Side effects can make you wonder if the treatment isn’t worse than the disease. The good news is that many people experience virtually no side effects from cancer treatment. Others may experience unpleasant side effects that are considered normal reactions to treatment. Be aware that side effects can include both physical and emotional issues. Some side effects may require specific treatments or changes in your overall cancer- treatment plan.
If you experience any side effects in response to your treatment, always tell your doctor, who can help you prevent or control them. You may find it helpful to track side effects in a symptom log. We’ve provided a downloadable version you can use:
Note: The Calendar and Symptom Log along with other tools is also available in the Patient Resources section.
Below are links to information about common side effects and tips for dealing with them. Be sure to keep track of any side effects and talk openly about them with your healthcare team.
Anemia As a cancer patient, you may find yourself with a low red blood cell count, known as anemia (a-NEE-me-a). This may cause you to experience some of the following symptoms:
• Fatigue • Difficulty breathing • Chest pain • Dizziness, lightheadedness • Pale skin • Feeling of being cold
Anemia can be caused by the cancer itself, the cancer treatment, blood loss during surgery or poor nutrition. If you are anemic because of nutritional deficits, such as low iron, your doctor may recommend dietary supplements. If your anemia is caused by your cancer treatment, you may receive a red blood cell transfusion or medication to stimulate red blood cell production.
You can do many things to help manage your symptoms of anemia:
• Call a member of your healthcare team if you experience any of the symptoms of anemia. • Schedule your activities so that you have time to rest. • Ask for help with daily activities. • Eat a well-balanced diet, drink lots of fluids and take supplements if your doctor recommends them. • Do some type of moderate exercise on a regular basis — exercise may increase your energy level. • Try relaxation techniques, such as meditation or deep breathing. • Breathe with your lips pursed when you are short of breath. • Rise slowly after sitting or lying down to prevent dizziness.
Constipation After food is broken down to waste products in your gastrointestinal (GI) tract, it moves through the intestines and is eliminated. Sometimes this process is slowed, causing irregular or infrequent bowel movements of hard, dry stools. Passing hard stools can be difficult or unsuccessful; you may experience discomfort or pain or even develop hemorrhoids as a result of straining. This is constipation.
Constipation can be caused by cancer itself, your treatment, other medications you are receiving or stress. In addition, dehydration or bowel obstruction can contribute to constipation and can cause nausea, vomiting, hemorrhoids and other problems.
Preventing Constipation To prevent constipation, be sensitive to your body and any changes. You know your body best, and when you regularly have a bowel movement. Be sure to allow ample time and privacy, and respond as soon as you sense the urge to have a bowel movement. Even if you are doing the best you can to prevent constipation, other factors can interfere with your normal bowel routine. Fatigue slows the GI tract, allowing waste to become dry, hard and difficult to pass. Fatigue can also rob you of the energy you need to have a bowel movement. If you are fatigued, it is important to take care of yourself by resting often.
Regular exercise is an important factor in stimulating bowel regularity. Walking is a simple yet effective way to achieve a regular exercise routine, but any type of daily exercise is beneficial.
Your diet also affects bowel regularity. Eating foods high in fiber keeps bowel movements regular and stools easy to pass. Avoid cheese products, refined grain or other foods that may cause constipation. Foods that are rich in fiber include:
• Whole-grain products • Bran • Nuts and seeds • Corn and popcorn • Fresh raw vegetables • Fruits with skins and peels • Coconut • Raisins, dates and prunes • Prune juice
Helpful tip: Your system works best when it’s on a regular routine. Try to schedule your meals at the same time every day.
Drinking plenty of fluid throughout the day, especially fruit juice and water, will help prevent constipation. Drink at least eight 8-ounce glasses of water daily. Also, sipping hot liquids right before attempting to have a bowel movement sometimes helps stimulate the bowels.
