Fifteen Most Common Chemotherapy Side Effects and Ways to Manage Them

What is Chemotherapy?

Chemotherapy is cancer treatment with one or more drugs that kill growing cancer cells. Chemotherapy drugs may be aimed at curing the cancer, prolonging life or simply reducing symptoms. Traditional chemotherapy drugs interfere with cell division.

Some important points related to chemotherapy are as follows:

• The efficacy of the chemotherapy treatment largely depends on the type and stage of the cancer.
• The dosage of the drugs is usually determined using a mathematical formula based on body surface area.
• The types of chemotherapy medications include alkylating agents, antimetabolites, anti-microtubule agents, corticosteroids, mitotic inhibitors, topoisomerase inhibitors and cytotoxic antibiotics.
• Most of the drugs are administered orally or intravenously.
• Targeted therapies involve drugs and delivery systems that specifically attack cancer cells.

What Causes Chemotherapy Side Effects?

Chemotherapy targets those cells that divide rapidly, and cancer cells divide more quickly than other cells of the body. Cells of the skin, hair, red blood cells produced in the bone marrow and other similar cells also multiply rapidly. The chemotherapy drugs target such healthy cells too. When the healthy cells are damaged by the chemotherapy drugs, it results in side effects.

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The factors that determine the extent of side effects of chemotherapy include:

• Individual variations
• Other ongoing treatments
• Previous health or surgical issues
• Age
• Lifestyle
• Hereditary factors
• Types of chemotherapy drugs
• Length of the treatment
• Type and stage of cancer

Chemotherapy most commonly affects the following cells, resulting in the corresponding symptoms as side effects.

• Digestive tract
• Hair follicles
• Bone marrow

• Skin and nails
• Mouth
• Reproductive system

Some key points to remember about the side effects of chemotherapy drugs:

• Side effects of chemotherapy vary in different individuals.
• Some side effects need immediate medical attention.
• Some side effects can be upsetting and disrupt your routine, but are not life-threatening and may require medical treatment
• Some side effects are long-term, but most of them last while you are undergoing chemotherapy.
• If there are no side effects, it does not mean that the treatment is inefficient. (It is just that you are lucky)

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Common Chemotherapy Side Effects

The side effects of chemotherapy can be varied. It is important to notice the side effects and tell your doctor about them. Most of the side effects can be treated symptomatically.

1. Fatigue one of the most common side effects of all types of chemotherapy, is a feeling of complete exhaustion in spite of sufficient sleep and rest. Lack of energy, always feeling sleepy, not wanting to do routine activities or grooming self, poor attention and concentration, and poor memory are some of the symptoms of fatigue.

Fatigue can be managed by simple changes in one’s routine like including walking, yoga and other light exercise. Acupuncture, massage and meditation also help in overcoming fatigue.

2. Hair Loss: Several chemotherapy regimens that contain carboplatin, daunorubicin, ixabepilone, paclitaxel and others cause hair loss. Some drugs cause changes in hair color, texture or thickness of hair.

Managing hair loss includes wearing a cold cap in hot sun, warm hat in cold climates, wearing a suitable wig or cutting hair very short. Joining a support group would be a great help in coping with hair loss.

3. Mouth and Throat Sores: Painful sores in the mouth and throat, called mucositis, is a common side effect of drugs like cyclophosphamide, methotrexate, mitomycin and other chemotherapy drugs. The sores look red and swollen like ulcers. Activities like eating, drinking, chewing, talking and swallowing may become difficult. If the patient’s immunity is low, oral yeast infection can occur and the inside of the mouth has a white coating.

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Do’s while handling mouth sores:

• Drink plenty of water to avoid dehydration
• Frequently rinse your mouth with salt water
• Include fruits and vegetables in your diet

Avoid the following to lower the risk of mucosal sores:

• Spicy foods
• Smoking and alcohol
• Using mouthwash

Ask your doctor for a remedy for mouth sores like pain gel, oral rinse or other topical medicines.

4. Appetite Loss and Weight Changes: Loss of appetite is mainly caused by the changes in the way food tastes and smells, mouth sores, nausea and feeling sick. Eating less than usual or not feeling hungry may contribute to malnutrition and weight loss.

Eating six small meals a day or snacking on the go can help in maintaining a healthy weight. Drink fluids between meals and not at meal times. Eat meals with family and friends. A simple 20-minute walk within an hour before a meal can build up an appetite.

Loss of appetite and diarrhea lead to weight loss. Pain medications, bone-strengthening medicines and steroids can produce side effects of unwanted weight gain.

Some tips to manage weight changes include:

• Limit sugars and saturated fat
• Avoid alcohol
• Exercise regularly

5. Diarrhea: Chemotherapy drugs like methotrexate, vinorelbine and others damage the inner lining of the intestine and interfere with the reabsorption of water. This can cause loose and watery bowel movements. Losing body fluids can further result in cramps, bloating and nausea.

Some ways to reduce the diarrhea and its effects include:

• Include foods high in pectin to help reduce diarrhea
• Eat foods rich in sodium and potassium to replace the loss
• Eating protein helps in reducing fatigue
• Eat small frequent meals
• Limit milk, nuts and high fiber foods
• Drink water after each bout of diarrhea
• Keep the anal area clean after each bowel movement

6. Nausea and Vomiting: Feeling sick in the stomach and throwing up is the body’s way of reacting to something new, especially chemotherapy drugs like eribulin, daunorubicin and others.

