Managing side effects
Chemotherapy drugs can damage healthy, fast-growing cells, such as the new blood cells in the bone marrow or the cells in the mouth, stomach, skin, hair and reproductive organs. When healthy cells are damaged, it causes side effects. This section provides information and tips to help you manage some common side effects of chemotherapy.
Preparing for side effects
Everyone reacts to chemotherapy differently. Some people have no side effects, others have many. Whether you experience side effects and how severe they are depends on the type and dose of drugs you are given and your reaction from one treatment cycle to the next.
If you have side effects, they will usually start during the first few weeks of treatment and occasionally become more intense with each treatment cycle. Before treatment begins, your doctor or nurse will discuss the side effects to watch out for or report, how to help prevent or manage them, and who to contact after hours if you need help.
Recording side effects
It can be useful to keep a record of your chemotherapy treatment in one place. This will help you recall details about when you had side effects, how long they lasted and what helped to make them better. Some people use a notebook or a diary, while others prefer to use a smartphone or tablet.
Share the information you record with your treatment team. They will be able to suggest ways to manage the side effects or, if appropriate, they may adjust your treatment.
Keep a list of the doses and names of your chemotherapy drugs, along with the names of your specialists. This will save time if you become ill and need to visit the emergency department. Make sure to tell the hospital staff that you are having chemotherapy.
How long side effects may last
Most side effects are short term, but some may be permanent. Side effects tend to gradually improve once treatment stops and the normal, healthy cells recover. Most side effects can be managed.
Some side effects from chemotherapy may not show up for many months or years. These are called late effects. Before treatment starts, talk to your doctor about whether you are at risk of developing late effects from your treatment and what you can do to help prevent them. After treatment, make sure to see your GP for regular health checks.
Long term and late effects of treatment
Permanent side effects of chemotherapy may include damage to your heart, lungs, kidneys, nerve endings or reproductive organs.
If damage to your heart muscle or lungs is a possibility, your doctor will monitor your heart and lung function throughout treatment to limit your risk of damage. They will adjust your chemotherapy if early changes are seen.
Occasionally, many years after having some types of chemotherapy, some people develop a new, unrelated cancer. The risk of this is very low, but other factors, such as continuing to smoke or very rare genetic conditions, can increase this risk. If any symptoms appear, even many years after treatment, ask your GP whether they could be related to the cancer treatment you received. Ask whether your hospital has a late effects clinic to help you manage any side effects you may experience after treatment.
Feeling very tired and lacking energy (fatigue) is the most common side effect of chemotherapy. You may have muscle aches and pains, get worn out quickly, have difficulty concentrating or find it difficult to do daily activities. Fatigue can appear suddenly and it doesn’t always go away with rest or sleep.
Fatigue may last for some weeks or months after a treatment cycle ends. Energy levels usually improve over time. While fatigue is a common side effect of chemotherapy, it can also be a symptom of depression. For more information on depression, visit beyondblue.org.au and talk to your health care team.
How to manage fatigue
- Allow your body to recover by taking regular breaks, resting or having a short sleep.
- Plan activities for the time of day when you tend to feel most energetic.
- Do some regular exercise, such as walking. Moderate intensity exercise can boost energy levels and make you feel less tired. Talk to your treatment team about suitable activities for you.
- Ask for, and accept, offers of support from family, friends and neighbours. They can help with shopping, driving, housework or gardening.
- If you have children, ask trusted family and friends to look after them during your chemotherapy sessions and to be on call in case you become unwell afterwards.
- Find ways to manage anxiety or trouble sleeping as these can increase fatigue. Relaxation or meditation exercises may help improve your sleep or give you more energy. Listen to Cancer Council’s online relaxation and meditation recordings or call 13 11 20 to request copies.
- Talk to your doctor about trying acupuncture – some studies suggest this may help reduce physical tiredness after chemotherapy.
- Check with your doctor whether your fatigue is related to low levels of red blood cells (anaemia). Anaemia can be treated.
- Discuss the impact of the treatment with your employer. You may be able to take a few weeks off, reduce your hours or work from home.
- Eat a healthy, well-balanced diet and don’t skip meals. Limit your alcohol intake.
Complementary therapies are sometimes used with conventional medical treatments. They may offer physical, emotional and spiritual support, help manage side effects, and improve quality of life.