If you usually have a bowel movement every one to three days, but have gone past that time and are experiencing uncomfortable symptoms (such as bloating, abdominal cramping or straining during bowel movement), be sure to call your healthcare team. They will assess the situation and suggest ways to deal with the problem. They may encourage you to use stool softeners, laxatives, suppositories and/or an enema. However, sometimes suppositories and/or enemas are not advisable, so always check with your healthcare team before treating constipation yourself.
Stool softeners work naturally with your GI tract without irritating the intestines. The softeners absorb water and expand to increase bulk and moisture content of the stool, which in turn encourages “motility” (natural movement of stools through the intestines).
If stool softeners alone are not effective, your healthcare team may recommend laxatives to help you regain regularity. Laxatives stimulate the intestinal walls to move waste rapidly and forcefully, thereby preventing your system from performing its natural function. It is not recommended that you take laxatives on a frequent basis because it can result in dependency, making it difficult to regain normal bowel habits.
Depression and Anxiety It’s completely natural to feel sad, anxious, angry or confused when you’re being treated for cancer. Emotions run high when you have a life-threatening disease that requires extensive treatment. Depression, however, is much more than sadness; it is a serious condition that must be treated, just like other medical conditions. It is not a normal part of having cancer.
If you feel depressed, you may not be motivated to keep your medical appointments, continue your treatment or generally take good care of yourself. That might lessen your chances of beating your cancer. You can do something about it, and should talk to your physician right away.
Anxiety can be caused by the need to sort through difficult and sometimes confusing choices about your treatment. You may be worried about how effective your treatment will be and what side effects it may cause. To help get beyond these feelings of depression and anxiety:
• Discuss your feelings and concerns with your healthcare team. Don’t keep them to yourself. • Consider professional counseling to help deal with what you’re feeling. • Join a support group to share what you feel with others who are going through the same experience. • Look to your family and friends for support. • Try relaxation techniques. • Don’t be afraid to take medication if it is prescribed for you. • Stay positive. It’s important in helping you fight your cancer.
Diarrhea While on chemotherapy, some people experience diarrhea, or the passage of frequent and watery stools with or without pain. When the small intestine does not sufficiently absorb fluid or food, the excess is passed on to the large intestine rather than into the bloodstream. Diarrhea can cause dehydration and chemical imbalance, which can produce excessive thirst, weakness and fatigue.
These problems can be brief or, if not managed effectively, may go on for many days and potentially lead to other complications. Diarrhea can be caused by cancer itself, your treatment, other medications you are receiving or stress.
Pay close attention to significant diarrhea. It can lead to pain, fatigue and decreased appetite. Diarrhea also can cause weight loss, fluid loss and chemical imbalances. If you have a change in bowel habits lasting more than two days, notify your healthcare team.
To treat diarrhea, your doctor may prescribe antidiarrheal medication, intravenous fluids or a change in diet. You can take the following steps as well:
• Eat bland, low-fiber foods (such as white rice and mashed potatoes). • Eat foods that contain salt (sodium) and those high in potassium that don’t contribute to diarrhea, such as baked potatoes, halibut, asparagus tips, avocados, bananas and citrus fruits. • Drink lots of clear fluids; avoid coffee, caffeinated tea, alcohol and milk. • Avoid smoking. • Clean thoroughly after bowel movements.
Skin Care A potential problem related to diarrhea is skin sensitivity. Remember to take special care of the skin and membranes around your rectal area. After each bowel movement, clean yourself well with mild soap. Rinse gently and pat dry. Do not rub. You may wish to use a sitz bath or sit in a tub of warm water to soothe your skin. Wipe with a pre-moistened wipe after each bowel movement and then apply a cream or ointment such as Vaseline®, Preparation H®, or Anusol® to protect skin from irritation and heal inflamed rectal tissue. Choose loose-fitting underwear to allow more air to reach the area. If you are still uncomfortable, speak to your healthcare team about other possible solutions.
Fatigue Fatigue is a general feeling of tiredness, weariness, weakness, exhaustion or lack of energy. It can have numerous causes — both physical and emotional — and can prevent you from leading a normal, active life or even feeling strong enough to come in for your treatment.
