Chemotherapy is one of the most important modalities of cancer treatment. The goal of chemotherapy depends on the stage and the entity of cancer.

Chemotherapy can be used for

  • Cure of cancer.
  • Decreasing the risk for further spread of the tumor.
  • Decelerating the growth of tumors.
  • Elimination of cancer cells that may have spread to other parts of the body from the original tumor.
  • Relief of symptoms caused by the tumor disease.

Chemotherapy is a combination of drugs that destroy cancer cells through different mechanisms and effectively help in the treatment of many types of cancer. Similar to other medicines, chemotherapy can cause side effects by affecting the normal cells, including hair roots, nails, intestine lining and the bone marrow.

How to manage chemotherapy side effects

Individuals react differently even to the same type of chemotherapy. Some people undergoing chemotherapy experience no side effects at all while others experience adverse effects that are mild and easy to control. Only a few may develop severe adverse effects. Any side effects that bother you should be reported to your physician or nurse.

Most common side effects
  • Nausea and Vomiting

    Can be controlled or lessened by:

    • Anti-nausea medications which your doctor can prescribe.
    • These drugs are usually given 30 to 60 minutes before chemotherapy in order to achieve their full effect. There are also medications which you can take at home after your treatment. Prevention is always a good strategy as it is more difficult to treat nausea that develops after chemotherapy.
  • How can you reduce the risk of having nausea?

    The signs and symptoms of lung cancer can take years to develop and may not appear until the disease is advanced.

    • Eat light meals throughout the day like 6 small meals instead of 3 big meals.
    • Avoid eating or drinking 1-2 hours before and after chemotherapy.
    • Avoid eating fried or fatty food and food with strong odors.
    • Eat food served cold or at room temperature.
    • Eat bland food like toasted bread, crackers, dry biscuits, cold meat, fruits, pickles, barley or rice soup, fruit juice and fizzy drinks.
    • Drink cold, clear and unsweetened fruit juice (e.g. apple or grape juice) or light colored sodas.
    • Sip liquids slowly.
    • Take a short walk or relax before taking your meals in order to reduce anxiety and nausea.
    • Meals should be taken in a well-ventilated room.
    • After eating avoid lying flat for at least 2 hours.
    • Wear clothes that are comfortable.
    • When feeling nauseated, breathe deeply and slowly.
    • Music, television, games, reading and chatting with family and friends can act as a good distraction.
    • Sometimes herbal teas like green tea or ginger tea may help.
    • Suck on mint, hard candy or ginger candy.
    • Listen to relaxation tapes before, during and after receiving chemotherapy.
    • In case of intense nausea, try to sleep.
    • Prescribed anti-nausea tablets should be taken 30 to 60 minutes before meals.
  • Hair Loss

    Hair loss occurs very often due to chemotherapy. The actual extent of hair loss depends on the person and the chemotherapy being given. This side effect is temporary and hair usually grows back after the treatment is completed. However it may be of a different shade and texture.

    How can you manage hair loss better?

    • Cut your hair short to make it look thicker and fuller. This will also make hair loss easier to manage.
    • Use a mild shampoo and conditioner.
    • Avoid excessive shampooing.
    • Use a soft hairbrush.
    • Avoid excessive blow-drying and combing of hair.
    • Avoid using curlers and tying hair in ponytails.
    • Make use of wigs, scarves and hats (It is recommended to get your wigs fitted before you lose your hair).
  • Fatigue and Anemia

    Fatigue is a temporary reduction in physical and emotional energy related to a disease or treatment (e.g. chemotherapy, radiation therapy or surgery). Fatigue interferes with daily activities, sleep patterns, and general well-being.

    How can you minimize fatigue and anemia?

    • Have plenty of rest (sleep more at night and take naps during the day) but do not overdo it.
    • Exercise has been shown to help reduce fatigue.
    • Eat a balanced and healthy diet.
    • Complimentary therapy like massage, medication and yoga may help.
    • Drink lots of water and other non-caffeinated liquids to prevent dehydration.
    • If necessary, your doctor can prescribe a hormone injection to stimulate the production of red blood cells.
    • Blood transfusion might be given in severe cases of anemia.
  • Infections and Neutropenia

    Most chemotherapy drugs affect the bone marrow, decreasing its ability to produce white blood cells that fight infections. Your white blood cell count will be checked regularly during the course of your treatment - a low neutrophil count would mean neutropenia. Low counts usually happen 7-10 days after chemotherapy. In case of low count of white blood cells, the bacteria enters the bloodstream and your body may not be able to eliminate the bacteria without an antibiotic.

    How can you prevent infections especially when neutropenia is present? Take care of your personal hygiene.

    • Wash your hands with an anti-bacterial soap (before eating and after using the bathroom).
    • Gently pat your skin dry after a warm bath or shower to prevent injury to the skin.
    • Clean the anal area thoroughly after bowel movement (Women- remember to clean from front to back).
    • Take care when clipping finger / toenails and do not tear or cut cuticles (use cuticle cream remover instead).
    • Use electrical razors.
    • Clean any cuts or nicks on the skin immediately by using soap and warm water followed by an antiseptic.
    • Do not squeeze or scratch pimples.
    • Women, avoid using tampons, bath salts /foams, and vaginal douches.

    Take care of your oral and dental hygiene.

    • Always use a soft toothbrush and avoid using dental floss.
    • Avoid using mouthwashes that contain alcohol.
    • Clean dentures with fresh water.
    • Dental procedures should not be performed when white blood cells are low. Consult your doctor in case of any emergency.

    Improve your Nutrition.

