mean your chemo drugs have damaged some nerves. This condition is called peripheral neuropathy. It may get worse as your treatment goes on.

Your doctor might give you a few different medicines to help. You can also try other steps:

  • Always wear shoes to protect your feet.
  • Wear gloves when you’re cooking or working outside.
  • Use bath mats in the shower.
  • Use a cane to balance yourself.

Appetite and Weight Changes

You might find that you’re less hungry than usual or not hungry at all. Some people feel full on just a little food. These changes can make you lose weight and keep you from getting the right nutrition. You may also lose muscle, making you weaker.

Talk to your doctor about appetite changes before they slow your recovery or get in the way of your treatment.

Some tips to manage appetite changes include:

  • Eat several small meals a day.
  • Snack whenever you feel hungry.
  • Choose foods that are high in calories and protein such as dried fruits, nuts, cheese, yogurt, eggs, cereal, ice cream, and nutrition shakes.
  • Cut down on nausea by eating cold food.
  • Add spices or condiments if food tastes too bland.
  • Do some light exercise about an hour before a meal. Your doctor can help you find an exercise program that’s right for you.

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Pain

Headaches, muscle pain, stomach pain, and other discomfort are another common side effect of chemotherapy. It might be brief or last a long time. It can also come and go. This pain can add to what is already a stressful time.

Tell your doctor about what you’re feeling and whether anything makes it better or worse. They can help you make a plan to manage it. This may include:

Skin and Nail Changes

You might notice changes to your skin and nails after you start chemotherapy. Your skin could be:

  • Dry
  • Discolored
  • Sensitive to the sun
  • Red and sore
  • Itchy

Nail problems include:

  • A bruised color
  • Dryness
  • Thinness or brittleness
  • Lifting off the nail bed
  • Ingrown nails

Creams can help prevent dryness and protect your skin from the sun. You may want to use nail polish to cover changes in your nail color. Take extra care to protect your skin and nails from damage during everyday activities. Wear gloves when cleaning or gardening, and keep your nails trimmed and clean.

Urinary Tract Problems

Some chemotherapy drugs can damage cells in your kidneys or bladder. This causes problems such as blockages, urinary tract infections, bleeding, and scar tissue.

Tell your doctor if you notice changes in your urine or in your bathroom habits, including pain when you pee, trouble starting to go, or feeling like you can’t empty your bladder all the way. They may give you medication or a procedure to ease your symptoms.

Lower your chances of having urinary problems by:

  • Drinking plenty of fluids, especially around chemo treatments
  • Peeing often
  • Avoiding caffeine, spicy foods, and alcohol

Mood Changes

Cancer treatment can be stressful. But chemotherapy drugs themselves could also affect your moods.

Talk to your doctor if you notice serious changes or if you feel like they’re interfering with your daily life. They can help you figure out whether the changes are a result of your treatment and help you come up with a plan to manage them.

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Sex-Related Changes

The physical and mental changes that come with chemotherapy can also affect your sex life. Sexual side effects include:

  • Not wanting to have sex as much or at all
  • Trouble becoming or staying aroused
  • Trouble reaching orgasm
  • Premature ejaculation or a “dry” orgasm in men
  • Pain or numbness in your genitals

Your medical team can recommend the best ways to manage symptoms. This may involve over-the-counter or prescription medicines, pelvic floor exercises, or counseling.

Fertility Problems

Chemotherapy can affect your ability to have children either for a short time or permanently. Damage to a woman’s ovaries or eggs may cause early menopause. Talk to your medical team about the risks before you start treatment. You might be able to freeze and store eggs or semen to use later.

Heart Problems

It’s rare, but certain chemo drugs are more likely to cause heart problems. These include:

Your doctor will keep your risk of heart problems in mind when making a cancer treatment plan. They might want you to have tests to watch for these issues.

How Long Do Side Effects Last?

Most chemo side effects stop once treatment is over. Some might take months or years to go away. If the drugs damage your organs, the effects could be permanent.

Talk with your doctor about the risks of side effects and how long you can expect them to last. Your medical team might be able to change your treatment or suggest things to make you feel better.

When to Call Your Doctor

Some side effects need medical help right away. Call your doctor if you have:

WebMD Medical Reference Reviewed by Gabriela Pichardo on June 07, 2020

Sources

SOURCES:

Ted Gansler, MD, director of medical content, American Cancer Society.

American Cancer Society: "A Guide to Chemotherapy," "Anemia in People With Cancer," "Peripheral Neuropathy Caused by Chemotherapy."

City of Hope: "Chemo brain due to cancer treatment: Who's at risk? What can be done?"

Hershman, D. Journal of Clinical Oncology, published online April 14, 2014.

Fred Hutchinson Cancer Center: "Cancer and Cognitive Functioning: Strategies for Improvement."

National Cancer Institute: "Fatigue (PDQ)," "Managing Chemotherapy Side Effects: Anemia," "Managing Chemotherapy Side Effects: Bleeding Problems," "Managing Chemotherapy Side Effects: Fatigue," "Support For People With Cancer: Chemotherapy and You."

University of Texas M.D. Anderson Cancer Center: "Chemobrain," "Doctor, Doctor: Focus on Chemotherapy."

UpToDate: "Prevention and treatment of chemotherapy-induced nausea and vomiting."

Breastcancer.org: “Managing Chemotherapy Side Effects,” “Neuropathy,” “Nail Changes.”

American Society of Clinical Oncology: “Appetite Loss,” “Side Effects of Chemotherapy,” “Treating Pain with Medication,” “Sexual Health and Cancer Treatment: Men,” “Sexual Health and Cancer Treatment: Women,” “Fertility Concerns and Preservation for Men,” “Fertility Concerns and Preservation for Women,” “Heart Problems.”

National Health Service (U.K.): “Chemotherapy side effects.”

National Cancer Institute: “Urinary and Bladder Problems.”

Canadian Cancer Society: “Bladder problems.”

National Comprehensive Cancer Network: “Mood Changes.”

American Cancer Society: “Chemotherapy Side Effects.”

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