There are two types of fatigue: acute and chronic. Acute fatigue can occur quickly but lasts a short time. It is usually associated with illness and some types of chemotherapy or radiation therapy. You can help relieve acute fatigue by limiting your activities and getting plenty of rest. Chronic fatigue is more serious, can last a longer period of time, and is not as readily relieved or eliminated as acute fatigue. Chronic fatigue can rob your body of precious energy that you need for your health and well-being, making it difficult for you to do the things that give meaning and value to life.
Sometimes fatigue is related to your chemotherapy or radiation therapy treatment, but it can also result from physical, emotional or “situational” causes.
Physical Causes of Fatigue
• Accumulation in your body of cells that have been destroyed by chemotherapy or radiation therapy • Lowered red blood cell count • Poor nutrition • Disruption in sleep or rest patterns • Pain • Constipation • Diarrhea
Emotional Causes of Fatigue
• Depression • Fear • Anxiety related to diagnosis or treatment • Coping with situations that cause stress • Feeling of dependence or loss of control
“Situational” Causes of Fatigue
• Diagnosis of cance • Anticipation of treatment • Feeling a loss of control over life • Change in quality of life
Dealing with Fatigue Recognizing the cause is the first step in treating fatigue. If you try to understand the source of your fatigue, you and your doctor will be better prepared to treat it. Then, once you understand why you’re feeling fatigued, you can take steps to treat it. Here are some tips:
• Rest Give yourself permission to rest whenever you feel tired. During the day, several short naps can be refreshing and help boost your energy level. At night, go to bed earlier or sleep later in the morning, if possible.
• Exercise Mild exercise, even a short walk, can be energizing. Remember not to overdo it; it’s important to keep a balance between activity and rest.
• Treat pain If pain is contributing to fatigue, tell your healthcare team. They can help you treat your pain.
• Treat constipation and diarrhea Constipation and diarrhea can also contribute to fatigue. Make sure you treat them promptly and thoroughly.
• Eat a proper diet Enjoy a well-balanced diet of leafy green vegetables and foods with high iron and protein content, such as meats, liver, organ meats, cheese, seafood, yogurt, cereals, nuts and legumes. These foods will increase your blood’s iron and protein levels, which may improve your energy. You may also want to include vitamin supplements and nutritional drinks in your diet. But first, be sure to talk with your healthcare team about the safest, most effective options for you.
• Try relaxation and meditation techniques Try to focus your attention away from your treatment and the disease. Relaxation, meditation, quiet reflection and visual imagery may be helpful. Distractions, such as reading or listening to music, can help you relax and turn your thoughts away from the disease.
• Communicate Do not carry the burden of fatigue or any side effects alone. Talk with your family and your healthcare team about how you’re feeling.
Infections Chemotherapy can’t necessarily tell the difference between a cancer cell and a healthy cell. As a result, chemotherapy can destroy normal cells in hair, skin, bone, blood and other areas of your body. Among the normal cells it can destroy are white blood cells. These cells help your body fight infection. A dangerously low white blood cell count is called neutropenia (new-tro-PEE-nee-uh), and it is one of the most serious possible side effects of chemotherapy.
Because white blood cells help your body fight infections, neutropenia makes your body less able to protect itself. Infections are especially dangerous for people receiving chemotherapy because:
• Infections can temporarily disrupt your cancer treatment or result in having your treatment dose decreased. Both of these situations may jeopardize the effectiveness of your cancer treatment. • If you get an infection during chemotherapy, you may need to be hospitalized. Today, most cancer patients are treated outside of the hospital. Unplanned hospitalizations can disrupt your life by restricting your daily activities, such as work, and force you to be away from your family and your support network. Plus, being in the hospital can increase your exposure to even more infections. • Serious infections can be life threatening.
Infections can start in almost any part of your body, including your mouth, skin, lung, urinary tract, colon, rectum and reproductive tract.
