Chemotherapy Side Effects

Most people who are told they need chemotherapy dread the anticipated side effects. However, side effects vary from person to person depending on the person's general health, the type of cancer, and the kind of chemotherapy received. Some people feel no side effects, while others feel many. Certain side effects, such as hair loss, can have more of an emotional impact than a physical one. Others may be permanent, such as infertility. While side effects from chemotherapy can't always be prevented, there are many things that can be done to lessen their impact.

One trait of a cancer cell is that it divides frequently. Therefore, chemotherapy targets frequently dividing cells. However, some healthy cells also divide frequently. Examples include cells in the bone marrow, lining of the digestive tract, the reproductive organs, and the cells lining hair follicles. Unfortunately, chemotherapy can't tell the difference between a cancer cell and a healthy cell that divides frequently. When chemotherapy goes after a healthy cell, it causes side effects.

One of the most important things someone experiencing side effects from chemotherapy can do is talk with the doctor or nurse. However, not everyone does this. Pat Baldwin, RN, MSN, OCN at the Veteran's Administration-Boston Healthcare System, and past Chair of Oncology Nursing Certification Corporation Test Development, agrees.

“The majority of people don't want to bother [their doctors or nurses],” said Baldwin. “They know we are busy, and they figure that they can tough it out. We'd rather they call us than wait a week worrying about something.”

Coping With Side Effects

Here are some things you can do for some of the most common side effects of chemotherapy.

Blood Problems

Blood problems are one of the most common side effects of chemotherapy. There are three common blood problems: neutropenia, a low level of neutrophils (a type of white blood cell) that fight infections; anemia, a low level of red blood cells; and thrombocytopenia, a low level of blood platelets that helps stop bleeding. When you are having chemotherapy, your doctor or nurse will check your blood counts. If you do have one of these conditions, you may have to take special precautions, have treatments to boost your blood count, or delay your treatment until your blood cell counts rise. Your doctor may order special shots of growth factor medicine to increase your white blood or red blood cell counts.

Neutropenia

People with neutropenia have a low level of neutrophils, a type of white blood cell. Since white blood cells help the body fight infection, people with neutropenia should watch for signs of infection, especially a fever. You have a higher risk of developing neutropenia if you are having chemotherapy and radiation at the same time.

To prevent infection:

• Wash your hands often.

• Avoid crowds.

• Stay away from people who are sick.

• Avoid anyone who has recently had a vaccine. Don't get a vaccine yourself without talking to your doctor or nurse.

• Avoid cutting yourself.

Call your nurse or doctor right away if you have a fever (temperature over 100.4° or if you have signs or symptoms of an infection (such as a cough with mucus or a burning sensation when you urinate). Do not take medicine for your fever without talking to your doctor or nurse first.

Anemia (Also See Fatigue)

 People with anemia have a low red blood cell count. Red blood cells help carry oxygen, so anemia may cause a person to feel tired, dizzy, or irritable.

If you have anemia:

• Balance rest and activity. Try not to do too much, and plan your day so you'll have energy when you need it.

• Get a good night's rest. Limit naps to no more than 30 minutes at a time during the day.

• Ask for help when you need it.

• Eat a well-balanced diet.

• Get up slowly when sitting or laying down to prevent dizziness.

Thrombocytopenia

 People with thrombocytopenia have a low level of blood platelets. Since blood platelets help stop bleeding by making blood clot, people with thrombocytopenia may bruise or bleed easily. You have a higher risk of developing thrombocytopenia if you are having chemotherapy and radiation at the same time.

If you have thrombocytopenia:

• Use a soft toothbrush.

• Don't use dental floss.

• Try not to cough or blow your nose hard.

• If you shave, use an electric razor.

• Avoid activities that could cause injury, such as in-line skating, snowboarding, and contact sports.

• DO NOT take aspirin. Talk to your doctor or nurse before taking any other over-the-counter medicines.

• Apply pressure and call your nurse or doctor right away if you have bleeding that doesn't stop.

Hair Loss

Hair loss, or alopecia, can be one of the most devastating side effects of chemotherapy. Many people, but not all, lose their hair when having chemotherapy. Some people's hair just gets thinner, while others lose hair on their head, face, and pubic area. Hair usually grows back after treatment, but sometimes it grows back a different color or texture.

You can't do anything to prevent hair loss during chemotherapy; however, there are ways to cope.   

Before hair loss happens:

• Use a mild shampoo and a soft hairbrush.

• Don't use rollers or a curling iron. Use a low setting when using a hair dryer.

• Don't color your hair, bleach it, relax it, or get a permanent.

• Cut your hair short. It will make your hair seem fuller. If you do lose your hair, it may be easier to cope with if your hair is shorter when it falls out.

•   If you decide to get a wig, try to get one before you start treatment. This way, you can match the wig to your hair color and texture.

• See if your insurance plans covers wigs.

• If you'd rather borrow a wig, contact your local American Cancer Society.

• Talk to others who have lost their hair due to chemotherapy.

After hair loss happens:

• Wear sunscreen, a hat, or a scarf on your head to protect your scalp.

• In the winter, wear a cap to bed to keep your head warm.

Nausea and Vomiting

 Nausea and vomiting are common side effects of many chemotherapy drugs.  Today there are many medicines that can help prevent or reduce vomiting and nausea.

To prevent or reduce the effects of nausea and vomiting:

• Increase your fluids. Try to drink fluids at least one hour before meals.

