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Below you'll find information about the side effects that you may experience after chemotherapy treatment|.
Chemotherapy can reduce the number of blood cells made by the bone marrow. Bone marrow is a spongy material that’s found in the middle of your bones. It makes special cells called stem cells that develop into the different types of blood cells:
You’ll have regular blood samples taken to check the number of these cells in your blood (called a full blood count).
If the number of your white blood cells is low, you’re more likely to get an infection|. The main white blood cells that fight bacteria are called neutrophils. When they are low you are neutropenic.
Your resistance to infection is usually at its lowest 7–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Developing an infection when your white blood cell count is low can sometimes be a serious complication of chemotherapy.
Although this may sound scary, most people don’t have any serious problems with infection. Some chemotherapy treatments are more likely than others to reduce your white blood cell count.
But even a mild infection can delay your chemotherapy treatment. Your doctor may wait until the infection has cleared and for your blood count to go back up before you continue.
Your chemotherapy nurse will talk to you about infection and show you how to check your temperature. Most hospitals consider a temperature above 38°C (100.4°F) to be high, although some hospitals use a lower temperature.
You can have an infection without showing a high temperature. Drugs, such as paracetamol, lower your temperature so they can hide or ‘mask’ an infection.
Always contact the hospital on the 24-hour contact numbers you’ve been given and speak to a nurse or doctor if:
Chemotherapy units usually have a policy they follow when someone with low white blood cells has an infection.
This is to make sure you get treatment with antibiotics straight away to prevent complications.
Some people may have to stay in hospital to have antibiotics given into a vein (intravenously). After a few days you can usually have them as capsules or tablets to take at home.
This drug| is sometimes used after chemotherapy to help your bone marrow make white blood cells more quickly and reduce the risk of infection.
If chemotherapy reduces the number of red blood cells in your blood, you may become very tired and feel you have no energy. You may also become breathless, and feel dizzy and light-headed. These symptoms happen because the red blood cells contain haemoglobin, which carries oxygen around the body.
If your haemoglobin is low you may be offered a blood transfusion|. You’ll feel more energetic and any breathlessness| will be eased.
If the number of platelets in your blood is reduced, you may bruise very easily or bleed more than usual from minor cuts or grazes.
Tell your hospital doctor or nurse about this and contact them straight away if you notice or have:
Some people may need a platelet transfusion|. This is given by drip (infusion) as a day patient. The platelets will start working immediately to prevent bruising and bleeding.
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain.
Blood clots can be very serious so it’s important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information about blood clots.
Your doctor or specialist nurse will tell you if the chemotherapy is likely to cause hair loss|. Knowing what to expect gives you time to prepare and find ways of coping.
Some drugs don’t make your hair fall out but can make it thinner. You might notice your hair becomes dry and brittle and breaks easily. Looking after the condition of your hair can make it less likely to break off.
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. But the cold cap only works with certain drugs and doesn’t always prevent hair loss. You can ask your doctor or nurse whether one would be useful for you.
Some chemotherapy drugs cause all or most of your hair to fall out, which can be very upsetting. There are lots of ways you can cover up, if you choose to, such as using wigs, hats, turbans, scarves or bandanas.
Hair loss usually starts within a few weeks of starting chemotherapy or, very occasionally, within a few days.
You usually notice your hair coming out more when you brush, comb or wash it, and you may find hair on your pillow in the mornings.
You may lose underarm, body and pubic hair as well.
Some chemotherapy drugs also make the eyelashes and eyebrows fall out.
Your hair will usually grow back over a few months once you’ve finished treatment. It will be very fine at first and may be a slightly different colour or texture than before. You’ll probably have a full head of hair after 3–6 months. To begin with, you should try to look after the condition of your hair.
If you’re not entitled to a free wig, you can get one from the NHS at a subsidised price.
Your digestive system (stomach and bowels) can be affected in different ways by chemotherapy.
Some chemotherapy drugs can make you feel sick (nauseous)|, or be sick (vomit).
Not all drugs cause sickness and many people have no sickness at all.
There are very effective treatments to prevent and control sickness.
If your chemotherapy is known to cause sickness, you’ll be given anti-sickness drugs| by injection or as tablets before your chemotherapy. You’ll also be given tablets to take at home afterwards. You should take these regularly, even if you don’t feel sick, and exactly as your doctor has prescribed them. It’s easier to prevent sickness than to treat it once it’s started.
Contact your doctor or nurse at the hospital if:
Try to have a small meal a few hours before chemotherapy but not just before it. If you’re managing to eat well in between treatments, don’t worry if you can’t eat much for a couple of days after chemotherapy.
Some complementary therapies, such as acupuncture, may help but ask your cancer doctor first.
Some people find Sea-bands® helpful. They use acupressure to help relieve nausea and are available from chemists.
Some chemotherapy drugs can cause diarrhoea|, usually in the first few days. Let your nurse or doctor know if this happens as they can prescribe medicine to reduce this.
Make sure you drink plenty of liquid (up to two litres a day)
to replace fluid you’re losing with diarrhoea. Eat less fibre (cereals, raw vegetables and fruits) until the diarrhoea improves.
