Why Side Effects Happen
Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. Cells commonly affected by chemotherapy are those in the bone marrow, mouth, digestive system, reproductive system, and hair follicles.
Most chemotherapy treatments inhibit cell division, and, therefore, will affect not only cancer cells but also normal cells that undergo active division like cells of the gastro-intestinal tract, for example.
What Are the Side Effects?
Certain classes of chemotherapy drugs are more frequently associated with side effects.
Common Side Effects
Dry Skin
Chemotherapy agents may induce dryness and peeling of the skin. A study involving chemotherapy patients receiving hormonal treatments reported dry skin as the most common side-effect (60.86%). To manage this side effect, stay hydrated, avoid exposure to a harsh climate, and avoid personal soaps and detergents without artificial dyes or fragrances when possible. Wear protective gloves while doing tasks such as household dishes or gardening, and use moisturizing body oil after showering.
Dry skin is extremely common with radiation treatments. It is so common that you may hear it referred to as “radiation dermatitis” or “radiodermatitis.” This is because your skin may not have enough time to regenerate healthy cells following the radiation damage. If you are having radiation on a part of the body where the skin is more delicate, such as the neck, you may be more prone to skin reactions. If your skin is already damaged, such as from sun exposure, these side effects may be worsened. It is estimated that 95% of those undergoing radiation treatment will experience some form of skin reaction.
Rashes
Rashes appear as discoloration of the skin and can be smooth or flat. Often, rashes cause irritation such as itching. Those with rashes as a result of their chemotherapy treatment should stay hydrated, avoid exposure to a harsh climate, and avoid personal soaps and detergents without artificial dyes or fragrances when possible. They may also want to opt for loose-fitting, cotton fabrics that may be more comfortable and avoid excessively hot baths. Colloidal oatmeal suspensions can be found in a variety of products, such as available in bath soaps. Studies have demonstrated that colloidal oatmeal can help with skin inflammation.
Some chemotherapies can make you extra sensitive to sunlight. This is called photosensitivity. It can mean you become red or burn from the sun more easily.
Fatigue
Fatigue is the most common side effect of cancer treatment. It can be caused by a variety of reasons, such as the death of healthy cells and psychological stress. Maintain a healthy lifestyle to the extent possible. For example, if you do not have the energy to go for a walk, discuss developing seated exercises with your provider. Stay hydrated and keep up with whole foods.
Nausea
Chemotherapy drugs can trigger the chemotherapy receptor zone (CTZ), which can cause nausea. Avoid foods with a strong smell (such as anchovies) and greasy foods. Eat small meals and rest after each meal. Consume beverages at room temperature. Your healthcare provider may be able to help prescribe a medication to help with nausea. Hydration is very important because nausea may induce vomiting, which can lead to dehydration.
Constipation
Constipation occurs when bowel movements are infrequent, dry, and hard. Constipation can occur as a result of cancer itself, or as the result of cancer therapies, or a combination. Staying hydrated can help soften stools. FIber, stimulant laxatives, or enemas are potential treatments. Auricular acupressure was found to be effective in reducing constipation in one study.
Hair Loss
Certain drugs have been deemed more likely to cause hair loss than others. Hormonal therapies are most associated with hair thinning. Some people choose to purchase a wig, and you can check to see if your insurance company will cover the cost. If you choose to forgo a wig, stock up on a nice selection of hats and/or headscarves! Some companies donate hats and headscarves for chemotherapy patients. Programs like Look Better, Feel Better help people adjust to changes in their appearance through support groups and beauty guides.
Diarrhea
Chemotherapy may damage the cells that line your intestines and cause loose stools. In certain cases, you may need to have IV therapy for remedial hydration. Diarrhea can cause complications such as renal failure and electrolyte disorders. Drinking beverages at room temperature and avoiding greasy, fatty foods can help. Remember the acronym BRAT: It stands for bananas, rice, apples, and toast. These are foods that are generally well-tolerated by an upset stomach.
