Managing side effects of chemotherapy
On this page: Feeling tired and lacking energy | Appetite changes, nausea and vomiting | Hair loss | Skin and nail changes | Mouth sores | Memory and concentration changes | Effects on the blood and immune system | Change in hearing | Constipation and diarrhoea | Sex and fertility | Nerve and muscle effects
While chemotherapy can kill cancer cells, it can also affect normal
cells that grow or divide rapidly, such as those in the bone marrow,
digestive tract, skin, hair and reproductive organs. When the
normal cells are damaged, this causes side effects.
This section discusses the most common side effects people
experience and offers suggestions to help manage them. Whether
or not you experience side effects, and how severe they are,
depends on the type and dose of drugs you’ve been prescribed and
how you react individually from one treatment cycle to the next.
Side effects vary greatly. Some people will have no side effects,
others will experience a range. If you have side effects, they will
usually start during the first few weeks of treatment, however they
can accumulate with each cycle.
Most side effects are temporary and can be managed. They tend
to gradually disappear once treatment has stopped and your
normal healthy cells have recovered. Depending on the side effects
you experience, your doctor may change the dose or type of
You should talk to your doctor or nurse before your treatment
begins about the side effects you should watch out for or report,
and who to contact out of hours if you have immediate concerns.
If the side effects change your appearance and self-esteem, consider
attending a free Look Good...Feel Better workshop.
It can be useful to record information about your chemotherapy
treatment in one place so 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 (download a PDF of our Chemotherapy booklet for a blank diary you can fill in and photocopy), while others
prefer technology such as a smartphone. You may want to make a
note of the date, time, symptoms experienced.
Sharing the information you record with your doctors and nurses
will help them give you suggestions for dealing with side effects or
adjust your treatment, if appropriate.
Feeling tired and lacking energy
Feeling tired and lacking energy (fatigue) is the most common
and often, debilitating side effect of chemotherapy. Fatigue can
include feeling exhausted, drowsy, confused or impatient. You
may have a heavy feeling in your limbs, or find it difficult to do
Fatigue can appear suddenly and rest may not relieve it. You might
still feel tired for weeks or months after a treatment cycle ends.
"I had no idea that I would still be feeling tired five months after finishing treatment... I didn't know how to make it better and I was scared that's how it would be: that I wouldn't go back to normal, that I would never go back to having energy again." - George, bowel cancer
- Save your energy. Help your
body recover by doing only
the things you really need to
do and resting more.
- Let people help you. Family,
friends and neighbours
often want to assist but may
feel unsure about what to
do. They could help with
shopping, driving, housework
- If you have children, ask for
help looking after them during
chemotherapy and a few
- Plan activities for the time of
day when you tend to feel
- Do light exercise, such as
walking, and/or keep up with
your normal exercise routine.
Regular exercise can help
reduce fatigue and increase
appetite. Talk to your health
care team about suitable
activities for you.
- Try to eat a well-balanced
diet with plenty of fruits and
- Do relaxation or meditation
exercises to see if they
improve your sleep or give
you more energy. Order a free copy of Cancer Council’s
- If you have a poor appetite,
nausea or vomiting, see below for tips.
- Check with your doctor
whether your fatigue is
related to low red blood cells
(anaemia) so that this can be
treated – see below.
- Discuss the impact of
your treatment with your
employer. Some workplaces
may allow you to work
flexibly during or after
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 some drugs temporarily change the
taste of foods. Sometimes you may not feel hungry, or you may not
enjoy the foods you used to like or crave foods you don’t usually eat.
Chemotherapy can make you feel sick (nauseated) or cause you
to vomit. Your medical oncologist will tell you if the drugs you
are given are likely to cause nausea and vomiting. Not everyone
feels sick during or after chemotherapy but, if nausea affects you,
it usually starts 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.
Anti-nausea (anti-emetic) medication helps most people avoid
chemotherapy related nausea or vomiting. This medicine can be
taken before, during or after treatment. It may be available as::
- tablets: can be taken regularly at home
- liquids: added to the chemotherapy
- wafers: dissolved under or on top of the tongue
- suppositories: placed in the rectum where they dissolve.
Finding a combination of anti-nausea medication that works for
you can take time. If you still have nausea or vomiting after using
the prescribed medication, let your nurse or doctor know.
Being unable to keep liquids down because of vomiting can cause
you to become dehydrated.
