Chemotherapy: What can be done about side effects?

Low blood counts

Chemotherapy can make you more likely to get infections. This happens because most anti-cancer drugs affect the bone marrow, making it harder to make white blood cells (WBCs), the cells that fight many types of infections. The doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors. Raising the white blood cell count greatly lowers the risk of serious infection.

Most infections come from bacteria normally found on our skin and in your mouth, intestines and genital tract. Sometimes the cause of an infection may not be known.
Ways to prevent infection:

• Wash your hands often during the day. Be sure to wash them before you eat, after you use the bathroom, and after touching animals.
• Stay away from people who have illnesses you can catch, such as a cold, the flu, measles, or chicken pox.
• Try to avoid crowds. Go to the mall or movie theaters when they are least likely to be busy.
• Stay away from children who recently have received “live virus” vaccines such as chicken pox and oral polio, since they may be contagious to people with a low blood cell count.
• If you have a catheter, make sure to watch for any signs of irritation or infection around the site.
• Do not cut or tear the cuticles of your nails.
• Be careful not to cut or nick yourself with scissors, needles, or knives.
• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Do not rub hard.
• Use lotion or creams to soften and heal your skin if it becomes dry and cracked.
• Avoid contact with animal litter boxes and waste, birdcages, and fish tanks.
• Avoid standing water—birdbaths, flower vases or humidifiers.
• Wear protective gloves when gardening or cleaning up after others, especially small children.
• Do not eat raw food, seafood, meat, or eggs.

Low platelet counts can also result from chemotherapy. If you notice unusual bleeding, including blood in your urine, stool, vomit, or bleeding gums, notify your doctor. Easier bruising or longer bleeding time after a minor cut is normal.

Red blood cells can also be affected by some chemotherapy drugs. Anemia is when you have not enough red blood cells to carry oxygen throughout your body. You may feel tired, short of breath, week, dizzy, faint, or like your heart is beating very fast. If you are anemic try to get as much rest as possible and limit how active you are. Make sure to eat well-balanced meals and talk with your doctor about what type of diet may be best for you. Call your doctor if you feel as though you may faint, your heart is beating very fast, or you feel short of breath.

Fatigue (tiredness)

Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It can be due to the disease, chemotherapy, low blood counts, lack of sleep, pain, stress, poor appetite, along with many other factors. This type of tiredness does not always go away with rest. Not everyone feels the same kind of fatigue. Some things to try to help you cope with fatigue:

• Plan your day so that you have time to rest.
• Take multiple short naps or breaks, rather than one long rest period.
• Try easier or shorter versions of activities you enjoy.
• Take short walks or do light exercise, if possible. You may find this helps with fatigue.
• Allow others to do some things for you that you usually do. Save your energy for things you enjoy.
• Keep a diary of how you feel each day and talk to your doctor or nurse about if your level of fatigue changes over time.

Mouth care

Good mouth care is very important while you are on chemotherapy. Chemotherapy can affect the normal rapidly growing cells lining the mouth.

If you have not been to a dentist recently or are concerned your teeth may have cavities please advise your nurse or doctor. Consult your doctor before having any dental work done during the time you are receiving chemo.

Mouth care should be done at least four times a day—after meals and at bedtime. You should brush your teeth using a soft bristled toothbrush and toothpaste. If you floss your teeth, usually you may continue to do so. Do not use dental floss if it causes pain, bleeding or if your platelet count is below 40,000. It is best to avoid commercial mouthwashes with high alcohol levels.

If you wear dentures, be sure to keep them clean and have them adjusted if they do not fit well. Do not wear your dentures if you have mouth sores.

Sores in or around the mouth are a sign of a more severe side effect. If they develop call your nurse or doctor. A special mouthwash or medication may be prescribed to help heal and/or lessen the pain. Sometimes your chemotherapy will be changed if you have sores. Your doctor may also suggest you suck on ice chips right before and after your chemotherapy to prevent mouth sores.

There are ways you can lower mouth irritation:

• Rinse your mouth with a warm salt water solution (1/2 teaspoon salt in 8 ounces of water) every two to three hours
• Avoid foods that are hot, irritating or spicy
• Eat foods that are soft, cool, nonspicy, and non-acidic. Foods that have been pureed in the blender may be easier for you to eat if your mouth is irritated.

