Chemotherapy Side Effects

Coping with side effects

Here are some things you can do for some of the most common side effects of chemotherapy.

Blood problems

There are three common blood problems caused by chemotherapy: neutropenia, a low level of neutrophils (a type of white blood cell that fights infections); anemia, a low level of red blood cells; and thrombocytopenia, a low level of blood platelets that help stop bleeding. When you are having chemotherapy, your doctor or nurse will check your blood counts regularly. If you do have one of these conditions, you may have to take special precautions, have treatments to boost your blood count, or delay your treatment until your blood cell counts rise.

Neutropenia

People with neutropenia have a low level of neutrophils, a type of white blood cell. Since white blood cells help the body fight infection, people with neutropenia should watch for signs of infection, especially a fever. You have a higher risk of developing neutropenia if you are having chemotherapy and radiation at the same time.

To prevent infection:

• Wash your hands often.

• Avoid crowds.

• Stay away from people who are sick.

• Avoid anyone who has recently had a live vaccine. Don't get a vaccine yourself without talking to your doctor or nurse.

• Avoid cutting yourself.

Call your nurse or doctor right away if you have a fever (temperature over 100.5 degrees Fahrenheit when taken by mouth) or if you have signs or symptoms of an infection (such as a cough or a burning sensation when you urinate). Do not take medicine for your fever without talking to your doctor or nurse first.

Anemia (also see fatigue)

People with anemia have a low red blood cell count. Red blood cells help carry oxygen, so anemia may cause a person to feel tired, dizzy, or irritable.

If you have anemia:

• Balance rest and activity. Try not to do too much, and plan your day so you'll have energy when you need it.

• Get a good night's rest. Nap if you need to.

• Ask for help when you need it.

• Eat a well-balanced diet.

• Get up slowly when sitting or lying down to prevent dizziness.

Thrombocytopenia

People with thrombocytopenia have a low level of blood platelets. Since platelets help stop bleeding by making blood clot, people with thrombocytopenia may bruise or bleed easily. You have a higher risk of developing thrombocytopenia if you are having chemotherapy and radiation at the same time.

If you have thrombocytopenia:

• Use a soft toothbrush.

• Don't floss your teeth.

• Try not to cough or blow your nose hard.

• If you shave, use an electric razor.

• Avoid any activities that could cause injury.

• DO NOT take aspirin unless directed to do so by your healthcare team. Talk to your doctor or nurse before taking any over-the-counter medicines.

• Apply pressure and call your nurse or doctor right away if you have bleeding that doesn't stop.

Hair loss

Hair loss, or alopecia, can be one of the most devastating side effects of chemotherapy. Many people, but not all, lose their hair when having chemotherapy. Some people's hair just gets thinner, while others lose hair on their head, face, and pubic area. Hair usually grows back after treatment, but sometimes it grows back a different color or texture.

You can't do anything to prevent hair loss during chemotherapy; however, there are ways to cope.

Before hair loss happens:

• Use a mild shampoo and a soft hairbrush.

• Don't use rollers or a curling iron. Use a low setting when using a hair dryer.

• Don't color your hair, bleach it, relax it, or get a perm.

• Cut your hair short. It will make your hair seem fuller. If you do lose your hair, it may be easier to cope with if your hair is shorter when it falls out.

• If you decide to get a wig, try to get one before you start treatment. This way, you can match the wig to your hair color and texture.

• See if your insurance plan covers wigs.

• If you'd rather borrow a wig, contact your local American Cancer Society.

• Talk to others who have lost their hair due to chemotherapy.

After hair loss happens:

• Wear sunscreen, a hat, or a scarf on your head to protect your scalp.

• Wear a cap to keep your head warm.

Nausea and vomiting

To prevent or reduce the effects of nausea and vomiting:

• Increase your fluids. Try to drink fluids at least one hour before meals.

• Eat small meals throughout the day.

• Take ginger. Try ginger ale or ginger tablets.

• Practice relaxation techniques.

• Keep busy to distract yourself.

• Take anti-nausea medicine as directed by your nurse or doctor. It if doesn't work, call your doctor and have the medicine changed. There are many different medicines and if one doesn't work, another will.

