Side effects

The side effects that you might experience depend on the drugs you receive. Ask your cancer doctor or nurse what to expect and how to deal with it. Most side effects are only temporary. Side effects usually disappear shortly after the treatment stops. However, some side effects are permanent.

Ask your specialist if you are likely to get any permanent side effects. This section lists the more common side effects and methods to help you deal with them. You probably won’t get all of them, but tell your cancer doctor or nurse about any that you do, as they need to know how you are coping with the drugs. They may be able to help control the side effects, or they may want to change the treatment to try to avoid them.

Changes to bone marrow

Bone marrow is the spongy tissue that fills the hollow cavities of many of the flat bones of the body. It produces new blood cells. Chemotherapy reduces the number of blood cells produced by the bone marrow.

The effects of chemotherapy on blood cells

White cells (are essential for fighting infections).

Effects of chemotherapy on white blood cells

You will be at increased risk of infection by not having enough white cells to fight bacteria.

Key points

If your temperature is 38° or more, or you feel unwell even with a normal temperature, call your cancer doctor or nurse.

Other signs of infection include swelling, redness, or pain. Do not ‘wait to see what happens’. Follow the advice of your cancer team. You may need to go to hospital for intravenous antibiotics.

 

Red cells (contain the red iron-rich pigment haemoglobin to carry oxygen around the body).

Effects of chemotherapy on red blood cells

They may cause you to feel tired, low in energy, dizzy, light-headed, and breathless, which are all symptoms of anaemia.

Key points

Let your cancer doctor or nurse know if you have any of these symptoms. Conserve your energy where you can. Talk to your cancer doctor or nurse about ways to manage fatigue. You may need a blood transfusion.

Platelets (help the blood to clot and prevent bleeding).

Effects of chemotherapy on platelets

These can increase the risk of bleeding, and you will bruise easily.

Key points

Contact your cancer doctor or nurse immediately if you have any unexplained bleeding or bruising. You may need a platelet transfusion.

Infection and fever

A fever can be a sign that your body has an infection. Fevers can also cause other problems, such as chills, shivering, and headaches. It is important, therefore, to investigate the cause of infection and to treat it appropriately. It is also possible to have an infection but to not have a fever, just to feel unwell. In either case, contact your cancer doctor immediately.

If fever develops (if your temperature is 38° or over) or you feel unwell, even with a normal temperature, don’t wait to see what happens - take action quickly. Contact your cancer doctor or nurse and follow the advice given.

“I found the hospital admitted you very quickly, which is great. I did feel like I shouldn’t burden the hospital and I would end up waiting forever. This was not the case and I found you’ll be seen promptly.” Ben

Fevers are an indication that something is wrong, and should be treated and reported. If they get too high, they can lead to dehydration and seizures. When someone is undergoing chemotherapy or radiation treatment, fevers often indicate infection, which is serious and requires medical attention.

High fevers do not destroy bacteria that cause infection. This is why your cancer doctor or health care team will treat both the fever and the possible infection. If your white blood cell count is low, your body will not be able to fight off the infection on its own.

Feeling tired

Fatigue/tiredness is a very common side effect of chemotherapy. If you do get tired, try to take things easier. Do only as much as you feel comfortable doing. Try to plan rest times in your day. Also try to ensure you are drinking plenty of fluids, eating well, and having some form of physical activity. This will help you cope better with the treatment.

Don’t be afraid to ask for some help. Family/whanau, friends, and neighbours may be happy to have the chance to help you - tell them how they can help.

If you’re not sleeping well, tell your cancer doctor or nurse. They may be able to suggest ways to help, or prescribe sleeping tablets or a mild relaxant.

Feeling sick (nausea) or vomiting

Not everyone feels sick after chemotherapy, and anti-sickness medication has greatly improved over the past decade. If you do feel sick you’ll find that it usually starts several hours after treatment and may last for a few hours. Anti-sickness medication is frequently given to prevent sickness occurring. It is important to take your medication for nausea exactly as prescribed. Check with your cancer doctor or nurse to find out if you can drive whilst on this medication. If nausea or vomiting persist longer than 24 hours, contact your oncology nurse or doctor.

