What are the side effects of chemotherapy?

Nausea is when you feel queasy or sick to your stomach; vomiting is when you throw up. Nausea and vomiting symptoms may begin within hours after the chemotherapy drugs are given and may last for several days.

Nausea and vomiting can be caused by:

• Your chemotherapy treatment
• Your cancer
• Constipation

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As chemotherapy attacks the cancer cells, it may affect your red blood cell, white blood cell and/or platelet counts. This is why you have regular blood tests done during treatment.

Your chemotherapy team will watch your blood counts each time you come for treatment and let you know what your counts are. If your counts are too low on a given day, your treatment may be delayed to the next week.

Red blood cells carry oxygen from your lungs to other parts of your body. When there are not enough red blood cells you may get tired or short of breath more easily.

• People with cancer often have a lower than normal amount of red blood cells. This is called mild anemia.
• Mild anemia needs no treatment and disappears once chemotherapy stops.
• If your anemia worsens, your medical oncologist may prescribe a treatment such as a blood transfusion or a medication to increase your red blood cell count.

White blood cells fight infections. When your white blood cell count is low, you are more likely to get an infection.

• Check with your cancer doctor before having any vaccinations, dental work or surgery while you are receiving chemotherapy.
• Tell other doctors or dentists that you are being treated with chemotherapy before you receive any treatment from them.

Platelets are responsible for clotting your blood. If your platelets are low because of chemotherapy, you are at risk for bruising or bleeding.

• Be extra careful when using a knife or any other sharp object.
• Let your medical oncologist or nurse know if you notice any bleeding that does not seem to stop.

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Fatigue is described as more than feeling tired. The feeling of fatigue does not go away after a rest or a good night sleep. Some of the signs of fatigue you may experience include getting tired quickly from doing normal things like taking a shower, cooking, going for a short walk, climbing stairs or having difficulty with your concentration or your memory. If you feel you are experiencing fatigue please share this with a member of your cancer health care team. Fatigue may be caused by:

• The cancer or the treatment
• Medications
• Stress
• Feeling worried or sad
• Pain
• A low red blood count (anemia)
• Nausea or vomiting
• Changes in your weight
• Changes in your diet
• Changes in your sleep habits

Exercise has been shown to be the best method for managing chemotherapyrelated fatigue. In general, it is safe to exercise during chemotherapy but it is important to speak to your doctor before starting any new exercise program.

Start exercise slowly. Aim to exercise 1-2 days a week until you get into a routine and your energy and strength improve. There are free cancer exercise classes offered in the community. Please speak to your oncologist, occupational therapist or physiotherapist for more information.

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You may not feel like eating for a few days after chemotherapy. If you can, try to eat small amounts of food as this can ease some of your side effects and give you energy. Make every bite count and drink fluids that provide you with calories and protein like milk, soy beverages, smoothies, and liquid nutritionals (e.g. Ensure, Boost).

The cells that line your mouth and throat can be damaged by the chemotherapy and can make eating difficult. 

Chemotherapy can cause:

• Dryness in the mouth
• A sore mouth, tongue or throat
• Mouth sores
• Infection in the gums, mouth or throat

Chemotherapy can have an irritating effect on the stomach. If you have a history of ulcer or problems with acid or heartburn, discuss your concerns with your primary nurse or medical oncologist.

Inform your doctor or primary nurse if you are suffering from:

• Indigestion
• Heartburn
• Excessive gas
• Stomach pain

Chemotherapy can affect healthy, fast growing cells like those found in your hair.

Here are some important things to know about hair loss:

• How much hair you lose depends on what chemotherapy you receive.
• You may lose all of your hair, have some thinning of your hair or you may not lose any hair.
• Hair loss can happen in all parts of your body including eyebrows and eyelashes.
• Hair loss can start within days or weeks of chemotherapy treatment.

Your hair will grow back when the chemotherapy treatments end (or perhaps in between treatments). It may take two to five months for your hair to grow back.

Sexuality is one aspect of our need for closeness, touch, caring and pleasure. You may have a decrease in desire for sex due to feelings of worry, changes in your body image or if you are having side effects of chemotherapy. Medically, unless told otherwise, you do not have to stop having sex. If you are having vaginal, oral or anal sex you should be using a condom or dental dam to protect your partner from risk or irritation. The irritation can be caused by small amounts of the chemotherapy sometimes staying in bodily fluids.