Low white blood cell count is the most common cause of chemotherapy dose reductions. Making your chemotherapy as effective, fast and problem-free as possible is an important goal and priority. If a low white blood cell count or infection forces a dose reduction, delays a cycle of treatment or requires your hospitalization, your chemotherapy may take longer than planned, causing unnecessary disappointment, anxiety and possibly inconvenience for you and your family. Delays and dose reductions can also make your chemotherapy less effective. Chemotherapy produces the best long-term results when patients receive their full dose with every dose, on time every time.
To help avoid infection, wash your hands frequently and avoid prolonged contact with people who have infections. Good nutrition and exercise can also help by keeping your body strong and fit.
Low White Blood Cell Counts Chemotherapy can’t necessarily tell the difference between a cancer cell and a healthy cell. As a result, chemotherapy can destroy normal cells in hair, skin, bone, blood and other areas of your body. Among the normal cells it can destroy are white blood cells. These cells help your body fight infection. A dangerously low white blood cell count is called neutropenia (new-tro-PEE-nee-uh), and it is one of the most serious possible side effects of chemotherapy.
Although rare, radiation therapy can also cause low white blood cell counts or low levels of platelets. While white blood cells help your body fight infection, platelets prevent bleeding.
This side effect is more likely to happen if you are receiving radiation therapy and chemotherapy combined. If your blood tests indicate you are experiencing this side effect, treatment might be delayed for about a week to allow your blood counts to return to normal.
Mouth Sores and Dry Mouth Mouth sores occur when chemotherapy destroys fast-growing healthy cells lining your mouth. Other causes include overgrowth of bacteria in your mouth or other factors unrelated to chemotherapy. Mouth sores are also called mucositis, stomatitis and esophagitis.
Contact a member of your healthcare team immediately if you experience any of the following: difficulty swallowing or eating; tenderness, swelling, dryness, or mild burning in your mouth and throat; red or white patches in your mouth; or bleeding gums.
Here are some tips for preventing and treating mouth sores:
Use a Mouth Rinse Use a mouth rinse at least five times a day. To make a mild mouth rinse, combine 1 quart of water, 1 tablespoon of salt, and 1 tablespoon of baking soda. Mix the ingredients to dissolve. Rinse and gargle.
If you wear dentures, it is best to remove them so the rinse can reach all of the gum area.
Avoid Alcohol and Tobacco Avoid alcohol and tobacco because they, too, can alter the lining of your mouth and throat.
Eat Soft Foods Eat soft foods and take small bites. Hard foods can irritate your mouth. You can also mix foods with gravy, butter, or sauce, or puree them to make swallowing easier. If necessary, your doctor can prescribe anesthetic medications or spray to numb your mouth and throat long enough to eat meals.
Take Good Care of Your Mouth and Teeth It is very important not to just clean but moisturize your mouth as well. Rinse your mouth with a salt/baking soda solution at least five times daily.
When brushing your teeth, you may find it more comfortable to soften your toothbrush with hot water or use a disposable foam stick or cotton swab with a nonirritating cleanser, such as baking soda. Remember to use gentle action, whether brushing, flossing or rinsing.
Use mouthwashes that do not contain alcohol. You should also protect your lips by applying salves, petroleum jelly or vitamin E oil. Remember to drink plenty of water to keep your mouth from drying out.
Because chemotherapy and radiation alter the lining of your mouth, dental problems, such as tooth decay, can result. Plan to visit your dentist at least 14 days before you have your first treatment. If you are receiving radiation therapy, especially to the head or neck, you may need to see your dentist more often than you normally would. And be sure to check with your doctor before making any follow-up dental appointments.
Relieve Dry Mouth Chemotherapy or radiation therapy can reduce the flow of saliva, a natural mouth rinse. Saliva carries away bacteria and particles that stick to your teeth. Dry mouth makes it harder to chew and swallow and can change the way food tastes.
Rinsing your mouth with a salt/baking soda solution five times daily and carrying a bottle of water with you can often soothe your mouth and prevent dryness. If the problem of dry mouth is severe, your doctor can prescribe medicines to produce artificial saliva or anesthetics that you can apply directly to sores and lesions. Remember to use caution in chewing and swallowing when using these numbing agents.
