Side effects

-Chemotherapy

Chemotherapy can cause unpleasant side effects, although many can be treated or prevented and most will pass once your treatment stops.

It's difficult to predict what side effects you'll get.

Here's a list of many of the common side effects, but it's unlikely you'll have all of these.

Tiredness

Tiredness (fatigue) is one of the most common side effects of chemotherapy.

Many people having treatment feel generally tired a lot of the time or tire very easily during everyday tasks.

It can help to:

get plenty of rest
avoid doing tasks or activities that you don't feel up to
do light exercise, such as walking or yoga, if you're able to – this can boost your energy levels, but be careful not to push yourself too hard
ask your friends and family for help with everyday tasks

If you're working, you may want to ask your employer for time off or to let you work part-time until your treatment has finished.

Feeling sick and vomiting

Many people having chemotherapy will have periods where they feel sick or vomit.

Your care team can give you anti-sickness medication to reduce or prevent this.

This is available as:

tablets or capsules
injections or a drip into a vein
suppositories – capsules you put into your bottom
a skin patch

Side effects of anti-sickness medicines include constipation, indigestion, problems sleeping and headaches.

Tell your care team if your medicine doesn't help or causes too many side effects. There may be a different one that works better for you.

Hair loss

Hair loss is a common side effect of chemotherapy, although it doesn't happen to everyone. Ask your care team if it's likely to be a side effect of the medicines you're taking.

If you do lose hair, it usually starts within a few weeks of your first treatment session. If you lose lots of hair this typically happens within a month or two.

It's most common to lose hair from your head but you can also lose it from other parts of your body, including your arms, legs and face.

The hair loss is almost always temporary. Your hair should start to grow back soon after your treatment has finished.

But sometimes the hair that grows back is a slightly different colour or it may be curlier or straighter than it used to be.

Coping with hair loss

Hair loss can be upsetting. Talk to your care team if you find losing your hair difficult to cope with.

They understand how distressing it can be and can support you and discuss your options with you.

For example, you may decide you want to wear a wig. Synthetic wigs are available free of charge on the NHS for some people, but you'll usually have to pay for a wig made from real hair.

Other options include headwear such as a headscarves.

Read more about advice about cancer and hair loss.

Preventing hair loss

It may be possible to reduce the chances of hair loss by wearing a cold cap while you're having chemotherapy.

A cold cap looks similar to a bicycle helmet and is designed to cool your scalp during a treatment session. This reduces blood flow to the scalp, reducing the amount of medicine that reaches it.

Whether or not you can use a cold cap depends on the type of cancer you have. Cold caps also work better with certain types of chemotherapy medicine, and they don't always work.

Ask your care team whether a cold cap might help you.

Infections

Chemotherapy can reduce your body's ability to fight infection. This makes you more likely to pick up infections that could make you seriously ill.

It's a good idea to take precautions to protect yourself against infection. For example:

wash your hands regularly with soap and water – particularly after going to the toilet and before preparing food and eating
try to avoid close contact with people who have an infection – such as chickenpox or flu
have the annual flu jab

A course of antibiotics may sometimes be prescribed to reduce your risk of developing an infection.

Anaemia

Chemotherapy lowers the amount of red blood cells, which carry oxygen around the body.

If your red blood cell count drops too low, you'll develop anaemia.

Symptoms of anaemia include:

tiredness and lack of energy – this tends to be more severe than the general fatigue associated with chemotherapy
shortness of breath
noticeable heartbeats (heart palpitations)
a pale complexion

Contact your care team as soon as possible if you have any of these symptoms. You may need treatment to increase your number of red blood cells.

Preventing anaemia

Including a high amount of iron in your diet can help reduce your risk of anaemia, as iron helps the body make red blood cells.

Foods high in iron include:

meat – particularly liver
beans and nuts
dried fruit – such as dried apricots
wholegrains – such as brown rice
fortified breakfast cereals
dark-green leafy vegetables – such as watercress and curly kale

Bruising and bleeding

Chemotherapy can reduce the number of cells called platelets in your blood. These help stop severe bleeding when you cut or injure yourself.

If you have a low number of platelets, you may have:

skin that bruises easily
severe nosebleeds
bleeding gums

Tell your care team if you experience these problems. You may need treatment to increase the number of platelets in your blood.

Sore mouth

Sometimes chemotherapy can make the lining of the mouth sore and irritated. This is known as mucositis.

