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Chemotherapy Side Effects Guide
Chemotherapy affects each person differently. This guide helps you understand the side effects you may experience, why they happen, and how to manage them with confidence and care. Whether you’re just beginning treatment or supporting someone who is, we’re here to walk alongside you every step of the way.
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Body & Energy
Understanding Anaemia:
Red blood cells carry oxygen throughout your body. Anaemia is a condition that occurs when your blood doesn’t have enough healthy red blood cells or haemoglobin—the part of the red blood cell that binds to oxygen. When this happens, your body’s tissues and organs don’t get the oxygen they need.
If you have too few red blood cells or your haemoglobin levels are low, your heart has to work harder to move oxygen-rich blood around your body. This can make you feel like your heart is racing or pounding. Other common symptoms include shortness of breath, weakness, dizziness, fainting, or feeling extremely tired.
Some types of chemotherapy can cause anaemia by affecting your bone marrow, which is responsible for producing new red blood cells.
Get plenty of rest: Aim for at least 8 hours of sleep each night. It’s also okay to take one or two short naps (no longer than an hour) during the day if you need them.
Pace yourself: Try to focus on the most important tasks. You might choose to go to work but leave the housework for another day, or order take-out instead of cooking. Give yourself permission to rest.
Say yes to help: If family or friends offer to help, let them. They can support you by looking after children, doing the shopping, driving you to appointments, or helping with household chores.
Eat well: A balanced diet with enough calories and protein can help keep your energy up and support your body’s healing. Protein is especially important to repair tissues affected by treatment. Ask your doctor, nurse, or dietitian for advice on the best diet for you.
Stand up slowly: Chemotherapy-related anemia can make you feel dizzy when getting up quickly. Take your time to rise from sitting or lying down.
Follow your care team’s advice: Your doctor or nurse will monitor your red blood cell count during treatment. If it drops too low, you may need a blood transfusion or medication to help your body make more red blood cells. You might also be advised to take iron or other vitamins.
- You feel unusually fatigued and are not able to do your usual activities
- You feel dizzy or like you are going to faint
- You feel short of breath
- It feels like your heart is pounding or beating very fast
Understanding Fatigue:
Fatigue is one of the most common side effects of chemotherapy. It can range from a mild feeling of tiredness to an overwhelming sense of exhaustion.
Many people describe fatigue as feeling weak, heavy, slow, worn-out, or lacking energy. Resting does not always help. Fatigue may appear during treatment and sometimes continues for weeks or even months afterwards. Certain chemotherapy drugs are more likely to cause fatigue. The emotional toll of treatment, frequent appointments, anxiety, and depression can also contribute. If you are receiving both chemotherapy and radiotherapy, your fatigue may be more intense.
Constipation may also occur if you’re less active than usual or spending more time sitting or lying down. A diet low in fibre or not drinking enough fluids can also contribute.
Find ways to relax: Techniques such as meditation, prayer, yoga, guided imagery, or visualisation can help reduce stress and support emotional well-being.
Eat and drink regularly: Aim for 5 to 6 small meals or snacks per day instead of three large meals. Choose foods that are easy to prepare, such as yoghurt, cottage cheese, soups, and frozen meals. Drink at least 8 cups of fluid a day, such as water or juice.
Plan time to rest: You may feel better after a short rest or nap during the day. Many people find that a rest of 10 to 15 minutes is more refreshing than a longer nap. If you do nap, try to keep it under one hour to avoid disrupting your night-time sleep.
Stay active: Gentle activity can reduce fatigue and help you sleep more soundly. Try going for a short walk, doing yoga, or using an exercise bike. Plan activities for the times of day when you feel most energetic. Speak with your doctor or nurse about what is safe and suitable for you during treatment.
Prioritise your energy: Fatigue may mean you cannot do everything you normally would. Focus on what matters most to you, and allow others to help with the rest. Calmer activities, such as reading, knitting, or listening to music, may be more manageable.
Improve sleep habits: Try to get at least 8 hours of sleep each night. Being active during the day and avoiding long naps can help improve your sleep quality. A relaxing bedtime routine may also help, such as reading, working on a puzzle, or listening to music.
Adjust your work schedule: Fatigue may affect your ability to work. Some people can continue working full-time, while others may need to reduce their hours or take time off. If possible, speak with your employer about adjusting your schedule or working from home.