Nausea and Vomiting In the course of your chemotherapy, you may feel mildly ill, be overcome by nausea or have bouts of vomiting (also referred to as “emesis”). These side effects can occur before, during, right after and days after you receive your chemotherapy. This may be caused by the cancer itself or its treatment.
Many drugs have been developed specifically to help prevent nausea and vomiting. Be sure to tell your doctor if you have a history of a weak or nervous stomach, motion sickness, or nausea in response to stress or trauma. Sometimes these conditions heighten your susceptibility to treatment-related nausea and vomiting.
Be aware that different drugs work for different people, and you may need more than one medication to get relief. Don’t give up and don’t accept nausea as something you have to put up with. Keep working with your healthcare team until you find the drug or combination of drugs that works best for you.
To help manage nausea and vomiting:
• Breathe deeply and slowly if you start to feel nauseated. • Avoid big meals; instead, eat small meals throughout the day. • Stay away from sweet, fried or fatty food. • Eat foods cold or at room temperature to avoid cooking odors. • For morning nausea, eat dry foods like toast before getting out of bed. (Don’t do this if you have mouth or throat sores or lack saliva.) • Drink cool, clear, unsweetened fruit juice, such as apple or grape, or light colored sodas that have lost their fizz, such as flat ginger ale. • Wear loose clothing — this is surprisingly helpful. • Get your mind off of the nausea by exercising, taking a walk, talking, listening to music or watching TV. • Use relaxation techniques (with or without music or visual imagery). • Sleep during periods of intense nausea.
Pain Some people with cancer may experience pain caused either by the cancer itself or its treatment.
Neuropathy One type of pain experienced by some cancer patients is neuropathy (new-RAHP-uh-thee), which causes numbness, tingling or pain in the hands and feet resulting from nerve damage. Some types of chemotherapy cause neuropathy.
Controlling Pain The good news is that pain can often be controlled through medication or other means.
Let your healthcare team know if you are feeling pain, and always call right away if you have sudden pain that you didn’t have before. This is particularly important if you experience pain in your chest or when you breathe. Your doctor or nurse will ask you to describe your pain:
• Where it is • How bad it is • How long it lasts • How often it occurs • Whether it is dull or sharp • What makes it better or worse
Once your healthcare team knows the type of pain you’re experiencing they will work with you to choose the best treatment. It could be over-the-counter medication, a prescription pain reliever, or even breathing and relaxation techniques.
Addiction to Pain Medication Many people with cancer fear they may become addicted to prescription pain medication. Discuss your concerns with your healthcare team.
Skin Changes Chemotherapy and radiation therapy may cause changes in your skin. With chemotherapy, the changes may be general (all over) or localized (occurring at the site of an injection or a vein). With radiation therapy, skin changes may occur in the area of treatment.
Possible Skin Changes with Chemotherapy Skin changes with chemotherapy vary from patient to patient and drug to drug. Some reactions occur immediately; others occur later and may be a result of receiving chemotherapy over time. Always keep your healthcare team aware of any skin changes you experience. In rare cases, an immediate reaction to chemotherapy can have serious consequences. Call your doctor immediately if you have problems breathing.
Changes may also involve your toenails and fingernails, mucous membranes or hair follicles.
Other changes, such as flushing of the skin, redness or skin rash may indicate a milder allergic reaction. These changes can appear immediately and become less severe after several hours, or they may not occur until after the treatment is finished. In any case, it is important that your healthcare team is aware of any reaction that occurs which may or may not be related to your treatment.
Preventing and Treating Short-Lasting Skin Changes Flushing, redness and rash may go away as the treatment continues, but still recur with each successive treatment. If you experience a rash recurrence, your doctor can prescribe an antihistamine prior to your next chemotherapy treatment to lessen the reaction. Cool cloths on your neck and/or cool compresses on the rash also may soothe the sensitive area. If itching occurs, avoid scratching. Your doctor may suggest hydrocortisone cream or other topical solutions to lessen the discomfort of itching. If itching continues after the treatment is over, be sure to tell your doctor.
