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 may not have the same reaction as someone else who is having the same treatment.
Chemotherapy drugs can cause side effects, but many of these can be well-controlled with medicines and usually go away when the chemo finishes. If the cancer is causing symptoms, chemotherapy can also make you feel better by relieving them. Your doctor or nurse will tell you more about what to expect. Always mention any side effects you’re having, as there are usually ways in which they can be controlled.
The main areas of your body that are affected by chemotherapy 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 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.
Very occasionally chemotherapy may cause permanent side effects. This will be explained to you by your doctor or nurse.
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 the 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 them to keep in touch through social media or texts so you don’t feel left out.
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.
Chemo can reduce the number of white blood cells, which help fight infection. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number you've been given and speak to a nurse or doctor if:
- you develop a high temperature – this may be over 37.5ºC (99.5ºF) or over 38ºC (100.4ºF) depending on the hospital's policy. Follow the advice that you have been given by your chemotherapy team• you suddenly feel unwell, even with a normal temperature
- you feel shivery and shaky
- you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection), diarrhoea.You'll have antibiotics to treat any infection.
You'll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low.
Chemo may reduce the number of red bloods cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia. It can make you feel very tired and lethargic. You may also become breathless.Anaemia can be treated with blood tranfusions. This should help you to feel more energetic and ease the breathlessness.
Chemo can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
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. 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 before the chemotherapy either as a tablet or into the vein. Drugs called steroids are also sometimes given to you to help prevent sickness.
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.
Some chemo drugs can cause diarrhoea. This often starts several days after treatment. If you’re taking chemotherapy tablets or capsules at home, it's important to let your doctor or nurse know if you have diarrhoea as your treatment may need to be interrupted. Medicine can be prescribed to help. It’s important to drink plenty of fluids if you have diarrhoea.
Some chemotherapy drugs, 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.
ConstipationSome chemotherapy drugs, 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.
Chemo can cause your taste to change, so that food might taste salty, 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 people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. If it doesn’t improve you can ask to see a dietician.
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.
Rarely a chemo drug may sometimes cause an allergic reaction while it’s being given. To reduce the chance of this happening, you’ll be given steroids before and after treatment. Signs of a reaction can include: skin rashes and itching; a high temperature; shivering; dizziness; a headache; and breathlessness. If you notice any of these effects, tell your nurse or doctor straight away so it can be treated quickly.
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.
Changes in how your kidneys workBack to top
Some chemotherapy drugs can affect how well your kidneys work. Before each treatment you will have a blood test to check how your kidneys are. 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.
Numbness or tingling in hands or feetBack to top
Some chemo drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, a sensation of pins and needles or muscle weakness (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 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. Sometimes your ability to have children (fertility) may be affected. Your cancer specialist and specialist nurse will talk to you about any possible late effects.