Some therapies have been proven to be safe and effective in scientific studies. For example, meditation, relaxation, massage and counselling can reduce anxiety, and acupuncture can reduce chemotherapy-induced nausea and fatigue.
It is important to talk to your doctors about any complementary therapies you are using or thinking about trying, as some could interfere with your treatment or make side effects worse.
Complementary therapies are different to alternative therapies, which are used instead of conventional medical treatments. Alternative therapies are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies.
Some chemotherapy drugs, pain medicines and anti-nausea drugs can cause constipation or diarrhoea. Tell your doctor or nurse if your bowel habits have changed.
Some people experience ongoing bowel problems after cancer treatment. If you find that dietary fibre makes any bowel problems worse, you may need to eat low-fibre foods.
How to manage bowel changes
- Eat more high-fibre foods, such as wholegrain bread and pasta, bran, fruits and vegetables, nuts and legumes (e.g. baked beans or lentils).
- If you are having treatment for bowel cancer, ask your treatment team if there is any specific dietary advice about fibre you can follow to avoid constipation.
- Drink plenty of fluids, both warm and cold. Prune, apple or pear juice can work well.
- Do some light exercise, such as walking.
- Ask your doctor about using a laxative, stool softener or fibre supplement.
- Avoid enemas or suppositories as they may cause infection.
- Let your treatment team know if you have constipation for more than a couple of days. They will be able to help.
- Choose bland foods such as clear broth, boiled rice or dry toast. Avoid spicy foods, wholegrain products, fatty or fried foods, rich sauces, and raw fruits or vegetables with skins or seeds.
- It may help to eat foods that are high in soluble fibre such as oats, white bread, white rice, pasta and bananas.
- Limit alcohol, fruit juice, soft drinks, strong tea or coffee, and foods containing artificial sweeteners as these stimulate the bowel.
- Drink water to help replace fluids lost through diarrhoea.
- Talk to your treatment team – they may change the drugs or doses or suggest other solutions, such as using over-the-counter medicines.
- If diarrhoea is severe or ongoing, let your treatment team know. It can cause dehydration and you may need to go to hospital.
It is common for your appetite to change during chemotherapy. Sometimes you may not feel hungry or you may prefer different types of food. The drugs may also temporarily change how food tastes.
Chemotherapy can make you feel sick (nauseated) or cause you to vomit. Not everyone feels sick during or after chemotherapy, but if nausea affects you, it often starts a few days after your first treatment. Nausea may last a short time or for many hours and it may be accompanied by vomiting or retching. Sometimes nausea lasts for days after treatment.
Often the best way to manage nausea is to prevent it from starting. Anti-nausea (antiemetic) medicine helps most people, but finding the right one can take time. If nausea or vomiting continues after using the prescribed medicine, let your nurse or doctor know early so that another medicine can be tried. Steroids may also be used to manage nausea.
Being unable to keep liquids down because of vomiting can cause you to become dehydrated. Signs of dehydration include a dry mouth and skin, dark urine, dizziness and confusion. It is not safe to be left alone if you are vomiting a lot, as the confusion may make it difficult to realise you have become seriously dehydrated.
How to manage appetite changes
- Eat what you feel like, when you feel like it. Have frequent snacks instead of large meals.
- Try to eat extra on days when you have an appetite.
- Avoid strong odours and cooking smells that may put you off eating. It might help to prepare meals ahead and freeze them for days you don’t feel like cooking.
- If the taste of certain foods has changed, don’t force yourself to eat them. Your sense of taste should return to normal after treatment ends.
- If you don’t feel like eating solid foods, try enriching your drinks with powdered milk, yoghurt or honey. Or try easy-to-swallow food such as scrambled eggs.
- Don’t use nutritional supplements or medicines without your doctor’s advice, as some could affect how your treatment works.
- Ask a dietitian for advice on the best eating plan during treatment and recovery.
- Have a light, bland meal before your treatment (e.g. soup with dry biscuits, crackers or toast).
- Sip water or other fluids throughout the day so that you don’t get dehydrated. Sucking on ice cubes or iceblocks or eating jellies can also increase your fluid intake. If water tastes unpleasant, flavour it with ginger cordial or syrup.