Sometimes diarrhoea can be more severe, and it’s important to contact the hospital if this happens. If you have more than 4–6 episodes of diarrhoea a day, contact the hospital on the telephone numbers you’ve been given and speak to a doctor or nurse.
Some chemotherapy drugs and also anti-sickness drugs and painkillers can cause constipation|. Let your nurse or doctor know if this happens so they can prescribe drugs to prevent or treat it.
Try to eat more fibre (cereals, raw vegetables and fruits) and drink plenty of liquid. Gentle exercise, such as short walks, can help to improve constipation.
Chemotherapy can affect your appetite. If you have a poor appetite try to eat little amounts as often as possible. Keep snacks, such as nuts, grated cheese or dried fruit, handy to eat whenever you can.
It’s important to try to eat well during your treatment. If you’re having problems ask your nurse for advice and you can also ask to see a dietitian.
You can add extra energy and protein to your diet with everyday foods or by using food supplements.
Chemotherapy can affect your sense of taste. You might find food tastes more salty, bitter or metallic. This will return to normal after chemotherapy finishes.
Chemotherapy can cause different mouth problems|, such as a sore mouth, mouth ulcers or infection. Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems.
Some chemotherapy drugs can make your mouth sore and you may get mouth ulcers about 5–10 days after they’re given. Mouth ulcers can become infected or you may develop an infection in your mouth.
The most common mouth infection is called thrush (or candidiasis). It shows as white spots on your mouth and tongue, or your tongue and mouth lining become red and swollen. Thrush is treated with anti-fungal tablets.
Some people are prescribed these tablets to prevent thrush.
Always let your doctor or chemotherapy nurse know if you have mouth ulcers, or any problems with your mouth. They can give you mouthwashes, medicines and gels to heal ulcers and clear or prevent any infection.
It’s a good idea to see your dentist before you start treatment. Dental treatment may need to be delayed during chemotherapy because of the risk of infection and a sore mouth.
A sore mouth or ulcers can make eating and drinking uncomfortable. These tips may help you:
The hardest time may be towards the end of the course of chemotherapy.
Try to cut down on things you don’t really need to do.
Ask family and friends, who are often keen to help in any way they can, to help with tasks such as shopping, household jobs or gardening.
If you have children, ask for help looking after them when you have chemotherapy and for a couple of days after.
Some people may need extra childcare help and a social worker can usually arrange this for you.
Make sure you get plenty of rest. But try to take some gentle exercise, such as short walks or more if you feel up to it, as well. This will give you more energy and helps to keep some of your muscles working.
Some people choose to, or need to, carry on working during chemotherapy. Most employers will reduce your hours and change work duties to make things easier for you.
The tiredness will get easier when chemotherapy is over. But it can be three or four months until you feel back to normal. Some people find that they still feel tired a year or so afterwards.
Some drugs can affect your skin. It may become dry or slightly discoloured. Chlorine in swimming pools can make this worse. Your skin may also be more sensitive to sunlight, during and after treatment.
Tell your cancer doctor or nurse if you develop any skin changes or rashes.
Chemotherapy may make your nails grow more slowly or become brittle or flaky. You may notice white lines appearing across them, or changes in the shape or colour of your nails. They should go back to normal after chemotherapy.
Protect your nails and hands by keeping them well moisturised. Wear gloves to protect them when doing chores in the house or garden. It’s fine to wear nail varnish but don’t use false nails during chemotherapy. If your toenails are affected, wear well-fitted shoes to cushion them.
Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, or a sensation of pins and needles (called peripheral neuropathy|).
It’s important to let your doctor know if this happens.
They may need to change the chemotherapy drug if it gets worse. Usually, peripheral neuropathy gradually gets better when chemotherapy is over but sometimes it’s permanent.
Some drugs can make you feel anxious, restless, dizzy, sleepy or have headaches. If you have any of these, it’s important to let your cancer doctor or nurses know.
They may be able to prescribe medicines that can help with some of these effects.
Some cancer treatments, such as chemotherapy, can cause changes in memory or concentration during and/or after treatment. Doctors sometimes call this mild cognitive impairment (MCI)|, but it’s more usually known as ‘chemo-brain’ or ‘chemo-fog’.
If this happens it’s usually mild. There are useful ways of managing it, such as using lists, post-it notes, calendars and your mobile phone for reminders. Doing some mental exercises, eating well, and getting enough rest can also help.
There’s more information about this in our section on mild cognitive impairment|.
Some chemotherapy drugs can affect how well your kidneys work (kidney function).
Before each treatment your kidneys will be checked with a blood test. You’ll be given fluid through a drip (infusion), before and after the treatment, to keep your kidneys working normally. The nurses may ask you to drink plenty of fluid and to record what you drink and the amount of urine you pass.
Some chemotherapy drugs can affect your hearing. You may have ringing in the ears (tinnitus) and lose the ability to hear some high-pitched sounds. Very occasionally your sense of balance may be affected. Any hearing loss (and balance changes if they occur) may be permanent. Tinnitus usually improves when treatment ends.
Tell your cancer doctor or nurse if you notice any hearing loss or tinnitus.
Content last reviewed: 1 October 2012
Next planned review: 2014
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© Macmillan Cancer Support 2013
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