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Managing Side Effects of Chemotherapy | Managing Side Effects of Radiotherapy

Click here to download our chemotherapy booklet

Managing Side Effects of Chemotherapy
Chemotherapy affects rapidly multiplying cells. This includes cancer cells and normal cells. The effect on normal cells may cause unwanted side effects. Side effects can vary greatly:

  1. From person to person - some people will have no side effects, others will experience a few
  2. According to the type of drugs
  3. From one treatment period to the next

Side effects usually start during the first few weeks of treatment. Most go away in time. The type and severity of any side effects have nothing to do with the success of the treatment.

Helping yourself during chemotherapy
Many people feel they have no control over their treatment when they are receiving chemotherapy. However, there are many things you can do to help yourself.

1. Tell your doctor of any side effects
Tell your doctor about any unusual, painful or worrying problems or side effects. He or she can help to make sure everything is all right. If you keep quiet, your doctor won't necessarily know anything is wrong. Consider keeping a diary to write down any side effects you experience and what you did to cope with them. Share this information with your doctor or nurse.

Contact your doctor urgently if any of these problems occur:

  1. fever over 38°C or chills
  2. sweating, especially at night
  3. easy bruising or any unusual bleeding
  4. sore throat
  5. mouth ulcers
  6. persistent or severe vomiting more than 24 hours after treatment
  7. severe constipation, diarrhoea or abdominal pain
  8. burning or stinging on passing urine
  9. tenderness, redness or swelling around the place where the injection goes in
  10. any serious unexpected side effects or sudden deterioration in health.

Side effects usually start during the first few weeks of treatment. Most go away in time. The type and severity of any side effects have nothing to do with the success of the treatment.

2. Keep active
Some people find relaxation or meditation helps them feel better. You will probably find it useful to stay active and exercise regularly if you can. The amount and type of exercise will depend on what you are used to and how well you feel. Discuss with your doctor what is best for you. Your hospital social worker or nurse will know whether the hospital runs any programs, or may be able to refer you to local community programs. You can also contact Hong Kong Cancer Fund's CancerLink Hotline on 3656 0800 for information on complementary therapies such as yoga or mediation.

3. Dealing with depression
Chemotherapy treatment and the side effects may cause you to feel depressed. Returning again and again to the hospital or doctor's office (places that represent the most frightening aspects of cancer), is not easy.

Tips:

Light excercise such as Qigong or yoga are great ways to relieve stress.
  1. Talking about your feelings or joining a support group may help.
  2. Spend time with friends who have a positive attitude. This will help you reduce negative thinking and focus on what can be done.
  3. Be as active as possible. Plan activities for each day, such as exercise or meeting people.
  4. Do things that make you feel good, such as watching funny movies, going for a walk, or having a massage.
  5. Get up at the same time every morning, regardless of how tired you feel.

If the depression is ongoing, tell your doctor or hospital social worker about it, as medication or counselling may help.

Fear of chemotherapy
It is natural to be worried about side effects but try to stay positive. You may have heard terrible stories about chemotherapy from your family and friends. Try not to listen to them. Everyone is different and reacts differently. Chemotherapy drugs are constantly being improved to give you the best possible result and to reduce side effects.

10 common side effects of chemotherapy

  1. Feeling tired and lacking energy
  2. Feeling sick or vomiting
  3. Constipation or diarrhoea
  4. Mouth problems
  5. Hair loss and scalp problems
  6. Itching skin and other skin problems
  7. Nerve and muscle effects
  8. Change in hearing
  9. Effects on the blood
  10. Fertility problems

What you can do

  1. Spend time with friends who have a positive attitude. This will help you reduce negative thinking and focus on what can be done.
  2. Be as active as possible. Plan activities for each day, such as exercise or meeting people.
  3. Do things that make you feel good, such as watching funny movies, going for a walk, or having a massage.
  4. Get up at the same time every morning, regardless of how tired you feel.

