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Side effects

Cancer chemotherapy produces different reactions in different people. Reactions may also vary from treatment to treatment. Since most side effects are temporary, they will gradually disappear once your treatment is complete.

Some side effects can be tiresome, but you and your doctor must weigh this against the benefits of treatment. Therefore, if you find it difficult to cope with any of the side effects, please discuss them with your doctor or nurse. There are many ways we can help you.

Monitoring your blood results

The production of blood cells in your body happens in your bone marrow. Bone marrow and cell production can be affected by chemotherapy. The following cells are particularly affected:

  • White blood cells - these help your body to fight infection.
  • Platelets – these help your blood to clot
  • Red blood – these cells carry oxygen to all the cells of the body

In order to safely deliver chemotherapy to you, we will require you to have a blood test no more than 48hrs before every treatment. We will also closely monitor your kidney and liver function throughout treatment. We will let you know when you next require a test and supply you with the relevant blood forms.

Avoiding infection

Once you start treatment, your immune system may not work as well as it should so we need you to try and avoid infection where possible and know what steps to take if you were to start to feel unwell. Please contact the Chemotherapy Helpline if you become ill while on chemotherapy. We will give you an alert card at your pre-assessment appointment and instructions on where and when to seek help.

Macmillan Top Tips for avoiding infection

  • Washing your hands regularly and having good personal hygiene
  • Avoiding people with an infection, and crowds or public places where there is a risk of picking up an infection
  • Checking with your doctor before you have any vaccines
  • If you have one, protecting your central or PICC line from bacteria and damage
  • Keeping your mouth clean.
  • Avoiding certain foods that may contain harmful bacteria.

Rarely, the side effects of chemotherapy can be life threatening. About 1–2% of patients die after chemotherapy treatments, often because they delay in seeking advice. So it is very important to contact the Chemotherapy Helpline if you become ill within 6 weeks of receiving a dose of chemotherapy.

Effects on your mouth 

Some drugs can make your mouth dry, sore and occasionally give you ulcers. Tell your nurse if it gets very uncomfortable.

Macmillan Top Tips for managing a sore / dry mouth
General advice:

  • Drink plenty of fluids
  • Keep your mouth moist and clean at all times
  • Avoid mouthwashes that contain alcohol
  • A simple mouthwash made from one teaspoon of salt to a pint of boiled, cooled water is ideal
  • Avoid smoking and alcohol

Dry mouth

  • Try soft foods or moisten foods with sauces or gravy
  • Stimulate saliva production with fruit juice or ice cubes, Pineapple, either fresh or tinned, is refreshing and can help to keep your mouth clean
  • Suck strongly flavoured pastilles or mints to keep your mouth moist

Sore mouth

  • Use a soft, bristled brush to gently clean your teeth after meals and each morning and night
  • Avoid very hot or cold, sharp, highly spiced, salty or tart foods and drinks

Nausea and vomiting (feeling sick and being sick)

Not all drugs cause nausea and vomiting – many people do not experience it at all. Nausea and vomiting may start a few hours to a few days after treatment. We will give you a supply of anti-emetic (anti-sickness) drugs to take home and the nurse will explain the best way to take them. If they don’t work well for you, talk to your doctor or nurse. There are other anti-emetic drugs that may help.

If you cannot stop vomiting and cannot keep any fluids down, it is very important to contact the Chemotherapy Helpline.

Macmillan Top Tips for managing nausea / vomiting

  • Avoid eating or preparing food when you feel sick
  • Avoid fried foods, or foods with a strong smell
  • Preparing small meals and eating little and often can be helpful
  • Eat cold or warm food if the smell of hot food makes you feel sick
  • Eat little and often and chew your food well
  • Peppermints or peppermint tea may help some people
  • Sip drinks slowly
  • Ginger biscuits or ginger beer can help some people
  • Try not to drink a lot just before you eat.

Diarrhoea (loose bowels)

Some chemotherapy can cause diarrhoea. If you have abdominal pain, are opening your bowels at night or are having your bowels open 3-4 times more than you would normally in a day, call us for advice. If you are concerned, please contact us straight away 

If you are on Irinotecan or Capecitabine chemotherapy and have any diarrhoea at all it is very important to contact the Chemotherapy Helpline.

Macmillan Top Tips for managing diarrhoea

  • Drink plenty of liquid (at least 2 litres or 3.5 pints a day) to replace the fluid lost with the diarrhoea
  • Avoid drinking alcohol and coffee
  • Eat small, frequent meals made from light foods, for example white fish, poultry, well-cooked eggs, white bread, pasta or rice
  • Eat your meals slowly
  • Eat less fibre (for example cereals, raw fruits and vegetables) until the diarrhoea improves
  • Avoid greasy, fatty foods such as chips and beef burgers, and spicy foods like chilli peppers

Constipation

Some drugs that you will be given during chemotherapy may cause constipation.

Macmillan Top Tips for managing constipation

  • Make sure you eat plenty of fibre (roughage) each day. Good sources of fibre include; whole-wheat breakfast cereals like Weetabix®, Shredded Wheat® or muesli, wholemeal bread and flour, brown rice, wholemeal pasta and fresh fruit and vegetables
  • Make sure you drink plenty of fluids – both hot and cold drinks will help. Aim to drink at least 2 litres (3.5 pints) a day. This is particularly important if you increase the amount of fibre in your diet, as eating fibre without drinking enough fluids can make constipation worse
  • You could try a natural remedy for constipation. These include prune juice, prunes, fig syrup and dried apricots
  • Gentle exercise, such as walking, will help keep your bowels moving
  • If you are constipated because of the medicines you are taking, it may be possible to change the dose you take. You may need to take laxatives (medicines that help you poo) as well. Your doctor can give you more advice

Effects on your hair

Not all chemotherapy drugs will cause your hair to fall out. Your doctor or nurse will advise you on this. Sometimes hair loss is so small you won’t notice, but some drugs will cause partial or complete hair loss. The amount of hair loss will depend on the drug, the dose and your reaction to the drug and usually begins within two or three weeks of your first treatment.

