Managing side effects of chemotherapy

Wednesday 1 August, 2018

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On this page: Feeling tired and lacking energy | Appetite changes, nausea or vomiting | Constipation or diarrhoea | Hair loss | Mouth sores | Skin and nail changesThinking and memory changesAnaemia  | Infections | Bleeding problems | Nerve and muscle effects | Change in hearingSex and fertility | Key points


Chemotherapy affects all cells that grow and divide quickly in the body. This includes cancer cells and normal cells, such as the new blood cells in the bone marrow or the cells in the mouth, stomach, skin, hair and reproductive organs. When chemotherapy damages normal cells, this causes side effects.

Whether or not you experience side effects, and how severe they are, depends on the type and dose of drugs you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. They tend to gradually improve once treatment stops and the normal, healthy cells recover. Sometimes, chemotherapy causes long-term side effects that don't go away. These may include damage to your heart, lungs, nerve endings, kidneys, or reproductive organs.

You may worry about the side effects of chemotherapy. If you feel upset or anxious about how long treatment is taking or the impact of side effects, let your doctor or nurse know. The drugs used for chemotherapy are constantly being improved to give you the best possible results and to reduce potential side effects. This section explains ways to manage the discomfort side effects may cause.

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, how to help prevent or manage them, and who to contact after hours if you need help.

If side effects change your appearance and self-esteem, consider registering for a free Look Good Feel Better workshop. For more details and to book, call 1800 650 960 or visit lgfb.org.au. You may also find it helpful to speak with a psychologist or counsellor, who can provide emotional support.

Recording side effects

It can be useful to keep a record of 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 make them better. Some people use a notebook or a diary, while others prefer to use 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, if appropriate, they may adjust your treatment.

Trying complementary therapies

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 therapies 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. These therapies are part of guidelines for complementary therapies and breast cancer.

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 make side effects worse. Complementary therapies are different to alternative therapies, which are used instead of conventional medical treatments. These are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies.

See Understanding Complementary Therapies.

Feeling tired and lacking energy

Feeling tired and lacking energy (fatigue) is the most common 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. For more information on depression, visit beyondblue.org.au and talk to your cancer care team.

"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." - Judy

Tips for managing fatigue

  • Plan activities for the time of day when you tend to feel most energetic.
  • Allow your body to recover by taking regular breaks.
  • Make time for regular exercise. Light to moderate exercise can reduce treatment-related fatigue and improve mood. Talk to your health care team about suitable activities for you. See Exercise for People Living with Cancer.
  • Ask for, and accept, offers of support from family, friends and neighbours. They can help 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.
  • Find ways to manage anxiety and/or trouble sleeping as these can affect fatigue. Relaxation or meditation exercises may help improve your sleep or give you more energy. Call 13 11 20 and check whether your local Cancer Council can provide CDs, or listen to The Thing About Cancer podcast episodes on fatigue and sleep.
  • Consider trying acupuncture – some studies suggest this may help reduce physical tiredness after chemotherapy.
  • See below for tips on dealing with exhaustion caused by a poor appetite, nausea and/or vomiting.
  • 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, 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. The drugs may also 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 prevent it from starting. Anti-nausea (antiemetic) medicine helps most people, but finding the right one can take time. If nausea or vomiting continue after using the prescribed medicine, let your nurse or doctor know so that another medicine can be tried. Steroids may also be used to manage nausea.

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 not safe to be left alone if you are vomiting a lot, as the confusion may make it difficult to realise you have become seriously dehydrated.

"Once I started chemotherapy, I went off my food. My mouth felt very dry, which made food taste unappetising. Adding extra sauce helped." - Helen

Tips for coping with nausea and changed appetite

Managing appetite loss

  • Eat what you feel like, when you feel like it. Have frequent snacks instead of large meals.
  • Try to eat extra on days when you have an appetite.
  • Avoid strong odours and cooking smells that may put you off eating. It might help to prepare meals ahead and freeze them for days you don't feel like cooking.
  • 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.
  • If you don't feel like eating solid foods, try enriching your drinks with powdered milk, yoghurt, eggs or honey.
  • Don't use nutritional supplements without your doctor's advice, as some could interfere with treatment.
  • Ask a dietitian for advice on the best eating plan during treatment and recovery.

Managing nausea

  • Eat a light, bland meal before your treatment (e.g. soup with dry biscuits, crackers or toast).
  • 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.
  • Sip fluids throughout the day. Sucking on ice cubes, iceblocks or jellies can also increase your fluid intake. If water tastes unpleasant, flavour it with ginger cordial or syrup.
  • 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 slice of toast rather than skipping food.
  • Listen to the The Thing AboutCancer podcast episode on appetite loss and nausea.

