Chemotherapy is a type of treatment to kill rapidly growing cancer cells. Chemotherapy drugs are used to treat many types of cancers.

Side Effects of Chemotherapy

Chemotherapy helps our body to kill rapidly growing cells but it also kills healthy cells which can cause side effects. Some side effects are mild and can be treated easily but sometimes they can cause serious complications. Here are some of the side effects caused from chemotherapy treatment: - 

1. Nausea and Vomiting.

2. Hair Loss (Alopecia).

3. Diarrhea and Constipation.

4. Fatigue.

5. Infection.

6. Loss of Appetite.

7. Change of Taste.

8. Peripheral Neuropathy (Impact over nerves)

9. Infertility and Sex.

10. Mouth Sores and Ulcers (Mucositis).                        

11. Hand and Foot Syndrome.

 

1. Nausea and Vomiting

Anti-Cancer treatment or chemotherapy can cause nausea and vomiting. It is a common side effect of cancer treatment and can be controlled easily. The following suggestions might help people with these side effects: - 

1. Drink plenty of fluids to prevent your body from dehydration.
2. Eat light meals and avoid spicy or junk foods.
3. Eat smaller meals at frequent intervals.
4. If you feel nausea or vomiting try drinking soda water or can also take aloe vera juice.
5. While on chemotherapy treatment your doctor may prescribe you anti-nausea medicines to prevent it from starting. Anti-nausea medicines may include Ondansetron (Emeset) and Metoclopramide (Perinorm). The following medicines can be taken to get relief: -

• Tab. Ondem 4MG thrice a day or 8mg twice a day.
• Tab. Perinorm 20mg twice a day.
• Tab. Dexa 4mg twice a day (Not to be taken if you are diabetic or on diabetes treatment.

Talk to your doctor before taking any medicines.

If you are not getting relief with the prescribed anti-nausea medicines or other preventive measures you should talk to your doctor to get relief. 

2. Hair Loss (Alopecia)

Hair loss due to chemotherapy also known as Alopecia in medical terms is a common side effect of chemotherapy drugs. Hair loss is the Temporary side effect of chemotherapy drugs and hair grows back after the completion of all the chemotherapy sessions. You can lose hair from other parts of your body during chemotherapy sessions like the head, face, underarms, and legs. To manage your hair loss here are some best possible ways: -

• Cool Cap: - While you are on chemotherapy you can use a cool cap. A cool cap is designed to make your scalp cool while on chemotherapy and helps in reducing hair loss. It reduces the blood flow to your scalp and prevents your scalp by reducing the amount of chemotherapy drug which reaches your scalp.
• Talk to your doctor about whether the cool cap is helpful to you or not as per your treatment plan.
  
  
• Short Hair: - You can also cut your hair short when your hair starts to fall out. As a Short hairstyle looks better or is less distressing or you can also shave your head completely.
  
  
• Wigs: - You can also purchase wigs to make your face look better. Talk with your wig stylist to create the best match for the wig and try to purchase a wig before losing any hair before for a better match.
  
  
• Soft hairbrush or comb: - Comb your hair gently or with a soft hairbrush to prevent hair loss.
  
  
• Avoid hair products: - If you are losing hair products like hair gels or dyes then try to avoid these chemical-based products till the chemotherapy treatment session ends. These products may harm your scalp.
  
  
• Scarves and Caps: - When you are outdoors you can wear a scarf or cap that may help your scalp from sunlight exposure and can also wear it normally if you are not wearing a wig.

3. Diarrhea and Constipation

You may suffer bowel movement changes that can cause diarrhea or constipation during chemotherapy treatment. In constipation, you face difficulty in passing stools or having hard stools and in diarrhea, you may have loose or watery stools. To prevent or manage this side effect you can do: - 

Inform your doctor before taking any medicines and also if diarrhea or constipation worsens and not getting relief from these medicines.

