Understanding Side Effects

All chemotherapy treatments cause side effects. That's because chemotherapy drugs are designed to damage rapidly dividing cells — a hallmark of cancer. The problem is that chemotherapy drugs cannot distinguish between cancer cells and rapidly growing healthy cells, such as blood cells and cells lining the mouth and gastrointestinal tract. Consequently, these healthy cells can be damaged in the process of treating the cancer, resulting in side effects.

Remember to tell your healthcare team in detail about any side effects you are experiencing at any point in your therapy.

The following are common side effects associated with chemotherapy, but the specific type of side effect depends on the agent administered or taken. Chemotherapy affects everyone differently. Some people have few or no side effects at all. The amount or severity of side effects is not an indicator of how well the chemotherapy drugs are working — it's just your body's own response to the treatment.

Side Effects You Can Monitor
Possible side effects that you will be able to monitor and report to your healthcare team:

• Gastrointestinal
  • Nausea and/or vomiting
    Some chemotherapy drugs can cause a queasy, upset-stomach feeling. Severe nausea can cause vomiting. There are medicines that can help reduce these feelings. In some cases, when taken before or at the same time therapy is started, these medicines can prevent nausea or vomiting from occurring.
    
    
  • 

    Don't hesitate to contact your healthcare team if you have any questions or concerns.
    Diarrhea
    Chemotherapy can affect your bowels by causing diarrhea. Diarrhea means having three or more watery bowel movements a day. If you experience diarrhea contact your healthcare team. However, if diahrrea is accompanied by a fever, contact your healthcare team immediately.
    
    Make sure you check with your healthcare team before choosing any antidiarrheal medications on your own.
    
    
  • Constipation
    Chemotherapy can also affect your bowels by causing constipation. If you become constipated, don't wait for more than three days before telling your healthcare team if you do not have a bowel movement. Constipation can be helped by drinking more fluids and by adding fiber, such as bran or prune juice, to your diet.
    
    Make sure you check with your healthcare team before choosing any medications to treat your constipation on your own.
    
    
  • Loss of appetite
    You may find you are not as hungry as usual. Food might also taste different. Again, usually this is temporary. One of the best ways to deal with this is to eat tasty meals in small amounts and to eat more often.
    
    
• Urinary problems
  Some chemotherapy drugs can irritate the lining of the bladder. Ask your physician if you should increase the amount of water or fluids you drink the day before your chemotherapy treatment and continuing for five days after your treatment. Be sure to empty your bladder often. Some chemotherapy drugs can also change the color of the urine. If your urine looks bright red or blood stained, let your healthcare team know right away.
  
  
• Mouth soreness
  If your mouth is sore, tell your healthcare team. There are some things you can do to help lessen the problem. Use a baking soda mouthwash often. Avoid citrus fruits and juices, and replace spicy, rough, or crunchy foods with foods that are soft and easy to swallow.
  
  
• Skin changes
  Some patients report rashes, itchy, dry or flaky skin, or changes in the color of the skin or nails. These changes are temporary, and could mean an allergic reaction to a drug you are being given. This is a good time to be gentle with your skin. Use soothing lotions, and avoid hot baths and showers, harsh soaps, and alcohol-based skin products. Chemotherapy drugs often make skin more sensitive to sunlight. Talk to your pharmacist about using a sunscreen, and avoid exposure to the sun.
  
  
• Sensory changes
  Some drugs may cause a tingling feeling or weakness in the hands and feet. You may have "pins and needles," be a bit unsteady on your feet, or have difficulty fastening buttons or opening jars. You may feel tired or confused. Tell your healthcare team if you have these symptoms. Remember that in most cases, these symptoms disappear slowly after the treatment ends. Still, reporting anything unusual is important.
  
  
• Vision changes
  Some chemotherapy drugs can cause problems with your eyes. If you have redness, increased tearing, feel something in your eye, vision changes, or pain, tell your healthcare team.
  
  
• Hair loss
  Some chemotherapy drugs affect hair cells. This can mean partial or complete hair loss. It can take two to five months, but in almost all circumstances, your hair will grow back after your chemotherapy is over. In the meantime, you may want to wear a wig or a hairpiece, or perhaps a scarf, cap, or turban. Ask about programs available in your area to help you look good and feel your best.
  
  
• Sexuality
  If you are a woman who is still menstruating, your periods may temporarily become irregular or stop, or you may have breakthrough bleeding. You also may have temporary symptoms like those of menopause, such as hot flashes or vaginal dryness or discharge. Women receiving chemotherapy still are able to become pregnant. So it's very important to use birth control and to avoid becoming pregnant while your cancer is being treated. Discuss birth control with your healthcare team and keep up with your regular PAP tests. If you are a new mother getting chemotherapy, stop breast-feeding.
  
  In men, some chemotherapy drugs can lower sperm counts, although the ability to father a child usually is not affected. You may wish to discuss sperm banking with your healthcare team, because this should be done before chemotherapy is started.
  
  
• Fertility
  How chemotherapy drugs affect babies who are conceived during treatments is unknown. It's therefore very important for you to use birth control while on chemotherapy and for several months after your treatments are finished. If you experience sexual concerns or problems, talk to your healthcare team.
  
  

When to Call Your Healthcare Team
You are probably attuned to changes in your body now more than ever. You must never take these changes for granted. According to The American Cancer Society, as a person living with cancer, you should alert your healthcare team right away if you notice any changes in your body or experience any of the following symptoms during your chemotherapy treatment¹:

• A fever of 100.5°F or greater
• Bleeding or unexplained bruising
• A rash or allergic reaction such as swelling or severe itching or wheezing
• Intense chills
• Pain or soreness at the chemotherapy injection site or catheter site
• Unusual pain including intense headaches
• Shortness of breath
• Prolonged diarrhea or vomiting
• Bloody stool or blood in your urine

Reference:

1. The American Cancer Society. When Do I Call My Doctor? Available at:
   http://www.cancer.org/docroot/ETO/content/ETO_1_7X_When_Do_I_Call_My_Doctor.asp.
   Accessed March 14, 2007.