Preventing and Treating Long-Lasting Skin Changes Examples of longer-lasting skin changes include: acne; skin, nail or vein darkening; excessively dry skin; and photosensitivity.
Acne Some people develop acne as a response to chemotherapy, but it often disappears within a few weeks following treatment. Typically, if you have a history of acne problems, they are more likely to occur with chemotherapy. To help manage or lessen this side effect, keep your face clean by washing several times a day. Your doctor also may recommend over-the-counter acne products. Remember to avoid foods that may aggravate the problem, and never scratch or pick at blemishes.
Darkening Darkening of the skin all over, under the nails or along veins can be caused by some chemotherapy drugs that may increase the levels of melanin in your body. Balanced levels of melanin give your skin an even color; however, too much melanin will result in dark patches or blotchy areas. Typically, darkening of the skin, nails or veins occurs two to three weeks after beginning treatment and may continue for some time after the last treatment. It will not, however, interrupt your scheduled chemotherapy treatments, and should fade over time.
Photosensitivity Photosensitivity is the skin’s reaction to ultraviolet rays from sunlight or tanning beds. Exposure to these harmful rays can cause severe burning and even blistering of the skin. To help manage this side effect, wear sunscreen at all times, even when you are outside for short periods of time.
It may be best to avoid any direct exposure to the sun until after your treatments are complete, and do not use tanning beds.
Possible Skin Changes with Radiation Therapy With radiation therapy, skin in the treatment area may appear red, irritated, swollen, blistered, sunburned or tanned. After time, your skin may also become dry, flaky, itchy or even peel. Most of these reactions go away a few weeks after treatment ends. In some cases, though, the treated area of skin will stay darker than it was before. It is important to let your doctor or nurse know about any skin changes, so they can suggest ways to ease the discomfort and possibly lessen further irritation.
Temporary Hair Loss It helps to know that hair loss (or alopecia) is almost always temporary. How much you lose and how quickly depends on your chemotherapy drugs or radiation therapy. With radiation therapy, you will only lose hair in the area of the treatment.
If your doctor tells you that hair loss is likely, remember that your hair will grow back.
Here are some tips for dealing with temporary hair loss:
• Before you start to lose hair, consider cutting it short. This will help make hair loss less troubling emotionally. For hair thinning, a short cut helps delay the need to cover up. • Be kind to your hair. Use mild shampoos and soft brushes. • If your appearance after you lose your hair bothers you, you can cover it up. Men generally choose to wear hats; women may prefer wigs, scarves (cotton is best), or hats. • If you choose to wear a wig, get it before your hair loss so you can match your existing color and hairstyle. Your insurance company may cover the cost of wigs. If not, ask a social worker or nurse where you can get one free of charge. • Contact the American Cancer Society about their free program: Look Good…Feel Better®. It provides professional instructions on looking and feeling better. To find out more, call 800.395.LOOK, or visit their website at www.lookgoodfeelbetter.org.
Thrombocytopenia (low platelet count) Thrombocytopenia (THROM-boh-site-oh-PEE-nee-uh) is a decrease in the number of platelets in your blood. Platelets are what cause your blood to clot. When you have thrombocytopenia, broken blood vessels under the skin occur more easily than usual, forming hematomas (hee-ma-TOE-muhs) or bruises. Thrombocytopenia also can result in unusual bleeding, such as nosebleeds, continuous bleeding from small cuts, bleeding gums, blood in the stool or urine, or heavier than normal bleeding during menstruation.
If your complete blood count (CBC) shows that your platelet count is low, your doctor may order a platelet transfusion to ensure your body can form clots in the event of a serious cut or bruise.
To minimize your chance of bruising and bleeding:
• Use a soft toothbrush, don’t floss, and use lip balm. • Blow your nose gently. • Don’t use tampons during menstruation. • Use an electric razor for shaving. • Be very careful around sharp objects, such as scissors and knives.