 

S.No	Constipation	Diarrhea
1.	Drink Plenty of fluids.	Drink plenty of fluids at least 2-3 liters a day and also, take supplements like ORS and Electrol.
2.	Eating of fiber-rich foods such as fresh fruits, vegetables,   and cereals.	Avoid junk or spicy foods.
3.	Do light exercises or jog to help in simulating bowel movements.	Eat a high protein diet.
4.	Your doctor may prescribe Bisacodyl Tablets (Dulcoflex) every 6 hours till constipation subsides.	Eat small frequent meals and snacks during the day.
5.	Take Lactulose or Cremaffin Syrup at bedtime.	Your doctor may prescribe Loperamide Capsule(Imodium) for every loose stool till diarrhea subsides. Take 2 Capsules of Immodium SOS  for diarrhea(Not to exceed 16mg/day).
6.		Add Prebiotics in your diet like Sporlac or Enterogermina.

 

4. Fatigue

Fatigue is the most common side effect of cancer treatment. Even cancer itself can cause fatigue. Fatigue impacts the quality of life and interferes with everyday routine work. Here are a few tips you can try to cope with fatigue during cancer treatment: - 

• Maintain your sleeping habits scheduled or limit your naps to less than an hour in the daytime to get proper sleep at night. Getting proper sleep helps in reducing fatigue. 
  
  
• Schedule time for rest in a day to reduce fatigue.
  
  
• Doing exercises or any other physical activity may help you preserve your energy level and is the best way to get rid of cancer-related fatigue.
• Sometimes treatment side effects make it hard to eat anything and because of this, your body didn’t get proper nutrition which may lead to fatigue. You can try eating frequent smaller meals instead of big meals or also get a diet chart made by the dietician to get proper nutrition.
  
  
• To reduce fatigue you can also keep your mind mentally refreshed by spending some time outside in the park or at a quiet place. This will make your mind mentally refreshed.
  
  
• There are a few medicines that may help ask your doctor about this.

5. Infection

Chemotherapy treatments increase the risk of infection as it lowers the number of white blood cell counts in your body. WBCs, help our body to fight infection. In medical terms, a lower count of WBCs in your body is called neutropenia. Here are some ways to prevent your body from infection while on chemotherapy: - 

• Maintain Hygiene: - While on chemotherapy you are recommended to maintain proper hygiene. Also, people who have a PICC line or Chemo port keep that area clean and dry always. Also, check your body for other signs of infection like fever and shivering.
  
  
•  Avoid Crowded Areas: - Avoid roaming in crowded areas and stay away from people who are sick and have a cold.
  
  
• Always wash your hands properly before and after eating food or after using the toilet.
  
  
• Eat freshly cooked foods and store food properly to avoid food poisoning. Also, avoid eating junk food.
  
  

5. Loss of Appetite

Sometimes you may not feel like eating anything during chemotherapy treatment. It is common in chemotherapy treatment or due to cancer itself. To manage appetite loss you may follow these steps: -

• Eat small frequent meals instead of large meals or eat when you feel like eating.
  
  
• Drink plenty of fluids if having a loss of appetite to prevent your body from dehydration.
  
  
• Eat light meals on treatment days and healthy snacks regularly.
  
  
• Medicines such as Megestrol and Cyproheptadine can be prescribed. Ask your doctor before taking any medicine.
  
  
• Talk to your doctor if having a loss of appetite during the treatment. 
  
  

7. Change of Taste

Change of taste is a common and temporary side effect of chemotherapy treatment. Which may lasts upto the treatment ends. To improve your taste changes you can follow these tips: -

• Eat food by adding extra flavor to it like add herbs, seasoning, and some extra spices.
  
  
• Always keep your mouth clean and healthy by brushing your teeth frequently to maintain oral hygiene.
  
  
• Rinse your mouth with warm soft water before eating anything that will help you to clear your taste buds.

If you are facing difficulty from the change of taste and do not feel like eating anything due to this feel free to contact your treating physician.

 

8. Peripheral Neuropathy (Impact over Nerves)

Certain chemotherapy drugs and other treatments for cancer can damage the nerves that control the movements and sensations of our hands, arms, legs, and feet. This is called peripheral neuropathy. If you have peripheral neuropathy you may feel tingling, burning, or pins and needles in your hands or feet. To cope with this situation you can try the following remedies: - 

• Exercise is the best treatment for people with peripheral neuropathy as exercise helps you in increasing blood flow to the hands or feet and you also get relief from pain by doing exercises. Yoga is the safest option for hand-feet movement exercises.
  
