Managing side effects of chemotherapy
On this page: Feeling tired and lacking energy | Appetite changes, nausea or vomiting | Hair loss | Skin and nail changes | Mouth sores | Constipation and diarrhoea | Memory and concentration changes | Anaemia | Infections | Bleeding problems | Nerve and muscle effects |
Change in hearing | Sex and fertility | Key points
While chemotherapy can kill cancer cells, it can also affect normal cells that grow or divide rapidly, such as the new blood cells in the bone marrow and the cells in the mouth, stomach, skin, hair and reproductive organs. When the normal cells are damaged, this causes side effects.
Whether or not you have side effects, and how severe they are, depends on the type and dose of drugs you are given and how you react individually from one treatment cycle to the next. Most side effects are temporary and can be managed. They tend to gradually disappear once treatment stops and the normal healthy cells recover.
Why chemotherapy affects the blood
Chemotherapy can affect the production of blood cells. The three main types of blood cells have specific functions:
- red blood cells – carry oxygen around the body
- white blood cells – fight infection
- platelets – help blood to clot and prevent bruising.
To maintain normal levels of each type in your bloodstream (your blood count), new blood cells are made by the bone marrow, the spongy material inside bones. Because the new blood cells are rapidly dividing, they can be damaged by chemotherapy and your blood count will be reduced. This may cause anaemia, infections or bleeding problems.
You will have blood tests to check that your blood count has returned to normal before your next chemo session.
This section discusses the most common side effects people experience from chemotherapy and offers suggestions to help manage them.
Preparing for side effects
Some people have no side effects, others experience a range. If you have side effects, they will usually start during the first few weeks of treatment and may become more intense with each treatment cycle. Before treatment begins, your doctor or nurse will discuss the side effects to watch out for or report, what medicine to take to help prevent or manage them, and who to contact after hours.
If the side effects change your appearance and self-esteem, consider attending the free Look Good Feel Better program. For more details and to book, call 1800 650 960 or visit lgfb.org.au.
It can be useful to record information about your chemotherapy treatment in one place. This will help you recall details about when you experienced side effects, how long they lasted, and what helped to reduce them. Some people use a notebook or a diary, while others prefer to use technology such as a smartphone or tablet. Share the information you record with your doctors and nurses. They will be able to suggest ways to manage the side effects or they may adjust your treatment, if appropriate.
Complementary therapies are sometimes used with conventional medical treatments. They may offer physical, emotional and spiritual support, help manage side effects, and improve quality of life. Some have been proven to be safe and effective in scientific studies. For example, therapies such as meditation, relaxation, massage and counselling can reduce anxiety, and acupuncture can reduce chemotherapy-induced nausea and fatigue.
It is important to talk to your doctors about any complementary therapies you are using or thinking about trying, as some could interfere with your treatment or worsen side effects. Complementary therapies are different to alternative therapies, which are used instead of conventional medical treatments. Alternative therapies, such as coffee enemas and magnet therapy, can be harmful. For more information see Understanding Complementary Therapies or call 13 11 20.
Feeling tired and lacking energy
Feeling tired and lacking energy (fatigue) is the most common and often the most debilitating side effect of chemotherapy. Fatigue can include feeling exhausted, drowsy, confused or impatient. You may have a heavy feeling in your limbs, get worn out quickly, or find it difficult to do daily activities.
Fatigue can appear suddenly, and rest may not relieve it. You might still feel tired for weeks or months after a treatment cycle ends. While fatigue is a common side effect of chemotherapy, it can also be a symptom of depression. If you think you may be depressed, it’s important to talk to your health care team as there are treatment options available.
Tips for managing fatigue
- Work out your priorities, so you save your energy for the most important things.
- Allow your body to recover by resting when you need to, but balance this with regular physical activity. Exercise can reduce treatment-related fatigue and can also help with other common side effects, such as nausea and loss of appetite.
- Aim to fit in some light exercise, such as walking, on most days and/or keep up with your normal exercise routine. Talk to your health care team about suitable activities for you. See Exercise for People Living with Cancer.
