Tracking side effects is one of the most important aspects of monitoring your chemotherapy treatment. If side effects are severe or impairing your day-to-day functioning, talk to your doctor immediately—there are a number of things you can do to help manage side effects. Here you will find descriptions of these side effects, as well as some other information you may find helpful.
This information is not intended to replace discussions with your doctor. Talk to your doctor about any side effects you may experience during and after treatment with chemotherapy.
Allergic reactions
Sometimes the body can have an allergic reaction—also called a hypersensitivity reaction—either to the chemotherapy drug itself or to other ingredients used in the preparation of the treatment such as chemical solvents. Hypersensitivity reactions are different from other chemotherapy side effects like nausea and fatigue. Hypersensitivity reactions can be immediate, occurring within the first two to three minutes of treatment. They may include difficulty breathing, flushing, swelling, and hives.
To reduce the risk of developing hypersensitivity reactions, doctors sometimes administer additional medications such as steroids or antihistamines to patients before chemo. This is called premedication. Premedications themselves may have side effects. These may include headache, dizziness, sleepiness, insomnia, and impaired coordination, among others.
Premedication is required for chemotherapy treatment containing solvents, since solvents can cause hypersensitivity reactions. Some taxane-containing chemotherapy treatments are prepared with solvents. These solvents are used to formulate the drug so it can be administered by injection. There is one taxane chemotherapy option that does not contain solvents—with this drug there’s no risk of solvent-related side effects and therefore no need for premedication to prevent these side effects.
What can I do?
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Fatigue and anemia
Fatigue can be related both to having cancer and to the treatment given to help fight the cancer, including chemotherapy. It’s a common symptom and can last days, weeks, or months.
Anemia is a specific condition that can cause you to feel weak and tired. It occurs when chemo reduces the body’s ability to make red blood cells. When red blood cell counts are low, the tissues in your body don’t have enough oxygen to function properly. Throughout treatment, your doctor will monitor your blood cell count and, if needed, take action to help boost the growth of your red blood cells. There are medications called growth factors that are available to help raise the number of red blood cells in your body.
What can I do?
- Get proper rest. Plan your day to allow time for short naps or breaks
- Take part in activities that relax you, such as yoga, visualization, or meditation
- Eat a well-balanced diet and limit your intake of alcohol and caffeine
- Drink plenty of fluids
- Perform light exercise daily—take short walks or modify physical activities you enjoy
- If you are anemic, get up slowly after sitting or lying down to help prevent dizziness
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Gastrointestinal and bladder problems
Nausea, vomiting, and/or diarrhea may occur with chemo treatment. If you experience nausea or vomiting, talk to your doctor, because medicines can be given to reduce or eliminate these symptoms. Because antiemetic and antinausea medications work differently for different people, you may need to try different options until you find the one that works best for you.
If chemo affects the cells that line the intestine, diarrhea can result. Diarrhea will usually disappear after treatment completion; however, tell your doctor right away if you experience severe abdominal or stomach area pain and/or severe diarrhea. In these cases, your doctor may prescribe medicine to control the diarrhea or administer intravenous (IV) fluids to replace the water and nutrients your body has lost.
Some chemo medications can cause your urine to change color or odor. You may be asked to provide a blood sample before chemo to make sure your kidneys are functioning properly. A 24-hour urine sample may also be required after treatment.
What can I do?
- Drink plenty of fluids slowly and frequently. Mild, clear liquids such as water, broth, and ginger ale are best
- Avoid drinking coffee, tea, and alcohol
- Avoid sweets as well as fried, greasy, and spicy foods
- Avoid high-fiber foods that can lead to diarrhea and cramping. Rather, eat low-fiber foods such as eggs, potatoes, white bread, or creamed cereals
- Avoid dairy products such as milk, cheese, and ice cream, as they worsen diarrhea
- Eat small meals throughout the day and chew your food well for easier digestion
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Neuropathy
Sometimes chemo can cause problems with your body’s nerves. A side effect known as sensory neuropathy—numbness, tingling, or a burning sensation in the hands and feet—occurs often with some types of chemotherapy. Because this condition can be debilitating, it may be necessary to interrupt your treatment until it improves, after which time treatment can be restarted at a lower dose. This condition can begin to resolve when treatment is complete.
What can I do?
