Chemotherapy is any medication that directly stops the cell's ability to grow and divide. Chemotherapy drugs may affect any rapidly-dividing cells in the body, both the normal and abnormal or cancerous ones. Chemotherapy may be given as an intravenous, oral, or injection treatment.
There are many different chemotherapy drugs and treatment regimens. Your treatment plan will be determined by your particular type of cancer, as well how advanced it is and your individual health needs. We are including some general information on side effects of chemotherapy below.
COMMON CHEMOTHERAPY SIDE EFFECTS
Taking Care of Yourself During Chemotherapy
This is a brief review of various side effects that people may experience on chemotherapy. We do not expect you to have all of them. You may also experience some side effects that are not reviewed here. Each medication causes different side effects, and, these side effects vary depending on the dose of the medication and the combination with other medications. Side effects vary from person-to-person and may change over time as well. Please use this handout for reference, and let us know if you have problems while on treatment. We have specific handouts and information booklets available for many of the drugs that you will receive as well.
In addition to physical side effects, cancer treatments can affect your personal life and relationships. Talk with your health care team. There are programs available to help you and your family cope with living with cancer. Ask about support groups or resource centers available in your area. Participating in your treatment begins by asking questions. Your health care team is here for you, to help you understand what to expect from your chemotherapy, and what you can do to help yourself.
NAUSEA and VOMITING
This may be associated with some chemotherapy treatments. It is best to anticipate and plan ahead to control nausea. You may be more at risk for nausea several hours after receiving chemotherapy and it may last for a few days afterwards. You may receive some anti-nausea medication intravenously at our office with your infusion. Most people are given some anti-nausea pills to take at home too, either at scheduled times or as-needed—take your anti-nausea medications as instructed by your physician or nurse. Call us if your medications are not working!
Sometimes people have less nausea if their stomach is not empty; so eating small, frequent snacks and light meals may be helpful. Avoid greasy, spicy, fatty or fried foods. Bland foods are often best tolerated. Avoid unpleasant tastes and foods with strong odors, especially if you are cooking.
Foods to try if you are nauseous:
Toast or Crackers Skinned Chicken Yogurt
Ice Cream, Sherbet Waffles Bland Fruits
Bland Vegetables Cereal Pasta, mild sauce
Oatmeal Eggs Rice
Sensitive tissues in the mouth and lips can become irritated and tender after receiving chemotherapy. Some treatments may cause mouth sores. This may occur a few days or a few weeks after certain types of chemotherapy. During your treatment you should continue to practice regular oral care with a soft toothbrush and any commercial toothpaste. Do not use mouth washes that contain alcohol as they can be irritating and drying. Remove dentures when you are not eating. If sores are causing pain with eating, eat soft, bland, and room-temperature foods until your mouth feels better. After meals and at bed time, rinse your mouth with the salt and soda rinse below. Keep your lips moist with a mild lip balm such as Chapstick or Vaseline. Please notify your team if your mouth is very sore and you are having problems eating/drinking or if you notice a white coating on your tongue or the back of your throat.
Salt/Baking Soda Mouthwash
1 teaspoon salt
1 teaspoon baking soda
500 milliliters (1/2 quart) of warm water
If you are scheduled to see your dentist, please inform them that you are undergoing treatment for cancer. Consult with us before having any dental procedures. Many people schedule a routine visit with their dentist prior to starting chemotherapy.
It is not uncommon for food and drinks to taste differently while receiving chemotherapy. This varies widely with each person. If you have a metallic taste in your mouth after chemotherapy, avoid using metal utensils for eating. Use herbs and mild spices to enhance flavor if foods have an unpleasant taste.
Numerous medications cause dry mouth, including many non-chemotherapy ones. There are oral rinses and artificial saliva products that may lessen dry mouth temporarily. Drinking fluids and sucking on hard candies may help too.
Diarrhea is an increase in the frequency of bowel movements which are loose or liquid. Some chemotherapy medications cause diarrhea. Changes in your bowel pattern are also related to your diet, hydration, activity level, and any other medications you are taking. Be sure to drink plenty of fluids to stay hydrated by replacing the fluids you have lost. Water, broth, ginger ale, and oral electrolyte solutions like Gatorade or Pedialyte are good choices. A bland, low-fiber diet is recommended if you have loose stools. We may recommend that you try Imodium AD (Loperamide) tablets, which are available over-the-counter without a prescription. You may follow the directions on the box unless told otherwise. If you were taking a stool softener or laxative before the diarrhea started, stop them and do not restart until your bowel movements have returned to normal. You should clean the rectal area gently after each bowel movement. If this area becomes irritated, warm soaks may be helpful. A hot water bottle or heating pad may help with any cramping. Please contact the office if you are having diarrhea, especially if you also have severe intestinal cramping or discomfort, blood in the stool, weakness/dizziness, or weight loss.
Constipation is common among chemotherapy patients, especially for the first few days after chemotherapy. Constipation means that you are having less frequent bowel movements than your normal pattern, or that you are having hard bowel movements with difficulty passing the stool. It is important to maintain a regular bowel regimen to prevent uncomfortable and prolonged constipation. Like diarrhea, constipation is also related to your diet, hydration, activity level, and any other medications you are taking. Drinking plenty of fluids, eating foods with fiber, and maintaining some physical activity can help you to keep your bowel movements regular. Warm fluids or prune juice may be helpful. We may also recommend an over-the-counter laxative such as Senna/Senokot. If you continue to have constipation, we may add a prescription laxative as well.