- If you are nauseous or have
vomited a lot, try to keep your
fluids up so that you don’t get
dehydrated. If you aren’t able
to keep fluids down, contact
your doctor immediately.
- Eat a light meal before your
treatment (e.g. soup and 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, ice-blocks or jellies
can also help to 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 altogether or forcing
yourself to have a full meal.
- Breathe deeply and gently
through your mouth if you feel
like you’re going to vomit.
- Avoid strong odours and
- Eat and drink slowly. Chew
your food well to make it
easier to digest.
- Prepare meals between
treatments and freeze them
for the days you don’t feel
- Eat what you feel like, when
you feel like it. For example,
have cereal at dinner time and
a main meal at lunch.
- Have small, frequent snacks
instead of large meals.
- If the taste of certain types of
food has changed, don’t force
yourself to eat them. Your
sense of taste should return to
normal after treatment ends,
but it may take some time.
- Ask your treatment team about
taking a stool softener if the
drugs make you constipated.
- Speak to the hospital dietitian
for advice about eating..
Call Cancer Council 13 11 20 for free information about eating healthily during and after treatment.
Many people having chemotherapy worry about hair loss.
people lose all their hair quickly, others lose it after several
treatments, or others may only lose a little hair or none at all.
Whether or not you lose your hair depends on the drugs you
receive. Some drugs don’t cause this side effect. 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 very difficult. You may feel
that your hair is part of your overall image and its loss can make
you feel physically unattractive, vulnerable or sad. It’s natural to
feel this way. Talking to your medical team may be helpful.
- Keep your hair and scalp
- 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.
- Cut your hair, especially if
long, before it falls out. This
can be less upsetting.
- 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.
- Limit the use of hair dryers,
rollers and harsh products.
- 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, use vegetable-
based dyes or those low in
chemicals. Test a small area
of hair for a reaction before
colouring your whole head.
- If your eyelashes fall out,
wear glasses or sunglasses
to protect your eyes from the
dust and sun while outside.
- Tell your nurse or doctor if
the skin on your scalp is very
sensitive, or if you have a lot
of discomfort and itchiness.
- Wear a wig, toupee, hat,
scarf or turban. Do whatever
feels the most comfortable
and gives you the most
- Consider choosing a wig
before chemotherapy starts.
You can borrow a wig from
hospitals or treatment centres
with a wig library. If you want
to buy a wig and you have
private health insurance,
check with your fund if you
are eligible for a rebate.
Call Cancer Council 13 11 20 for assistance in finding a wig library or shop.
Skin and nail changes
Some chemotherapy drugs can affect your skin. It can darken,
peel or become dry and itchy. It is also likely to be more sensitive
to the sun, during and after treatment.
Some people find their nails also change and become brittle and
dry, develop ridges, or have white lines across them.
Use a moisturising soap
or sorbolene cream as
a soap replacement.
- After showering, gently pat
your skin dry with a towel. Try
not to rub your skin too hard.
- Use a moisturising lotion
or cream containing the
ingredient urea to stop the
- Wear loose, non-restricting
clothing. Choose cotton fabric
instead of rough wool or
- Wash your clothing in mild
detergent for people with
- Stop shaving or waxing until
your skin is completely healed.
- Protect your skin from the
sun – especially between
10am and 3pm – by wearing
(SPF 50+), a hat and
protective clothing. This
advice applies to everyone,
but is especially important for
people having chemotherapy.
- If your skin becomes red
or sore in the area where
the intravenous device went
in, tell your doctor or nurse
- 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 radiation
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.
- 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.
- Soothe tender gums and
mouth sores with plain
- Keep your mouth clean and
use a mouthwash to help
heal mouth sores. Don’t use
containing alcohol as they
may dry out or irritate your
mouth. Try a homemade
mouthwash (1 tsp bicarbonate
of soda or salt in a glass of
warm water) at least four times
a day. Start when treatment
commences to prevent mouth
- Sip fluids, especially water,
and eat moist foods such as
casseroles or soups if you
have a dry mouth. Moisten
foods with butter and sauces.
- Try sucking on ice while
you’re having intravenous
chemotherapy to reduce
- Blend foods to make them
easier to eat.
- Avoid very hot foods, and
spicy, acidic or coarse foods,
(e.g. nuts or grains), as these
can aggravate mouth sores.
- Don’t smoke or drink alcohol,
as this irritates the mouth.
Memory and concentration changes
Some people say they have trouble thinking clearly following
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.
