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Possible side effects of some chemotherapy drugs

  • Tiredness
  • Bone marrow
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhoea and constipation
  • Your mouth
  • Taste changes
  • Your hair
  • Skin changes
  • Your nails
  • Effects on the nerves
  • Effects on the nervous system
  • Change in kidney function
  • Changes in hearing
  • Second cancer

Tiredness

While having chemotherapy, and for some time afterwards, you may feel very tired (fatigued) and have a general feeling of weakness. It is important to allow yourself plenty of time to rest. The tiredness will ease off gradually once the chemotherapy has ended, but some people find that they still feel tired for a year or more afterwards.

Cancerbackup's section on coping with fatigue gives helpful tips on dealing with tiredness during chemotherapy treatment and suggests ways of saving energy.

Bone marrow

Chemotherapy can reduce the number of blood cells produced by the bone marrow. Bone marrow is a spongy material that fills the bones and produces the cells (called stem cells) which develop into the three different types of blood cells:

  • Red blood cells, which carry oxygen to all cells in the body.
  • White blood cells, which are essential for fighting infection.
  • Platelets, which help the blood to clot and control bleeding.

All these cells normally stay inside the bone marrow until they are mature enough to perform their functions properly. They are then released into the bloodstream so that they can circulate around the body in the blood.

White blood cells If the number of white cells in your blood is low you are more likely to get infections as there are fewer white cells to fight off bacteria.

If your temperature goes up, or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital straight away. Most hospitals consider a temperature above 38ºC (100.5ºF) to be high, although some hospitals use a lower or higher temperature. The doctors and nurses at your hospital will tell you which temperature they use.

Your regular blood tests will also show the number of white cells in your blood. If you get an infection when your white blood cell level is low you will need to have antibiotics. These may be given intravenously (into the vein) in the chemotherapy day unit or you may be given antibiotic capsules or tablets which can be taken at home. You may need to be admitted to hospital for the antibiotic treatment.

Sometimes, after chemotherapy, a drug called G-CSF growth factors can be used to help your bone marrow make white blood cells more quickly and reduce the risk of infection. G-CSF is a special protein, made naturally in the body. It can now be produced in the laboratory.

Helpful hints - infection

  • Tell your doctor at once if you develop a temperature as you may need to have antibiotics
  • Keep clean. Always wash your hands thoroughly before preparing your food
  • Read our information on avoiding infection when your immunity is low

Blood cells are usually at their lowest level from 7–14 days after the chemotherapy treatment, although this will vary depending on the type of chemotherapy.

Red blood cells If the level of red blood cells (haemoglobin) in your blood is low you may become very tired and lethargic. As the amount of oxygen being carried around your body is lower, you may also become breathless. These are all symptoms of anaemia – a lack of haemoglobin in the blood. People with anaemia may also feel dizzy and light-headed, and have aching in their muscles and joints.

During chemotherapy you will have regular blood tests to measure your haemoglobin. A blood transfusion may be given if your haemoglobin is low – Cancerbackup has a section on blood transfusions.

The extra red cells in the blood transfusion will very quickly pick up the oxygen from your lungs and take it around the body. You will feel more energetic and any breathlessness will be eased.

Sometimes a drug called erythropoietin can be used to stimulate the bone marrow to produce red blood cells more quickly. Erythropoietin is given as an injection just under the skin of the thigh or abdomen. The injection may be given from three times a week to once every three weeks.

Platelets If the number of platelets in your blood is low you may bruise very easily, develop blood spots in the skin (petechiae) or rashes (purpura), and may have nosebleeds or bleed more heavily than usual from minor cuts or grazes. If you develop any unexplained bleeding or bruising you should contact your doctor or the hospital straight away, and you may have to be admitted to hospital for a platelet transfusion. A fluid containing platelets is given by drip into your blood. The platelets will start to work immediately, to prevent bruising and bleeding. Cancerbackup has a section on platelet transfusions.

Your regular blood tests will also be used to count the number of platelets in your blood. If your platelets are low, take care to avoid injury; for example, if you are gardening, wear thick gloves. You can use a soft toothbrush to clean your teeth to reduce the risk of scratching your gums and making them bleed.

Nausea and vomiting

Some, but not all, chemotherapy drugs can make you feel sick (nausea), or actually be sick (vomit). Many people have no sickness, as there are now very effective treatments to prevent and control it. It is much less of a problem than it was in the past. If you feel sick, it may start from a few minutes to several hours after the chemotherapy is given, depending on the drugs you are having. The sickness may last for a few hours or, rarely, for several days.