1. Feeling tired
Feeling tired and lacking energy (fatigue) is the most common side effect of chemotherapy. Fatigue can include feeling exhausted, tired, sleepy, drowsy, confused or impatient. You may also have trouble concentrating and lose your appetite. Fatigue can appear suddenly and rest may not relieve it. You may continue to feel tired after treatment ends.

Tips:

  1. Plan your day so you have time to rest.
  2. Save your energy. Do not do more than you can comfortably do.
  3. Take short naps or breaks.
  4. Eat well and drink plenty of fluids.
  5. Take short walks or do light exercise.
  6. Let other people help you.

If you are not sleeping well, tell your doctor or nurse. They may be able to help. But do not take any pills or medications unless they say you can. Some pills and medications may react badly with your chemotherapy.

2. Feeling sick or vomiting
Not everyone feels sick (nauseous) after chemotherapy. If it does occur, it usually starts a few hours after treatment and may last many hours. If you still feel nauseous after a few days, contact your doctor. Changes to your diet are to be expected. Sometimes you may not feel hungry. Try to catch up on days when you do feel hungry. Eat small, frequent meals or snacks if your appetite is poor. Be willing to change your meals around. If you happen to feel hungrier at breakfast time, have your main meal then and a light meal (such as breakfast cereal) at a time when you feel less like eating. It is important you find a diet that meets your needs.

Tips:

  1. Eat a light meal before your treatment (for example, soup and dry biscuits) and drink as much fluid as possible.
  2. Drink small amounts more often rather than large drinks after treatment. Soda water, dry ginger ale or weak teas are all good choices. Ice cubes, icy-poles or jellies are other ways to increase your fluid intake.
  3. Avoid foods that usually upset your stomach.
  4. Eat smaller amounts more often.
  5. Eat slowly and chew well to help you digest your food better.
  6. Eat dry toast or crackers - they often help.
  7. Don't do anything too strenuous after a meal; have a lie down for a while.
  8. Try breathing deeply through your mouth whenever you feel like being sick.
  9. Prepare meals between treatments and freeze them for the days you don't feel like cooking.
  10. Try to avoid odours that bother you such as cooking smells, perfume or smoke.
  11. Ask your doctor for medication to stop you feeling sick.

Anti-nausea medication can help. If you have intravenous treatment, anti-nausea medication may be added to the drip before and during treatment. If nausea is likely, you will be given anti-nausea tablets to take at home. These are best taken regularly. Several anti-nausea medications are available. It may take some time before you find the medication that is right for you, but keep trying. Anti-nausea suppositories are sometimes used to help control nausea or vomiting. These are placed in the back passage (rectum), where they dissolve.

3. Constipation or diarrhoea
Some chemotherapy drugs, pain relief medicines and anti-nausea drugs can affect the lining of the digestive system and cause constipation or diarrhoea. Let your doctor or nurse know if you experience constipation - your medication may be changed or other medication given to relieve the constipation. At first, diarrhoea can be treated with medication at home. If the diarrhoea is severe, it may cause dehydration and you may need to be admitted to hospital. If you have diarrhoea, it is important to return to a balanced diet that includes fresh fruits and vegetables and wholegrain bread and pasta after the diarrhoea has stopped.

Tips:

  1. If you have constipation, eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruit and vegetables.
  2. If you have diarrhoea, avoid spicy foods, coarse wholegrain products, fatty or fried foods, rich gravies and sauces and raw fruit or vegetables with skins or seeds. Instead, try snacking on clear broth and toast, biscuits and cheese, or cooked rice.
  3. Drink plenty of fluids. This will help loosen the bowels if you have constipation and replace the fluids lost through diarrhoea. Warm and hot drinks work well.
  4. Get some light exercise. Walking is a good option.
  5. Eat small, frequent snacks instead of big meals.

4. Mouth problems
Some chemotherapy drugs can cause mouth sores or infections, particularly in people with head and neck cancer. Ask your doctor or nurse whether you need to take extra care.