- Take care when grasping objects that may be dangerous if you are experiencing any numbness in your fingers (for example, scissors or a knife)
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Pain and muscle effects
Chemo can sometimes cause painful side effects. You may experience pain resulting from mouth sores or headaches, stomach pain, or joint and muscle pain, any of which can occur shortly after treatment begins. Not everyone experiences pain, but, if you do, it can usually be relieved with medication or other pain control methods. A range of medications may be recommended to help you manage pain, including over-the-counter medications such as acetaminophen (brand name Tylenol®), or nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil® or Motrin®. For more severe pain, prescription opioids such as morphine may also be prescribed, in addition to coanalgesics, which can help opioids and NSAIDs work better. Talk to your doctor about the pain relief options that may be right for you.
What can I do?
- Provide your doctor or pharmacist with as many details about your pain as possible—where you feel it, what it feels like, how strong it is, how long it lasts, what eases the pain, and what makes the pain worse
- Take pain medication on a regular schedule for persistent or chronic pain, as advised by your doctor
- Try relaxation techniques to help lessen tension, reduce anxiety, and control pain
- Move carefully to avoid falls and use handrails when available
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Hair loss, nail and skin problems
Hair loss (alopecia) is a common side effect of chemo. It doesn’t always happen right away—it may begin several weeks after your first treatment or after several treatments. When hair loss does occur, your hair may begin to get thinner or fall out gradually or in clumps. It can occur anywhere you have hair, including the head, face, arms and legs, underarms, and pubic area. While losing your hair can be hard to accept, keep in mind that the hair loss is temporary and that your hair will grow back once treatment has ended.
You may also experience minor skin problems during chemo. These may include redness, itching, peeling, dryness, acne, and increased sensitivity to the sun. Skin and nail texture may change and the skin and nails may darken. Most effects on skin and nails are not serious, but they can be of concern to some patients. Generally speaking, skin problems are often temporary and usually subside once treatment ends.
What can I do?
- Be gentle to your hair and scalp
- Use low heat when using a hair dryer
- Consider cutting your hair short
- If you plan to wear a wig and want it to match your natural hair color, shop for it before treatment begins
- Find a funky hat, comfy turban, or scarf—try on a bunch until you find a look that makes you feel most comfortable
- Avoid direct sunlight, especially between 10 am and 4 pm
- Keep your skin clean and dry and avoid perfume that contains alcohol
- Protect your nails by wearing gloves while doing household chores
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Memory and attention problems
As many as one in four people experiences memory and attention problems after chemo. Sometimes called “brain fog” or “chemobrain,” these side effects can cause problems concentrating, remembering things, or finding the right word. Often frustrating, these side effects can begin soon after treatment ends, or much later.
What can I do?
- Set up reminders of things that need to be done each day
- Repeat what you want to remember to help you retain the information
- Write down important information or activities in a notebook or pocket calendar
- Try to think through what you want to say before you speak
- Exercise your brain—try games or puzzles that can help keep your brain sharp
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Infection
White blood cells in your body help protect you against bacterial infections. Because chemo makes it harder for your body to make white blood cells, you may become more susceptible to infection. During chemo, your doctor will routinely monitor your white blood cell count and prescribe medicine to help speed the recovery and growth of white blood cells if needed.
What can I do?
- Call your doctor immediately if you experience a fever
- Wash your hands often
- Try to avoid crowds and people with colds
- Immediately clean and protect cuts
- Check with your doctor before getting immunization shots
- Take a bath or shower daily using mild soap
- Use lotion to prevent your skin from cracking
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Bleeding or bruising
Your body makes certain blood cells, called platelets, that help it stop bleeding when it is injured. This is called clotting. Drugs used in chemotherapy can affect your body’s ability to make platelets. Without enough platelets, you may bleed or bruise more easily than usual.
What can I do?
- Call your doctor if you experience unexpected bruising or bleeding
- Avoid contact sports or activities that might cause you to get hurt
- Take extra care when using tools or other sharp objects
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Mouth, gum, and throat problems
Some drugs used for chemo can cause painful sores in the mouth, gums, and throat. They can also dry out these sensitive tissues, causing irritation and bleeding. Because of the many germs that live in the mouth, these sores can become easily infected—making good oral care critical during cancer treatment.
What can I do?
- Use lip balm or another lip moisturizer (ask for your doctor’s recommendation)
- Use a soft toothbrush and brush your teeth after eating
- Be gentle when flossing
- Use mouthwash that does not contain alcohol
- Frequently rinse your mouth with warm salt water
- Avoid foods that might irritate your mouth, such as spicy foods, orange juice, and pretzels
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Hot flashes
Chemo may also cause a woman to experience menopause or menopause-like symptoms, such as hot flashes.
What can I do?
- Layer clothing to easily adjust to your body’s temperature
- Avoid caffeine and alcoholic drinks
- Exercise
- Use relaxation methods to control stress
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