    • Take a balanced and healthy diet.
    • Food must be cooked properly.
    • Drink plenty of fluids.
    • Avoid vegetables that cannot be peeled (e.g. salad vegetables) and peel fruits before eating them.

    General safety precautions:

    • Avoid getting in contact with people who have cold, flu, open sores or any type of infection.
    • Avoid crowded areas.
    • Avoid exposure to direct sun light or use sunscreen.
    • Wear shoes to prevent cuts or burns on your feet.
    • Avoid using rectal (anal) thermometers, enemas and suppositories.

    Be aware of your body and signs of infections:

    • Fever >38 °C, report immediately.
    • Chills.
    • Burning sensation during urination.
    • Severe cough, sputum or sore throat.
    • Unusual vaginal discharge or itching.
    • Redness, swelling or tenderness of a wound, sore, pimple or intravenous catheter site.

    Note: Report any signs of infection to your physician especially when the white blood cell count is low. When having fever, do not use any medication without consulting your physician.

  • Bleeding and Low Platelets

    Chemotherapy drugs can affect the ability of the bone marrow to produce platelets that help stop bleeding by forming blood clots.

    When should you inform the doctor?

    • Unexpected bruising.
    • Small red spots under the skin.
    • Blood in the urine.
    • Black or bloody bowel movement.
    • Bleeding from the gum or nose.

    How can you prevent problems if your platelet count is low?

    • Avoid falls or other injuries by not participating in contact sports and activities.
    • Use an electric razor rather than
    • regular razor.
    • Use a nail clipper or a file rather than scissors.
    • Avoid blowing your nose.
    • Use a soft toothbrush.
    • Never use medications that affect the platelet functions (e.g. aspirin).
  • Diarrhea

    The cells in the intestinal tract are vulnerable to the effects of chemotherapy and can cause diarrhea or loose bowel motion. Diarrhea dehydrates the body, resulting in losing some important minerals that your body needs, such as potassium.

    How can you prevent/manage diarrhea?

    • Drink 8-10 glasses of fluids a day including soup/broth or soda (non-caffeinated brands).
    • Eat low fat dairy products (e.g. low fat yogurt).
    • Eat smaller meals throughout the day rather than three big meals.
    • Follow BRAT diet (bananas, rice, apple sauce and toast) as advised.
    • Eat bland, low fiber food such as white chicken meat without skin, scrambled eggs, crackers, pasta without sauce, white bread, mashed or baked potatoes and pureed vegetables.
    • Avoid fatty, fried or greasy food
    • Take the prescribed medication to control diarrhea.
  • Constipation

    Some chemotherapy drugs such as, narcotics and sedatives can slow down the normal movement of the bowels.

    How to deal with constipation?

    • Drink 8-10 glasses of clear fluids a day.
    • Eat soft and high fiber food (e.g. bran, whole-wheat bread and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, popcorn, milkshake and juice).
    • Do exercises such as walking.
    • Use laxative as prescribed by your doctor.
  • Skin and Nail Problems

    Chemotherapy can cause minor skin problems such as rash, redness, acne, itching, peeling and a “dry looking “or “dry feeling” skin. Intense itching of the skin can be caused by dehydration or chemotherapy. Some chemotherapy drugs or radiation therapy treatment may also cause the skin to change in appearance, and darken in color. Finger nails which are hardened skin cells may become more brittle than usual and change in color or appearance.

    How can you prevent skin problems?

    • If acne develops, use medicated creams or soaps and consult your doctor.
    • Resist the urge to scratch to prevent skin tear.
    • To avoid dryness, use creams or lotions when your skin is still moist after a bath.
    • Avoid products that contain perfume (these include deodorants, powders and soap).
    • Avoid using tapes and adhesive dressings on your skin.
    • Avoid extreme temperatures (too hot, too cold).
    • Wear comfortable clothes.
    • Drink plenty of clear fluids.
    • Avoid direct sunlight.

    Certain chemotherapy drugs given intravenously can cause tissue damage, if they leak out of the vein. Inform your physician and/ or nurse when noticing pain or a burning sensation, swelling and redness at the injection site.

  • Nerve and muscle changes (neuropathy)

    Some chemotherapy drugs can affect the nervous system or muscles. Report to your doctor or nurse right away if you notice any nerve or muscle changes. It is important to treat these problems as soon as possible.

    Nerve and muscle related symptoms can be present as:

    • Tingling, numbness or weakness in hands and/or feet.
    • Weak, tired or sore muscles.
    • Constipation.
    • Jaw pain.
    • Loss of balance, clumsiness, having trouble with co-ordination (e.g. difficulty picking up objects and buttoning your clothes).
    • Dizziness.
    • Feeling colder than normal.
    • Pain while walking.

    How can you manage nerve & muscle related problems?

    • If you do not feel well, be careful when grasping objects. Avoid falling by moving carefully and using handrails whenever possible.
    • Wear gloves when gardening, cooking, washing dishes, etc.
    • Wear shoes with rubber soles.
  • Flu-like Syndrome

    This syndrome can be caused by an infection, cancer and/or the treatment itself. It is important to check with your doctor if you experience these flu-like symptoms:

    • Muscle ache
    • Headache
    • Tiredness
    • Nausea
    • Slight fever
    • Chills
    • Poor appetite

    How can you manage flu-like symptoms?

    • Maintain good nutrition and a healthy lifestyle.
    • Exercise regularly and moderately.
    • Have plenty of rest.
    • Relieve stress.
    • Discuss your fears and feelings with family members, support group and health care professionals.
    • Learn about your disease.