Side effects of chemotherapy

Managing common side-effects

Side-effects can begin within days of starting treatment, but it is more common for them to occur weeks or even months later. If your side-effects are severe, your cancer treatment team may reduce the dose to see if that helps. Most side-effects are temporary and will lessen once you have completed your treatment. Occasionally they are permanent. Your cancer treatment team will discuss the risks with you.There are many ways that side-effects can be managed.
Chemotherapy

Infection, high temperature and feeling unwell

A high temperature (over 38◦) can be a sign that your body has an infection. You may also have other symptoms, such as chills, shivering and headaches. It is also possible to have an infection without having a high temperature — you may just feel unwell.
During treatment for your cancer, the number of white blood cells (cells that fight infection) may be reduced. This will mean that your body is unable to fight infection in the usual way. The risk of infection is serious and the first sign of increased temperature or feeling generally unwell requires urgent medical attention.
Do not wait to see what happens. It is important to contact your cancer treatment team or go to your nearest hospital emergency department immediately, and tell them you are receiving treatment for cancer.

 

Signs of anaemia – low red blood cells

During treatment for your cancer, the number of red blood cells (cells that carry oxygen around your body) may be reduced. You may feel tired, low in energy, dizzy, light-headed or breathless. These are all symptoms of anaemia. Your cancer treatment team will take regular blood tests to check the levels of red blood cells in your body. If these become too low and you are experiencing symptoms, you may need a blood transfusion. Your cancer treatment team will talk to you about the risks and benefits of this.

Signs of low platelets

During treatment for your cancer, the number of platelets in your blood (cells that help the blood to clot and prevent bleeding) may be reduced. Low platelet levels can increase the risk of bleeding, and you may bruise easily. You may notice that you bleed easily when cleaning your teeth or experience nose bleeds. Any signs of unusual bleeding should be reported to your cancer treatment team immediately. Your cancer treatment team will take regular blood tests to check the platelet levels in your blood. If these become too low and you are experiencing symptoms, you may need a platelet transfusion. Your cancer treatment team will talk to you about the risks and benefits of this.

Fatigue (feeling unusually tired)

Fatigue is a very common side-effect of treatment and can be difficult to cope with. It often gets worse as treatment goes on, making it hardest to manage towards the end of and after treatment. Your fatigue will begin to ease when treatment is over. But it can take several months until you feel your energy increasing. Tips to manage fatigue:
• Staying active during treatment may help you to manage fatigue.
• Regular gentle exercise, such as short walks, has been shown to be helpful in relieving fatigue.
• Do only as much as you feel comfortable doing.
• Plan rest times in your day while aiming to keep your usual day and night routines.
• Drink plenty of fluids and eat well.
• Ask for some help from family/whānau, friends and neighbours – tell them what you need.
Read the Cancer Society information sheets Cancer-related fatigue and If you have difficulty sleeping for more information.

Feeling sick (nauseous) or vomiting (being sick)

Not everyone feels sick or vomits after treatment. Medication is often given to prevent sickness occurring. It is easier to
prevent sickness than to treat it once it has started. If you do feel sick you will find that it usually starts several hours after treatment. Anti-sickness and anti-nausea medication has greatly improved in recent years. It is important to take your medication for nausea as prescribed. If nausea or vomiting continues for longer than 24 hours or you are unable to hold down any fluids, contact your cancer treatment team. After hours – contact your cancer treatment team or go to
your nearest emergency department or after-hours service.
If you are feeling sick here are some ideas to try:
• Eat lightly before each treatment.
• Eat smaller amounts more often.
• Eat your main meal at the time of the day when you feel best.
• Dry toast or crackers often helps.
• Try drinking clear, cool drinks.
• It may help to avoid alcohol and limit caffeine, milk products and high-fat foods.
• If cooking or cooking smells makes you feel sick, ask others to cook for you, or prepare meals between treatments and freeze them.
• Some people find relaxation or meditation helps them to feel better.
The Cancer Society has an information sheet, Coping with the Side Effects of Chemotherapy and Radiation Treatment: Fever, nausea (feeling sick), which is available on our website.
Contact your local Cancer Society or phone the Cancer Information Helpline 0800 CANCER (226 237) for advice on relaxation programmes.

Bowel problems

Some cancer treatments are known to cause diarrhoea and constipation. You may be prescribed medication to control these. Make sure you take these medicines as prescribed. Drink plenty of liquid to replace the fluid you are losing with
diarrhoea and try to avoid:
• alcohol
• caffeine
• milk products
• high-fat foods
• high-fibre foods.
If diarrhoea or constipation persists it can make you very unwell. Seek urgent medical attention and advice from your cancer treatment team. If you are constipated, try to eat more fibre (cereals, raw vegetables and fruit) and drink plenty of liquid. Gentle exercise, such as short walks, can help to improve constipation. Talk to your cancer treatment team for more advice.