If your hair begins to fall out you may feel tenderness in your scalp around the hair follicles. Hair loss can be upsetting – don’t be afraid to discuss your feelings with the nurse. The pre-assessment nurse can refer you to the Hair Advisory Service at the Berkshire Cancer Centre for advice before starting your treatment.

Macmillan Top Tips for managing hair loss

  • Use gentle hair products and non-medicated shampoo
  • Only use conditioner on the middle and ends of your hair
  • When drying your hair with a towel, don’t rub hard
  • Use a brush with wide-spaced prongs or a wide-toothed comb
  • Wear a soft cap or turban at night
  • Avoid too much heat from hairdryers, heated rollers or hair straighteners
  • Avoid colouring, perming or relaxing your hair
  • Try not to tie your hair in a tight band.

Effects on your skin

Some chemotherapy drugs may affect your skin, causing it to become dry, itchy, or your skin may become sensitive to the sun. Sometimes the skin may develop dark patches, especially over the veins used for chemotherapy. This is temporary and it will gradually fade when your treatment is complete.

Your nails may discolour or white ridges may appear for a time and your nails may not grow as quickly as normal.

Macmillan Top Tips for managing skin and nail side effects

  • Avoid soap and perfumed products
  • Gently cleanse your face, avoiding products containing alcohol
  • Use a moisturiser at least once a day
  • Use emollient creams to relieve itchy skin
  • For oily skin, use a wash-off cleanser followed by oil-free moisturiser
  • Use foundations, bronzers and green-tinted primers to control changes in skin tone
  • Protect yourself against the sun
  • Avoid scratching or wet-shaving your skin

Your nails may become brittle, flaky, ridged or lined. Sometimes they may become painful or swollen. To look after your nails, you can:

  • Use nail-strengthening cream, hand cream and cuticle cream
  • Use an emery board instead of cutting your nails
  • Use nail varnish to hide discolouration but not if your nails are split
  • Wear gloves when doing chores
  • Wear comfortable shoes
  • Don’t wear false nails

Effects on your fertility

Not all chemotherapy drugs will make you infertile. Infertility may be temporary or permanent, depending on the drugs and the duration of the treatment. If fertility is important to you, please discuss it with your doctor before you start treatment.

Women
Some drugs may affect your ovaries and stop production of eggs. This will make you infertile and may bring on symptoms that seem like the menopause, such as irregular periods or your periods may stop, hot flushes, and dryness of your skin and vagina. Your doctor may be able to prescribe hormone tablets for you, to help reduce these symptoms. The hormones will not make you fertile again.

It is important to try and avoid becoming pregnant during treatment as the drugs may affect your unborn baby. There are many effective methods of contraception and you should discuss them with your partner and, if necessary, your nurse or doctor.

In some circumstances, fertility preservation can be arranged before starting chemotherapy. Please discuss this with your consultant.

Men
Chemotherapy may reduce the number or quality of the sperm you produce, which will affect your ability to father children. If you are likely to want children in the future, it may be possible for you to bank your sperm. Please discuss this with your consultant before starting treatment.

Sex and chemotherapy
Chemotherapy and its side effects can affect your sex life and fertility. It can help to talk through any concerns with your doctor or specialist nurse. It’s also important to try to talk about how you feel with your partner.

It is still possible for a woman to get pregnant or for a man to get his partner pregnant during chemotherapy. It’s important to use contraception during treatment and for a few months after. This is to avoid pregnancy as the drugs could harm a developing baby. Breastfeeding during chemotherapy treatment is also not advised.

It is important to use effective barrier contraception while on chemotherapy to protect your partner in case there is any chemotherapy in semen or vaginal fluid.

Tiredness (fatigue)

Many patients feel very tired and this is not relieved by rest. This is quite normal and there are many reasons for this. Maintaining your usual activities as much as possible may help. Try to incorporate some activity such as a short walk into your daily routine, but do rest when you feel you need to.

If you have a planned social event, take it easy for a while before and afterwards. Please telephone for advice and inform your nurse or doctor at your next hospital visit if you become much more tired than usual.

Macmillan Top Tips for managing fatigue / tiredness

  • Being physically active may improve your energy levels and increase your appetite. Try setting yourself small goals that you can achieve, such as walking to the front door. Some exercise, even a small amount, is better than no exercise at all
  • Eating well and drinking lots of fluids can help increase your energy levels. Your doctor or nurse can give you advice on your diet
  • You may find that you feel more stressed when you are having treatment. This can make you feel more tired. Try to make time to relax. There are relaxation techniques you can use to relieve tension and increase your energy
  • Complementary therapies may also help you cope with fatigue and help you to relax. If you are interested in complimentary therapies, please ask your chemotherapy Nurse about ‘My Cancer My Choices’. The practitioners who run the service are trained in treating people who are undergoing chemotherapy 
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    Royal Berkshire NHS Foundation Trust,
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    Reading,
    RG1 5AN
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    Tel: 0118 322 5111