- Let people help you. Family, friends and neighbours often want to assist but may feel unsure about what to do. They could ease your load by helping with shopping, driving, housework or gardening.
- If you have children, ask trusted family and friends to look after them during your chemotherapy sessions and to be on call in case you become unwell afterwards.
- Plan activities for the time of day when you tend to feel most energetic.
- Try to eat a well-balanced diet with plenty of fruits and vegetables.
- Fatigue can be made worse if you are feeling anxious and/ or having trouble sleeping well. Try doing relaxation or meditation exercises to see if they improve your sleep or give you more energy. Order a free mindful medication CD or relaxation CD.
- Consider whether you would like to try acupuncture, which some studies suggest may help reduce physical tiredness after chemotherapy.
- Chemotherapy sometimes causes a poor appetite, nausea and/or vomiting, all of which can leave you feeling exhausted. See below for tips.
- Check with your doctor whether your fatigue is related to low levels of red blood cells (anaemia). Anaemia can be treated.
- Discuss the impact of the treatment with your employer. Some workplaces may allow you to work flexibly during or after chemotherapy. Options include taking a few weeks off work, reducing your hours or working from home.
Appetite changes, nausea or vomiting
It is common for your appetite to change when you are going through chemotherapy, and the drugs may temporarily change how food tastes. Sometimes you may not feel hungry or you may prefer different types of food.
Chemotherapy can make you feel sick (nauseated) or cause you to vomit. Not everyone feels sick during or after chemotherapy, but if nausea affects you, it will usually start a few hours after treatment. Nausea may last for many hours and be accompanied by vomiting or retching. Sometimes nausea lasts for days after treatment.
Often the best way to manage nausea is to stop it before it starts. Anti-nausea (anti-emetic) medicine helps most people, but finding the right one can take time. If you still have nausea or vomiting after using the prescribed medicine, let your nurse or doctor know so that another medicine can be tried.
Being unable to keep liquids down because of vomiting can cause you to become dehydrated. Signs of dehydration include a dry mouth and skin, dark urine, dizziness and confusion. It is best not to be left alone if you are vomiting a lot, as the confusion may make it difficult to realise you have become seriously dehydrated.
Tips for coping with nausea and changed appetite
- If you are nauseous or have vomited a lot, try to keep sipping fluids so that you don’t get dehydrated. If you aren’t able to keep fluids down, contact your doctor or hospital immediately. They may be able to treat the vomiting, or you may need to have fluids through an intravenous drip in hospital.
- Eat a light meal before your treatment (e.g. soup with dry biscuits or toast), and drink as much fluid as possible.
- Sip fluids throughout the day, rather than trying to drink a lot at once. Sucking on ice cubes, iceblocks or jellies can also increase your fluid intake.
- If your stomach is upset, try drinking fizzy drinks such as soda water or dry ginger ale.
- If you wake up feeling sick, eat a dry biscuit or a slice of toast rather than skipping food.
- Breathe deeply and gently through your mouth if you feel like you’re going to vomit.
- Eat what you feel like, when you feel like it. Have frequent snacks instead of large meals.
- Avoid strong odours and cooking smells. Prepare meals ahead and freeze them for days you don’t feel like cooking.
- Eat and drink slowly. Chew your food well to make it easier to digest.
- Consider trying acupuncture, which research shows can reduce chemotherapy-related nausea and vomiting.
If the taste of certain foods has changed, don’t force yourself to eat them. Your sense of taste should return to normal after treatment ends.
- Speak to the hospital dietitian for advice about eating.
- See Nutrition and Cancer and Understanding Taste and Smell Changes for more information.
Many people having chemotherapy worry about hair loss. Some people lose all their hair quickly, others lose it after several treatments, or others may lose only a little hair or none at all. Ask your doctor if hair loss is a possibility and how you can prepare.
