Every person experiences chemotherapy differently, both physically and emotionally. Each person experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects. Fortunately, as the science of cancer treatment has advanced, so has the science of managing treatment side effects.
Whatever you experience, remember there is no relationship between how the chemotherapy makes you feel and whether you derive benefit from it.
Many people feel fine for the first few hours following chemotherapy. Usually, some reaction occurs about four to six hours later. However, some people don't react until 12 or even 24 to 48 hours after treatment. Some people experience almost all of the side effects described below, while others experience almost none.
We have many treatments to help you deal with side effects. Please let us know how you are feeling, so that we can address your concerns and help make you more comfortable.
Your well-being is very important to us. There is a delicate balance between the benefits of chemotherapy and the harm of possible side effects. Please tell your doctor if you feel that the harm outweighs the benefit.
Before starting chemotherapy we suggest that you take care of some of your basic health needs. If time permits, have your teeth cleaned before rather than while you are having chemotherapy. If you need major dental work, try to postpone it until after chemotherapy. If you need your teeth cleaned while receiving chemotherapy, please let your doctor or nurse know beforehand. Please discuss any concerns with your doctor or nurse.
You can have a family member, friend or support person accompany you to your chemotherapy sessions. We recognize that cancer has an impact on you as a whole person and also on your family and loved ones.
To varying degrees, all people with cancer struggle with the challenges of coping and adjusting to these life changes. At the Cancer Center, we have a number of programs to support you through the process, such as the Peer Support Program, support groups and individual counseling, that are available to all cancer patients.
Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are made in the bone marrow and help fight against infection. Neutrophils are one type of WBC that fights infection. Often your neutrophil count will determine whether or not you will receive chemotherapy on schedule.
A fever of 101° Fahrenheit (38.3° Celsius), or chills with or without a fever, can be a serious sign of infection. You must call your cancer specialist even if it's at night or on the weekend.
An infection is most likely to occur when your neutrophil count is low. You are most susceptible to a bacterial infection about seven to 12 days after your chemotherapy infusion. Most bacterial infections result from your body's inability to fight off normal bacteria present in your gastrointestinal tract or skin. Bacterial infections do not commonly result from being in a crowded place. So, if you are feeling well, we encourage you to continue to go out to the movies or out for a meal.
However, viral infections such as colds and flu are common and are transmitted easily from other people. To reduce your chance of infection, wash your hands frequently and avoid close contact with anyone who is ill during this time.
The table below will help you understand your temperature in both Fahrenheit and Centigrade:
Remember, always call your doctor if you have a temperature of 101° Fahrenheit (38.3° Centigrade) or higher.
Around the third day following a chemotherapy treatment, some people may experience flu-like symptoms such as muscle aches and pains. If you experience these aches, you can take over-the-counter medications such as Tylenol or Advil. If necessary, contact your doctor for stronger medication.
Medications called antiemetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your doctor or nurse will recommend what is expected to work best for you.
If possible, have your prescriptions filled before your treatment day. Please call your doctor or nurse if your medications do not give you adequate relief or if you experience side effects with the anti-nausea medication.
Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy.
Most people have to make some adjustment in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. As much as possible, try to maintain your everyday activities. It can be very beneficial to both your physical and emotional recovery. The fatigue will go away after you recover from chemotherapy.
The Cancer Resource Center also hosts monthly Fatigue Management workshops to address these concerns. For more information, call (415) 885-3693.
Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect.
Most often, hair loss begins about two to three weeks after starting chemotherapy. Some people will lose relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you most comfortable. Many people choose different head coverings for different situations.
We have many resources to assist you during this time, including the Friend to Friend Gift Shop and the Look Good... Feel Better! program. Please visit the Cancer Resource Center on the first floor of 1600 Divisadero St. for additional referrals and resources for wig and head covering boutiques.
If you decide to buy a wig, try to buy one while you still have your own hair because you can better match color and style. You may want to ask your doctor for a prescription for a "cranial prosthesis" (i.e., a wig), as some insurance companies will only pay for a wig with a prescription for a cranial prosthesis.
Your hair will begin to grow back after you stop chemotherapy. It usually takes from two to three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its original texture after some time.
During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to odors. Don't worry if you don't have an appetite the first few days or a week following chemotherapy; it is not unusual. As you feel better, your appetite will improve.
Reflux — when food backs up into your esophagus — burping, or a burning sensation may worsen nausea. Please report these symptoms to your physician or nurse so that they can be treated. You may find that you can tolerate only certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids: eight to 10 eight-ounce glasses per day, more if you have a fever or diarrhea.
Recommendations for healthy nutrition include a diet low in fat (less than 20 percent fat) and high in whole grains, fruits and vegetables, and plant-based proteins. Some people want to begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed. Some people prefer small, slow changes, while others benefit from a "major overhaul." We encourage you to become informed and make healthy dietary and lifestyle changes.
Many people gain weight while on chemotherapy for reasons that are not well understood. Again, if you have concerns about nutrition, please consult our staff dietitian at (415) 885-3693.
Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24 hours or blood in your stool, call your doctor or nurse. Do NOT use over the counter anti-diarrhea medications like Imodium unless advised to do so by your physician or nurse.
Some chemotherapy and anti-nausea drugs can cause constipation. Also, you may be more prone to constipation because your activity level and diet have changed. If you experience constipation, contact your doctor or nurse the same day.
Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed.
Neuropathy, which literally means disease or dysfunction of the nerves, can happen to some people. Some of the most common symptoms of the type of neuropathy caused by chemotherapy include tingling and burning, numbness or pain in the affected areas, loss of your sense of position — knowing where a body part is without looking at it — and loss of balance. The most commonly affected areas are the tips of fingers and toes, although other areas are sometimes affected as well.
Tell your doctor about any symptoms that you experience. Early detection and treatment are the best way to control your symptoms and prevent further nerve damage.
For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause.
With menopause, you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. If you experience any of these symptoms, talk to your doctor or nurse to get information and treatment for the symptoms.
If your periods continue during treatment, they are likely to change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause.
If you have a question or concerns, staff will take your message and your nurse or physician will call you back. Please allow two days notice for medication refills.
If your call is urgent, please tell us immediately when you call.
If you are calling at night, on a weekend or a holiday, please call the same clinic number. You will speak with a staff member of the answering service who will take your name and number. A physician will be paged and will call you back. Please be prepared to tell the answering service:
Please remember that we are here to make this time less difficult for you and call us with any questions or concerns.
For additional information or resources, please visit:
Cancer Resource Center
1600 Divisadero St., First Floor
San Francisco, CA 94115
Reviewed by health care specialists at UCSF Medical Center.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.