There is some evidence that self-help techniques such as relaxation,
exercise and memory games can help. Tell your doctor if this issue
is affecting your day-to-day life.
- Use a calendar to keep track
of tasks, appointments, social
commitments, birthdays, etc.
- Write down what you have to
remember. For example, make
to-do lists or record where
you parked the car.
- Choose activities that require
less concentration. For
example, read magazines with
short articles instead of books
with several characters or
- Learn something new,
take up a new hobby, or
do crosswords or number
- Plan activities so you do
things that require more
concentration when you
are fresher, such as in the
- Get plenty of sleep. Deep
sleep is important for memory
- Do light exercise each day.
This may help you to clear
your mind and sleep better.
- Talk to your partner, family
or friends about how you’re
feeling. This can help prevent
Effects on the blood and
Some chemotherapy drugs affect the bone marrow, which is the
soft and spongy material inside the bones. The bone marrow
makes three types of blood cells:
red blood cells: carry oxygen throughout the body
- white blood cells: fight infection
- platelets: help blood to clot and prevent bruising.
The bone marrow’s job is to maintain normal levels of blood
cells (your blood count) to keep you fit and healthy. When
chemotherapy affects the bone marrow, your blood count is
reduced. The count may fall with each treatment. This can cause
problems such as anaemia, infections and bleeding problems,
depending on the type of blood cell affected.
Your health care team will do regular blood tests to make sure your
blood cells return to normal levels before your next treatment.
A low red blood cell count is called anaemia. This can make you
feel tired, lethargic, dizzy or breathless.
You may need a blood transfusion to build up your red blood cells
and treat the anaemia.
Eating a nourishing diet with foods rich in iron and B vitamins
is also important if you are anaemic. Good sources include
wholegrain breads and cereals, lean meat and green leafy vegetables.
If white blood cell numbers drop during chemotherapy, it
can make you more prone to infections. Sometimes doctors
recommend taking antibiotics as a precaution against infection.
If the number of neutrophils (a type of white blood cell that help
protect against infection) drop during chemotherapy, 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.
When to contact your doctor
Contact your doctor or treatment centre urgently if any of the following occur:
chills or sweats
- a temperature of 38°C or more
- persistent or severe vomiting
- severe abdominal pain, constipation or diarrhoea
- unusual bleeding
- redness or swelling around the site of the intravenous chemotherapy device
- any serious unexpected side effects or sudden deterioration in health.
Also, contact your GP or treating specialist if you experience other
symptoms that may be due to an infection. For example, sweating,
especially at night; sore throat; mouth ulcers; burning or stinging
on passing urine; or easy bruising.
Managing the risk of infections when your immunity is low
- Check your temperature
- See your doctor if you are
unwell, even if you just have
- Wash your hands with soap and
water before preparing food and
eating, and after using the toilet.
- Try to eat freshly cooked or
prepared foods. Avoid pre-made
sandwiches, salads and
takeaway; soft cheeses; raw
or rare fish, meat and eggs;
unpasteurised dairy products
and soft-serve ice-creams.
- Use separate chopping boards
and utensils for raw and cooked
foods, and clean thoroughly with
hot, soapy water.
- Wash fruits and vegetables well,
or peel where possible.
- Store raw and cooked foods
- Put leftover food in airtight
containers in the fridge as soon
- Cook food thoroughly to reduce
the risk of bacteria developing.
- Don’t eat food or drinks past
their use-by or best before dates.
- Avoid people who are unwell,
especially if they have the flu,
conjunctivitis, measles, mumps,
a cold sore or chickenpox.
- Avoid crowded places such as
public transport during rush
hour, shopping centres or public
pools to reduce the risk of
picking up an infection. This is
not always practical, so use your
- Check with your doctor
about having the flu vaccine if
you are having chemotherapy
- Let your doctor know if you think
you have been in close contact to
someone with chicken pox.
A decrease in platelets can cause you to bleed for longer than
normal after minor cuts or scrapes, or to bruise more easily. You
may need a platelet transfusion if they are low.
- Be careful when using
scissors, needles, knives or
razors. Small cuts or nicks
can 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, and
to prevent infection from soil,
which contains bacteria.
- Use a soft toothbrush to avoid
irritating your gums.
- If you bleed, apply pressure
for about 10 minutes and
bandage, if appropriate.
- If you have problems with
bleeding, talk to your doctor.