When hair loss does occur, it usually starts 2–3 weeks after the first treatment and grows back when chemotherapy is completed. Before and while your hair is falling out, your scalp may feel hot, itchy, tender or tingly. Some people find that the skin on their head is extra sensitive, and they may develop pimples on their scalp.
Although losing head hair is most common, you may also lose hair from your eyebrows, eyelashes, arms, legs, chest and pubic region.
It takes 4–12 months to grow back a full head of hair. When your hair first grows back, it may be a different colour or curly (even if you have always had straight hair). In time, your hair usually returns to its normal condition.
Many people find losing their hair difficult. You may see your hair as part of your overall image and its loss can make you feel sad or vulnerable. Talking to your treatment team may help.
Tips for managing hair loss
- Keep your hair and scalp very clean. Use a mild shampoo like baby shampoo. If you want to use lotion on your head, use sorbolene. Check with your nurse before using any other hair or skin care products.
- Comb or brush your hair gently using a large comb or hairbrush with soft bristles.
- Explain to family and friends, especially children, that the chemotherapy may make your hair fall out.
- Cut your hair, especially if it is long, before it falls out. You could also consider shaving your head. Some people say this gives them a sense of control.
- Wear a light cotton turban or beanie to bed if you are cold at night, or to collect hair.
- Use a cotton, polyester or satin pillowcase, as nylon can irritate your scalp. If you prefer to leave your head bare, protect it against sunburn and the cold.
- Talk to your hairdresser about making your hair look as good as possible even if it is thin or patchy. If you want to dye your hair during or for about six months after chemotherapy, it is best to use vegetable- based, non-chemical dyes.
- If your eyelashes fall out, wear sunglasses outside to protect your eyes from dust and sun.
- Wear a wig, hat, turban or scarf, or go bare-headed – whatever feels best to you.
- Consider choosing a wig before chemotherapy starts. Call Cancer Council 13 11 20 for assistance in finding a wig library or shop.
- Consider booking in for a Look Good Feel Better workshop, where you can try on wigs and hair coverings and learn new make-up techniques. Visit lgfb.org.au or call 1800 650 960.
- See hair loss for more information.
Skin and nail changes
Your skin may peel, darken or become dry and itchy during and after chemotherapy treatment. It is also likely to be more sensitive to the sun.
Some people find their nails also change and become brittle and dry, develop ridges, or have white lines across them.
Tips for looking after your skin and nails
- Use a moisturising soap or sorbolene cream as a soap replacement. After showering, gently pat your skin dry with a towel.
- Use a moisturising lotion or cream containing the ingredient urea to help with the dryness.
- Wear loose, non-restricting clothing. Choose cotton fabric instead of rough wool or synthetic fibres.
- Wash your clothing in mild detergent for people with sensitive skin.
- Stop shaving or waxing until your skin is healed.
- Protect your skin from the sun, especially between 10am and 3pm. Wear high-protection sunscreen (SPF 50+), a broad-brimmed hat, protective clothing and sunglasses, and try to stay in the shade. This advice applies to everyone, but is especially important when having chemotherapy.
- If your skin becomes red or sore in the area where the intravenous device went in, tell your doctor or nurse immediately.
- Avoid chlorinated swimming pools as the water can make skin changes worse.
Some chemotherapy drugs can cause mouth sores, such as ulcers, or infections. This is more likely if you have had or are having radiotherapy to the head, neck or chest, or if you have dental or gum problems. If you notice any change in your mouth or throat, such as sores, ulcers or thickened saliva, or if you find it difficult to swallow, contact your doctor.
Tips for mouth care
- Discuss any dental problems with your doctor before seeing the dentist. If you need any dental work, tell your dentist you are having chemotherapy.
- Use a soft toothbrush to clean your teeth twice a day.
- Try a homemade mouthwash (1 tsp bicarbonate of soda or salt in a glass of warm water) four times a day. Avoid mouthwashes with alcohol.
- Try to prevent mouth ulcers by sucking on ice during chemotherapy sessions.
- Sip fluids, especially water, and eat moist foods such as casseroles or soups if you have a dry mouth. Moisten foods with gravy or sauce.