If you feel sick, try some of these ideas:

  • Eat lightly before each treatment.
  • Eat smaller amounts more often.
  • Eat slowly and chew well to help you digest your food better.
  • Eat your main meal at the time of the day when you feel best.
  • Try not to eat fatty things.
  • Eat dry toast or crackers - they often help.
  • Drink clear, cool, and unsweetened drinks like apple juice.
  • Don’t do anything too strenuous after a meal, but try not to lie down for at least two hours after a meal.
  • Try breathing deeply through your mouth whenever you feel like being sick.
  • If cooking or cooking smells make you feel sick, ask others to cook for you, or prepare meals between treatments and freeze them.
  • Ask the cancer nurse or hospital social worker where you can learn relaxation or meditation methods. Contact the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).

Not wanting to eat

You may have no problems with your appetite during treatment, or you may not feel like eating at all. Your sense of taste may change. This change can last for the duration of chemotherapy but will then return to normal once chemotherapy stops. Changes to your appetite can be because of your treatment, your cancer, or just because of the whole experience of having cancer and being treated for it.

Whatever your experience, do try to eat as well as possible during your treatment to maintain your energy levels and avoid weight loss. If you do not feel like eating, try different foods until you find foods you want to eat. Eat smaller amounts more often, or try drinking special liquid supplement foods that you can get from your pharmacist. Even when you are unable to eat very much it is important to drink plenty of clear fluids.

You might find the Cancer Society’s booklet Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga Matepukupuku helpful. It has many suggestions and recipes, and you can get it free from the Cancer Society, or you can download it from our website. Your hospital may have its own diet information for cancer patients. You can also talk to the hospital or community dietitian for advice about what to eat.

Weight gain

Some people gain weight during chemotherapy. Talk to a dietitian if this becomes a problem for you. Any weight gained during chemotherapy can be due to medication, but usually comes off when treatment stops.

Hair loss

Some people don’t lose their hair while others lose all their head and body hair. Whether this happens to you depends on what drugs you are given. Ask your cancer doctor if you are likely to lose your hair.

Your hair may start to fall out two to three weeks after the first treatment, or it may not fall out for quite a while. Your scalp may feel hot or itchy just before your hair starts to fall out. The Cancer Society has an Information Sheet titled ‘Managing Hair Loss’ that you can view on the Society’s website, by contacting your local Cancer Society for a copy, or by ringing the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).


Above: A woman taking part in the Look Good Feel Better programme.

Your hair will grow back again when your treatment stops. It takes between 4 and 12 months to grow back a full head of hair. It is possible your new hair may be a different texture or colour. Your scalp may be quite itchy as your hair grows back. Frequent shampooing can help. Many people find losing their head hair very upsetting. Try to remember that it will grow back. Until it does you might want to wear a wig.

It’s a good idea to get a wig fitted before you start losing your hair, so that it matches as closely as possible your style and colour. You may want to get your hair cut shorter so that it fits better under a wig. Spend some time choosing one that suits you.

“I am pleased to say my first round of chemo I handled very well. I was very tired but I didn’t have the bad nausea. They kept saying ‘You’re doing so well!’ and I kept thinking I’m doing what I have to do.” Stephanie

The Government helps pay for the cost of a wig. You must get a certificate from your cancer doctor that states you are entitled to a wig. Some people don’t bother with a wig. They stay bald or cover up with a scarf or hat. What you do is up to you. There is no medical reason why you have to cover up your head. However, your scalp will be more sensitive to the sun than normal, so you should wear a hat or a high-protection sunscreen (SPF 30+) on your scalp when you’re in the sun. In the winter your head may feel much colder than it normally would.