Sore or dry mouth and throat

Cancer treatment medication can give you a sore mouth or mouth ulcers. If your mouth is very sore, or you get ulcers or thrush (a white coating in the mouth), see your cancer treatment team straight away for advice on treatment. It is important to keep your teeth, gums and mouth very clean during your treatment to help stop infections. Your cancer treatment team
can show you how to do this.
Use a very soft toothbrush or a cotton bud for your teeth and gums, and avoid vigorous or rough brushing. Use a mouthwash regularly. Ask your cancer treatment team for advice or you can make one yourself by mixing one teaspoon of salt and one teaspoon of baking soda (sodium bicarbonate) in four cups of warm water. Use it four times a day after meals or as often as you need to.
Eat soft foods and have lots to drink. Avoid anything with a high acid level such as grapefruit, tomatoes or oranges, and avoid spicy foods and alcohol. Use a lip salve or ointment on your lips if they are dry. If your mouth or throat is dry and you have trouble swallowing, try some of these ideas:
• suck on ice blocks
• drink lots of liquids
• moisten foods with butter or sauces
• dunk dry biscuits in tea
• ask your dentist, doctor or nurse about artificial saliva
• blend foods, and eat soups and ice cream
• smoking and vaping should be avoided
You may find the Cancer Society booklet Living with a dry mouth/Te noho me te waha maroke helpful.
Changes in appetite Treatment can affect your appetite. Your sense of taste and the texture of food may change during treatment. You may find that all foods taste the same, have no flavour or taste metallic.
It is important to try to eat as well as you can to keep up your energy levels and avoid weight changes. If you do not feel like eating, try eating small snacks often. Keep snacks such as nuts, grated cheese and dried fruit handy.
• You might find the Cancer Society’s booklet Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga
Matepukupuku helpful.
• A Cancer Society information sheet, Taste changes with chemotherapy and radiation treatment, is available on our
website.
• Talk to your cancer treatment team for more advice. They may be able to refer you to the hospital or a community dietitian.

Losing your hair

Some people don’t lose their hair during treatment for cancer. Other people find that their hair becomes thin and dry, while some people lose all the hair from their head and their body. Whether this happens to you depends on what medication you are given. Your cancer treatment team will advise you if this is a likely side-effect of your treatment. Your hair may start to fall out two or three weeks after your first treatment, or it may take a while. Your scalp may feel hot or itchy just before your hair starts to fall out.
“When in turmoil or doubt, choose change. I
chose change to ‘control a controllable’ – cutting
my long hair short then shorter still and dyed in
two bright colours. On the first day of my
chemotherapy I shaved it. I’m enjoying the
opportunity to reinvent, create and embrace
the ‘new me’. Rachel ”

Managing hair loss

Many people find losing their hair very upsetting. For most people hair will grow back. Until it does you might want to wear a wig, a scarf or a hat. If you choose a wig it is a good idea to look at wigs before you start losing your hair so you can make sure it matches your style and colour.
Hats 1999
The Government offers a subsidy to help pay for the cost of a wig. You must get a certificate from your cancer treatment team that states you are entitled to a wig. Some people don’t bother with wigs. They stay bald or cover up with scarfs or hats. What you do is up to you. There is no medical reason for your having to cover up your head. However, your scalp will be more sensitive to the sun than normal, so you should wear a hat and a high-protection sunscreen (SPF 30+) on your scalp when you are in the sun. In the winter your head may feel much colder than it normally would. It takes between 4 and 12 months for your hair to regrow after treatment. Your head may be quite itchy as your hair begins to grow back and it is not unusual for new hair to have a different texture or colour.
Here are some tips for looking after your hair:
• Use gentle hair products and conditioner for dry hair.
• Pat hair dry after washing it and gently brush with a wide-toothed comb.
• Avoid using hairdryers, straighteners, tongs or curlers.
• Avoid perming or colouring your hair if it is brittle or your scalp is dry.
• If you want to colour your hair, use a mild, vegetable-based colourant and test a strand of your hair first – ask your hairdresser for advice.
• Some hairdressers suggest that it is best to wait for six months after treatment before colouring your hair.
The Cancer Society has an information sheet, Managing Hair Loss.

Losing your eyebrows and eyelashes

There are make-up techniques that you can use to draw in eyebrows if you lose hair in this area. Or you can have your eyebrows tattooed if your hair loss is expected to be permanent.
If your eyes are irritated due to the loss of eyelashes, ask your cancer treatment team about eye drops that may help.

 


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

Look Good Feel Better workshops

Look Good Feel Better helps people affected by cancer to manage the appearance-related side-effects of cancer treatment. It provides free practical classes with skincare, make-up and headwear demonstrations.The goal that participants leave feeling empowered and ready to face their cancer diagnoses with confidence.
There are now some classes for men. These are relaxed, one-and-ahalf- hour practical sessions focused on hair, skin, body and mind. You can find out more about these workshops on the Look Good Feel Better website www.lgfb.co.nz.
“I went to a group a while back – it was to do
with make-up. I thought only women used makeup.
But I found it really useful and interesting. I
learned about using face cream, lip balm and
hand cream for dry skin after chemo treatment.
Also protecting your skin from the sun and what
food to eat if you feel sick. I’d advise anyone to
go to a workshop if they get the chance. Kerry ”

Effects on your nerves

Numbness and tingling (peripheral neuropathy)

Some medications cause pins and needles, tingling and a loss of feeling in fingers or toes or both, muscle weakness (particularly in the legs), a change in hearing, or ringing in the ears. This is called peripheral neuropathy. Chemotherapy treatments are most likely to cause this condition.
If tasks such as doing up buttons or tying shoelaces become too difficult, let your cancer treatment team know before your next treatment. A slight change in your treatment may be needed, so make sure you tell your cancer treatment team if this develops. Peripheral neuropathy usually gets better when treatment is over, but sometimes it is permanent.