Tips:

  1. Use a soft toothbrush to clean your teeth twice a day. You may be given special mouthwashes to try to prevent mouth infections such as thrush.
  2. Rinse (swill and spit) with a teaspoon of salt in a glass of warm water at least four times a day.
  3. Don't use commercial mouthwashes without first asking the doctor. Sometimes they can irritate your mouth.
  4. Sip fluids, especially water, and eat moist foods such as casseroles if you have a dry mouth. It may also help to suck on frozen pineapple or chew sugar-free gum.
  5. Blend foods
  6. Eat soups and ice-creams
  7. Moisten foods with butter

If you notice any change in your mouth or throat, such as sores or thickened saliva, or find it difficult to swallow, contact your doctor. Discuss any dental problems with your doctor. Before you have any dental treatment, tell your dentist you are having chemotherapy.

5. Hair loss and scalp problems
Most people having chemotherapy worry about losing their hair. Some drugs may cause hair to thin or fall out but many others do not cause hair loss.

If you do lose some or all of your hair, it will usually grow back when your treatment stops.

When hair loss does occur, it usually starts two to three weeks after the first treatment. Some people lose all their hair very quickly; others lose it after several treatments, while others may only lose a little hair or none at all. Your scalp may feel hot or itchy just before your hair starts to fall out. Although losing head hair is most common, some people may also lose hair from their arms, legs, chest, pubic region and eyelashes. If hair loss occurs, you can wear a hat, scarf or wig. The important thing is to do whatever feels comfortable and gives you the most confidence. Cancer care specialists at CancerLink or staff within the Cancer Patient Resource Centres throughout numerous public hospitals can help you find a suitable wig.

Tips:

  1. Keep your hair and scalp very clean.
  2. Use a mild shampoo like baby shampoo.
  3. Comb or brush your hair gently using a large comb or a hairbrush with soft bristles.
  4. Use a cotton, polyester or satin pillowcase--nylon can irritate your scalp.
  5. Avoid hair perms and dyes which may increase hair loss.
  6. Avoid daily use of hair dryers and rollers and harsh hair care products.
  7. Use sunscreen, a hat or scarf to protect your head from the sun.
  8. Wear a light cotton turban or beanie to bed, if you are cold at night.
  9. If your eyelashes fall out, wear glasses or sunglasses to protect your eyes from the sun and dust when outside.

It takes between four to twelve months to grow back a full head of hair. When your hair first grows back it may be a little different. Sometimes it will be curly even though you have always had straight hair. In time your hair will return to its normal condition and you will be able to continue your usual hair care routine. Your scalp can be itchy when your hair is growing back. Frequent shampooing can relieve the itching.

6. Itching skin and other skin problems
You may notice the following changes:

  1. skin may darken
  2. peel
  3. become dry and itchy
  4. more sensitive to the sun.

Tips:

  1. Dust corn flour over the itchy parts.
  2. Use a lotion or cream to stop the dryness. Ask your doctor for something to help if these suggestions don't work.

7. Nerve and muscle effects
Some drugs can cause tingling and loss of sensation in the fingers and/or toes, and muscle weakness in the legs. If this happens, tell your doctor or nurse before your next treatment. A slight change in the treatment is usually all that is needed to stop this happening in the future.

8. Change in hearing
Some chemotherapy drugs can cause loss of the ability to hear high-pitched sounds. They can also cause a continuous noise in the ears known as tinnitus. Let your doctor know if you notice any change in your hearing.

9. Effects on the blood
The soft and spongy material inside bones (the bone marrow) makes three types of blood cells:

  1. white blood cells: fight infection
  2. red blood cells: carry oxygen to cells throughout the body
  3. platelets: help blood to clot and stop bleeding.

The bone marrow's job is to maintain normal levels of blood cells (the blood count) to keep you fit and healthy. Some chemotherapy drugs can occasionally affect the bone marrow so that your blood count is reduced. The count may fall with each treatment. Blood tests will be done regularly to make sure your blood cells return to normal before your next treatment. Occasionally, a low blood count will cause some problems. These are related to the type of blood cell affected.

