POTENTIAL SIDE EFFECTS

Cells, especially those that divide rapidly, can be damaged by chemotherapy. Side effects are caused by damage to healthy cells. Side effects are usually temporary, and subside after the cells repair themselves.

Healthy cells like blood cells forming in the bone marrow, cells in the digestive tract (mouth, stomach, intestines, and esophagus), cells in the reproductive system and hair follicles are most likely to be affected by chemotherapy. Although side effects can sometimes be uncomfortable, they are measured against the treatment’s ability to destroy cancer. Drugs are available to help prevent specific side effects, especially nausea and vomiting. 

You should openly discuss with your doctor or health care provider what side effects you can anticipate. If you know what is likely to occur, you are better prepared to cope with any side effects that do happen. In this case, knowledge is power, because you will be emotionally and medically prepared to minimize these aspects of your treatment. 

What Side Effects Most Often Occur?

Nausea and Vomiting
Some chemotherapy patients may experience nausea and vomiting. Many people do not experience any gastro intestinal symptoms after chemotherapy and others may feel the effects for hours, a day, or even longer. Let your doctor know if you experience any nausea or vomiting. Each chemotherapy agent and each drug combination has its own potential for side effects, like nausea. Combining several chemotherapeutic agents may increase the nausea and vomiting.

TIPS to Cope with Nausea and Vomiting
The good news is that very successful anti-nausea and anti-vomiting drugs (antiemetics) are available. Your doctor will find the right drug for you to reduce this side effect.

  • Try to relax as much as possible before treatment sessions.
  • Changing the time of day you receive treatments may make a difference.
  • Eat slowly.
  • Avoid hot and spicy foods.
  • Talk to your doctor or nurse about medications to control your symptoms.
  • Avoid foods with strong odors.

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Hair Loss
You may experience complete or partial hair loss associated with taking chemotherapy. Since everyone’s hair is different and grows at different rates it is impossible to know for sure how much hair you may lose or when it will happen. About eighty five to ninety percent of your hair is actively growing at all times and that makes it susceptible to the effects of chemotherapy. The degree of hair loss depends on the chemotherapeutic drugs, the dosage, and how it is given. If you are going to experience hair loss, it usually starts 2 – 3 weeks after your first dose of chemotherapy and may continue for 1 – 2 months. Chemotherapy induced hair loss is reversible and your hair will grow back. Hair re-growth often starts after several cycles of chemotherapy but you may lose some of that with additional treatments. When re-growth occurs, there may be changes in color and texture. It is common for hair to grow back curlier than it was; however, a change is color is uncommon. Hair loss, even when expected, can be discouraging and depressing. You usually notice more loss in the morning on your pillow or in the shower. Chemotherapy does affect all hair including underarm, leg and pubic hair. You may experience loss of eyebrows, eyelashes and facial hair with long-term chemotherapy. Everyone person is different therefore the effects from the chemotherapy can be different on everyone. Remember that losing hair from your head, face and body can be hard to accept. It’s common and all right to feel angry or depressed about this loss. Talk about your feelings 

TIPS to Cope with Hair Loss

  • Choose your wig or hairpiece before hair loss occurs so you can better match color and style.
  • Scarves, hats and turbans are attractive and can be cooler than a wig.
  • Ask you physician for a prescription for a “cranial prosthesis”. The cost of the wig may be partially covered by your health insurance. 
  • Shorter haircuts make your hair look thicker and fuller and may make hair loss easier to manage if it occurs. 
  • Hair and scalp care should be gentle:
  • Use mild shampoos
  • Use soft hairbrushes
  • Use low heat when drying your hair
  • Don’t use brush rollers to set your hair
  • Don’t dry your hair or get a permanent

Constipation
Some chemotherapy treatments can cause constipation. It can also happen if you are less active than normal, you are eating less, or if you are taking pain medication. If you have not had a bowel movement in more than a day or two, you should talk to your doctor. Constipation is a side effect that can be easy to treat. Your doctor may want to rule out other causes of your constipation so check with your doctor before you take a laxative or an enema, especially if your white blood cell count is low. 

TIPS to Cope with Constipation

  • Drink plenty of fluids, as much as 8-12 glasses a day if you do not have renal or heart disease(s). Warm and hot fluids can be more helpful.
  • Eat foods with a high fiber content – fruits, green leafy vegetables, whole grain cereals, bread, bran, raisins, currants, prunes, figs and dates, for example.
  • Exercise if you’ve gotten an okay from your doctor. Even a short walk can help.

