Chemotherapy Side Effects: What to Expect and When to Call

Why chemotherapy causes side effects

Chemotherapy works by killing cancer cells, which grow and divide quickly. It can also harm healthy cells that grow quickly, such as the cells lining the mouth and intestines, the cells that make hair grow, and the blood-forming cells in the bone marrow. That is why the same few problems show up for so many patients.

Not everyone gets every side effect. It depends on the medicines used and on the person. Side effects also say nothing about how well the treatment is working. The doctor checks progress with exams, blood tests and scans, not by how sick the patient feels.

Many side effects ease between cycles or after the last session. A few can last longer or show up later, such as nerve problems or effects on the heart, lungs, kidneys or fertility, so keep going to follow-up visits even after treatment ends.

• Tell the doctor about every medicine, vitamin and herbal product the patient takes, because some can raise bleeding risk.
• Keep the cancer team's phone number, including any after-hours number, somewhere the whole family can find it.

Nausea and vomiting

Nausea can start within the first 24 hours after treatment, or it can come one to seven days later. Some patients even feel sick before a session, just from the sights, sounds or smells of the treatment room. Anti-nausea medicine is usually started before chemotherapy, because nausea is harder to control once it begins, so follow the schedule the doctor gives exactly.

Simple habits help too. Vomiting that will not stop can lead to dehydration, so watch for dizziness, weakness or confusion and call the care team if these appear.

Anti-nausea and other supportive medicines need a doctor's prescription. If the family needs to order them, 2MG Inc., a Philippine FDA-licensed distributor, delivers with a pharmacist checking every prescription, and medicines that must stay cold are packed for the cold chain. See our price list for current prices.

• Eat five or six small meals instead of three big ones.
• Try cold or bland, starchy foods such as crackers, toast or plain rice, and avoid greasy, fried, sweet or spicy food if it bothers the patient.
• Sip water, clear soup, juice or tea throughout the day.
• Sit up, or lie with the head raised, for about 30 minutes after eating.
• Eat in an airy room away from strong cooking smells.
• Keep a short note of when the nausea happens and what was eaten, and show it to the doctor.
• Ginger foods or drinks may help some people. Ask the doctor before trying acupressure bands, supplements or any herbal remedy.

Hair loss

Only some chemotherapy medicines cause hair loss, so ask the doctor whether the patient's treatment is likely to. When it does happen, hair often starts to grow back two to three months after chemotherapy ends. The new hair is very fine at first and may be curlier, straighter or a different colour.

Losing hair can be upsetting, and feeling angry, sad or embarrassed is common. Talking openly about it at home, including with children, and talking with other patients who have been through it can help.

• Use a mild shampoo, wash less often, and pat hair dry gently.
• Use a soft brush or wide-tooth comb, and skip hair dryers, flat irons and tight clips.
• Protect the scalp from the sun with a hat, scarf or sunscreen.
• If the patient wants a wig, choose it before the hair falls out so the colour can be matched.

Tiredness and low red blood cells

Tiredness is one of the most common side effects of chemotherapy. It is not ordinary tiredness: the patient may still feel exhausted after resting. One cause is anaemia, a low red blood cell count, because chemotherapy can affect the bone marrow, where red cells are made. Pain, poor sleep, loss of appetite, vomiting or diarrhoea, infection and stress can all add to it.

Tell the care team if the patient is too weak to do normal daily things, or still feels very tired after resting or sleeping. Breathlessness can also be a sign of a low red cell count and should be reported.

• Take short naps of under an hour so night sleep is not disturbed.
• Save energy for what matters most, and do it at the time of day the patient feels strongest.
• Let family members take over cooking, cleaning and errands where they can.
• Gentle walking may help energy levels; ask the doctor what is safe.
• Eat small meals often, drink plenty of water, and limit coffee and alcohol.

Mouth sores

Chemotherapy can cause painful sores in the mouth and throat. Sores can make it hard to eat and drink, which raises the risk of dehydration. Check the mouth every day for sores or white spots, and tell the doctor or nurse about any changes.

Call the doctor or nurse if mouth, lip or throat pain makes it hard to eat, drink or sleep, or if there is a fever of 38°C or higher.

• Brush the teeth, gums and tongue gently with a very soft toothbrush after meals and before bed.
• Rinse the mouth during the day with warm water, salt and baking soda; ask the nurse for the right recipe.
• Choose soft, moist food such as lugaw, soup or mashed vegetables, and add sauce to dry food.
• Avoid crunchy, salty, spicy or very sweet food, alcohol and tobacco.
• Ask the doctor whether to floss if the gums bleed easily.

Low blood counts: infection and bleeding

Chemotherapy often lowers the number of white blood cells called neutrophils, which fight infection. This is called neutropenia. When the count is low, the body cannot fight germs well, so any sign of infection during chemotherapy needs a call to the care team straight away. Treatment usually starts at once, sometimes with antibiotics through a drip in hospital.

Chemotherapy can also lower platelets, the cells that help blood clot. Low platelets can cause easy bruising, nosebleeds, bleeding gums, or tiny red or purple spots on the skin. Ask the team for a list of products to avoid, because aspirin, ibuprofen and many over-the-counter medicines that contain them can make bleeding worse.

• Wash hands well with soap and water, especially before eating, and ask visitors and caregivers to do the same.
• Stay away from people who are sick and avoid crowds where possible.
• Cook meat, fish and eggs all the way through, and keep hot food hot and cold food cold.
• Keep any catheter or line site clean and dry.
• Use an electric shaver instead of a razor, wear slippers or shoes even at home, and be careful with knives and other sharp things.
• For a cut, press firmly on it with a clean cloth until the bleeding stops.

Warning signs: call the doctor or go to the emergency room now

Do not wait for the next scheduled visit if any of the signs below appear. Call the cancer care team at once, and if you cannot reach them, go to the nearest hospital emergency room and tell the staff that the patient is on chemotherapy. Ask the team in advance what temperature they want you to act on. The US National Cancer Institute uses 38°C (100.5°F), while Cancer Research UK tells patients to report 37.5°C or higher, or a temperature below 36°C.

Check with the doctor before giving paracetamol, ibuprofen or aspirin for a fever, because these can hide a serious infection. For chest pain, severe trouble breathing, or possible sepsis (confusion or slurred speech, extreme shivering, severe breathlessness, mottled or discoloured skin, or passing no urine for a day), call 911, the Philippines' nationwide emergency hotline, or go straight to the emergency room.

• Fever of 38°C or higher, or the temperature your team told you to watch for
• Shaking chills, sore throat, cough, burning when urinating, or redness, swelling or pain where a line or catheter goes in
• Trouble breathing, sudden breathlessness, or chest pain
• Bleeding that does not stop after a few minutes of pressure, vomiting blood, red or pink urine, or black or bloody stools
• Severe headache, vision changes, confusion or unusual sleepiness
• Vomiting or diarrhoea that will not stop, or four or more watery stools in 24 hours
• A new rash, or swelling of the lips, mouth or throat
• Pain, swelling, warmth or redness in one leg or arm
• Unusual or severe new pain