Nausea and vomiting

Chemotherapy may cause nausea and vomiting. This can vary in length and severity from person to person and also depends upon the medications you are receiving. You may receive anti-nausea medications to help control this. Be sure you understand the directions, because if the anti-nausea medication is taken properly, it is often possible to prevent or lessen nausea.

Eating a light meal before your chemotherapy treatment may prevent some of the nausea and vomiting that can occur. After your treatment, it may help if you take a nap or just rest quietly.

If the smell of food causes nausea, avoid strong smelling foods such as tuna, cabbage, or onions. If the food is kept covered until serving time, have someone remove the cover before you enter the room, thus letting the first strong aromas escape.

Nausea may last longer than vomiting. If you feel sick, you could try taking sips of 7-up, ginger ale, fruit juice, tea, broth, tonic water or bouillon. Continuing to drink fluids will help prevent dehydration. Be sure to use the anti-nausea medicine that your doctor has prescribed as directed.

Eating dry foods such as toast or crackers, particularly after getting up in the morning seems to relieve nausea for some people. Cold clear beverages such as soda pop or fruit juices may help, too. Small pieces of popsicles, fruit ices, or sucking on ice chips may help. If you have mouth sores, you should avoid tart or citrus flavors.

Some people have found that relaxation techniques or hypnosis can help them control their nausea and vomiting. If you are interested in trying either of these, ask your doctor or nurse.

Diarrhea

If you have loose stools, eat frequent small amounts of cooked, easy to digest foods such as soups, and jello. Eating foods warm instead of hot or very cold and eating slowly may lower the likelihood of diarrhea. You should also drink frequent small amounts of fluids (7-up, ginger ale, tea, broth, water). Drinking eight or more glasses of liquids each day is best when having liquid stools.

For severe diarrhea, it is sometimes helpful to avoid dairy products. Your doctor may give you medications for diarrhea. It is important to take them as prescribed.

Lowering the fiber (also called roughage) in your diet may also help to control diarrhea. Fiber usually helps you have softer, more regular stools. However, when your intestines are irritated by therapy, normal levels of fiber may be too much.

Foods high in fiber include raw fruits and raw vegetables, bran, whole grain cereals, whole grain breads, and popcorn. You may need to avoid these foods while going through treatment.

If you have five loose stools in 12 hours, or if the diarrhea is associated with cramps or bleeding, call your doctor.

Constipation

You may have constipation as a result of chemotherapy, pain medication, anti-nausea medications, or changes in your diet or activity. Constipation is when your bowel movements are less often and you have trouble going to the bathroom. Constipation can be lessened by increasing the fiber in your diet. Increasing fluids and activity may also help to prevent constipation.

If you do not have a stool for two or more days past what is normal for you, call your doctor or nurse. If you are on pain medications such as narcotic pain medications (Codeine, Dilaudid, Morphine), you may need to start using laxatives or stool softeners. Try to keep your bowels moving regularly. Your doctor will advise you on which laxatives may be used.

Hair loss

Some chemotherapy drugs affect hair. Sometimes chemotherapy can affect all body hair, including eyebrows, lashes, and pubic hair. The loss is usually temporary. You may lose some or all of your hair. It may come out gradually or it might happen all at once. Hair loss can vary but usually starts two to three weeks after your first treatment and can take about one week for all the hair to fall out. You may want to wear scarves or buy a wig or toupee if you lose your hair. If you plan to wear a wig, you may want to look for it before you lose your hair. This way you can match the color and style of your hair more closely. There are some very good services which can help you cope with hair loss and any appearance changes. Let your nurse know if you would like more information.

If you lose your hair it will be important to protect your scalp, not only from the sun, but also from heat and cold. It is important to use sunscreen on your scalp if you choose not to wear a hat or scarf.

Most people will find their hair comes back two to three months after your last treatment, but this may be different for each person. The feel of and/or color of your hair may change temporarily or permanently.