Your doctor will prescribe anti-sickness drugs (anti-emetics) to stop or reduce this side effect. If the chemotherapy you are having does not usually cause sickness you will be given anti-sickness medicine to take ‘when required’. If your chemotherapy is known to cause sickness, anti-emetics may be given by injection or as tablets before your chemotherapy. You will also be given tablets to take at home afterwards.

Steroids can also be helpful in reducing nausea and vomiting. Given in this way, they often give a sense of well-being, as well as helping to reduce feelings of sickness and loss of appetite. It is important to take the anti-sickness medicines whether you feel sick or not – it is easier to stop sickness from coming on than treating it once it has already started.

Helpful hints - eating and digestion

  • If you feel sick or are sick, tell your doctor as soon as possible. Anti-sickness drugs can be prescribed which usually work well
  • Avoid eating or preparing food when you feel sick
  • Avoid fried foods, fatty foods or foods with a strong smell
  • Eat cold or warm food if the smell of hot food makes you feel sick
  • Eat several small snacks and meals each day and chew the food well
  • Have a small meal a few hours before treatment, but don't eat just before treatment
  • Drink plenty of liquid slowly, taking lots of small sips
  • Ginger, either as ginger biscuits or ginger beer can reduce feelings of sickness
  • Avoid filling your stomach with fluid before you eat
  • Peppermints or peppermint tea may help
  • Some complementary therapies (such as homeopathy, acupuncture or sea-bands) may help. Cancerbackup has a section about complementary therapies and cancer

Loss of appetite

Some chemotherapy drugs can reduce your appetite for a while.

Cancerbackup's section on diet and the cancer patient has some helpful tips on boosting appetite.

Diarrhoea and constipation

Some chemotherapy drugs can affect the lining of the digestive system and this may cause diarrhoea for a few days. Some chemotherapy drugs (or drugs given to control side effects such as nausea) can cause constipation.

If you have any diarrhoea or constipation, or are worried about the effects of chemotherapy on your digestive system, you can talk to your doctor or chemotherapy nurse, or ask them to arrange for you to see a dietitian.

Helpful hints - diarrhoea and constipation

  • If you have diarrhoea, eat less fibre, and avoid cereals, raw fruits and vegetables
  • Drink plenty of fluid (up to two litres a day) to replace the fluid lost in diarrhoea
  • If you are constipated, eat more fibre, raw fruits, cereals, and vegetables. Have prune juice and warm drinks. Try to take gentle exercise, if possible

Your mouth

Some drugs can cause a sore mouth, which may lead to mouth ulcers. If this happens it is usually about 5–10 days after the drugs are given and will clear up within three to four weeks. Your doctor can prescribe mouthwashes to help. The mouth ulcers can become infected, but your doctor or specialist nurse can give you treatment to help prevent or clear infection. Cleaning your teeth regularly and gently with a soft toothbrush will help to keep your mouth clean. If your mouth is very sore, gels, creams or pastes can be used to paint over the ulcers to reduce the soreness. Your cancer specialist can tell you about these.

Helpful hints - your mouth

  • To keep your mouth fresh and moist, eat fresh pineapple
  • Clean your teeth or dentures gently every morning, evening and after each meal
  • Use a soft-bristled or child's toothbrush
  • If your toothpaste stings or brushing your teeth makes you feel sick, try using a mouthwash (such as one teaspoon of bicarbonate of soda dissolved in a mug of warm water)
  • If your doctor prescribes a mouthwash for you, use it regularly as prescribed to prevent soreness
  • Use dental tape or floss each day, gently
  • Keep your lips moist by using Vaseline, or a flavoured lip balm if you prefer
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food. These may irritate your mouth
  • Keep your mouth and food moist. Add gravies and sauces to your food to make swallowing easier
  • Try to drink at least 1.5 litres (3 pints) of fluid a day (water, tea, weak coffee, and soft drinks such as apple juice)
  • Avoid acidic drinks such as orange and grapefruit juice. Warm herbal teas may be more soothing
  • Let your doctor know if you have mouth ulcers, as you may need medicines to help heal the ulcers and clear any infection
  • Sucking crushed ice while the chemotherapy drugs are being given may help to prevent a sore mouth
  • Read our section on mouth care during chemotherapy

Taste changes

Chemotherapy can affect your sense of taste; food may taste more salty, bitter or metallic. Your normal sense of taste will come back after the chemotherapy treatment finishes.