Anti-emetics can help curb nausea and vomiting. Avoid fatty and spicy foods, eat small amounts and avoid strong smells that can cause you to throw up. Ginger can help ease nausea.

7. Constipation: Difficult bowel movements can be caused by chemotherapy drugs and pain medications used in cancer patients.

The following tips can lower risk of constipation:

• Drink enough fluids
• Eat a balanced diet
• Incorporate exercise and physical activity in your daily routine
• Include fiber in your diet (It should be remembered that very high fiber content in the food can cause diarrhea)

8. Blood, Heart and Nervous System Effects: Chemotherapy drugs can harm cells in the bone marrow where blood cells are produced and result in the following problems.

• Reduced red blood cells – anemia
• Reduced white blood cells – neutropenia (reduced immunity)
• Reduced platelets – increased risk of bleeding

Blood tests like complete blood count, WBC, RBC count, platelet count and bleeding tests must be included in chemotherapy routine. Medications to improve the production of red blood cells are usually prescribed by the doctor. Iron supplements, food rich in iron content and vitamin B12 can be taken.

Some chemotherapy drugs can cause Cardiomyopathy, that is, weakening of heart muscles; and arrhythmia (abnormal heart rhythm).

Some chemotherapy drugs can cause nerve damage and result in symptoms like:

• Tingling
• Weakness or numbness in hands, legs or feet
• Burning
• Weakness or tiredness of muscles or muscle aches
• Loss of balance
• Clumsiness
• Sudden, sharp pricking or stabbing sensations
• Shaking or trembling of body due to weakness

The following can help you live with the neurological deficiencies:

• Supplements like folic acid
• Complementary procedures like massage and acupuncture
• Adequate rest
• Use a cane to walk
• Protect from injury and burning
• Physiotherapy

9. Mood Changes: When the chemotherapy drugs affect the central nervous system, faculties like thought patterns, coordination, emotions and decision making are affected. The person may have poor concentration further leading to depression, anxiety and stress.

Keep your brain active by reading, and solving puzzles like crossword and Sudoku. Stick to a certain routine and use calendar to set reminders. Admit that you are forgetful so that others will understand.

10. Sexual and Reproductive Issues: Being tired or the sick feeling due to cancer treatment can cause an inability to enjoy sex. Chemotherapy can affect fertility in men and women.

Hormonal changes can occur, causing hot flashes, irregular periods, dryness of vaginal tissues and other changes in women, and problems with erection in males. Chemotherapy during pregnancy can harm fetus very severely. Some drugs can affect sperm count that can cause temporary or permanent infertility.

Symptoms related to sexual and reproductive issues can be overcome by simple tips:

• Tackle vaginal dryness with lubricants or moisturizers
• Make sex interesting with different positions
• Ask your doctor if hormone replacement therapy is possible

11. Infection Risk: The lowered immunity is the reason for the inability to fight infection. The mouth, throat, sinuses, urinary tract, lungs and skin are the most common infection prone areas. Common symptoms of infection include redness and swelling, high fever, mucus or pus, burning sensation while urinating, and shivering.

Avoid infection with the following tips:

• Maintain personal hygiene
• Avoid contact with people who have infection
• Avoid large crowds
• Wash your hands regularly
• Avoid allergens like dust and pollen

12. Bruising and Bleeding: Bleeding occurs when blood flows outside the body or into a body cavity. A bruising is the result of damaged blood vessels and bleeding into the skin, giving the skin a black and blue appearance. Bruising, also called hematoma usually occurs due to trauma or injury.

Patients undergoing chemotherapy may have easily bruised skin, nosebleeds and bleeding gums due to reduced platelet count.

Applying pressure or ice on the bleeding site can help reduce the bleeding. Platelet transfusion can be done to improve the platelet count.

13. Skin and Nails: Chemotherapy can cause dry, sore and flaky skin that peels off. The skin becomes sensitive to sunlight and exposure to sunlight can result in rashes. Flakier nails, cracked nails, red cuticles, white lines across the nails and dark, yellow coloring of nails are also seen.

Protect your skin with suitable lotions and skin products. Protect the skin from sunlight and ask your doctor for treatment of dry and itchy skin.

14. Sleep Problems: Insomnia, or sleep disturbances, is also a side effect of chemotherapy drugs.

Keeping awake and active during the day can be a simple remedy for getting a good night’s sleep. Other tips are to avoid stimulants like caffeine. Light exercise late in the evening can help in getting good sleep.

15. Taste and Smell Changes: The smell and taste receptors that line up the nose and mouth are altered. Some foods may taste rancid or bitter and your favorite food may now give a metallic taste in your mouth.

Managing taste and smell changes can be done with the following tips:

• Eat light and try new foods
• Try eating cold foods
• Suck on ice chunks or chips
• Rinse your mouth regularly
• Eat several hours before your chemotherapy session
• Ask someone else to cook for you
• Don’t force yourself to eat foods that taste bad to you

Simple Tips to Manage Chemotherapy Side Effects

Some tips to manage the side effects caused by chemotherapy include:

• Try complementary and alternative medicine
• Avoid direct exposure to sunlight
• Use sunscreens
• Take enough rest
• Exercise regularly
• Use daily planner
• Talk to your partner about any issues related to sex
• Join support groups
• Keep busy with activities like puzzles, riddles, playing with children and reading