Symptoms tend to develop a few days after treatment starts and include:

the inside of your mouth feeling sore – as if you've burnt it by eating very hot food
mouth ulcers, which can become infected
discomfort when eating, drinking and/or talking
a dry mouth
reduced sense of taste
bad breath

Tell your care team if you have any of these problems. They may recommend painkillers or special mouthwashes that can help.

Avoiding spicy, salty or sharp foods can also help.

Mucositis usually clears up a few weeks after chemotherapy finishes.

Loss of appetite

You may lose your appetite while you're having chemotherapy, but you should try to drink plenty of fluids and eat what you can.

It may help to:

eat smaller meals more often instead of three large meals a day
eat healthy snacks regularly
eat light meals on the day of your treatment
sip drinks slowly through a straw, rather than drinking them straight from a glass

Tell your care team if you're worried about your diet or lack of appetite.

Skin and nail changes

Some chemotherapy medicines can cause temporary changes to your skin.

For example, it may become:

dry
slightly discoloured (this may be patchy)
more sensitive to sunlight
red and sore
itchy

Talk to your care team if you have any problems with your skin. They can advise you about creams that can help and how to protect your skin from the sun.

Chemotherapy can also make your nails become brittle or flaky, and white lines may develop across them. This should go back to normal after your treatment has finished.

Using moisturiser on your nails may help and nail varnish (but not quick-drying varnish or false nails) can be used to cover your nails during treatment if you like.

Memory and concentration problems

Some people have problems with their short-term memory, concentration and attention span during chemotherapy. You may find that routine tasks take much longer than usual.

It's unclear why this happens, but the symptoms usually improve once treatment is finished.

Things such as using lists, post-it notes, calendars and your mobile phone for reminders can help. Doing some mental exercises, eating well, and getting enough rest may also be useful.

Sleep problems

Some people having chemotherapy have difficulty falling asleep, or wake up in the middle of the night and can't get back to sleep. This is known as insomnia.

The following may help to improve your sleep:

set regular times for going to bed and waking up
relax before bed time – try taking a warm bath or listening to calming music
use thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
avoid caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed
avoid watching TV or using phones, tablets or computers shortly before going to bed
write a list of your worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning

Contact your care team if this advice doesn't work, as you may need additional treatment. Read more about treatments for insomnia.

Sex and fertility issues

Many people find that they lose interest in sex during chemotherapy. This is usually temporary and your sex drive should gradually return after your treatment has finished.

Some chemotherapy medicines can also reduce fertility in men and women. This is often temporary, but can be permanent in some cases.

Before starting treatment, ask your care team whether your fertility may be affected. If you're at risk of infertility, they will discuss your options with you.

Women may be able to have their eggs frozen to be used later in IVF. Men may be able to have a sample of their sperm frozen so it can be used for artificial insemination at a later date.

You should avoid becoming pregnant or fathering a child during your treatment, as chemotherapy medicines could harm the baby. Use a barrier method of contraception, such as a condom.

Diarrhoea and constipation

You may have diarrhoea or constipation a few days after you begin chemotherapy.

Your care team can recommend suitable medication and diet changes that can help.

Read more about diarrhoea treatments and constipation treatments.

Emotional issues

Having chemotherapy can be a frustrating, stressful and traumatic experience. It's natural to feel anxious and to wonder if your treatment will be successful.

Stress and anxiety can also increase your risk of getting depression.

Speak to your care team if you're struggling to cope emotionally. They can offer support and discuss possible treatment strategies.

Joining a cancer support group may also help. Talking to other people in a similar situation can often reduce feelings of isolation and stress.

The charity Macmillan Cancer Support has a directory of support groups . You can also call the Macmillan Support Line free on 0808 808 00 00 (Monday to Friday, 9am-8pm).

When to get urgent medical advice

While the side effects of chemotherapy can be distressing, most aren't serious.

But contact your care team immediately if you have any of the following symptoms:

a high temperature of 38C (100.4F) or above
shivering
breathing difficulties
chest pain
flu-like symptoms – such as muscle aches and pain
bleeding gums or nose
bleeding from another part of the body that doesn't stop after applying pressure for 10 minutes
mouth ulcers that stop you eating or drinking
vomiting that continues despite taking anti-sickness medication
four or more bouts of diarrhoea in a day

You should have been given a card with emergency phone numbers to call. Ring NHS 111 if you don't have a card or can't find it.

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Chemotherapy - Side Effects