Side effects of chemotherapy
Different chemo drugs cause different side effects. Some people just have a few side effects and others have more. It’s hard to predict how it’s going to be for you, as everyone is different. Your reaction may not be the same as someone else’s having the same treatment.
Most of the side effects are short-term and will gradually disappear once treatment stops. Very occasionally chemotherapy may cause permanent side effects, but this will be explained to you by your doctor or nurse.
The main areas of your body that are affected by chemo are where normal cells rapidly divide and grow. This includes the lining of your mouth, your tummy and bowel, your hair, your skin and your bone marrow (where new blood cells are made).
Before your chemo starts, your chemo nurse will tell you more about the side effects of the drugs you’re going to have. For example, they’ll be able to tell you whether the drugs will cause your hair to fall out or not.
During your treatment, and for a while afterwards, you’ll probably feel very tired. You won’t have your usual amount of energy and will probably find the tiredness builds up as your treatment goes on. It will ease off gradually when treatment ends, but it can sometimes carry on for a couple of months or longer.
Get plenty of rest, try to pace things and don’t overdo it. But try to get some gentle exercise (like short walks) as well. Being active increases your energy levels and helps keep up your muscle strength.
Even if you don’t feel well just after your chemo, you might find that you recover quickly enough before the next session to be able to do some of the things you enjoy.
If you feel up to going out with your friends, there's no reason why you can’t go. But be careful to avoid crowded places when you’re at more risk of getting an infection. You can talk to your chemo nurse about this.
Let your friends know that you might have to cancel plans at short notice if you’re not up to it. Ask your friends to keep in touch through text, email or social networking sites so you don’t feel you’re losing touch.
If you're still studying, you may need to take time away from school, college or university, depending on the chemo you’re having. Talk to your doctor or chemo nurse about this. It might be possible to get your school or college to send you work so you can carry on studying while you’re at home or in hospital. Try not to worry about catching up. Schools and colleges are used to helping pupils who’ve been ill, and they can set up any extra help you need.
Reduced level of blood cells
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Chemotherapy can reduce the number of blood cells made by the bone marrow. Bone marrow is the spongy material that fills the bones and makes the early blood cells(called stem cells). Stem cells grow into the different kinds of blood cell:
White blood cells, which fight infection.
Red blood cells, which carry oxygen around the body.
Platelets, which help the blood clot and control bleeding.
Having a low level of blood cells can sometimes lead to problems. Throughout your chemo treatment you’ll have blood samples taken to monitor the number of these cells (called a full blood count). Your blood count is always checked before you have chemotherapy.
Your level of blood cells is usually at its lowest around 10-14 days after chemo. Then they gradually increase and are usually back to normal when your next chemo is due.
If the level of your white blood cells is low, you can pick up infections more easily and it can be hard to fight them off.
You’ll need to keep a check on your temperature. Your nurse will explain this to you and show you what to look out for. You’ll be given a 24-hour number to contact if you get problems. Always contact the hospital straightaway if:
you have a high temperature - this is usually over 38ºC, but may be lower, depending on the advice you’ve been given by your chemo nurse.
you feel unwell, even with a normal temperature.
you have signs of an infection, for example a sore throat or mouth, a cough, going to the toilet a lot to wee, and feeling shivery.
You’ll need to be treated with antibiotics straightaway if you have an infection.
If the level of your red blood cells is reduced (called anaemia), you can become very tired and lethargic. You might also feel a bit breathless, because less oxygen is being carried around your body, or you might feel a bit dizzy.
If the level of your red blood cells is very low, your doctor might advise you to have a blood transfusion. This will give you more red blood cells, so you’ll be less tired and breathless.
If the level of platelets in your blood is low, you might bruise very easily, bleed more than usual from a small cut or graze, or have nosebleeds, a rash or bleeding gums. If you notice any of these, contact the hospital straight away and let your chemo nurse or doctor know.
If your platelets drop to below a certain level, you might need a platelet transfusion (where fluid containing platelets is given to you in a drip).
Some chemo drugs can make you feel sick (called nausea) or sometimes be sick (vomit). Not everyone feels sick when they have chemo, and not all chemo drugs cause sickness. But if you do get this side effect, there are some really good anti-sickness drugs around. If one doesn’t work for you, your doctor will try another, so this side effect is usually well controlled.
You’ll be given anti-sickness drugs into a vein before the chemotherapy. Drugs called steroids are also sometimes given to you to help prevent sickness.
You’ll also be given anti-sickness tablets to take home.
Make sure you take them exactly as your nurse has told you to, even if you don’t feel sick. It’s easier to prevent sickness before it starts than to treat it once it’s started.
Contact the hospital if the anti-sickness tablets aren’t working for you.
Diarrhoea and constipation
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Some chemo drugs can cause diarrhoea for a few days after you’ve had treatment. If this happens, your doctor can prescribe anti-diarrhoea drugs for you to take. If you have diarrhoea:
drink plenty of liquid (up to 2 litres a day) to replace lost fluid
cut down on high-fibre foods (such as cereals, raw fruit and vegetables) until it gets better.