- Soothe tender gums and mouth with plain yoghurt.
- Blend foods to make them easier to eat. Try smoothies with fruit and yoghurt.
- Avoid smoking and alcoholic drinks, as well as very hot foods and spicy, acidic or coarse foods (e.g. nuts or grains). These can all aggravate mouth sores.
- See mouth health and cancer treatment or call 13 11 20 for information.
Constipation or diarrhoea
Some chemotherapy drugs, pain medicines and anti-nausea drugs can cause constipation or diarrhoea. Tell your doctor or nurse if your bowel habits have changed.
Tips for managing bowel changes
- Eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruits and vegetables, nuts and legumes (e.g. baked beans or lentils).
- Drink plenty of fluids, both warm and cold, to help loosen the bowels. Prune, apple or pear juice can work well.
- Do some light exercise, such as walking.
- Don’t use enemas or suppositories. They are not recommended for people having chemotherapy.
- Let your treatment team know if you have constipation for more than a couple of days. They will be able to help.
- Choose bland foods such as clear broth or boiled rice. Avoid spicy foods, wholegrain products, fatty or fried foods, rich sauces, and raw fruits or vegetables with skins or seeds.
- Limit alcohol, fruit juice, soft drinks, strong tea or coffee, and dairy products, as these stimulate the bowel.
- Drink water to help replace fluids lost through diarrhoea.
- Talk to your pharmacist about using over-the-counter medicines for diarrhoea.
- If diarrhoea is severe, it can cause dehydration and you may need to go to hospital.
Memory and concentration changes
Some people say they have trouble thinking clearly after they have had chemotherapy. This is called cognitive impairment or, sometimes, ‘chemo brain’. You may find that it takes you more time to process information, or you may experience short-term memory loss or have trouble concentrating for long periods. This side effect may last for a short time or for years.
There is some evidence that self-help techniques such as exercise, relaxation, and memory games can help. Tell your doctor if this issue is affecting your day-to-day life.
Tips for managing cognitive changes
- Use a calendar to keep track of tasks, appointments, social commitments, birthdays, etc.
- Write down anything you need to remember, e.g. to-do items, where you parked the car, when to take medicine.
- Plan to do things that require focus when you are fresher, such as in the morning. At other times, choose activities that need less concentration, e.g. read magazines instead of complex novels.
- Get plenty of sleep. Deep sleep is important for memory and concentration.
- Do light exercise each day. This may help you to clear your mind and sleep better.
- Learn something new, e.g. take up a new hobby or do crosswords or puzzles.
- Talk to your partner, family or friends about how you’re feeling. This can help prevent misunderstandings and frustration.
A low red blood cell count is called anaemia. This can make you feel tired, lethargic, dizzy or breathless. The tips for coping with fatigue may be helpful. To minimise dizziness, take your time when you get up from sitting or lying down.
Your treatment team will monitor your red blood cell levels. If the levels drop too low, you may need a blood transfusion to build them up again.
If white blood cell numbers drop during chemotherapy, it can lower your immunity. This makes you more prone to infections and less able to fight any infections that do occur. Your doctor may recommend antibiotics as a precaution against infection.
The white blood cells known as neutrophils protect you against infection by destroying harmful bacteria and yeast that enter the body. A low level of neutrophils (neutropenia) is a common side effect of chemotherapy. If you have neutropenia, you may be given an injection of granulocyte-colony stimulating factor (G-CSF) after chemotherapy. Your doctor or nurse will speak to you about possible side effects. Some people may experience bone pain or tenderness at the injection site, or show signs of an allergic reaction.
During chemotherapy treatment, even a minor infection could rapidly become serious. See when you need to contact your doctor urgently.
Tips for managing low immunity and infections
- Check your temperature every day and seek urgent medical attention if it rises to 38oC or above.
- See your doctor if you are unwell, even if you just have a cold.
- Wash hands well with soap and water before handling food and after using the toilet.