(1) Infection
During chemotherapy, colds and flu may be harder to shake off and scratches and cuts may get infected easily. See your doctor if you are unwell: don't wait out a cold when you are having chemotherapy. Sometimes doctors recommend taking antibiotics as a precaution against infection. If you are having chemotherapy in winter, check with your doctor about having a flu injection.

Granulocyte-colony stimulating factor (G-CSF) is a treatment given by injection to some people after chemotherapy. It helps to increase the number and function of a type of white blood cell called neutrophils, which help to protect against infection. G-CSF is not prescribed for everyone after chemotherapy; you may wish to check with your doctor if it is an option for you.

(2) Bleeding problems
A fall in the number of platelets can cause you to bleed for longer than normal after minor cuts or scrapes, or to bruise more easily.

Tips

  1. Take care not to cut yourself when shaving or using nail scissors.
  2. If you bleed, apply pressure for about 10 minutes.

(3) Anaemia
If the red blood cells are low, anaemia can occur. This can make you feel weak, tired and look pale.

Tips

  1. Avoid people with coughs, colds and other infections. Naturally this is not practical with people you are living with, so just use your commonsense.
  2. Let your doctor know if you are in contact with a person who has chickenpox. You may need an injection to prevent chickenpox or shingles.
  3. Be careful not to cut or nick yourself when using scissors, needles, knives or razors. Small cuts can harbour germs and can be a good place for an infection to start.
  4. Wash your hands with soap after using the toilet and before eating to avoid spreading germs.

10. Fertility problems
Chemotherapy may affect sexual organs and functioning in both women and men. This may have a temporary or permanent effect on your ability to have children (fertility). It is best for you and your partner to talk about these issues with your doctor.

■ For women
Some women's periods become irregular during chemotherapy but return to normal after treatment. For other women, chemotherapy may cause periods to stop completely (menopause). After menopause, women can't have children. The signs of menopause include hot flushes, sweating, particularly at night, and dry skin. Talk to your doctor about medication for relieving the symptoms of menopause. Early menopause (before age 40) may cause bones to become weaker and break more easily. This is called osteoporosis.

■ For men
Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. This can cause infertility, which may be temporary or permanent. The ability to get and keep an erection may also be affected but this is normally temporary. Women may be able to store eggs (ova) and men may have sperm stored before treatment starts for use at a later date. Ask your doctor about this.

■ Contraception
Although chemotherapy reduces fertility, it is possible for some women to become pregnant while having chemotherapy and a man having chemotherapy could still make his partner pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the unborn baby. Birth control (contraception) must be used. Ask your doctor about your contraceptive options. The Pill may be prescribed to some young women as a contraceptive and to help protect the ovaries from the effects of chemotherapy. Should you or your partner become pregnant, talk to your doctor urgently.

Tips

  1. Use birth control.
  2. Use a condom during sexual intercourse for the first 48 hours after chemotherapy because some of the drugs may end up in the sperm.
Click here to download our radiotherapy booklet

Managing Side Effects of Radiotherapy
Radiotherapy is an effective treatment for many cancers, but it can cause unwanted side effects. Side effects usually start around the second or third week of treatment and are at their worst two-thirds of the way through treatment. Fortunately, most side effects will go away in time and there are ways to reduce the discomfort they may cause.

Side effects vary:

  1. from person to person - some people will have no side effects, other will experience a few
  2. depending on the area of the body being treated
  3. from one treatment period to the next.

The type and severity of your side effects have nothing to do with the success of your treatment.

Helping yourself during radiotherapy

  1. Talk to your radiation oncologist about possible side effects.
  2. Before your treatment begins, ask your doctor what short term and long-term side effects to expect.
  3. Tell your radiation oncologist or nurse of any side effects.
  4. If you have a particularly severe side effect, the doctor may prescribe a break in your treatments or change your treatment.
  5. Ask your radiation oncologist if you can take any medicines, creams, home remedies or alternative or complementary therapies. Some of these remedies can affect how radiotherapy works in your body.