LOWER BLOOD COUNTS
Some chemotherapy regimens cause your blood “counts” to go down temporarily. These counts will be checked regularly through bloodwork during treatment. These results are important to help us determine if it is safe to give your next treatment and, if you are at risk for infection or bleeding. We may administer booster shots to help your body produce more blood cells or order blood transfusions if needed.
If white blood cell counts are lowered, your body may not fight off bacterial infections as well. Your white blood cells are expected to be at their lowest approximately 7 to 14 days after your treatment. If you develop a fever over 100.4 degrees F or shaking chills, it is important to seek medical attention right away, especially if it is 7 to 14 days after your last chemotherapy treatment. If this occurs 7 to 14 days after your last chemotherapyt treatment, do not wait until morning—call the main office number to speak to the on-call doctor immediately. Keep a thermometer at home to check your temperature if you are not feeling well.
If red blood cell counts are lowered, this is called anemia. This may cause you to feel more tired or more easily short of breath. Try to eat regular meals and plan to rest or adjust your activities as needed. If you have severe difficulty breathing, seek medical attention immediately.
If platelets are lowered, your blood may not be able to clot as quickly. In this case, avoid cuts, bumps, and bruises. Be sure to use a soft toothbrush, avoid flossing, and do not shave with a blade. Seek medical attention if you develop bleeding that does not stop. Ask us before using Aspirin, Ibuprofen (Advil), or Naproxen (Aleve, Naprosyn). These medications may interfere with your blood’s clotting action.
Fatigue is a decrease or lack of energy. You may feel more tired than usual while receiving chemotherapy. Be in control of your fatigue—don’t let it control you! Try to plan your day, prioritize and use your energy for the most important things. Conserve your energy by taking frequent breaks throughout the day if you feel tired. It is okay to accept help from your family and friends and, even to ask for assistance from others. Go to bed and wake up at the same time each day. In most cases, light exercise is fine and is even recommended. However, please be aware of your body and adjust your level of activity to how you feel. There are many exercise programs that are geared to those who are undergoing these types of treatments. Check with your team about specific recommendations for activities during chemotherapy. Please let us know if fatigue is so overwhelming that it is interfering with your usual activities.
Some, though not all, chemotherapy drugs affect hair cells. This can lead to thinning of the hair or total hair loss, depending on your treatment. Hair loss usually occurs 2 to 3 weeks after your first dose of chemotherapy. Hair loss on the head is most noticeable, but any body hair growth may be affected or slowed. Hair loss is expected to be temporary, with hair regrowth after you finish chemotherapy. Hair is generally a similar color, though it may be a different texture once it regrows.
We recommend use of mild shampoos and avoiding any chemical treatments that may cause additional damage to your hair during chemotherapy. You may prefer to cut your hair short prior to starting treatment to make it easier to manage. Or you may prefer to use a hat, scarf, wig or hairpiece. You may find such headcovers at numerous stores or online. You can shop for a wig or hairpiece before hair loss begins to match your color and style preferences. Depending on your insurance, you may be reimbursed for the tax or some of the cost of a wig with an order from your doctor. There are also support programs that can help you to get a free or donated wig.
Many people find that their skin is more dry or sensitive while on chemotherapy. Some treatments may cause rash or itching or nail changes and discoloration. Most of these changes are mild and temporary during treatment. Avoid sunburns and use sunscreen and lip balm with a minimum SPF of 15. Wear a protective covering on your head, and put on long-sleeved clothing if you plan to be outside in direct sunlight or at mid-day. Avoid long, hot baths and pat your skin dry gently. You should use a mild soap. If dry skin occurs, you may use a lotion such as Vaseline Intensive Care, Lubriderm, Cetaphil or an aloe vera containing lotion. Apply liberally and frequently if needed. Clear polish on your nails is okay, but in general, manicures are not recommended due to the risk of infection. Please let us know if you have a widespread or painful rash, if you have persistent itching, or if your nail cuticles are red and painful.
SEXUALITY and FERTILITY
It is common to have a decrease in sexual desire during treatment. Mood, body image, fatigue, and other side effects all play a role. Share your feelings with your partner. Other activities may enable you to feel close to your partner, such as hugging and cuddling or massage. If you experience sexual concerns or problems, please talk to your team for specific recommendations.
Hormone changes are common. If you are a woman who is still menstruating, your periods may become irregular or may stop completely. You may also have menopausal-like symptoms, such as hot flashes or vaginal dryness. Depending on your age and other factors, this may be a permanent change. Men may experience impotence and lower sexual desire as well.
Because some chemotherapy drugs or other treatments may lead to permanent sterility and inability to have children, discuss this with us immediately if you are considering having children after your treatment! Options such as sperm banking, egg banking, or ovarian protection may be utilized.
Many anticancer drugs could be harmful and may cause birth defects in babies conceived during treatment. It is still possible to get pregnant or to father a child during treatment, so contraception must be practiced regularly. Condoms are an effective measure for preventing pregnancy. Oral contraceptives or IUDs may be an option for some female patients. If you are a lactating mother receiving chemotherapy, you should stop breastfeeding.