Other nerve effects

Some medication can make you feel anxious, restless, dizzy or sleepy, or cause headaches. If you have any of these symptoms it is important to tell your cancer treatment team. They may be able to prescribe medicines that can help with some of these side-effects.

Itchy skin and other skin problems

Your skin may redden, peel or become dry and itchy. You may also notice drying and cracking of your fingers around the nails. Nails may become discoloured, brittle or ridged and you may get some acne. Tell your cancer treatment team about any skin problems.
Many over-the-counter products won’t be suitable to use, although Vaseline is recommended in some instances. Ask your cancer treatment teamfor suggestions on what may help. It is especially important to cover up your skin and use a high protection sunscreen (SPF 30+) in the sun when having chemotherapy.

Forgetfulness and concentration problems (chemo-brain)

Many people say they find it hard to concentrate, focus and remember after chemotherapy. This is often called chemo-brain. This can be very frustrating and it may help to know it can happen to anyone who has treatment. It is not clear if these problems are caused by chemotherapy alone, but the problem usually gets better
with time.
There are useful ways of managing chemo-brain, such as:
• eating well, taking regular exercise and getting enough rest
• creating lists and reminders
• doing memory exercises.

Effects on your kidneys

Some cancer treatments can affect how well your kidneys work (kidney function). Before each treatment your kidney function may be checked with a blood test to make sure your kidneys are working normally. It is useful to drink plenty of fluids throughout treatment.

Managing hormone changes

Treatment can affect your menstrual cycle. Some women may enter early menopause and experience hot flushes. Thyroid function may be affected, particularly when having immunotherapy. This may result in weight changes and fatigue.
Keeping active, eating well and following the advice of your cancer treatment team for any suggested medication, such as thyroid medication, will help in managing these side-effects. The Cancer Society information sheet, Early menopause and cancer, is available on our website.

Relationships and sexuality

For some people, being diagnosed with cancer and having treatment have no effects on their sexuality or sex lives. For others they can have profound impacts and affect how they feel about themselves and their relationships.
The side-effects of treatment may mean that you do not feel like having sex. You may feel too tired, feel sick or be in pain. It is important to keep talking with your partner and sharing how you are both feeling. Sex drive usually returns soon after treatment ends. Sexual intercourse is only one of the ways you can express affection for each other. Talking with your partner and sharing your feelings can result in greater openness, sensitivity and physical closeness. Gestures of affection, gentle touches, cuddling and fondling can also reassure you and your partner of your need for one another.
You may find it useful to read the Cancer Society booklet Sex and Cancer/Hōkakatanga me te Matepukupuku which is available on our website.

The need to use contraception and effects on fertility 

It is important to use effective contraception during treatment and for a few months afterwards to avoid pregnancy. This is because the medication could harm a growing baby. Your cancer treatment team can advise you about the effects of medication on fertility.
During treatment it is usually best to use a condom because side-effects, such as sickness and diarrhoea, can make the contraceptive pill less effective.
For men, treatment may reduce the number of sperm produced. 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.
For women, medication can affect fertility and can reduce the hormones made by the ovaries. You may notice changes in your monthly periods, which can sometimes stop altogether. It is still possible to become pregnant, even with irregular periods. Some cancer treatments can cause symptoms of early menopause, including hot flushes, irritability, sleep disturbance, achy bones and vaginal dryness. Menopausal symptoms are likely to be temporary for younger women.
For some women closer to natural menopause, periods may not return once treatment is completed. Vaginal thrush is common if you are having chemotherapy, especially if you are taking steroids or antibiotics. You can be prescribed treatment for this.

Pregnancy

If you know you are pregnant before starting treatment, or become pregnant during treatment, tell your cancer treatment team straight away. They will talk things over carefully with you and your partner and will explain the possible risks of continuing treatment during pregnancy.

Treatment and breastfeeding

Breastfeeding during cancer treatment is not advised. This is because the medication could be passed to your baby through breast milk. You may be able to express extra milk before treatment starts and freeze it to use later.
You may be able to start breastfeeding after treatment, but this will depend on whether you are having any other treatment that could interfere with breastfeeding. Your cancer treatment team will tell you about this. Having treatment will not affect your ability to breastfeed in the future.

Protecting your partner

If you have sex in the first few days after having treatment for your cancer, you will need to use a condom. This is to protect your partner against any chemotherapy medication in semen or vaginal fluid. Cancer cannot be passed on to your partner and sex should not make the cancer worse, unless you are advised otherwise by your cancer treatment team.

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