Accept support: Let friends and family help with daily tasks, such as cooking, shopping, or driving you to appointments. You do not need to do it all on your own.
Connect with others: Talking to people who have been through cancer treatment can provide useful insights. Support groups are a great way to share experiences and coping strategies. Your care team can help you find a local or online group.
Keep a fatigue diary: Tracking how you feel each day can help you recognise patterns and plan your energy use more effectively. Share this with your nurse or doctor.
Speak with your care team: Your doctor may prescribe medicine to help reduce fatigue or address underlying causes, such as low red blood cell counts (anaemia), poor appetite, or depression.
- Anaemia
- Pain Medications
- Appetite changes
- Poor sleep
- Low activity levels
- Breathing difficulties
- Infections
- Doing too much at once
- Other medical conditions
Understanding Pain:
Some types of chemotherapy can cause pain, such as burning, tingling, numbness, or shooting pains in your hands and feet.
You may also experience headaches, muscle aches, mouth sores, or stomach pain. Pain can be caused by the treatment itself or by the cancer.
- Talk to your care team: Describe your pain clearly—where it is, what it feels like, how long it lasts, and what helps or worsens it. Use a scale from 0 to 10 to describe how strong it is.
- Be consistent with medication: Take pain relief as prescribed, even if you’re not currently in pain. Skipping doses can make pain harder to manage.
- Try relaxation techniques: Deep breathing, gentle yoga, or meditation may help reduce tension and discomfort.
- Involve your support network: Let family and friends know if you’re in pain so they can help and support you.
- Ask about specialist support: A pain or palliative care specialist can provide additional options to help manage your symptoms.
- Report any changes: Let your doctor or nurse know if your pain changes or worsens, so your treatment plan can be adjusted if needed.
Understanding Appetite Changes:
It’s common for chemotherapy to affect your appetite. This can happen for several reasons, such as nausea, soreness in the mouth or throat, or changes in taste caused by medication. Feelings of tiredness or low mood can also reduce your desire to eat. For some, appetite loss lasts only a day or two; for others, it may continue for weeks or months.
Even when you don’t feel like eating, it’s important to nourish your body. Foods rich in protein, vitamins, and calories help fight infection and repair tissues affected by treatment. Not eating enough can lead to weight loss, weakness, and increased fatigue.
Some cancer treatments may have the opposite effect, leading to weight gain or increased appetite. Always speak with your doctor, nurse, or dietitian about what to expect and how to manage changes in appetite.
Eat little and often: Aim for 5 to 6 small meals or snacks a day instead of three large meals. Choose foods and drinks that are high in protein and calories.
Stick to a schedule: Try to eat at regular times, even if you’re not feeling hungry. Keeping to a routine helps ensure your body gets the nourishment it needs.
Opt for liquids if solids are difficult: Milkshakes, smoothies, soups, and juices can be easier to manage and still provide essential nutrients.
Reduce metallic taste: Some chemotherapy drugs leave a metallic taste in your mouth. Eating with plastic utensils may help reduce this effect.
Gently boost your appetite: Light physical activity, like a short walk before lunch, can stimulate hunger. Try not to fill up on drinks right before or during meals, as this may reduce your appetite.
Change the setting: A change of scenery or company can make meals more enjoyable. Try eating in a different room, with friends or family, or even while listening to music or watching TV.
If eating continues to be difficult, your care team may recommend vitamins, supplements, or medications to stimulate your appetite. In some cases, additional nutritional support through a feeding tube or IV may be needed.
Understanding Flu-like symptoms:
Some chemotherapy treatments, particularly when combined with biological therapy, can cause flu-like symptoms.
These symptoms usually last between one and three days. However, they may also be signs of an infection or the cancer itself, so it’s important to speak with your doctor or nurse if you experience them.
Symptoms may include:
• Muscle and joint aches
• Headache
• Fatigue
• Nausea
• Fever or chills
• Loss of appetite
Rest as needed
Stay hydrated
Eat small, nourishing meals to maintain strength
Monitor your temperature and report a fever of 38°C or higher
Let your care team know if symptoms persist or worsen
Digestion & Elimination
Nausea & vomiting, Constipation, Diarrhoea, Urinary/kidney/bladder
Understanding Constipation:
Constipation can be a side effect of chemotherapy or pain-relieving medicines. It means your bowel movements happen less often than usual, and your stools may be hard, dry, and difficult to pass. This can lead to discomfort, including bloating, nausea, stomach cramps, belching, or a feeling of pressure in the rectum.
