There are a wide range of side effects associated with chemotherapy treatments. Some are serious while others are more a nuisance. Here’s a look at seven common side effects and ways to cope.

Fatigue

Fatigue, or tiredness, is one of the most common complaints that I hear from patients. Depending on the treatment regimen, there will be some days that are better than others, especially if steroids are involved. Steroids are used a long with treatment regimens to prevent side effects or reactions. Steroids can also be part of the treatment itself. If you are taking steroids, you could have more energy on those days, and then “crash” a day or so after you stop the steroids. Patients might also feel very tired the day they get treated. Treatment can make you feel tired or drained all the time, with some days being slightly better than others. There are a variety of factors that contribute to fatigue, including anemia and depression. It can be caused by the cancer, the treatment, sleep problems, and nutrition problems. It’s important to keep in touch with your care team. Stay as active as you can, resting when necessary. Activities like yoga and walking can be helpful.

Hair loss

The amount of hair loss varies depending on the treatment. With some regimens, hair loss is inevitable. Chemotherapy drugs such as taxols and vincristine cause over 80% of hair to be lost. Some other medications can also cause much if not all of the hair to be lost. Others still can cause thinning. Hair loss will usually start a couple weeks after treatment, and your treatment team will tell you if your medications will most likely cause you to lose your hair. They will help you with wig fitting or other hair coverings. When the hairs begin to fall out, patients will sometimes cut their hair short because it can make the follicles sensitive. Other patients will simply shave their head. Hair will typically start to regrow around three months later. Scalp cooling is useful in preventing hair loss, but does require effort and commitment on the part of the patient. It also takes extra time, and your center may or may not have a scalp cooling device. If you’ve lost your hair, it’s important to use sun screen and head coverings during the hot summer months.

Muscle aches and pains

Muscle and joint aches and pains are a common side effect of certain medications used in cancer treatments. They may also occur from the cancer itself, or if electrolytes in the body are too high or too low. Electrolytes are molecules like potassium, magnesium, sodium, and calcium. They serve important functions all throughout the body, including the heart. Pre-existing conditions such as arthritis can contribute to joint aches and pains. Alternating active periods with rest periods, eating healthy foods, and staying hydrated can help. Medications can be added as necessary but check with your care team for recommendations. Physical therapy, massage, and hot/cold therapy can also help. Intense pain in one extremity or the other, accompanied by redness and/or warmth can indicate a blood clot. Your care team should know about that immediately.

Bowel problems aka constipation and/or diarrhea

Some chemotherapy treatments can be constipating, while others present a risk for diarrhea. Radiation can also contribute to diarrhea. Pain medications are also a culprit for constipation. Signs that can mean you’re constipated are feeling very full, having bloating and cramping, or noticing changes in how often you have a bowel movement. Diarrhea can mean going to the bathroom more often, and it can also refer to the consistency of the stool, or the amount. Sometimes when we try to fix one problem, we cause another. This can mean going from constipated to loose stools and back again. Sometimes it’s a struggle to find just the right spot. Treatment for diarrhea can involve Imodium or lomotil. Constipation can be treated with stool softeners and laxatives, but reach out to your care team for recommendations. I always tell my patients that we don’t want them to get too constipated and we don’t want them having diarrhea for very long. Let us know is my mantra! The triage nurse can give specific recommendations. Call your care team and ask for help.

Low blood counts

Chemotherapy affects cells in your body, wiping out good ones (like your white blood cells) along with the bad ones (the cancer). If your white blood cells get too low, you can become neutropenic, meaning you are more at risk for infection. Your doctor’s office would make sure that you know your counts are low so that you can avoid sick people, wear a mask if you have to go out, and check yourself for a temperature. If you would run a temperature of 100.4 or greater, your doctor’s office would need to know.

Another problem that can occur with treatment is low red blood cells. If your hemoglobin gets too low, you may be more tired, dizzy, or short of breath. That’s because your hemoglobin carries oxygen around the body. When it gets too low, your cells aren’t getting oxygen. If it gets too low, your doctor would give you a blood transfusion.

A third type of low blood count that can occur is low platelets. Platelets are what enables your blood to clot when you get a cut, for instance. Someone with very low platelets could be in danger of having serious bleeding, either internally or externally. Signs of internal bleeding can be bruising or something called petechiae, which are tiny, red, “pin-prick” spots. If you notice that your stool is black when you have a bowel movement, that can be a sign of internal bleeding. Your doctor will explain what to watch for, and you would need to notify them if you notice any type of bleeding.

Neuropathy

Neuropathy can show up as numbness, tingling, or sensitivity to the touch. It can cause weakness and a lack of coordination. It might feel like pins-and-needles, or like burning. There is a lot of variety in how neuropathy feels, and also how severe it is. Some people are hardly bothered by their neuropathy, while others are severely impacted to the point it is difficult to care for themselves. Chemotherapy drugs can cause neuropathy but can also be the result of a tumor pressing on nerves. Let your care team know if neuropathy is becoming an issue. Medications can help along with acupuncture, relaxation techniques, and massage.

Nausea and vomiting

Some chemotherapy treatments have more potential to cause nausea than others. You will get medications to prevent nausea before chemotherapy treatment, along with a prescription to have at home for if you get nauseous while at home. Often this medication is zofran. I tell my patients to not try to “stick it out.” Just take the nausea medication. If your chemotherapy has a very high risk of nausea, you will receive a medication that gives you anti-nausea protection for several days, even after you go home. It is long-acting. Steroids help prevent nausea and your doctor may prescribe steroids for you to take at home. You may also be given a prescription called zyprexa which has been found to lessen nausea for patients on active chemotherapy treatment. Eating small, frequent meals can be helpful. Acupressure and acupuncture have also been proven to help.

When getting chemotherapy, you might not get all of the previous side effects. You may find that just one or two of them are a problem. Or maybe you don’t notice much of anything! Some people seem to cruise through treatment, while others get every side effects imaginable. Whatever your experience, there are ways to manage side effects of treatment. Your treatment team is there to help you, so let them know if you are having bothersome effects from your chemotherapy.