  
• Massage also helps in increasing blood flow to the hands or feet and may give you temporary relief from pain.
  
  
• It is recommended to avoid drinking alcohol.

If not getting relief your doctor may prescribe steroids or pain medications to reduce inflammation and pain. Always consult with your doctor before taking any medications.

9. Infertility 

Some of the chemotherapy drugs can slow down or stop you from producing sperm or Egg or any other fertility changes. The risk of permanent fertility changes is higher for people treated with some type of chemotherapy. Not all chemotherapies cause infertility. Your doctor will discuss you before starting your treatment. Your doctor will provide you with the following options for the future before starting treatment: - 

For Males: - 

Your doctor may guide you to preserve your sperm for the future in any authorized IVF center.

For Females: - 

Your doctor may prescribe you for Ovum preservation in any authorized I.V.F center.

Note - The sperm and ovum preservation process is to be done before starting chemotherapy and this process is to be done under the guidance of your treating physician.

10. Mouth Sores and Ulcers (Mucositis)

Anti Cancer drugs or therapy is a treatment to kill rapidly growing cancer cells but this treatment also kills healthy cells of our body which can lead to mouth sores and ulcers. In medical terms, mouth sores and ulcers occurring from anticancer drugs are known as Mucositis. It can be more painful and discomfort for the patient and can appear on any soft tissues of the mouth including your lips, tongue, gums, roof, and floor of the mouth. It is usually fully reversible and a temporary side effect of anti-cancer therapy. Sometimes it can extend into the esophagus tube that helps us in carrying the food to our stomach. Anti Cancer drugs or Head & Neck Radiation Therapy both can cause mouth ulcers and sores during the treatment if given alone or combined. Some examples of Intravenous and Oral anticancer drugs that can cause mouth ulcers & sores are as follows:-

• Intravenous Anticancer Drugs: - Cisplatin, Doxorubicin, Etoposide, Fluorouracil (5FU), Methotrexate, Carboplatin, Paclitaxel, and other drugs.

• Oral Anticancer Drugs: - Capecitabine, Lenvatinib, Lapatinib, Sunitinib, Sorafenib, Etoposide, Cyclophosphamide, and others.

Symptoms

Following are the few symptoms of mouth ulcers and sores: - 

1. Redness & Swelling inside the mouth: - During the anticancer treatment a patient may have redness and swelling over the lining of the mouth.
2. Painful Ulcers: - Having pain on the ulcers or on the site of inflammation.
3. Mouth Bleeding: - When bleeding occurs from mouth ulcers.
4. Pus or Mucus in Mouth: - Developing pus and mucus in the mouth may lead to mouth infection and main source of the development of mouth ulcers and sores.
5. Difficulty in eating or swallowing: - Mouth ulcers also prevent us from eating anything or create difficulty in swallowing.
6. Burning Sensations: - Burning sensation may develop while eating hot or cold foods.

Prevention

To prevent your mouth from mouth ulcers and sores following tips may help: - 

1. Quit Smoking: - During the course of treatment, a person has to quit his smoking habit as smoking prevents the mouth from healing itself and also develops difficulties in anticancer treatment.

2. Sucking of Ice Chips: - It is recommended to patients who are undergoing anticancer treatment to suck ice chips around their mouth half an hour before the treatment, Ice Chips can help in cooling the mouth & reduces the risk of mouth ulcers and sores.

3. Oral Hygiene: - To prevent your mouth from infection mouth cleaning is important. A mouth infection can cause painful mouth ulcers. Brushing teeth twice a day with soft bristles toothbrush.

4. Drink Plenty of Water: - It is recommended to drink plenty of water during the treatment to prevent your mouth from ulcers.

5. Avoid Drinking Alcohol: - Alcohol also irritates a mouth ulcer that’s why it is recommended to avoid intake of alcohol.

Treatment

These are the following treatment options to treat mouth ulcers and sores: - 

1. Salt water gargles: - If mouth ulcers and sores situation develop you can simply gargle with warm salt water on a regular basis.

2. Apply Topical Anesthetic Products: - If having painful mouth ulcers or sores you can apply topical anesthetic products that will help in reducing pain. Some examples are Hydrocort 1% gel, Zytee gel, and Orabase gel.