• Eat small meals throughout the day.

• Take ginger. Try ginger ale or ginger tablets.

• Practice relaxation techniques.

• Keep busy to distract yourself.

• Take anti-nausea medicine as directed by your nurse or doctor. It if doesn't work, call your doctor and have the medicine changed. There are many different medicines and if one doesn't work, another will.

Constipation

According to the American Cancer Society, 50 percent of people with cancer have constipation. Medicines, especially pain medicines, lack of activity, and lack of food and fluids can cause this unpleasant condition.

To prevent or reduce the effects of constipation:

• Ask your doctor or nurse if you can add more fiber to your diet. Foods such as fruits with skins (such as apples and pears), raw vegetables, whole grains, and bran, are high in fiber.

• Try not to eat foods that can cause constipation, such as eggs, cheese, and chocolate.

• Stay active and talk to your doctor or nurse about exercising.

• Drink lots of fluids.

• Remember not to take any over-the-counter medicines, such as stool softeners and laxatives, without talking to your doctor or nurse.

Diarrhea

Diarrhea can be a very serious condition. According to the American Cancer Society, 75 percent of chemotherapy patients have diarrhea. Severe diarrhea can affect a person's activities and health.

To prevent or reduce the effects of diarrhea:

• Drink plenty of fluids. The best fluids are clear, mild fluids, such as water, ginger ale, and clear broth.

• Don't drink very hot or cold liquids.

• Eat small meals throughout the day.

• Eat low-fiber foods, such as white bread, white rice, and chicken without the skin.

• Avoid high-fiber foods.

• Avoid foods with caffeine, such as coffee and tea.

• Avoid fried, greasy, or spicy foods.

• Avoid milk and milk products.

• Don't smoke.

• Make sure you are not taking any stool softeners or laxatives

Fatigue (See Anemia)

Fatigue is often one of the most overlooked and misunderstood side effects of chemotherapy. Fatigue can appear suddenly and it can last after your treatment ends.  It's important to try to keep active if you have fatigue.

To prevent or reduce the effects of fatigue:

• Plan rest periods and short naps throughout the day.

• Plan activities throughout the day, not all at once.

• Ask for help if you need it.

• Talk to your boss about adjusting your work schedule.

• Try to schedule your chemotherapy for early in the day or late in the afternoon. Allow time to rest afterwards.

• Eat small, frequent, well-balanced meals.

• Drink plenty of fluids.

• Try some light exercise, such as walking.

• Talk with others who have cancer fatigue.

Sexual and Reproductive Problems

Both men and women can have sexual and reproductive problems when they are undergoing chemotherapy.

Men and women may have a decreased desire for sex. A man may not be able to get or keep an erection. A woman may have vaginal dryness, making intercourse painful. Sexual problems can also cause emotional problems, so couples need to be open with each other and explore ways to stay intimate during this time.  Talk with your doctor or nurse for specific suggestions or ask for a referral for therapy if this is an issue.

Both men and women can become temporarily or permanently infertile due to chemotherapy. If childbearing is an issue, men may want to save their sperm in a sperm bank before beginning treatment. Women can have embryos frozen, although each state has laws regarding human embryo freezing. Women can also have their ovarian tissue frozen. Researchers are performing clinical trials on this procedure. Autologous transplantation, using frozen-thawed ovarian tissue, has some health risks as well.

If still menstruating, women can still get pregnant during chemotherapy, and deliver a healthy child. However, chemotherapy can damage chromosomes, causing birth defects. It's important to use birth control when having sex if still of childbearing age. Some women can't use the pill as a form of birth control during chemotherapy and should use something else.

Chemotherapy causes some women's periods to stop. Some women go through menopause, while others only feel symptoms of menopause, such as hot flashes and vaginal dryness. If you have hot flashes, dress in layers, exercise, and avoid caffeine and alcohol. Talk to your pharmacist about vaginal gels or lubricants for vaginal dryness. Also, wear cotton underwear and loose-fitting pants to prevent yeast infections.

Mouth Problems

When you have chemotherapy, your taste and smell may change, your mouth may get dry, and you may develop mouth sores. These conditions are usually temporary and end after you finish chemotherapy. Talk to your doctor about seeing your dentist before beginning chemotherapy, since pre-existing dental problems may cause more problems during treatment. For example, dental problems can cause infections if white blood cell counts become lower.

To prevent or reduce the effects of mouth sores and mouth dryness:

• See your dentist before your chemotherapy starts.

• Check your mouth twice a day, and let your doctor or nurse know if you have any mouth problems.

• Gently brush your teeth with a soft toothbrush. Brush 30 minutes after eating and at bedtime.

• Don't use mouthwash that contains alcohol.

• Eat cold foods or foods at room temperature.

• Eat soft foods that are not too hot, spicy, acidic, or hard to chew.

• Don't smoke or use tobacco products.

• Drink plenty of fluids.

• Ask your doctor about taking medicine for mouth sores.

When dealing with the side effects of chemotherapy, sometimes common sense is the best medicine.

“Dealing with chemotherapy and its side effects is really common sense in terms of what people need to do for themselves,” said Baldwin. “Rely on lifelong experience. There's no magic answer. What works for you when your stomach's upset and you have nausea will most likely work again (when it is a side effect of chemotherapy). Don't be afraid to ask your doctor or nurse questions.”