Helpful hints - changes to sense of taste

  • Eat only the foods that you like and ignore those that do not appeal to you
  • Use seasonings and herbs to flavour your cooking
  • Try marinating food, or using strongly flavoured sauces to go with food
  • Sharp-tasting foods such as fresh fruit are refreshing and leave a pleasant taste in the mouth
  • Some people find that cold foods taste better than hot foods

Your hair

Some drugs do not make your hair fall out, or the amount of hair lost is so slight it is hardly noticeable. Some chemotherapy can damage the hair and make it brittle. If this happens, the hair may break off near the scalp a week or two after the chemotherapy has started. Some chemotherapy drugs can make all of your hair fall out and this can be very distressing.

The amount of hair that falls out, if any, depends on the type of drug or combination of drugs used, the dose given and how the drug affects you personally.

If your hair falls out, it usually starts within a few weeks of beginning treatment, although very occasionally it can start within a few days. Underarm, body and pubic hair may be lost as well. Some drugs also make the eyelashes and eyebrows fall out. If your hair does fall out, due to the chemotherapy, it will grow back over a few months once you have finished your treatment.

Scalp cooling Some people having certain types of chemotherapy may be able to prevent hair loss by using a 'cold cap'. This works by temporarily reducing the blood flow and the amount of the drug reaching the scalp. Unfortunately, the cold cap is only effective with certain drugs. You can ask your doctor or chemotherapy nurse whether one would be useful for you. Cancerbackup has a separate section on scalp cooling.

Helpful hints - your hair

  • If your drugs are likely to make your hair fall out, it can help to have your hair cut quite short before treatment. The weight of long hair pulls on the scalp and may make hair fall out faster
  • Use gentle hair products
  • Avoid perming or colouring your hair if it is brittle or if your scalp is dry and itchy.
  • If you colour your hair, use a mild vegetable-based colourant and ask your hairdresser or chemotherapy nurse for advice
  • Try not to brush or comb your hair too roughly – use a soft or baby's brush
  • Avoid using hair dryers, curling tongs and curlers. Pat your hair dry gently after washing it
  • If it is likely that your hair will fall out, ask your doctor or nurse about wigs early on, so that the wig can be as close a match as possible to your normal hair
  • You may like to wear a hat or scarf when you go out. There are also turbans which can be worn in the house
  • Read Cancerbackup's section on coping with hair loss

Skin changes

Some drugs can affect your skin. These may make your skin become dry or slightly discoloured, which may be made worse by swimming, especially if there is chlorine in the water. Any rashes should be reported to your doctor. The drugs may also make your skin more sensitive to sunlight, during and after the treatment. Protect your skin from the sun by wearing a hat and sunglasses, covering your skin with loose clothing and using sunscreen cream on any exposed areas.

Helpful hints - skin changes

  • Avoid wet shaving - an electric razor is less likely to cause cuts
  • If your skin becomes dry or itchy, rub in a little moisturising cream to soothe it
  • Wear a hat, loose clothing and high-factor sunblock cream if you are going out in the sun, to prevent your skin burning

Your nails

Chemotherapy may make your nails grow more slowly. You may notice white lines appearing across them. Sometimes the shape or colour of your nails may change: they may become darker or paler. False nails or nail varnish can disguise white lines. Your nails may also become more brittle and flaky.

Effects on the nerves

Some chemotherapy drugs can affect the nerves in the hands and feet. This can cause tingling or numbness, or a sensation of pins and needles. This is known as peripheral neuropathy. Let your doctor know if it occurs. Usually, it gradually reduces when the chemotherapy treatment ends, but if it becomes severe it can damage the nerves permanently. Your doctor will keep a close check on you and may need to change the chemotherapy drug if the problem gets worse. Cancerbackup has a section on peripheral neuropathy.

Effects on the nervous system

Some drugs can make you feel anxious, restless, dizzy, sleepy or have headaches. Some people also find it hard to concentrate on anything. If you have any of these effects let your doctor know, as medicines can often be given to help. The Cancerbackup nurses can give you advice on how to cope with these effects.

Change in kidney function

Some chemotherapy drugs such as cisplatin and ifosfamide can cause damage to the kidneys. In order to prevent kidney damage, fluids may be given by drip into your vein for several hours before you have the treatment. Your kidney function will be carefully checked by blood tests before each treatment. Your nurses may ask you to drink plenty of fluid and it is important to do this. They may also ask you to measure the amount of urine you pass.

Changes in hearing

Some chemotherapy drugs can cause loss of the ability to hear high-pitched sound. They can also cause a continuous noise in the ears known as tinnitus, which can be very distressing. Let your doctor know if you notice any change in your hearing.

Second cancer

Some chemotherapy drugs can increase the risk of developing particular types of cancer or leukaemia later in life. This is rare and your doctors will weigh up the small increase in risk of cancer or leukaemia, against the benefit of the chemotherapy in treating your current cancer. They will discuss with you if the chemotherapy you are having may cause a second cancer.