“I’d always been proud of having really long hair and I think I coped well. I got it cut shorter and shorter as I came up to treatment.” June

Sore or dry mouth or throat

Chemotherapy drugs can give you a sore mouth or mouth ulcers. The cells that make up the lining of your mouth replace themselves very frequently, and so the drugs start acting on them quickly.

If your mouth is very sore, or you get ulcers or thrush (a white coating in the mouth) see your cancer doctor or nurse straight away for advice on treatment.

It is important to keep your teeth, gums, and mouth very clean during your treatment to help stop infections. The nurses can show you how to do this. Use a very soft toothbrush or a cotton bud for your teeth and gums, and avoid vigorous or rough brushing.

Use a mouthwash regularly. Don’t use a ‘bought one’ because they can be too drying and make your mouth more painful.

Ask your cancer doctor or nurse for advice or you can make one yourself by mixing 1 teaspoon of salt and 1 teaspoon of baking soda (sodium bicarbonate) in 4 cups of warm water. Use it four times a day after meals or as often as you need to. Your cancer doctor may give you a special liquid mouthwash.

Eat soft foods and have lots to drink. Don’t have anything with a high acid level such as grapefruit, tomatoes, or oranges, and avoid spicy foods and spirits. Use a lip salve or ointment on your lips if they are dry.

If your mouth or throat is dry and you have trouble swallowing, try some of these ideas:

  • Suck on ice blocks.
  • Drink lots of liquids.
  • Moisten foods with butter.
  • Dunk dry biscuits in tea.
  • Ask your dentist, doctor, or nurse about artificial saliva.
  • Blend foods and eat soups and ice creams.
  • Don’t smoke

Numbness and tingling (peripheral neuropathy)

Some drugs cause tingling and loss of feeling in fingers or toes or both, muscle weakness (particularly in the legs), or a change in hearing, or ringing in the ears. If this happens, let your cancer doctor or nurse know before your next treatment. A slight change in your treatment may be needed.

Itchy skin and other skin problems

Your skin may redden, peel, or become dry and itchy. You might get drying and cracking of the fingers around the nails. Your nails may become discoloured, brittle, and ridged. You may get some acne. Tell your cancer doctor about any skin problems. Use a lotion or cream to stop the dryness. Ask your cancer doctor for something to help if these suggestions don’t work.

Your skin may go red or thicken where the injection or the drip goes in. If this happens tell your cancer doctor or nurse immediately. It’s especially important to cover up your skin and use a high-protection sunscreen (SPF 30+) in the sun when having chemotherapy.

Bowel problems

Some chemotherapy drugs are known to cause diarrhoea. You may be prescribed medication to control this. Make sure you take these medicines as prescribed. If diarrhoea persists, seek medical attention and advice.

You will find some helpful suggestions in the Cancer Society booklet Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga Matepukupuku. This is available from the Cancer Society, by ringing the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237), or you can download this booklet from our website. If problems persist, tell your cancer doctor.

If you get diarrhoea:

  • Drink between meals to replace lost fluids.
  • Eat small, frequent meals.
  • Avoid seeds, pips, and skins in fruit, vegetables, and grains.
  • Avoid cow’s milk. Lactose (milk sugar) in milk can cause cramping pains and diarrhoea. Mild cheese and yoghurt are low in lactose and can be eaten.

If you are constipated:

  • Drink at least six to eight cups of fluid (1500ml) each day.
  • Eat regular meals; don’t miss breakfast.
  • Add extra fibre to your food. For example, add wheatbran flakes to your breakfast cereal or use them in cooking.

Forgetfulness and concentration problems (sometimes called chemo brain)

After chemotherapy many people say they find it hard to concentrate, focus, and remember. This is often called chemo brain. It can be very frustrating. It may help to know it can happen to anyone who has chemotherapy. Researchers are trying to discover what causes these concentration problems. It is not clear if these problems are caused by chemotherapy alone. The problem usually gets better with time.

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