Common side effects

  1. Feeling tired and lacking energy
  2. Skin problems
  3. Hair loss
  4. Nausea & diarrhoea
  5. Face, mouth, neck & upper chest problems
  6. Dental problems
  7. Fertility problems

Feeling tired and lacking energy
During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Some people are able to carry on as usual, but many people find they can't do as much and feel tired during and after treatment. Your weakness and weariness may build up slowly during the course of treatment but should go away gradually after treatment is over.

Tips

  1. Save your energy. Help your body by doing less and doing restful things in your leisure time.
  2. Try to get more sleep at night and take naps during the day if you can.
  3. Let other people help you. Family members, neighbours and friends may be glad of the chance to help you with tasks like shopping, child-care, housework and driving.
  4. Take a few weeks off work during or after your radiotherapy, or work fewer hours. Maybe you can do some of your work at home. Some people feel well enough to continue to work full time if your treatment appointments can be organised to suit their work hours.

Skin problems
Radiotherapy may make your skin dry and itchy in the treatment area. Some of the radiation passes through your body and out the other side, so the skin there may also be affected, although probably not as much. You may temporarily develop a sunburnt look - such as redness, tanning or burning - in the treated area.

Tips

  1. Wear soft clothing. Some of the dye marks may rub off on your clothes, so it is best to wear loose and comfortable older clothes that you can throw out if they get stained.
  2. Avoid wearing tight clothes such as girdles or close-fitting collars that may irritate the skin.
  3. Protect the treatment area from the sun. Stay out of the sun and, before going outdoors, always cover your treated skin with light, close-weave clothing. Ask your doctor about using a sunscreen (SPF 30+).
  4. Tell your doctor about changes in your skin, such as cracks or blisters, very moist skin, rashes, infections or peeling, or any changes in your nails.
  5. Don't rub, scrub or scratch treated skin or any sensitive spots. Let the dye outlines after your treatment wear off gradually.
  6. Avoid using any soaps, creams, deodorants, medicines, perfumes, cosmetics, talcum powder or other substances on the treatment area without your doctor's approval. Many products leave a coating that can interfere with radiotherapy.
  7. Bath or shower in lukewarm water - hot water can injure your sensitive skin. Pat skin dry with a soft towel. Don't put very hot or cold things (hot-water bottle, ice pack, etc) on the treatment area.
  8. Don't use a blade razor on the treatment area. Check with your doctor or nurse before using an electric razor.

Hair loss
If you have hair in the area being treated (scalp, face or body), you may lose some or all of it during radiotherapy. Usually it will grow back and return to normal after the treatments are finished. You will not lose hair outside the treated area.

Tips

  1. Wear a wig or toupee -- or hats, scarves or turbans. Do whatever feels comfortable and gives you the most confidence.
  2. If you plan to buy a wig, it is a good idea to choose it early in your therapy so you can match the colour and style of your own hair.
  3. If you prefer to leave your head bare, protect it against sunburn or extreme cold.
  4. Expect the hair that first grows back to be a little different. It might, for instance, be curly although you have always had straight hair. In some people, it will be a little thinner and, occasionally after a large dose of radiotherapy, the new growth can be patchy for a while.
  5. Look after your scalp the same way as other treatment areas anywhere else on your body.
  6. Ask your hairdresser to make your hair look as good as possible even if it is thin or patchy. In time, your hair will probably return to its normal condition and you can resume your usual hair care routine.

Loss of appetite
Eating healthy and varied food is important when you are being treated for cancer so you remain as well as possible and get the most from your treatment. Depending on the site of your treatment, you may lose your normal interest in food during your course of radiotherapy. Even when you know that eating properly is important, there may be days when you can't eat much.