Some chemo and anti-sickness drugs can make you constipated. If this happens to you, let your doctor or nurse know so they can prescribe something to help. If you’re constipated:
eat more fibre (such as cereals, fruit and vegetables), and drink plenty of fluids
do some gentle exercise, like short walks.
Try not to feel embarrassed talking to your doctor or nurse about these side effects. They’re very used to talking about and dealing with these kind of problems.
Some chemo drugs can cause a sore mouth and sometimes mouth ulcers. You’ll usually be given mouthwashes to use regularly. If your mouth is sore, your doctor can prescribe a mouthwash to prevent infection and gels to ease the pain.
It’s really important to look after your mouth and keep your teeth clean while you're having chemo. Remember to:
brush your teeth regularly and gently with a soft toothbrush
floss daily (unless you have low platelets)
use any mouthwash regularly as prescribed (usually about four times a day)
contact the hospital if your tongue or the inside of your mouth is red and sore, or there are any tiny white spots - these could be signs of a mouth infection.
Chemo can cause your taste to change, so that food might taste bitter or metallic. Your normal taste will come back when treatment finishes. Until then avoid the foods that are most likely to cause a strange taste, but try to make sure you’re still eating healthily.
Some chemo drugs make your hair fall out, although not all of them do. Sometimes hair just gets thinner or becomes dry or brittle and breaks easily. Your doctor or nurse will be able to tell you if you’re likely to lose your hair or not.
When I was told I'd be having chemo I felt embarrassed that all my hair would fall out. But when I was undergoing treatment and saw all the other young people without their hair, it didn't bother me as much.
Hair loss usually starts within a few weeks of starting treatment, or rarely within a few days. As well as the hair on your head, you can also lose underarm, pubic and body hair. Some chemo drugs also make you lose your eyelashes and eyebrows.
Losing your hair can be really tough to cope with. Your hair will grow back again once you’ve finished treatment, and there are lots of different ways you can cover up until then. Talk to your chemo nurse about your options. You can use wigs, bandanas, scarves, baseball caps, beanies and hats. Or you might choose to shave your head and not cover up at all - it’s completely down to you.
Some wigs can look a lot like your own hair. If that’s what you want, it’s a good idea to have one fitted before you lose your hair, so that you can get a close match. Or you might want to try something completely different. You can usually get a wig on the NHS and have it styled by your usual hairdresser.
You might want to have your hair cut short before you start chemo. This is because the weight of long hair pulling on the scalp can make it fall out faster. When you start to lose your hair, wearing a soft hat or a turban at night can help collect any loose hair.
If your hair doesn’t fall out but becomes thinner or brittle, it helps to look after the condition of your hair. You’ll need to do this when your hair is growing back, until it’s in good condition again. Here are some tips for looking after your hair:
Use gentle hair products and pat hair gently dry with a towel after washing it.
Avoid using hairdryers, straighteners and tongs.
Use a brush with wide prongs or a wide-toothed comb, and be gentle when brushing your hair.
If your hair’s still brittle or your scalp is dry and itchy, don’t colour your hair. Wait until it’s in better condition, and when it is use a vegetable-based colourant - ask your hairdresser for advice.
We have more information about hair loss. This info is written for anyone who's looking for information about hair loss, not just for young adults, and includes a video of Bengu telling her story of hair loss.
Some chemo drugs can affect how well your kidneys work, so while you're having chemo you’ll have blood tests to check your kidneys. To prevent problems, you’ll be given lots of fluids through your drip before and after the chemo. You’ll also be encouraged to drink plenty of fluids.
Certain drugs can affect the nerves in your hands and feet. This causes tingling or numbness and a sensation of pins and needles (called peripheral neuropathy). It’s important to let your doctor know if you have these symptoms.
This side effect usually gets better gradually after treatment is over, but it can take several months. Sometimes damage to the nerves is a long-term problem .
Some chemo drugs can affect your skin and make it dry or itchy, slightly discolour it, or cause a rash. Use a moisturiser to keep your skin supple and well moisturised. Let your nurse know about any skin changes you notice.
Your skin might also be more sensitive to sunlight during and after chemotherapy treatment. Protect yourself from the sun by wearing loose clothing, a hat and high-factor sunscreen (SPF 30+) on exposed skin.
Some chemo drugs can affect your hearing. You might not be able to hear high-pitched sounds as well as you could before, or you might have a high-pitched ringing in your ears (called tinnitus). Any hearing loss can be permanent, but tinnitus usually improves when your treatment ends.
Treatments like chemotherapy that help cure cancer may very occasionally cause long-term side effects, or cause other health problems to start years after treatment (called late effects).
Doctors are always trying to find new ways of preventing or reducing the chances of late effects as much as possible.
After your chemotherapy is over you’ll come back to the clinic for check-ups, usually for many years. Any health problems linked to the treatment you had can be picked up and treated early.
Possible late effects depend on the type and dose of chemotherapy drugs you were given. Your cancer specialist and specialist nurse will talk to you about any possible late effects.