Constipation may also occur if you’re less active than usual or spending more time sitting or lying down. A diet low in fibre or not drinking enough fluids can also contribute.
Track your bowel movements: Keep a record and share it with your doctor or nurse. This helps them understand what’s normal for you and whether constipation is developing.
Stay hydrated: Aim to drink at least 8 cups of water or other fluids daily. Warm or hot drinks such as tea or coffee can help, as can fruit juices; prune juice is especially effective for some people.
Keep moving: Daily activity like walking, cycling, or gentle yoga can help relieve constipation. If you’re unable to walk, ask your healthcare team about exercises you can do while sitting or lying down.
Eat more fibre: Include high-fibre foods in your diet, such as wholegrain bread and cereals, dried beans and lentils, raw vegetables, fresh and dried fruit, nuts, seeds, and popcorn. Drinking plenty of fluids helps fibre do its job by softening stools.
Let your doctor or nurse know if you haven’t had a bowel movement in two days:
They may recommend a fibre supplement, laxative, stool softener, or enema, but always check with your healthcare team before using these treatments.
Your doctor may also prescribe a stool softener to help you avoid straining or rectal bleeding.
Understanding Diarrhoea:
Diarrhoea refers to frequent bowel movements that may be soft, loose, or watery.
Chemotherapy can cause diarrhoea by damaging the healthy cells that line your small and large intestines. It can also increase the speed of bowel movements.
In some cases, diarrhoea may be caused by infections or by medicines used to treat constipation.
Eat small, frequent meals: Aim for 5 or 6 small meals or snacks each day instead of 3 large meals.
Replace lost salts: Chemotherapy-related diarrhoea can lead to a loss of important salts such as sodium and potassium. Ask your doctor or nurse which foods are best to help replace these. Good sources include bananas, oranges, peach or apricot nectar, and potatoes.
Stay hydrated: Drink 8 to 12 cups of clear fluids daily, such as water, clear broth, ginger ale, or sports drinks. Sip slowly, and choose drinks at room temperature. Let fizzy drinks go flat before drinking. If drinks make you feel thirsty or nauseous, dilute them with extra water.
Choose low-fibre foods: High-fibre foods can worsen diarrhoea. Opt for low-fibre options like bananas, white rice, plain white toast, and plain or vanilla yoghurt.
Contact your care team: Let your doctor or nurse know if your diarrhoea lasts more than 24 hours, or if you also have cramping or pain. You may need medication to control it or IV fluids to help replace lost fluids and nutrients. Do not take over-the-counter diarrhoea medication without checking with your doctor or nurse first.
Be gentle when cleaning: After a bowel movement, use a baby wipe or a spray bottle with water instead of dry toilet paper. This helps avoid irritation. Let your doctor or nurse know if the rectal area becomes sore, bleeds, or if you have haemorrhoids.
Ask about a clear liquid diet: Your doctor may recommend a clear liquid diet for a short time to allow your digestive system to rest. Most people follow this diet for no more than five days.
Very hot or cold drinks
Alcoholic beverages
Dairy products such as milk, cheese, ice cream, and milkshakes
Spicy foods including chilli, hot sauces, and curries
Greasy or fried foods like chips and burgers
Caffeinated items such as coffee, black tea, cola, and chocolate
Gas-producing foods such as cabbage, broccoli, dried beans, soy milk, and other soy products
High-fibre foods such as raw fruits and vegetables, wholegrain breads and cereals, nuts, and cooked dried beans
Skin, Hair, Nails
Hair loss, Skin/nail changes, Radiation recall
Understanding Hair Loss:
BEFORE HAIR LOSS:
- Talk with your care team: Your doctor or nurse can tell you whether your specific treatment is likely to cause hair loss.
- Take control: You may find it easier to manage if you cut your hair short or shave your head before it starts falling out. If you decide to shave, use an electric shaver to avoid irritating your scalp.
- Plan ahead for a wig: If you choose to wear a wig, consider buying one before chemotherapy begins so you can match the colour and style of your natural hair. A hairdresser can help shape the wig to your preference. Make sure it fits comfortably.