- If your stomach is upset, try drinking fizzy drinks such as soda water or dry ginger ale.
- If you wake up feeling sick, eat a dry biscuit or slice of toast rather than skipping food.
- If you aren’t able to keep fluids down, contact your doctor or hospital immediately. They may be able to treat the vomiting, or you may need to have fluids through an intravenous drip in hospital.
Many people having chemotherapy worry about hair loss (alopecia). Whether you lose your hair will depend on the drugs prescribed. Some people lose all their hair quickly, while others may lose only a little hair or none at all. Although losing hair from the head is most common, you may find your eyebrows and eyelashes fall out, and you may lose hair from your underarms, legs, chest and pubic area.
When hair loss does occur, it usually starts 2–3 weeks after the first treatment. Before and while your hair is falling out, your scalp may feel hot, itchy, tender or tingly. Some people find that the skin on their head is extra sensitive, and they may develop pimples on their scalp. After chemotherapy ends, it takes 4–12 months to grow back a full head of hair. When your hair first grows back, it may be a different colour or curly (even if you have always had straight hair). In time, your hair usually returns to its original condition.
Coping with hair loss – Many people find losing their hair difficult. Its loss can affect your self-confidence and make you feel sad or vulnerable. For many people, it’s a public sign of the cancer diagnosis. Talking to your treatment team about how you feel may help.
Scalp cooling – Some people may be able to reduce scalp hair loss by wearing a “cold cap” on their head while chemotherapy is delivered. The cap is attached via a hose to a cooling unit, which fills the cap with cold liquid. This reduces the blood flow and the amount of chemotherapy drug that reaches the scalp. The cold cap can only be used with certain drugs and types of cancer, and doesn’t always prevent hair loss. Ask your treatment centre if they offer cold caps and if they are an option for you.
Ways to manage hair loss
- Keep your hair and scalp very clean. Use a mild shampoo like baby shampoo. If you want to use lotion on your head, use sorbolene. Check with your nurse before using any other hair or skin care products.
- Comb or brush your hair gently using a wide tooth comb or a hairbrush with soft bristles.
- Explain to family and friends, especially children, that the chemotherapy may make your hair fall out.
- Cut your hair, especially if it is long, before it falls out. Some people say this gives them a sense of control.
- Talk to your hairdresser about making your hair look as good as possible even if it is thin or patchy.
- Wear a wig, hat, turban or scarf, or go bare-headed – whatever feels best to you. If you prefer to leave your head bare, protect it against sunburn and the cold.
- If you plan to wear a wig, choose it before treatment starts so you can match your own hair colour and style. Call Cancer Council 13 11 20 for information about wig services.
- Use a cotton, polyester or satin pillowcase, as nylon can irritate your scalp. Wear a light cotton turban or beanie to bed if you are cold.
- Avoid dyeing your hair during or for about six months after chemotherapy or consider using vegetable-based dyes.
- If your eyelashes fall out, wear sunglasses outside to protect your eyes from dust and sun.
- If your eyebrows fall out, you can buy reusable eyebrow wigs to wear until your eyebrows grow back.
- Contact Look Good Feel Better – this national program helps people manage the appearance-related effects of cancer treatment. Workshops are run for men, women and teenagers. Call 1800 650 960 or visit lgfb.org.au.
Some people say they have difficulty concentrating, focusing and remembering things after they have had chemotherapy. This is called cancer-related cognitive impairment. Other terms used to describe this include “chemo brain”, “cancer fog” and “brain fog”.
Thinking and memory changes may be caused by treatment or medicines, fatigue and sleep problems, or emotional concerns, such as stress or depression. These problems usually improve with time, although some people experience issues for years. Tell your doctor about any thinking and memory changes you are having and if they are affecting your day-to-day life or your work.
Ways to improve concentration
- Use a calendar or set a timer on your phone to keep track of tasks, medical appointments, when to take medicines, social commitments, birthdays, etc.
- Write down anything you need to remember, e.g. to-do items, where you parked the car.
- Get plenty of sleep. Deep sleep is important for memory and concentration.
- Do light exercise every day to help you be more alert and sleep better.
- Learn something new, e.g. take up a new hobby or do crosswords or puzzles.
- Discuss changes to your ability to concentrate and remember things with your partner, family or workplace, and ask for their support or assistance.