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

Constipation

  • 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.
  • Ask your doctor about using a laxative, stool softener and/or fibre supplement.
  • Avoid enemas or suppositories as they may cause infection.
  • Let your treatment team know if you have constipation for more than a couple of days. They will be able to help.

Diarrhoea

  • 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 cancer care team – they may change the treatment or suggest other solutions, such as using over-the-counter medicines.
  • If diarrhoea is severe, let your cancer care team know. It can cause dehydration and you may need to go to hospital.

Watery eyes can be a symptom of a blocked tear duct. This can be caused by some chemotherapy drugs. Regularly massaging the area and using eye drops can help clear blockages. Let your cancer care team know if this issue is ongoing.

Hair loss

Many people having chemotherapy worry about hair loss (alopecia). Whether or not you lose your hair will depend on the drugs you are prescribed. Some people lose all their hair quickly and others lose it after several treatments, while others may lose only a little hair or none at all. Although losing head hair is most common, you may find your eyebrows and eyelashes fall out, and you may lose hair from your underarms, legs, chest and pubic region.

When hair loss does occur, it usually starts 2–3 weeks after the first treatment. 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. After chemotherapy ends, 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 original condition.

Coping with hair loss

Many people find losing their hair difficult. Your hair may help form part of your sense of self – its loss can affect your self-confidence and make you feel sad or vulnerable. For many people, it's a public sign of the cancer diagnosis. Talking to your treatment team may help.

Scalp cooling

Some people may be able to reduce or prevent hair loss by using a "cold cap". This works by temporarily reducing the blood flow and the amount of chemotherapy drug that reaches the scalp. A cap is worn on the head and attached via a hose to a cooling unit, which fills the cap with cold liquid. It is worn while the chemotherapy is delivered.

The cold cap can only be used with certain drugs and types of cancer, and doesn't always prevent hair loss. Check with your doctor or nurse whether a cold cap would be an option for you and whether it is available at your treatment centre.

Karen's story

"I'd been feeling unwell – eating made me feel nauseous and I couldn't stand to have anything tight around my stomach. My GP booked me in for some scans and then I was referred to an oncologist and I had a biopsy. After that, the diagnosis of non-Hodgkin lymphoma was confirmed.

"I received the standard chemotherapy drugs for the first few months of treatment, and then I took part in a clinical trial.

"During the week I had treatment, I would feel okay as the nurses would give me medicine. The next week, I would get side effects like diarrhoea, vomiting and constipation. I took ginger to help with the nausea, and I tried to live my normal life whenever I felt well enough.

"I had good support from work, my family and friends, and the hospital staff were brilliant. I still have regular check-ups and I'm back to living my usual active life."

Tell your cancer story.

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 a 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. 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.
  • Use a cotton, polyester or satin pillowcase, as nylon can irritate your scalp.
  • 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 vegetablebased, 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. If you prefer to leave your head bare, protect it against sunburn and the cold.
  • Consider choosing a wig before chemotherapy starts. Call Cancer Council 13 11 20 for assistance in finding a wig library or shop.
  • Consider registering for a Look Good Feel Better workshop, where you can try on wigs and other head wear and learn new make-up techniques. Call 1800 650 960 or visit lgfb.org.au.
  • Read Cancer Council's Hair Loss fact sheet available from your local Cancer Council website, or call 13 11 20 for more information.

Mouth sores

Some chemotherapy drugs can cause mouth sores, such as ulcers, or infections. This is more likely if you have had or are having radiation therapy to the head, neck or chest, or if you have dental or gum problems.

If you notice any sores, ulcers or thickened saliva, or if you find it difficult to swallow, tell your doctor.

Tips for mouth care

  • Discuss any dental issues with your oncologist before seeing the dentist. If you need any dental work, tell your dentist you're having chemotherapy.
  • Use a soft toothbrush to clean your teeth twice a day.
  • Rinse your mouth four times a day with 1 tsp bicarbonate of soda or salt in a glass of warm water. Avoid mouthwashes containing 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 or mouth with plain yoghurt.
  • Blend foods to make them easier to eat. Try smoothies made of 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.
  • Read the Mouth Health and Cancer Treatment fact sheet, available from your local Cancer Council website, or call 13 11 20 for information.

