Managing side effects

Blood cells are made in the bone marrow, which is the spongy part in the centre of the bones. The bone marrow makes 3 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.

New blood cells are constantly being made in the bone marrow. These rapidly dividing cells 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 or bleeding problems, and increase the risk of infections.

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.

Anaemia

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.

Download our fact sheet ‘Fatigue and Cancer’

Infections

Chemotherapy can reduce your white blood cell level, making it harder for your body to fight bacterial infections. Bacterial infections that cause sickness may come from somewhere in your body (e.g. the bowel) and are not necessarily caught from other people. 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. Your doctor may recommend antibiotics as a precaution against infection.

There are many types of white blood cells. One type, called 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 boost 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. 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 and COVID-19 vaccines
• ask people close to you to consider having the flu and COVID-19 vaccines
• ask family and friends with a cold, flu or other contagious infection (e.g. COVID-19 or a cold sore) not to visit while they have symptoms
• avoid shaking hands, hugging and kissing other people
• try to avoid crowded places, such as shopping centres; if this is not possible, wear a face mask
• 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 (weeing)
• a severe cough or sore throat
• shortness of breath
• vomiting that lasts more than a few hours
• severe abdominal (belly) pain, constipation or diarrhoea
• unusual bleeding or bruising, such as heavy nosebleeds, blood in your urine (wee) or black faeces (poo)
• prolonged faintness or dizziness and a rapid heartbeat
• any sudden deterioration in your health.

Vaccinations

Some vaccinations are safe to have during chemotherapy treatment and others are not. It is safe to have the flu vaccine and the COVID-19 vaccines available as at July 2022, but speak to your doctor before having these vaccinations.

During chemotherapy and for at least 6 months afterwards, you should not have vaccinations that contain a live vaccine. These include: the varicella (chickenpox), zoster (shingles), and MMR (measles, mumps, rubella) vaccines.

Bleeding problems

A low level of platelets (thrombocytopenia) can cause problems. You may bleed for longer than normal after minor cuts, 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 Triple Zero (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.
• When brushing your teeth, 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.

Many people feel very tired, weak, drained and become quickly worn out while they are having chemotherapy. This is called fatigue and it is the most common side effect of chemotherapy.

You may also:

• develop muscle aches and pains
• have difficulty concentrating
• find it difficult to do daily activities.

Fatigue can affect you suddenly and it doesn’t always go away with rest or sleep. For some people, it may be hard to do everyday things, creating feelings of frustration and isolation.

Fatigue caused by chemotherapy may last for some weeks or months after a treatment cycle ends. Many people find that their energy levels return to normal within 6–12 months of treatment ending.

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.

Download our fact sheet ‘Fatigue and Cancer’

How to manage fatigue

• Allow your body to recover from treatment 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. Your treatment team may be able to suggest 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 sleeping difficulties as these can increase fatigue. Relaxation or meditation exercises may help improve the quality of your sleep or boost your energy levels. Listen to the relaxation and meditation tracks in Cancer Council’s Finding Calm During Cancer podcast or call 13 11 20 to request CDs.
• 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. Try to limit the amount of alcohol you drink.
• See our ‘Exercise for People Living with Cancer’ and ‘Cancer, Work & You’ booklets for more information.

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; 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, beard 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. Hair 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. It may help to talk to your treatment team about how you feel.

Scalp cooling – Some treatment centres provide cold caps, which may reduce head hair loss. Cold caps can only be used with certain drugs and some types of cancer, and they don’t always stop hair loss.

Worn while chemotherapy is being given, the cap is attached to a cooling unit. This reduces blood flow and the amount of chemotherapy drug that  reaches the scalp. Some people find the cold cap uncomfortable, and the cold temperature may be painful. If you are interested in trying a cold cap, ask your treatment centre if it is 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 moisturiser on your head, use sorbolene. Check with your nurse before using any other hair or skin care products on the scalp.
• Comb or brush your hair gently with 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.
• Consider cutting your hair before it falls out. Some people say this gives them a sense of control.
• 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. Or consider a new style or colour for a bit of fun.
• Some treatment centres have wig loan services; call Cancer Council 13 11 20 for information about wig services.
• You could try a silk or satin pillowcase as these smooth fabrics can decrease hair tangles.
• Avoid dyeing your hair during chemotherapy or for about 6 months afterwards, or consider using vegetable=based dyes.
• If your eyelashes fall out, wear sunglasses outside to protect your eyes from dust and sunlight.
• If your eyebrows fall out, you may wish to wear reusable eyebrow wigs or transfers until your eyebrows grow back.
• Contact Look Good Feel Better – this program helps people manage the appearance-related effects of cancer treatment. Call 1800 650 960 or visit lgfb.org.au.

Download our fact sheet ‘Hair Loss’

It’s 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 make you 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 (when you feel the need to vomit but can’t). Sometimes nausea lasts for days after treatment.