Some chemotherapy drugs can cause mouth sores, such as ulcers, or infections. This is more likely if you have had or are having radiation therapy to the head, neck or chest area, high-dose chemotherapy or a stem cell transplant, or if you have dental or gum problems or need a course of antibiotics.
If you notice any sores, ulcers or thickened saliva, or if you find it difficult to swallow, tell your doctor.
Looking after your mouth
- Discuss any dental issues with your oncologist or haematologist before seeing the dentist. If you need any dental work, tell your dentist you’re having chemotherapy.
- Use a soft toothbrush to clean your teeth twice a day.
- Rinse your mouth four times a day with 1/4 tsp bicarbonate of soda and 1/4 tsp salt dissolved in a cup of warm water. Avoid mouthwashes with alcohol.
- Sip fluids, especially water, and eat moist foods such as casseroles or soups if you have a dry mouth. Moisten foods with gravy or sauce.
- Soothe tender gums or mouth with plain yoghurt.
- Sucking on ice during chemotherapy sessions may help to prevent mouth ulcers.
- Blend foods to make them easier to eat. Try smoothies made of fruit and yoghurt.
- Avoid smoking and alcoholic drinks, as well as very hot foods and spicy, acidic or coarse foods (e.g. nuts or grains). These can all make mouth sores worse.
Some chemotherapy drugs may cause your skin to peel, darken or become dry and itchy. During treatment and for several months afterwards, your skin is likely to be more sensitive to the sun.
You may find your nails also change and become darker than usual, or develop ridges or white lines across them. Your nails may also become brittle and dry or lift off the nail bed. These changes usually grow out.
Taking care of your skin
- Use an oatmeal body wash or sorbolene cream instead of soap. Gently pat your skin dry with a towel rather than rubbing it.
- Use a moisturising lotion or cream containing the ingredient urea to help with the dryness.
- Wear loose, non-restricting clothing. Choose cotton fabric instead of rough wool or synthetic fibres.
- Use mild detergent to wash your clothing if you have sensitive skin.
- Don’t shave or wax until your skin is healed.
- Protect your skin from the sun when UV levels are 3 or above. Wear high-protection sunscreen (SPF 50+), a broad-brimmed hat, protective clothing and sunglasses, and try to stay in the shade. This advice applies to everyone, but is especially important for people having chemotherapy.
- Avoid chlorinated swimming pools as the water can make skin changes worse.
- If your skin becomes red or sore in the area where the intravenous device went in, let your doctor or nurse know immediately.
Blood cells are made in the bone marrow, which is the spongy part in the centre of the bones. The bone marrow makes three main types of blood cells, which have specific functions:
- red blood cells – carry oxygen around the body
- white blood cells – fight infection
- platelets – help blood to clot and prevent bruising.
Because the new blood cells are rapidly dividing, they can be damaged by chemotherapy, and the number of blood cells (your blood count) will be reduced. Low numbers of blood cells may cause anaemia, infections or bleeding problems.
You will have blood tests at the beginning of treatment and before each chemotherapy cycle to check that your blood count is adequate before you have chemotherapy. If your blood count has not recovered, your doctor may delay treatment.
If your red blood cell count drops below normal this is called anaemia. A reduced amount of oxygen circulates through your body, which can make you feel tired, lethargic, dizzy or breathless. To minimise dizziness, take your time when you get up from sitting or lying down.
Your treatment team will monitor your red blood cell levels. Let them know if you have any symptoms of anaemia during your course of chemotherapy. If the levels of red blood cells drop too low, you may need a blood transfusion to build them up again.
Chemotherapy can reduce your white blood cell level, making it harder for your body to fight infections. Viruses such as colds, flu and COVID-19 may be easier to catch and harder to shake off, and scratches or cuts may get infected more easily. You may also be more likely to develop a serious infection without an obvious cause and need to be admitted to hospital. Your doctor may recommend antibiotics as a precaution against infection.
Many types of white blood cells make up the total white cell count. A type of white blood cell known as a neutrophil protects you against infection by destroying harmful bacteria and yeasts that enter the body. During chemotherapy, some people have low levels of neutrophils. This is known as neutropenia.