- Try to eat freshly cooked or freshly prepared foods. Avoid pre-made sandwiches, salads and takeaway; soft cheeses; raw or rare fish, meat or eggs; unpasteurised dairy foods; and soft-serve ice-creams.
- Use separate chopping boards and utensils for raw and cooked foods, and clean well with hot, soapy water.
- Wash fruits and vegetables well, or peel where possible.
- Store raw and cooked foods separately. Put leftover food in airtight containers in the fridge as soon as possible.
- Cook food thoroughly to reduce the risk of bacteria developing.
- Don’t eat food or drinks past their use-by or best before dates.
- Stay away from people who are unwell, especially if they have the flu, conjunctivitis, measles, mumps, a cold sore or chickenpox. If a member of your household is unwell, try to avoid close contact until they have recovered.
- Try to avoid crowded places such as public transport during rush hour, shopping centres or public pools to reduce the risk of picking up an infection.
- Check with your doctor about having the flu vaccine if you are having chemotherapy during winter.
- Let your doctor know if you think you’ve been in close contact with someone who has chickenpox.
Platelets are the blood cells that help the blood to clot, and a low level of platelets (thrombocytopenia) can cause problems with bleeding. You may bleed for longer than normal after minor cuts or scrapes, have nosebleeds or bleeding gums, or bruise easily.
Your treatment team will monitor your platelet levels. If chemotherapy causes thrombocytopenia, you may need to go to hospital for a platelet transfusion.
Contact your treatment team or call 000 if you have any persistent bleeding, such as a nosebleed that doesn’t stop within 30 minutes.
Tips for when you have a low platelet count
- Be careful when using scissors, needles, knives or razors, as you may bleed easily. Small cuts or nicks can also harbour germs where an infection can start.
- Use an electric razor when shaving to reduce the chance of nicking yourself.
- Wear thick gloves when gardening to avoid injury. (The gloves will also prevent infection from soil, which contains bacteria.)
- Use a soft toothbrush to avoid irritating your gums.
- Avoid cuts and scrapes on your feet by wearing comfortable, well-fitting shoes indoors and outside.
- Take care when blowing your nose.
- If you bleed, apply pressure for about 10 minutes and bandage as needed.
- If you have problems with bleeding, talk to your doctor.
Nerve and muscle effects
Some drugs can cause tingling (‘pins and needles’), pain or loss of sensation in your fingers and/or toes, and muscle weakness in your legs. This is called peripheral neuropathy. If you experience these side effects, tell your doctor or nurse before your next treatment. Your treatment may need to be changed or the problem carefully monitored.
For many people, peripheral neuropathy is a short-term issue, but for others, it can last a long time or even be permanent. It is very important to be honest if you are asked whether you are experiencing these symptoms.
Tips for managing peripheral neuropathy
- Take care when moving around – you may be more prone to trip and fall if your feet are numb or your legs are weak.
- Keep your hands and feet warm to help the blood circulate. Gloves and warm socks can help when it’s cold.
- Soak your hands and feet in warm water to relieve symptoms.
- Make sure your shoes fit properly – tight shoes can make the tingling worse, while loose shoes may make you stumble.
- Use your elbow to check water temperature so you don’t scald yourself.
- Talk to an occupational therapist from your treatment team about aids that may help, e.g. bed posts to raise the sheets off your feet.
- If your symptoms are severe, talk to your doctor about medicines that may offer relief.
Change in hearing
Some chemotherapy drugs can affect your hearing. Your doctor may recommend that you have a hearing test before you start treatment. You may be at risk of losing the ability to hear high-pitched sounds. Sometimes, chemotherapy also causes a continuous ringing noise in the ears known as tinnitus. While these changes are usually temporary, let your doctor know if you notice any change in your hearing.
Sex and fertility
Chemotherapy can have an impact on your desire or ability to have sex. It may also affect sexual organs and functioning in men and women. This can affect your ability to have children (fertility).