Change in hearing
Some chemotherapy drugs can affect your hearing. Your doctor
may recommend that you have a hearing test before you start
You may be at risk of losing the ability to hear high-pitched sounds.
Chemotherapy can also cause 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.
Constipation or diarrhoea
Some chemotherapy drugs, pain relief medicines and anti-nausea
drugs can cause constipation or diarrhoea. Tell your doctor or
nurse if your bowel habits have changed.
- Eat more high-fibre foods, such
as wholegrain bread and pasta,
bran, fruit and vegetables, nuts
and legumes (For example, baked
beans or lentils).
- Ease constipation by drinking
fruit juice. Try prune, apple or
- Drink plenty of other fluids,
both warm and cold, to help
loosen the bowels.
- Do some light exercise, such
- Don’t use enemas or
suppositories. They are not
recommended for people having
- Let your doctor or nurse know if
you have constipation for more
than a couple of days. They may
change your medication or give
you other medication to relieve it.
- Choose bland foods such as
clear broth or boiled rice. Avoid
spicy foods, wholegrain products,
fatty or fried foods, rich gravies
and 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 may
further stimulate the bowel.
- Drink water to help replace the
fluids lost through diarrhoea.
- Talk to your pharmacist for advice
about using over-the-counter
medications to treat diarrhoea
- If the diarrhoea becomes severe,
it can cause dehydration and
you may need to be admitted to
Sex and fertility
Chemotherapy may impact on your desire or ability to have sex. It
may also affect sexual organs and functioning in both women and
men. This can lead to a temporary or permanent effect on your
ability to have children (your 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.
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, you should take safety precautions .
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.
For more information, see sexuality and intimacy.
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.
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
- After menopause, women
can’t have children. Signs of
menopause include hot flushes,
sweating – especially at night –
and dry skin.
- Menopause – particularly if
before age 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
For more information about pregnancy and chemotherapy, see the main Chemotherapy page.
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, seek
For more information, see sexuality and intimacy.
Although chemotherapy reduces fertility, it is still possible for some
women to 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 doctor immediately.
The type of birth control you choose will depend on what you
and your partner are comfortable using. Some people use barrier
contraception (e.g. condoms), which provide protection against
any cytotoxic drug by-products that may be secreted in body
f luids. Young women may be prescribed the Pill as a contraceptive
and to help protect the ovaries from the effects of chemotherapy.
Nerve and muscle effects
Some drugs can cause tingling and loss of sensation in your fingers
and/or toes, and muscle weakness in your legs. If this happens, tell
your doctor or nurse before your next treatment. Your treatment
may need to be changed or the problem carefully monitored.
"I had numbness and terrible pain in my hands from one drug. Doing exercises and soaking my hands in warm water helped. The doctors stopped that drug so the side effects wouldn't become permanent." —
Ann, ovarian cancer
- Many people experience side
effects from chemotherapy.
Side effects are caused when
the chemotherapy damages
rapidly dividing healthy cells.
- Most side effects are
temporary and gradually go
away after you’ve finished
- Common side effects include
feeling tired, loss of appetite,
nausea, mouth sores,
digestive problems, hair loss
and skin problems.
- You may also have nerve
and muscle effects, hearing
changes and a reduced ability
to concentrate or remember
- You will also be at an
increased risk of infections.
This is because chemotherapy
can reduce your levels of
white blood cells, which
are necessary for fighting
- You may have sexuality and
fertility problems, such as
reduced sexual desire (libido)
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.
- Your doctor or nurse will advise
you on how to cope with any
side effects. You may be given
medication or suggestions for
eating, drinking and looking
- If you have any side effects
that weren’t discussed with
you before treatment, let your
health care team know so that
they can help you.
- It may be helpful to record
your symptoms, when they
occurred and what you did
to relieve them. Show your
notes to your doctor or
nurse so they are aware of
how the chemotherapy is
Information reviewed by: A/Prof Paul Craft, Medical Oncologist, The Canberra Hospital,
Medical Oncology, Australian National University Medical School and Clincial Director, Canberra Region
Cancer Centre, ACT; Kate Archibald, Clinical Nurse Specialist (Oncology), Monash Health, VIC; Elaine
Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches Health Service, NSW; Ilne
Geddes, Consumer; Tina Griffiths, Nurse Coordinator Chemotherapy, Cancer Services, Olivia Newton-
John Cancer & Wellness Centre, VIC; and Cecelia van Raders, Team Leader, Cancer Council Helpline,
Cancer Council Queensland, QLD.