Skin and nail changes

Some chemotherapy drugs may cause your skin to peel, darken or become dry and itchy. During treatment and for several months afterwards, your skin is likely to be more sensitive to the sun.

Some people find their nails also change and become darker than usual, or develop ridges or white lines across them. Your nails may also become brittle and dry. These changes usually grow out.

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 rather than rubbing it.
  • 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 when UV levels are 3 or above. 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, let your doctor or nurse know immediately.
  • Avoid chlorinated swimming pools as the water can make skin changes worse.

Thinking and memory changes

Some people say they have difficulty concentrating, focusing and remembering things after they have had chemotherapy. This is called cancer-related cognitive impairment or, sometimes, "chemo brain" or "cancer fog". Thinking and memory changes may be caused by treatment or medicines, fatigue and sleep problems, or emotional concerns, such as stress or depression. These problems usually improve with time, although some people experience issues for years.

Tell your doctor about any thinking and memory changes you are having, and if this issue is affecting your day-to-day life or your return to work.

Tips for managing cognitive changes

  • Use a calendar to keep track of tasks, appointments, social commitments, birthdays, etc.
  • Learn something new, e.g. take up a new hobby or do crosswords or puzzles.
  • Write down anything you need to remember, e.g. to-do items, where you parked the car, when to take medicine.
  • Discuss these issues with your partner, family or workplace, and ask for their support or assistance.
  • Get plenty of sleep. Deep sleep is important for memory and concentration.
  • Do light exercise every day to help you feel more alert and sleep better.
  • Read the Understanding Changes in Thinking and Memory fact sheet, available from your local Cancer Council website. You can also listen to The Thing About Cancer podcast episode on brain fog.

How chemotherapy affects the blood

Blood cells are made in the bone marrow, which is the spongy part in the centre of the bones. The bone marrow makes three main types of blood cells, which have specific functions:

  • red blood cells – carry oxygen around the body
  • white blood cells – fight infection
  • platelets – help blood to clot and prevent bruising.

Because the new blood cells are rapidly dividing, they can be damaged by chemotherapy, and the number of blood cells (your blood count) will be reduced. Low numbers of blood cells may cause anaemia, infections or bleeding problems.

You will have blood tests at the beginning of treatment and before each chemotherapy cycle to check that your blood count has returned to normal before you have chemotherapy.

Anaemia

If your red blood cell count drops, a reduced amount of oxygen circulates through your body. This can cause anaemia, which 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. Let them know if you experience any symptoms of anaemia while having chemotherapy. If the levels of red blood cells drop too low, you may need a blood transfusion to build them up again.

Infections

If white blood cell numbers drop during chemotherapy, it can lower your immunity. This makes you more likely to get infections and less able to fight any infections that do occur. Your doctor may recommend antibiotics as a precaution against infection.

Many types of white blood cells make up the total white cell count. A type of white blood cell known as a neutrophil protects you against infection by destroying harmful bacteria and yeasts that enter the body. During chemotherapy, some people get low levels of neutrophils. This is known as neutropenia.

If you have neutropenia, you may be given an injection of growth factor drugs called granulocyte-colony stimulating factor (G-CSF) after chemotherapy to encourage the bone marrow to make more white blood cells. 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 become serious quickly. See below for when you need to contact your doctor urgently.

"After chemotherapy I became very susceptible to infections. A small scrape can quickly become serious. But when I feel like an infection is coming on, I've learnt to see my doctor straightaway." - Brigita

Taking care with infections during chemotherapy

Reduce your risk

To prevent the spread of infection:

  • check with your doctor about having the flu vaccine
  • ask people close to you to consider having a flu shot
  • ask family and friends with a cold, flu or other contagious infection (e.g. chickenpox, measles or a cold sore) to wait until they feel well before visiting
  • as far as practical, avoid close contact with people you live with if they are unwell
  • try to avoid crowded places, such as shopping centres or public transport in peak hour
  • wash your hands with soap and water before preparing food and eating, and after using the toilet
  • prepare and store food properly to avoid foodborne illness and food poisoning
  • eat freshly cooked foods; avoid raw fish, seafood, meat, eggs and soft cheeses; and wash fruits and vegetables well before eating.

When to seek medical help

Contact your doctor or go to the nearest hospital emergency department immediately if you experience one or more of the following symptoms:

  • a temperature of 38°C or higher
  • chills or shivering sweating, especially at night burning or stinging feeling when urinating
  • a severe cough or sore throat shortness of breath vomiting that lasts more than a few hours
  • severe abdominal pain, constipation or diarrhoea
  • unusual bleeding or bruising, such as nosebleeds, blood in your urine or black bowel motions
  • prolonged faintness or dizziness and a rapid heartbeat
  • any sudden deterioration in your health.