Constipation

Medicines (especially pain medicines), lack of activity, and lack of food and fluids can cause this unpleasant condition.

To prevent or reduce the effects of constipation:

• Ask your doctor or nurse if you can add more fiber to your diet. Foods such as fruits with skins (like apples and pears), raw vegetables, whole grains, and bran, are high in fiber.

• Stay active and talk to your doctor or nurse about exercising.

• Drink lots of fluids.

• Remember not to take any over-the-counter medicines, such as stool softeners and laxatives, without talking to your doctor or nurse.

Diarrhea

Diarrhea can be a very serious condition.

To prevent or reduce the effects of diarrhea:

• Drink plenty of fluids. The best fluids are clear, mild fluids, such as water, ginger ale, and clear broth.

• Don't drink very hot or cold liquids.

• Eat small meals throughout the day.

• Eat easy-to-digest foods, such as white bread, white rice, and chicken without the skin.

• Avoid foods with caffeine, such as coffee and tea.

• Avoid fried, greasy, or spicy foods.

• Avoid milk and milk products.

• Make sure you are not taking any stool softeners or laxatives.

Fatigue (see anemia)

Severe tiredness, called fatigue, is often one of the most overlooked and misunderstood side effects of chemotherapy. Fatigue can appear suddenly and it can last after your treatment ends. It's important to try to keep active if you have fatigue.

To prevent or reduce the effects of fatigue:

• Plan rest periods and short naps throughout the day.

• Plan activities throughout the day, not all at once.

• Ask for help if you need it.

• Talk to your boss about adjusting your work schedule.

• Try to schedule your chemotherapy for early in the day or late in the afternoon. Allow time to rest afterward.

• Eat small, frequent, well-balanced meals.

• Drink plenty of fluids.

• Try some light exercise, such as walking.

• Talk with others who have cancer fatigue.

Sexual and reproductive problems

Both men and women can have sexual and reproductive problems when they are undergoing chemotherapy.

Men and women may have a decreased desire for sex. A man may not be able to get or keep an erection. A woman may have vaginal dryness, making intercourse painful. Sexual problems can also cause emotional problems, so couples need to be open with each other and explore ways to stay intimate during this time. Talk with your doctor or nurse for specific suggestions or ask for a referral for therapy if this is an issue.

Both men and women can become temporarily or permanently infertile due to chemotherapy. If childbearing is an issue, men may want to save their sperm in a sperm bank before beginning treatment. Women can have embryos frozen and may also be able to have their ovarian tissue frozen. If still menstruating, women can still get pregnant during chemotherapy. However, chemotherapy can damage chromosomes, causing birth defects. It's important to use birth control when having sex if you are still of childbearing age. Some women can't use the pill as a form of birth control during chemotherapy and should talk to their doctors about the best birth control for them during this time.

Chemotherapy causes some women's periods to stop. Some women go through menopause, while others only feel symptoms of menopause, such as hot flashes and vaginal dryness. If you have hot flashes, dress in layers, exercise, and avoid caffeine and alcohol. Talk to your pharmacist about vaginal gels or lubricants for vaginal dryness. Also, wear cotton underwear and loose-fitting pants to prevent yeast infections.

Mouth problems

When you get chemotherapy, your senses of taste and smell may change, your mouth may get dry, and you may develop mouth sores. These conditions are usually temporary and end after you finish chemotherapy. Talk to your doctor about seeing your dentist before starting chemotherapy, since pre-existing dental problems may cause more problems during treatment. For example, dental problems can cause infections if white blood cell counts become lower.

To prevent or reduce the effects of mouth sores and mouth dryness:

• See your dentist before your chemotherapy starts.

• Check your mouth twice a day, and let your doctor or nurse know if you have any mouth problems.

• Gently brush your teeth with a soft toothbrush. Brush after eating and at bedtime.

• Don't use mouthwash that contains alcohol.

• Eat cold foods or foods at room temperature.

• Eat soft foods that are not too hot, spicy, acidic, or hard to chew.

• Don't smoke or use tobacco products.

• Drink plenty of fluids.

• Ask your doctor about taking medicine for mouth sores.