3. Mouth Washes: - To get relief from mouth ulcers you can use alcohol-free mouthwashes such as chlorhexidine mouthwash. Do not use alcohol-based mouthwashes.

4. Painkillers: - Some painkillers help in reducing pain from mouth ulcers like Naproxen, Diclofenac, and Paracetamol. Consult with your doctor before taking any medications.

5. Avoid Junk or Spicy Foods: - Avoid eating junk foods and spicy foods as it will lead to a burning sensation in your mouth.

6. Eating Soft and Moist Foods: - Soft and moist foods are easy to chew and swallow. While having ulcers in the mouth soft & moist foods are recommended. Some examples are Yogurt, Boiled Vegetables, Cooked Cereals, and others. Also, ensure that the food is cooled to room temperature before eating.

7. Stop Treatment Temporarily: - If not getting relief in mouth ulcers and sores from any treatment it Is possible to stop anticancer treatment for some days or reduce the dosage for relief. Consult with your doctor for any changes in treatment.

11. Hand and Foot Syndrome

Hand-foot syndrome or Hand-to-foot syndrome is a side effect that can cause redness, swelling, pain, or Itching sensation on the palms of the hands and soles of the feet which can occur with several types of Chemotherapy injections or Drugs used to treat cancer. A few Examples of Intravenous Chemotherapy and Oral Chemotherapy Drugs which can cause Hand-foot syndrome are as follows:  

• Intravenous Chemotherapy Drugs - Inj.  5-Flurouracil (5FU), Continuous infusion of Inj. Doxorubicin, Inj. Docetaxel, Inj. Paclitaxel and high dose of Interleukin-2.

• Oral Anticancer Drugs – Lenvatinib, Cabozantinib, Capecitabine, Axitinib, Pazopanib, and others.

Symptoms of Hand & Foot Syndrome

These are the few symptoms of hand-foot syndrome which can be mild or moderate if not get proper treatment of it.

1. Redness overhand or feet: - Redness is the common symptom of hand-foot syndrome which is similar to a sunburn.

2. Inflammation with pain: - People have inflammation in their hands or feet and also have pain in them.

3. Tingling or Burning: - If tingling and burning feelings develop in hands or feet.

4. Ulcers or Sores: - Developing of Ulcers and sores in hands or feet which can lead to mild discomfort to painful sensation on hands or feet.

5. Difficulty in doing any work or usual activities: - Hand-foot Syndrome also prevents us from doing daily routine work 

Like having trouble walking or having difficulty in picking up small things or doing any work.

Prevention

To prevent your hands and feet following tips may help:

• Avoid using hot water as much as possible while bathing or washing dishes or utensils.
• Taking cool showers or baths.
• Cool your hands and skin but do not apply ice directly to the skin.
• Avoid exposure to the sun or other heat sources.
• Avoid activities that cause pressure or rubbing on hands or feet like Aerobics, Jogging, and Sports playing, and avoid lifting heavy objects.
• Avoid contact with harmful chemicals used for household cleaning or washing detergents.
• Avoid using hard surface tools that require pressure on your hands like Knives, Screwdrivers.
• Don’t walk barefoot. Use soft slippers and loose-fitting shoes to move the air freely against your skin.
• Avoid rubbing lotions into your hands and feet. Can apply skin care creams to moisten your hands.

Treatment

The following options may help you to treat hand-foot syndrome:

• Pain Relievers: People with hand-foot syndrome can use lidocaine (Brand name) cream over painful areas in the palms and soles to reduce pain. Can also take pain medications like Naproxen for relief of inflammation and pain. Talk to your doctor before taking any medications.
• Gently Apply Moisturizing cream containing urea, salicylic acid, or ammonium lactate to moisturize the skin.
• To reduce pain and inflammation people can also apply steroid creams like Hydrocortisone cream to the hands & feet and can also take oral steroid medicines.
• If the condition is worsening and no relief from the steroid creams and medications it is possible to stop taking chemotherapy drugs for some days or can also reduce the dosage for relief. Consult with your doctor before stopping or doing any changes to the chemotherapy treatment.

Apart from this if you have any queries regarding your treatment you may talk to your treating physician.