Changes in sexuality
Many people have a range of worries that cause them to lose interest in sex while they’re having treatment. Aside from feeling tired and unwell, you may feel less confident about who you are and what you can do, or there may be a physical reason for not being able or ready to have sex. For example, vaginal dryness or erection difficulties are common issues after treatment. Changes in appearance can also affect feelings of self-esteem and, in turn, sexuality.
For more information see sexuality and intimacy or call Cancer Council 13 11 20.
Partners may also feel concerned about having sex. They might fear injuring the person with cancer or feel uncomfortable with the changes in their partner. If you have sex after receiving chemotherapy, follow the safety precautions described below.
Sexual intercourse may not always be possible, but closeness and sharing can still be a part of your relationship. Talk about how you’re feeling with your partner, and take time to adapt to any changes. Try to see yourself as a whole person (body, mind and personality) instead of focusing only on what has changed.
Although chemotherapy often reduces fertility, it is important to realise that it may not rule out pregnancy. Some women can still become pregnant while having chemotherapy, and a man having chemotherapy could still make his partner pregnant.
Chemotherapy drugs can harm an unborn baby, so women should not become pregnant during the course of chemotherapy, and men should not father a child. Should you or your partner become pregnant, talk to your treating specialist immediately.
The type of birth control you choose will depend on what you and your partner are comfortable using. Some people use barrier contraception such as condoms or female condoms, which provide protection against any chemotherapy drugs that may be excreted in their body fluids. Young women may be prescribed the contraceptive pill – as well as preventing pregnancy, the pill may help protect the ovaries from the effects of chemotherapy.
Changes in fertility
If you want to have children in the future, talk to your doctor about how chemotherapy might affect you and what options are available. Women may be able to store eggs (ova) or embryos, and men may be able to store sperm for use at a later date. This needs to be done before chemotherapy starts and requires careful consideration.
Effects on women
- For some women, periods become irregular during chemotherapy but return to normal after treatment. For others, chemotherapy may cause periods to stop completely (menopause).
- After menopause, women can’t conceive children. Signs of menopause include hot flushes, sweating – especially at night – and dry skin.
- Menopause – particularly when it occurs in women under 40 – may, in the long term, cause bones to become weaker and break more easily. This is called osteoporosis. Talk to your doctor about ways to manage menopausal symptoms.
Effects on men
- Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. This can sometimes cause infertility, which may be temporary or permanent.
- The ability to get and keep an erection may also be affected, but this is usually temporary. If the problem is ongoing, talk to your doctor.
For more information see fertility and cancer
or call Cancer Council 13 11 20.
- Many people experience side effects from chemotherapy. Side effects are caused when the chemotherapy damages rapidly dividing healthy cells.
- Your doctor or nurse will advise you on how to cope with any side effects. You may be prescribed medicine or given suggestions for eating, drinking and looking after yourself.
- It may be helpful to record your symptoms, when they occurred and what you did to relieve them, possibly in a chemotherapy diary. Show your notes to your doctor or nurse.
- Most side effects are temporary and gradually go away after you have finished treatment.
- Common side effects include feeling tired, loss of appetite, nausea, hair loss, mouth sores, skin problems and bowel issues.
- You may have a reduced ability to concentrate or remember things. There can also be nerve and muscle effects and hearing changes.
- You will be at increased risk of infections. This is because chemotherapy can reduce your levels of white blood cells, which are necessary for fighting infections.
- You may have sexuality and fertility problems, such as reduced sexual desire or loss of fertility. You might be able to store eggs (ova), embryos or sperm for use at a later date. Talk to your doctor about these issues.
- If you have any side effects that weren’t discussed with you before treatment, let your health care team know.
Reviewed by: Dr Andrew Haydon, Medical Oncologist, The Alfred Hospital and Cabrini Hospital, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches, NSW; Mish Blacher, Consumer; Nicole Loft, Haematology Nurse Practitioner, Royal Adelaide Hospital, Central Adelaide Local Health Network, SA; Simoene Smith, 13 11 20 Cancer Information Consultant, Cancer Council NSW, NSW.