To speed up the production of new white blood cells and protect you from infection, your doctor may give you injections of a growth factor drug called granulocyte-colony stimulating factor (G-CSF). Your doctor or nurse will speak to you about possible side effects. Some people may experience bone pain or tenderness at the injection site or show signs of an allergic reaction. Let your doctor know if you have any of these side effects.
Taking care with infections during chemotherapy
Reduce your risk
To prevent the spread of infection:
- check your temperature daily and any time you feel unwell
- avoid touching your eyes, nose and mouth with your hands
- check with your doctor about having the flu vaccine
- ask people close to you to consider having a flu vaccine
- ask family and friends with a cold, flu or other contagious infection (e.g. COVID-19 or a cold sore) not to visit until the symptoms have gone away; keep in contact through phone and video calls instead
- avoid shaking hands, hugging and kissing other people try to avoid crowded places, such as shopping centres or public transport in peak hour wash your hands with soap and water before preparing food and eating, and after using the toilet prepare and store food properly to avoid foodborne illness and food poisoning
- eat freshly cooked foods; avoid raw foods (fish, seafood, meat and eggs) and soft cheeses; wash fruits and vegetables well before eating.
When to seek help
Contact your doctor or go to the nearest hospital emergency department immediately if you experience one or more of the following symptoms:
- a temperature of 38°C or higher
- chills or shivering
- sweating, especially at night
- burning or stinging feeling when urinating
- a severe cough or sore throat
- shortness of breath
- vomiting that lasts more than a few hours
- severe abdominal pain, constipation or diarrhoea
- unusual bleeding or bruising, such as heavy nosebleeds, blood in your urine or black faeces (poo)
- prolonged faintness or dizziness and a rapid heartbeat
- any sudden deterioration in your health.
A low level of platelets (thrombocytopenia) can cause problems. You may bleed for longer than normal after minor cuts or scrapes, have nosebleeds or bleeding gums, or bruise easily. Periods may be longer or heavier.
Your treatment team will monitor your platelet levels. If chemotherapy causes severe thrombocytopenia, you may need a platelet transfusion. Ask your specialist to explain the risks and benefits of this procedure.
Contact your treatment team or call 000 if you have any persistent bleeding, such as a nosebleed that doesn’t stop within 30 minutes.
How to manage a low platelet count
- Be careful when using knives, scissors or needles, as you may bleed easily from small cuts or nicks.
- Use an electric razor when shaving your face or body to reduce the chance of nicking yourself.
- Wear thick gloves when gardening to avoid injury. (This will also prevent infection from soil, which contains bacteria.)
- Avoid contact sports and high-impact activities, as these could cause bruising or bleeding if you get knocked or fall over.
- Use a soft-bristled toothbrush to avoid irritating your gums.
- Wear comfortable, well-fitting shoes indoors and outdoors to avoid cuts on your feet.
- Blow your nose with care.
- If you bleed, apply pressure to the area for about 10 minutes and bandage as needed.
- If you have problems with bleeding, talk to your doctor.
Some chemotherapy drugs can damage the nerves that send signals between the central nervous system and the arms and legs. This is called peripheral neuropathy. Symptoms include tingling (“pins and needles”), numbness or pain in your hands and feet, and muscle weakness in your legs.
For many people, peripheral neuropathy is a short-term issue, but for others, it can last a long time or even be permanent. If you experience numbness and tingling, tell your doctor or nurse before your next treatment. Your treatment may need to be changed or the problem carefully monitored.
Ways to manage numb hands or feet
- Take care when moving around – you may be more likely to trip and fall if your feet are numb or your legs are weak.
- Wear gloves and socks to keep hands and feet warm, or soak your hands and feet in warm water to relieve symptoms.
- Use your elbow to check the water temperature so you don’t scald yourself.
- Talk to an occupational therapist from your treatment team about aids that may help, e.g. posts to raise the sheets off your feet if they’re irritated by the weight of the sheets.
- Wear well-fitting shoes with non-slippery soles.
- Clear walkways of hazards and remove loose rugs.
- If your symptoms are severe, talk to your doctor about medicines that may offer relief.
Chemotherapy can affect your sexuality and fertility in emotional and physical ways. These changes are common. Some changes may be only temporary while others can be permanent.