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Diarrhea
Certain cancers can cause diarrhea, and some chemotherapy drugs can, too. If you feel pain, cramping or have diarrhea for more than a day, call the doctor. There are a number of anti-diarrhea medicines available. Never take an over-the-counter medicine without asking your doctor.

TIPS to Cope with Diarrhea 

  • Avoid high fiber foods, like raw vegetables, cereals, whole grain breads, nuts, beans and popcorn.
  • Avoid caffeine and milk products.
  • Drink plenty of fluids.
  • Unless your doctor has told you not to, eat more foods rich in potassium, such as bananas, potatoes and oranges.
  • Ask you doctor about a prescription or over-the-counter medication that can help.

Nerve and Muscle Effects
Chemotherapy can sometimes affect the cells of the nervous system. Certain drugs can cause what’s referred to as “peripheral neuropathy.” This condition affects the nerves and can sometimes affect your muscles to make them weak, tired or sore. Peripheral neuropathy may cause the following symptoms.

  • Tingling, burning, weakness or numbness in hands or feet
  • Loss of balance or clumsiness
  • Difficulty picking up objects and buttoning clothing
  • Walking problems
  • Jaw problems
  • Stomach pain and constipation

TIPS to Cope with Nerve and Muscle Effects

  • If your fingers become numb, be careful when grasping objects that are sharp and hot.
  • If you are off-balance to weak, move carefully and use handrails.
  • Use bathmats in the shower or tub.
  • Wear no-skid shoes.

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Anemia
More than half of all chemotherapy patients develop anemia during the course of their treatment. While chemotherapy gets rid of cancer cells, it also gets rid of healthy cells, including red blood cells. Chemotherapy may also suppress the bone marrow’s ability to produce new red blood cells. A low red blood cell count is known as anemia, which can affect you more than everyday fatigue. Symptoms of anemia include: 

  • Fatigue 
  • Weakness/Tiredness
  • Pale skin 
  • Rapid heartbeat 
  • Shortness of Breath
  • Loss of Concentration
  • Difficulty exercising

TIPS to Cope with Anemia
Eat a well-balanced diet with frequent meals, iron-rich foods or vitamin supplements and check with your doctor. 

Low White Blood Cell Count
Many of the drugs used in chemotherapy get rid of cancerous cells as well as healthy cells, including white blood cells. With this condition, your body has less ability to fight against infection. 

TIPS to Cope with a Low White Blood Cell Count

  • Wash your hands often during the day – especially before eating, after using the toilet, and after touching items handled by the public like shopping carts and railings.
  • Use a moisturizer to keep your hands from cracking.
  • Avoid crowds, if possible. 
  • Stay away from anyone who has a cold or the flu
  • Stay away from children who have just been immunized. 
  • Don’t get immunized yourself unless your doctor says it’s okay. 
  • Clean your rectal area thoroughly, but gently, after bowel movements. 
  • Tell your doctor about any irritation or hemorrhoids.
  • Use an electric shaver instead of a razor.
  • Let your doctor know about any infections that appear and be aware of your blood cell counts when your doctor checks them.

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Low Platelet Count
Platelets are produced by your bone marrow and collect at sites of injury to stop bleeding. As with other blood cells, chemotherapy can reduce the count of these healthy cells while getting rid of cancerous cells. If you are bruising more easily or notice unusual bleeding from a cut, talk to your doctor.

Fatigue
Fatigue is one of the common side effects of chemotherapy. When you think of fatigue, you might think of a time when you stayed up too late, got up too early and worked a full day. The fatigue associated with cancer treatments is an extreme level of exhaustion. Fatigue is different for everyone. Fatigue interferes with day-to-day life. Many patients describe fatigue as a feeling of exhaustion. 

Depression
Many of the anxieties involved in coping with cancer can sometimes lead to depression. Medical causes in cancer patients can include: uncontrolled pain, treatment with some anti-cancer drugs, abnormal levels of calcium, sodium or potassium in the blood anemia, vitamin B12 or folate deficiency, fever, and abnormal levels of thyroid hormones or steroids in the blood. Cancer patients are sometimes diagnosed with ”reactive depression” which is characterized by moodiness and inability to perform usual activities. When these symptoms interfere with your daily life, your doctor may recommend treatment.

TIPS to Cope with Depression

  • Talk with your doctor or nurse. He or she may recommend treatment such as crisis intervention, counseling or medications.
  • Ask your doctor to refer you to a psychiatrist or psychologist.
  • Consider seeing a family therapist or licensed clinical social worker.
  • Look for support groups of others dealing with depression – there are some just for cancer patients. (Check Support Services in this Guide.)
  • Some people find talking with a member of the clergy helpful.

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