Here are some things to consider:

• It is common for people receiving chemotherapy to have periods of disinterest in sex.
• The ability to feel pleasure from touching, hugging and cuddling may become more important than sexual intercourse.
• You may also be referred to the SHARE clinic to discuss your sexual and reproductive health needs.
• Talk to your partner about your concerns and why you are not interested in sex while you are receiving chemotherapy. Usually, your interest in sex will return after you complete your treatments.
• If you have any questions about sexual health and chemotherapy please ask your nurse.

Birth control

• Chemotherapy may damage sperm and may harm an unborn child if used during pregnancy.
• A form of birth control must be used while you are being treated with chemotherapy.
• Tell your medical oncologist immediately if you or your partner becomes pregnant.
• DO NOT breastfeed while undergoing treatment.

Hormone changes in women

Chemotherapy can affect hormone levels in women, leading to changes in the way sexual organs function.

Women may experience:

• irregular menstrual periods
• loss of menstruation
• menopausal symptoms such as hot flashes, or vaginal dryness
• painful or uncomfortable intercourse
• change in sexual desire or enjoyment

For more information about how to deal with sexuality issues during cancer treatment, contact the Canadian Cancer Society.

• Some chemotherapy drugs can cause infertility (not able to get pregnant) in women by putting them into an early menopause. Men can also be affected by specific drugs.
• Talk to your medical oncologist about fertility risks associated with your chemotherapy plan.
• You may be referred to a fertility clinic or sperm bank if needed.

Both constipation (difficulty having a bowel movement) and diarrhea (loose, watery stools three or more times a day) can be side effects of certain chemotherapy drugs. Both should be discussed with your medical oncologist or primary nurse if these persist for more than a few days.

Constipation

Constipation can be caused by:

• chemotherapy drugs
• pain medications
• eating habits

Ask your nurse or pharmacist about laxatives or stool softeners to help you with a bowel movement (poo).

Symptoms of constipation are:

• less frequent bowel movements
• need to strain to pass bowel movements
• small, hard or firm stools
• stomach ache or cramps
• bloated stomach
• feeling of fullness or discomfort
• passing more gas than usual or belching
• nausea or vomiting

It is important for your comfort and health that you move your bowels at least every two or three days.

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Diarrhea

Symptoms of diarrhea are:

• loose or watery stools three or more times daily
• abdominal cramps
• pain
• bloating
• sore skin in the anal area from frequent movements
• excess water loss (dehydration)

Important things to remember about diarrhea:

• Notify your primary nurse or medical oncologist immediately if you have three or more loose watery stools in 24 hours.
• Take prescribed medications to control the diarrhea exactly as directed.
• Immodium can help with your diarrhea. Take 2 pills after first loose watery stool (poo) and every 2 hours until diarrhea has stopped.

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• Many drugs are removed from your body through the kidneys and bladder. Drinking 8-10 cups of fluids each day helps to flush the drugs through your body.

Some drugs may irritate your bladder. Call your primary nurse for the following:

• If you have pain while passing urine.
• If you feel the need to pass urine often.
• If you pass urine in small amounts.
• If you see blood in your urine.

Some chemotherapy drugs will cause your urine to change color. This colour change is temporary and will not cause you any harm.

Some chemotherapy drugs can cause minor changes in your skin such as:

• redness
• rashes
• itching
• peeling
• dryness
• acne
• increased sensitivity to the sun

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• Usually the side effects disappear on their own a few weeks after treatment ends.
• Some drugs can cause more severe effects. If you are receiving one of those drugs, your primary nurse or doctor will give you more information about skin changes.
• Sometimes, the chemotherapy drugs can irritate your vein as they are being infused. The skin around your vein may turn dark. This skin change will get better on its own.
• If you have any concerns please call the home infusion pump nurse 416-480-6176.

• Your nails may become darkened, yellow, brittle or cracked. You can use nail-strengthening products that are found in drug stores but these products may irritate your skin or nails. Talk to your doctor or nurse if this bothers you or doesn’t go away.
• Your eyes might become dry or irritated. If you have changes in your vision talk to your doctor or nurse.
• You may experience numbness, tingling or a 'pins and needles' feeling in your fingers or toes. It may be difficult to do up buttons or pick up small objects. Though this is temporary, it is important to inform your healthcare providers if you have these symptoms.
• Some drugs can potentially cause damage to your heart muscle which can affect how well your heart can pump blood to your lungs. You may need to have a heart test before you start treatment to make sure your heart muscle is working well. You may also need this test repeated while you are on treatment.