Often the best way to manage nausea is to prevent it from starting, so you will usually be given anti-nausea (antiemetic) medicine before, during and after chemotherapy sessions. Anti-nausea 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 make you dehydrated. Signs of dehydration include a dry mouth and skin, dark urine (wee), 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

Appetite loss

• Eat what you feel like, when you feel like it.
• Try eating frequent snacks rather than large meals.
• 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. After treatment finishes, your sense of taste should return to normal.
• If you don’t feel like eating solid foods, try enriching your drinks with powdered milk, yoghurt or honey. Or try easy-to-swallow foods such as scrambled eggs.
• Don’t use nutritional supplements or medicines without your doctor’s advice, as some products could affect how your treatment works.
• Ask a dietitian for advice on the best foods to eat during treatment and recovery.

Nausea

• Have a light, bland meal before your treatment (e.g. soup with dry biscuits).
• Sip water or other fluids throughout the day so that you don’t get dehydrated. Sucking on ice cubes or iceblocks, or eating jelly 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 a meal.
• If you can’t 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.

Download our booklet ‘Nutrition for People Living with Cancer’

Listen to our podcast ‘Appetite Loss and Nausea’

Some chemotherapy drugs, pain medicines and anti-nausea medicines can cause constipation or diarrhoea. Tell your doctor, pharmacist 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

Diarrhoea

• 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, bananas and pasta.
• Limit alcohol, fruit juice, soft drinks, strong tea or coffee, and foods containing artificial sweeteners, as these stimulate the bowel.
• Drink plenty of 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.

Constipation

• Eat more high-fibre foods, such as wholegrain bread and pasta, fruits and vegetables, bran, nuts and legumes (e.g. baked beans or lentils).
• If you are having treatment for bowel cancer, ask your treatment team if there are any foods you should or shouldn’t eat to help 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 using 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.

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 if your feet are numb or your legs are weak.
• Ask your treatment team about exercising. Moderate exercise has been shown to reduce the symptoms of peripheral neuropathy.
• 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 burn yourself.
• Talk to an occupational therapist 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.

Download our fact sheet ‘Understanding Peripheral Neuropathy and Cancer’

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).
• Talk to your partner, family or workplace about changes to your memory and concentration – they may be able to give you more support or assistance.

Download our fact sheet ‘Understanding Changes in Thinking and Memory’

Listen to our podcast ‘Brain Fog and Cancer’

Some chemotherapy drugs can damage healthy cells in the mouth and cause mouth sores, such as ulcers or infections.

Chemotherapy treatment may also reduce the amount of saliva (spit) in your mouth, make your saliva thick or sticky, or make your mouth dry. This is called xerostomia or dry mouth. 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 to have any dental work, tell your dentist you’re having chemotherapy.
• Use a soft toothbrush to clean your teeth twice a day.
• Rinse your mouth often – when you wake up, after you eat or drink, and at bedtime. Ask your doctor or nurse what type of alcohol-free mouthwash to use. They may give you a recipe for a homemade mouthwash. Talk to your doctor or nurse about medicines to relieve pain and help with healing.
• Sip fluids, especially water, and eat moist foods such as casseroles or soups if you have a dry mouth.
• Soothe tender gums or mouth with plain yoghurt.
• Try sucking on ice during chemotherapy sessions. This 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.

Download our fact sheet ‘Mouth Health and cancer treatment’

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. It is recommended that you avoid having your nails done at a nail salon, as this can increase the risk of infection during chemotherapy.

Taking care of your skin

• Use a soap-free wash when showering. Gently pat your skin dry with a towel rather than rubbing it.
• Use a good quality moisturising lotion or a cream containing the ingredient urea to help with the dryness.
• Wear loose, non-restricting clothing. Choose clothes made from soft 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.

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 to have sex 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 with your partner about how you’re feeling, 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.

Download our booklet ‘Sexuality, Intimacy and Cancer’

Using contraception

In most cases, your doctor will advise you to use some form of barrier contraception (condom, female condom or dental dam) after each treatment session. This is to protect your partner from any chemotherapy drugs that may still be in your body fluids.

As chemotherapy drugs can harm an unborn baby, your doctor may talk to you about using contraception for some months 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 a reliable form of contraception to avoid pregnancy while having treatment. Talk to your specialist immediately if you or your partner become pregnant.

Changes in fertility

Chemotherapy can affect your ability to have children (fertility), which may be temporary or permanent. If you may 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 for use at a later date, and men may be able to store sperm. This needs to be done before chemotherapy starts and requires careful consideration. In some cases, hormone injections can reduce activity in the ovaries and protect eggs from being damaged by chemotherapy.

Download our booklet ‘Fertility and Cancer’

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 stopped working, causing early menopause. After menopause, you can’t get pregnant naturally. Signs of menopause include hot flushes, night sweats, aching joints and dry or itchy skin. Menopause – particularly when it occurs 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 menopause symptoms.

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, watery eyes and body odours.

Changes in 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.

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 has been shown to reduce chemotherapy-induced nausea. Some studies suggest acupuncture may also reduce fatigue.

It is important to talk to your doctors about any complementary therapies you are using or thinking about trying, as some can interfere with your treatment or make any 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.

Download our booklet ‘Understanding Complementary Therapies’