Side effects of chemotherapy for advanced melanoma
Chemotherapy drugs may cause unpleasant side effects, but these can usually be well controlled with medicines.
Not all drugs cause the same side effects and some people may have very few. Your doctor will tell you about any problems that your treatment may cause. The main side effects are described here, along with ways to avoid or reduce them.
You’re likely to become tired and have to take things more slowly. If you’re tired, do as much as you feel like and try to pace yourself. Taking a little exercise, such as a short walk, may actually help to improve tiredness.
Lowered resistance to infection (neutropenia)
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Chemotherapy can reduce the number of white blood cells produced by the bone marrow, increasing your risk of infection. This effect can begin about seven days after treatment has been given and your resistance to infection usually reaches its lowest point about 10-14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has recovered. Occasionally it may be necessary to delay treatment if your number of blood cells (blood count) is still low. However this is very uncommon.
The chemotherapy can also reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low level of red blood cells)
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While having chemotherapy you may become anaemic. This can make you feel very tired and lethargic and you may also become breathless. Anaemia can be treated by blood transfusions.
Some of the drugs used may make you feel or be sick, but there are vey effective anti-sickness drugs (anti-emetics) to prevent or control this. If the sickness isn’t controlled or continues, even with anti-sickness treatment, let you doctor know. They can prescribe other medicines that may be more effective.
Your mouth may become sore (or dry), or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
It’s unusual to lose all your hair with the drugs that are commonly used to treat melanoma. Some drugs may cause your hair to get thinner. If you lose your hair or it gets thinner it will start to grow back again when you finish your treatment.
Although they may be difficult to cope with at times, these side effects will disappear once treatment is over.
Contraception and fertility
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Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in semen or vaginal fluid.
Chemotherapy can also affect your fertility.
Young women may find that chemotherapy treatment brings on an early menopause. They may have signs of the menopause, such as hot flushes and sweats. Hormone replacement therapy (HRT) can be given to replace hormones that are no longer being produced. You may find it helpful to talk this through with your cancer specialist.
Diane tells her story of coping with menopausal symptoms after breast cancer treatment.