Sexual or Reproductive Issues
People going through chemotherapy may experience erectile dysfunction (ED), or vaginal dryness.
Side Effects Timeline
Cancer cells tend to grow rapidly so chemotherapy drugs are developed to target rapidly growing cells. Our bodies also have healthy cells which grow rapidly. When healthy cells are damaged by chemotherapy, side effects often occur. Healthy cells which grow rapidly and are most often adversely affected by chemotherapy include:
Hair folliclesBlood-forming cells in bone marrowCells in the digestive tract, mouth and reproductive system.
Each person responds to chemotherapy differently so some people may not experience many side effects while other people might have several side effects. Side effects can also vary by the how chemotherapy is administered, such as an oral pill versus an intravenous infusion of chemotherapy medication.
When to expect side effects is difficult to predict due to the different types and durations of chemotherapy plus each person’s unique response to chemotherapy treatment. However, here are some general time frames when side effects can be expected:
Hair loss: Hair loss can start within two weeks of chemotherapy and continue for up to two months later. Nausea and/or vomiting: Nausea and/or vomiting can occur within a few hours or be delayed by a few days after a chemotherapy treatment. Diarrhea or constipation: Diarrhea or constipation can occur within a few hours to a few days after a chemotherapy treatment. A recent study indicates these symptoms might be related to how chemotherapy impacts the movement of the intestines instead of solely being related to how chemotherapy adversely affects the rapidly dividing cells in the intestines. Fatigue: Fatigue is often the most common side effect and typically occurs during or shortly after a treatment. Dry skin or rashes: Skin problems can occur at any time during the chemotherapy regimen, often developing a few weeks after the start of chemotherapy.
Long-Term Effects/Late Effects
Most side effects go away after treatment, but some of them continue, come back, or develop later. A number of long-term effects are associated with chemotherapy treatment.
Cardiac Concerns
Those who have treatment for left-sided breast cancer may experience damage to the heart and coronary arteries. It is important to speak with your oncologist about these concerns. A respiratory grating is a technique used for left-sided breast cancer that can help mitigate these effects.
Fatigue
Many people feel fatigued long after their chemotherapy has finished. It is important to share this with your provider. Frustrating cognitive effects, sometimes referred to as chemobrain, can be very frustrating, but the symptoms usually improve over time.
Infertility
Infertility following treatment varies by treatment type and dose. It is important to let your care team know if you want to have children or may want to. They can discuss options with you such as sperm preservation, embryo preservation, and freezing eggs.
Peripheral neuropathy
Peripheral neuropathy may present as numbness and burning in your feet and hands and constipation. Some drugs that are more likely to cause peripheral neuropathy are Taxotere (docetaxel) and Taxol (paclitaxel). The medications Platinol (cisplatin), Oncovin (vincristine), and Novelbine (vinorelbine), can also result in peripheral neuropathy.
Hearing Loss
Platinol (cisplatin) is commonly linked to hearing loss (ototoxicity).
Osteoporosis
This is the most common delayed effect of chemotherapy. Osteoporosis can make bones more vulnerable to fracture and lead to bone loss.
Pulmonary fibrosis
Chemotherapy can lead to pulmonary fibrosis in certain people, especially when chemotherapy is combined with radiation to the chest region.
Kidney and Bladder Effects
Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood. Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine. People on chemotherapy often receive steroids, which can hasten the development of cataracts in some people.
A Word From Verywell
Concerns about side effects prior to beginning treatment for chemotherapy are normal. There is a wealth of information available on the specific symptoms associated with personal factors and specific chemotherapy agents. Every treatment path is unique. Maintaining an optimistic attitude and relying on your support system can help to significantly reduce anxiety. Although it is important to take time to research your care, it is also important to take time to disconnect and relax.
After the initial breakdown period is completed, there is a small period of rest where the body is able to recover and build new healthy cells. How the body adjusts to chemotherapy depends on each individual person’s unique response to the chemotherapy, the length of the chemotherapy cycle as well as what chemotherapy medications are administered.