- Be gentle with your hair: Use a mild or baby shampoo, and pat your hair dry with a soft towel rather than rubbing.
- Avoid damaging products and tools: These include:
– Curling or straightening irons
– Rollers or curlers
– Hairdryers
– Hair bands and clips
– Hairspray, hair dye, or chemical treatments (like perms or relaxers)
AFTER HAIR LOSS:
- Protect your scalp: Your scalp may feel sensitive. Wear a soft hat, scarf, or turban when outside, and avoid extreme heat or cold. Stay away from sunbeds and direct sunlight. Use sun protection on your scalp when outdoors.
- Stay warm: Without hair, you may feel colder. Head coverings, including wigs, hats, or scarves, can help keep you warm.
- Use a satin pillowcase: Satin causes less friction than cotton, which may be more comfortable while sleeping.
- Talk about how you feel: If hair loss is upsetting, it may help to talk with someone you trust, such as a doctor, nurse, family member, friend, or another person who has been through cancer treatment. You do not have to face it alone.
Neurological & Sensory
Nervous system changes, Eye changes
Reproductive & Sexual Health
Infertility, Sexual changes
Understanding Infertility:
Some types of chemotherapy can affect fertility in both women and men. This means that you may not be able to conceive a child in the future. Chemotherapy can damage the reproductive organs or the cells responsible for producing eggs or sperm.
In women, chemotherapy may harm the ovaries, reduce the number of healthy eggs, and lower hormone levels. This can lead to early menopause and infertility. In men, chemotherapy can reduce sperm count, affect sperm quality or mobility, or damage sperm cells altogether.
Whether fertility is affected depends on the type of chemotherapy, the dose, your age, and any other health conditions you may have. For some people, fertility returns after treatment, but for others, it may be a permanent change.
If having children in the future is important to you, speak with your doctor or nurse before treatment begins. They can help you understand your options and refer you to a fertility specialist for personalised support.
- Talk with your doctor or nurse before treatment begins: If you hope to have children in the future, it is important to discuss this with your care team as early as possible.
- Chemotherapy can affect fertility in both women and men, and in some cases, the effects may be long-lasting or permanent.
- For women, your doctor may refer you to a fertility specialist to explore options such as egg or embryo freezing before chemotherapy begins.
- For men, options may include sperm banking (freezing and storing sperm) for future use.
- Use effective birth control during treatment:
It is essential to avoid pregnancy during chemotherapy. The medications used can harm a developing baby, particularly during the first trimester.- For women, if you have not yet gone through menopause, your doctor may recommend a pregnancy test before starting treatment, and will advise on suitable contraception to use during and shortly after treatment.
- For men, it is important to ensure your partner does not become pregnant while you are undergoing chemotherapy, as your sperm may be affected by the treatment and could increase the risk of birth defects.
- Ask about timing and recovery: In some cases, fertility may return after treatment. Your care team can advise you on whether fertility preservation is necessary and what to expect in the months or years following chemotherapy.
- Seek emotional support if needed: Concerns about fertility and family planning can be deeply emotional. Counsellors, support groups, or fertility specialists can help you explore your options and provide guidance during this part of your journey.
Risks & Long-Term Effects
Infection, Second cancers, Fluid retention
Platelets are blood cells that help your blood to clot when you’re injured. Chemotherapy can lower your platelet count by affecting the bone marrow, which is responsible for producing them. A low platelet count is known as thrombocytopenia. When this happens, you may bruise more easily (even without injury), experience nosebleeds or bleeding in your mouth, or notice a rash of tiny red or purple spots on your skin.
DO:
Use a very soft toothbrush, and soften the bristles further by running them under hot water before brushing.
Blow your nose gently to avoid injury.
Be cautious with sharp objects such as scissors or knives.
Use an electric shaver instead of a razor to avoid cuts.
Apply gentle, firm pressure to any cuts until the bleeding stops.
Wear shoes at all times, even indoors or in hospital.
DO NOT:
Use dental floss or toothpicks.
Play contact sports or do activities where there’s a risk of injury.
Use tampons, enemas, suppositories, or rectal thermometers.
Wear clothing with tight collars, cuffs, or waistbands.
Drinking alcohol (beer, wine, or spirits).
Having sex.