Changes in sexuality
You may notice a lack of interest in sex or a loss of desire (libido), or you may feel too tired or unwell to want to be intimate. You may also feel less confident about who you are and what you can do. There may be a physical reason for not being able or interested in having sex, e.g. vaginal dryness or erection difficulties. Changes in appearance can also affect feelings of self-esteem and, in turn, sexuality.
If you have a partner, it may be helpful for them to understand the reasons why your libido has changed and to know that people can have a fulfilling sex life after cancer, but it often takes time. Some partners may feel concerned about having sex – they might fear injuring the person with cancer, feel uncomfortable with the changes in their partner or worry about being exposed to chemotherapy drugs.
Sexual intercourse may not always be possible, but closeness and sharing can still be a part of your relationship. Talk about how you’re feeling with your partner and take time to adapt to any changes. Try to see yourself as a whole person (body, mind and personality) instead of focusing only on what has changed. If you’re worried about changes to how you feel about yourself, your relationships or sexual functioning, you may find talking to a psychologist or counsellor helpful.
As chemotherapy drugs can harm an unborn baby, your doctor may talk to you about using contraception during and after chemotherapy. Although chemotherapy often affects fertility, it doesn’t always. If you are in a heterosexual relationship and sexually active, you will need to use some form of contraception to avoid pregnancy while having treatment. If you or your partner become pregnant, talk to your specialist immediately.
You will also need to use some form of barrier contraception (condom, female condom or dental dam) to protect your partner from any chemotherapy drugs that may be present in your body fluids.
Changes in fertility
Chemotherapy can affect your ability to have children (fertility), which may be temporary or permanent. If you want to have children in the future, talk to your doctor about how chemotherapy might affect you and what options are available. Women may be able to store eggs (ova), embryos or ovarian tissue, and men may be able to store sperm for use at a later date. This needs to be done before chemotherapy starts and requires careful consideration. Some women are able to have hormone injections to reduce activity in the ovaries and protect eggs from being damaged by chemotherapy.
Effects of chemotherapy on ovaries – Chemotherapy can reduce the levels of hormones produced by the ovaries. This can cause your periods to become irregular or even stop for a while, but they often return to normal within a year of finishing treatment. If your periods do not return, the ovaries may have completely stopped working, causing early menopause.
After menopause, women can’t conceive children naturally. Signs of menopause include hot flushes, night sweats, aching joints, dry or itchy skin, and trouble sleeping. Menopause – particularly when it occurs in women under 40 – may, in the long term, cause bones to become weaker and break more easily. This is called osteoporosis. Talk to your doctor about ways to manage menopausal symptoms or ask for a referral to a specialist menopause clinic.
Effects of chemotherapy on sperm – Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. This can sometimes cause infertility, which may be temporary or permanent. The ability to have and keep an erection (erectile dysfunction or impotence) may also be affected, but this is usually temporary. If impotence is ongoing, talk to your doctor.
Some other common side effects of chemotherapy may include hearing problems and watery eyes.
Changes in hearing – Some chemotherapy drugs can affect your hearing. Your doctor may recommend that you have a hearing test before you start treatment, and this may be repeated before each treatment cycle. You may be at risk of losing the ability to hear high-pitched sounds. Sometimes, chemotherapy also causes a continuous ringing noise in the ears known as tinnitus. These changes can happen alone or together, and are usually temporary. Let your doctor know if you notice any change in your hearing.
Watery eyes – This can be a symptom of a blocked tear duct, which can be caused by some chemotherapy drugs. Regularly massaging the area and using eye drops can help clear blockages. Let your cancer care team know if this issue is ongoing.
Body odours – Chemotherapy can affect your sense of smell and you may notice unpleasant smells more. Talk to your cancer care team if you are concerned about a change in body odour.
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This information is reviewed by
This information was last reviewed August 2020 by the following expert content reviewers: Clinical A/Prof Rosemary Harrup, Director, Cancer and Blood Services, Royal Hobart Hospital, TAS; Katie Benton, Advanced Dietitian, Cancer Care, Sunshine Coast Hospital and Queensland Health, QLD; Gillian Blanchard, Oncology Nurse Practitioner, Calvary Mater Newcastle, NSW; Stacey Burton, Consumer; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Andrew Greig, Consumer; Steve Higgs, 13 11 20 Consultant, Cancer Council Victoria; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.