Skin reaction/changes

The skin is another area of the body that may show some side effects of chemotherapy. If you receive your chemotherapy by injection and you develop redness, pain or a sore area at/or near the site, during or after treatment, be sure to let your nurse or doctor know. It is very important that you call your nurse or doctor if the area is red, swollen, forming a blister, or if there is an open sore.

Possible side effects of some medicines affecting the skin include itching, scaling skin, redness, peeling or acne. A few medicines may cause darkening of the skin, nails, or darkening of the skin directly over the vein. Talk to your nurse or doctor about any changes. These skin changes will gradually fade when the course of therapy is done.

It is important that you keep your skin clean and dry. Moisturizing lotion may be helpful, but check with your nurse or doctor if you are receiving, or have received, radiation therapy in the past.

Some types of chemotherapy can make your skin more sensitive to sunlight. Shielding yourself from the sun’s rays is important. Avoid sun lamps. You may be more sensitive to these rays and experience sunburn. You should use a sunscreen that has a Sun Protection Factor (SPF) of 15 or higher. Call your doctor if you have any concerns about any area on your skin.

Some chemotherapy medicines may cause eye irritation. Eye drops are sometimes prescribed by your doctor. It is important that you use them as directed. Check with your doctor before taking any over-the-counter eye medicine.

Pain or nerve changes

Some of the drugs used for chemotherapy may cause changes in your nervous system. These changes can be temporary or permanent. Other changes in the body can cause pain as well. It is important to talk with your doctor or nurse about any pain or nerve changes you may be having. Your cancer treatment center may have a pain or palliative care clinic or team that you can work with to manage your pain.

Changes in fertility

Males

Chemotherapy drugs may lower the number of sperm cells and reduce their ability to move. These changes can cause infertility, which may be temporary or permanent. Infertility affects a man’s ability to father a child, but not a man’s ability to have sexual intercourse. Other possible effects of these drugs are problems with getting or keeping an erection and damage to the chromosomes, which could lead to birth defects.

• Before starting treatment, men should talk to their doctor about sperm banking—a procedure that freezes sperm for future use—if infertility may be a result of treatment.
• It is important to use birth control with your partner during treatment. Ask your doctor how long birth control is needed.
• Use a condom during sexual intercourse for the first 48 hours after each dose of chemotherapy because some of the chemotherapy may end up in the sperm.
• Ask your doctor if the chemotherapy will affect your ability to father a child. If so, will the effects be temporary or permanent?

Women

Anti-cancer drugs can affect the ovaries and lower the amount of hormones they make. Some women find their menstrual periods stop completely or become irregular while having chemotherapy. These changes may be temporary or permanent.

Damage to the ovaries may cause infertility, the inability to become pregnant. Infertility caused by cancer treatment can be either temporary or permanent. Whether infertility occurs, and how long it lasts, depends on many things, including the type of drug, the dosage given and the woman’s age.

Although pregnancy may be possible during chemotherapy, it is NOT advisable because some anti-cancer drugs may cause birth defects. Doctors advise women of childbearing age, from the teens through the end of menopause, to use some type of birth control during their treatment, such as condoms, spermicidal agents, diaphragms, or birth control pills. Birth control pills may not be appropriate for some women, such as those with breast cancer. Ask your doctor about birth control options for you.

Changes in sexuality

Chemotherapy can cause changes in how your body responds sexually. Changes can vary depending on whether you are a man or woman and which treatments you may be getting.

Males

Men may have difficulty having or keeping an erection or having an orgasm. They may also be too tired, stressed, or not as interested in sex. Talk with your doctor or nurse about any symptoms you may be having.

Women

Women may have symptoms of menopause, when their monthly cycles may stop due to treatment. These symptoms could be hot flashes, vaginal dryness, or feeling irritable. Other common side effects of chemotherapy are bladder or vaginal infections, discharge, itching, or being too tired, stress or not being interested in sex.

There are ways to manage any changes your body is going through. Cotton underwear and loose fit clothing will make you more comfortable and less likely to develop any irritations or infections. Vaginal lubricants can be helpful for vaginal dryness or other medicines. Talk with your doctor or nurse about any symptoms you may be having.

UI Cancer Information Services