Taking herbs, vitamins, minerals, aspirin, or any over-the-counter medicines, as they can interfere with chemotherapy or increase bleeding risk.
Bruising without cause
Tiny red or purple spots on your skin
Red- or pink-coloured urine
Black or bloody stools
Heavy or prolonged menstrual bleeding
Vaginal bleeding not related to your period
Headaches or changes in your vision
A warm or hot sensation in an arm or leg
- Extreme drowsiness or confusion
Understanding Infection:
Some types of chemotherapy can reduce the number of white blood cells your bone marrow produces. White blood cells play a key role in helping your body fight infection. When your white cell count drops, your body is more vulnerable to infections.
One important type of white blood cell is called a neutrophil. A low neutrophil count is known as neutropenia. Your doctor or nurse may check for neutropenia with regular blood tests. If you are neutropenic, you will need to watch carefully for signs of infection and may need to take your temperature daily using a digital thermometer.
Contact your doctor or nurse immediately if your temperature is 38°C or higher.
- White cell monitoring and medication: Your care team will monitor your white blood cell count during treatment. If needed, your doctor may prescribe medicine to help boost your white cell count and lower the risk of infection.
- Wash your hands often: Use soap and water before eating or cooking, after using the toilet, blowing your nose, coughing, sneezing, or touching animals. Carry hand sanitiser for times when soap and water are not available.
- Disinfect surfaces: Use sanitising wipes to clean items you frequently touch, such as doorknobs, light switches, mobile phones, and ATM keypads.
- Be gentle with personal hygiene: After bowel movements, use baby wipes or a spray bottle of water instead of dry toilet paper. Let your doctor or nurse know if your rectal area becomes sore, bleeds, or if you develop haemorrhoids.
- Avoid contact with illness: Stay away from people who are sick, including anyone recently vaccinated with a live virus such as chickenpox or polio. If unsure, check with your doctor, nurse, or local health authority.
- Avoid crowds: Try to visit shops or attend events at quieter times to reduce exposure to germs.
- Prevent cuts and nicks: Do not cut or tear cuticles. Use an electric shaver instead of a razor, and take care when using scissors, needles, or knives.
- Care for your catheter site: Watch for signs of infection, such as redness, swelling, soreness, or discharge. Report any concerns to your doctor or nurse.
- Maintain good oral hygiene: Brush your teeth with a very soft toothbrush after meals and before bed. You can soften the bristles with warm water. Use alcohol-free mouthwash, and check with your care team before any dental visits.
- Protect your skin: Avoid squeezing or scratching pimples. Use moisturiser on dry or cracked skin, and gently pat your skin dry after bathing.
- Clean any cuts straight away: Use warm water, soap, and antiseptic, and continue cleaning daily until a scab forms.
- Be cautious with animals: Avoid cleaning litter trays, picking up dog waste, or cleaning bird cages or fish tanks. Always wash your hands after touching pets.
- Ask before having vaccinations: Some vaccines contain live viruses and should not be given during chemotherapy. Always check with your doctor first.
- Chills or sweats
- Redness or swelling
- Headache
- Rash
- Cough
- Painful or frequent urination
- Bloody or cloudy urine
- Earache
- Sinus pain or pressure
- Stiff neck
FOOD SAFETY MATTERS:
- Keep hot foods hot and cold foods cold. Refrigerate leftovers straight away.
- Wash fruits and vegetables thoroughly before eating.
- Avoid raw or undercooked fish, seafood, meat, chicken, or eggs.
- Do not eat foods or drinks that are mouldy, spoiled, or past their expiry date.
- Call your doctor immediately (even at night or on weekends) if you think you have an infection.
- Be sure you know how to reach your care team out of hours.
- Do not take any medication for fever or infection without checking first.
Understanding Second Cancers:
Some types of chemotherapy can reduce the number of white blood cells your bone marrow produces. White blood cells play a key role in helping your body fight infection. When your white cell count drops, your body is more vulnerable to infections.
One important type of white blood cell is called a neutrophil. A low neutrophil count is known as neutropenia. Your doctor or nurse may check for neutropenia with regular blood tests. If you are neutropenic, you will need to watch carefully for signs of infection and may need to take your temperature daily using a digital thermometer.
Contact your doctor or nurse immediately if your temperature is 38°C or higher.