Chemotherapy - side effects

Most patients get tired during chemotherapy. The tiredness usually builds up with successive treatments. Regular gentle exercise may help combat the symptom of fatigue. It may take some months for energy levels to recover completely following treatment.

Some chemotherapy drugs can make patients feel sick (nausea) or actually be sick (vomiting). There are very effective medicines to prevent and control nausea and vomiting. Most patients receive standard anti-sickness drugs before and for a few days after each treatment. Occasionally alternative anti-sickness drugs may be required if patients feel or are very sick with their first treatment.

Some chemotherapy drugs can cause diarrhoea; others may cause constipation. Dietary measures and medicines can help reduce diarrhoea and constipation.

Not all chemotherapy drugs cause hair loss. However, some treatments cause hair thinning or even complete hair loss. Some patients also lose body hair, including eyebrows and pubic hair. Hair begins to fall out 10 to 14 days after the first treatment. Hair loss is temporary; your hair will grow back when the treatment has finished. The scalp may feel uncomfortable when the hair begins to fall out. If the scalp becomes dry and itchy moisturising cream can help. 'Scalp cooling’ (also known as a ‘cold cap’) can be used with some chemotherapy treatments to help prevent hair loss. Your nurse will be happy to discuss if this is suitable for you. If you require a wig, please talk to your nurse, who will be able to help.

Some patients experience a sore mouth or mouth ulcers during chemotherapy. Other patients suffer watery or gritty eyes or a sore nose with occasional nose bleeds. Your nurse or doctor will advise on appropriate interventions. The symptoms usually improve over a few days.

Chemotherapy can cause changes in the sense of taste. Some patients experience a metallic taste; others lose their sense of taste altogether. This usually resolves quickly after treatment is complete.

Finger and toe nails may grow poorly or become brittle during chemotherapy. It can take many months for new nails to regrow. It is very rare for chemotherapy drugs to cause rashes but you should report any skin changes to your doctor or nurse. A few chemotherapy drugs can cause redness or tenderness in the hands and feet which sometimes requires an interruption in treatment before the symptoms resolve.

Reactions to chemotherapy drugs are rare but in the unlikely event you suffer one it will almost certainly occur in hospital, during the infusion. The chemotherapy nurses are well trained to deal with allergic reactions. Most patients suffer no long term harm if they react to a drug infusion..

Steroids are effective at preventing sickness and many patients receive a short course of steroid tablets after each cycle of chemotherapy. Some patients suffer restlessness, agitation, indigestion and poor sleep during steroid treatment, but these side effects are short-lived.

Some chemotherapy drugs cause temporary flu-like aches and pains for a few days after treatment. Anti-inflammatory tablets can help.

Some drugs cause tingling and numbness in the fingers and toes and others may cause temporary hearing problems or tinnitus. With most drugs, this resolves over time.

Blood clots in the calves (Deep Vein Thrombosis, DVT) or lungs (Pulmonary Embolus, PE) are more common in patients on chemotherapy, especially patients with PICC lines or portacaths (devices used to facilitate easy delivery of chemotherapy) in place, though blood clots still only occur very rarely. Please report swollen legs or breathlessness to your doctor or nurse.

In extremely rare cases some chemotherapy drugs and certain antibody treatments can cause weakening of the heart muscle. Heart function is always assessed before and during treatment where indicated and, where necessary, cardiac medication may be required.

Many drugs are expelled from the body via the kidneys. It is important to maintain a good fluid intake (at least 2-3 litres a day) during treatment. The kidney function will be monitored during treatment with regular blood tests.

During administration, intravenous drugs may leak out of the vein. It is important to report any pain experienced during the infusion to your nurse who will then take appropriate action.

Young patients can become infertile after treatment. If this is a risk your doctor will have already discussed the implications with you. All patients should use barrier contraception during chemotherapy.