Tips

  1. Eat smaller amounts more often.
  2. Try to catch up on days when you do feel like eating.
  3. You may find you can drink a lot, even if you don't feel like eating solid foods. If so, try enriching your drinks with powdered milk, low-fat yoghurt, eggs, honey or weight-gain supplements. The hospital dietician will also be able to help if you have problems with food.

If you have radiotherapy in the head and neck area, chewing or swallowing might be difficult or painful.

Nausea and diarrhoea
If you have radiotherapy to your stomach or part of your lower abdomen, you may have to cope with an upset stomach or diarrhoea. These problems will fade when your treatment is over.

Tips

  1. Ask your radiation oncologist to prescribe medicine to relieve diarrhoea.
  2. Check with your radiation
  3. oncologist, radiation therapist or nurse before taking any home remedies during your radiotherapy treatment.
  4. Eat nothing or only a bland snack such as toast, dry biscuits or apple juice for a few hours before your treatment. If the problem persists, you can ask your doctor for medicine to prevent nausea.
  5. Try having nothing but clear liquids as soon as diarrhoea starts, or when you feel it is going to start. Liquids that will not make your diarrhoea worse include apple juice, peach nectar, weak tea and clear broth.

After the diarrhoea has cleared up, it is important to return to a healthy eating plan that includes fresh fruits and vegetables and wholegrain breads and pasta.

Face, mouth, neck and upper chest problems
Radiotherapy is often used to treat cancers in the face, mouth, neck and upper chest and can bring excellent results. Depending on the area treated, it can affect your mouth and teeth, making eating difficult. After about two weeks of treatment, your mouth or throat may become dry and sore and your voice may become hoarse. This should start to improve after another two or three weeks and is usually gone about a month after treatment finishes. You might also have some phlegm in your throat, or a lump-like feeling that makes it hard to swallow.

Tips

  1. Suck ice chips and sip cool drinks.
  2. Avoid tobacco and alcohol (including mouthwashes containing alcohol) because they will dry your mouth even more.
  3. Ask your doctor or nurse for information on artificial saliva preparations.
  4. If eating is uncomfortable or painful, ask your doctor for something to relieve the pain.
  5. Try to have more liquids or soft food if chewing and swallowing are painful.
  6. Your doctor may advise you to try a diet supplement. You can buy these at a pharmacy without a prescription and many are available in a variety of flavours. You can use them alone or with other foods, such as pureed fruit.
  7. If your sense of taste changes during radiotherapy, try different ways of preparing food. For example, lemon juice makes many foods, including meat and vegetables, tastier.

Your doctor can help you with these problems or see a speech pathologist if you continue to have difficulties swallowing.

Dental problems
If you are having radiotherapy to your mouth, your teeth will be more likely to decay. If possible, discuss dental care with your doctor before treatment starts, and tell your dentist about your treatment, so that the doctor and dentist can discuss any dental work you need before radiotherapy begins. Your dentist will probably want to see you often during your radiotherapy. He or she will give you detailed instructions about caring for your mouth and teeth, to help prevent tooth decay and to deal with problems such as mouth sores.

What about my sex life?
Men and women usually find that radiotherapy to the pelvic area causes sexual intercourse to temporarily become uncomfortable and undesirable. In women, they may experience a dry, itchy or burning sensation in the vaginal area. If you have these problems you should tell your doctor or nurse, because the symptoms can usually be relieved quickly and easily. Radiotherapy to the pelvic area can also cause a woman's vaginal tissues to shrink, making sexual intercourse painful. These changes are permanent and can become progressively worse. However, regular intercourse, the use of an instrument to expand the vagina (a dilator) and vaginal lubricants can stop the deterioration.

Radiotherapy and breast cancer
As with radiotherapy for any cancer, tiredness and skin tenderness can be a problem for women receiving radiotherapy for breast cancer. The breast being treated might change a little in size or shape. The change is permanent, but it is usually only slight and probably won't be noticeable under clothing. Several months after radiotherapy some women may notice that their breast feels a little firmer to the touch. It usually softens over time.