Bleeding problems

Platelets are the blood cells that help the blood to clot. 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 a platelet transfusion. Ask your oncologist to explain the risks and benefits of 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 toothbrush with soft bristles to avoid irritating your gums.
  • Wear comfortable, well-fitting shoes indoors and outdoors to avoid cuts and scrapes on your feet.
  • Blow your nose with care.
  • 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"), numbness or pain in your fingers and/or toes, and muscle weakness in your legs. This is called peripheral neuropathy. It is caused by damage to the nerves that send signals between the central nervous system and the arms and legs.

For many people, peripheral neuropathy is a short-term issue, but for others, it can last a long time or even be permanent. If you experience numbness and tingling, tell your doctor or nurse before your next treatment. Your treatment may need to be changed or the problem carefully monitored.

Tips for managing numb hands or feet

  • Take care when moving around – you may be more prone to trip and fall if your feet are numb or your legs are weak.
  • Use gloves and warm socks to keep your hands and feet warm, or soak your hands and feet in warm water to relieve symptoms.
  • 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. posts to raise the sheets off your feet if they're irritated by the weight of the sheets.
  • Some treatment centres offer ice mitts to help reduce peripheral neuropathy. If you are interested in trying these, ask your treatment centre if they are available and how much they cost.
  • If your symptoms are severe, talk to your doctor about medicines that may offer relief.

Changes in hearing

Some chemotherapy drugs can affect your hearing. Your doctor may recommend that you have a hearing test before you start treatment, and this may be repeated before each cycle of chemo. 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 (libido) 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

A range of issues can cause people 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. There may also be a physical reason for not being able or interested in having sex, e.g. vaginal dryness or erection difficulties. Changes in appearance can also affect feelings of self-esteem and, in turn, sexuality.

If you have a partner, it may be helpful for them to understand the reasons why your libido has changed and to know that people can have a fulfilling sex life after cancer, but it often takes time. Some 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 contraception recommendations outlined 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. If you're worried about the changes to your relationships or sexual functioning, you may find talking to a psychologist or counsellor helpful.

See Sexuality, Intimacy and Cancer, and listen to The Thing About Cancer podcast episode on sex and cancer.

Using contraception

Your doctor may talk to you about using contraception during and after chemotherapy. Although chemotherapy often affects fertility, this doesn't mean it rules 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 plan to avoid becoming pregnant during chemotherapy treatment, and men should not father a child. If you or your partner become pregnant, talk to your 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 a condom or female condom, which provides protection against any chemotherapy drugs that may be present in their body fluids.

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.

See Fertility and Cancer.

Effects of chemotherapy on women

Chemotherapy can reduce the levels of hormones produced by the ovaries. For some women, this causes periods to become irregular during chemotherapy but they return to normal after treatment. For other women, 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 of chemotherapy 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 have and keep an erection may also be affected, but this is usually temporary. If the problem is ongoing, talk to your doctor.

Key points about side effects

Why side effects occur

Many people experience side effects from chemotherapy. Side effects are caused when the chemotherapy damages rapidly dividing healthy cells.

Common side effects

  • Chemotherapy can cause fatigue, loss of appetite, nausea, bowel issues such as constipation or diarrhoea, hair loss, mouth sores, skin and nail problems.
  • You may have trouble concentrating or remembering 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.
  • Most side effects are temporary and gradually improve after you have finished treatment.

Managing side effects

  • 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.
  • If you have any side effects that weren't discussed with you before treatment, let your health care team know.

Reviewed by: Dr Prunella Blinman, Medical Oncologist, Concord Cancer Centre, Concord Repatriation General Hospital, and Clinical Senior Lecturer, Sydney Medical School, The University of Sydney, NSW; Gillian Blanchard, Oncology Nurse Practitioner, Calvary Mater Newcastle, and Conjoint Lecturer, School of Nursing and Midwifery, The University of Newcastle, NSW; Julie Bolton, Consumer; Keely Gordon-King, Psychologist, Cancer Council Queensland, QLD; John Jameson, Consumer; Dr Zarnie Lwin, Medical Oncologist, Royal Brisbane and Women's Hospital, and Senior Lecturer, School of Medicine, The University of Queensland, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Felicia Roncolato, Medical Oncology Staff Specialist, Macarthur Cancer Therapy Centre, NSW.

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