Managing chemotherapy side effects
While chemotherapy can kill cancer cells, it can also affect normal cells that grow or
divide rapidly, such as those in the bone marrow, digestive tract, skin, hair and
reproductive organs. When the normal cells are damaged, this causes side effects.

Feeling tired and lacking energy
Appetite changes, nausea or vomiting
Hair loss
Skin and nail changes
Mouth sores
Memory and concentration changes
Effects on the blood and immune system
Change in hearing
Constipation and diarrhoea
Sex and fertility
Nerve and muscle effects

Feeling tired and lacking energy
Feeling tired and lacking energy (fatigue) is the most common and often,
debilitating side effect of chemotherapy. Fatigue can include feeling exhausted,
drowsy, confused or impatient. You may have a heavy feeling in your limbs, or find
it difficult to do daily activities.
Fatigue can appear suddenly and rest may not relieve it. You might still feel tired for
weeks or months after a treatment cycle ends.
Save your energy. Help your body recover by doing only the things you really need
to do and resting more.
Let people help you. Family, friends and neighbours often want to assist but may
feel unsure about what to do. They could help with shopping, driving, housework or
If you have children, ask for help looking after them during chemotherapy and a few
days afterwards.
Plan activities for the time of day when you tend to feel most energetic.

Talk to your health care team about suitable activities for you. Check with your doctor whether your fatigue is related to low red blood cells (anaemia) so that this can be treated. Chemotherapy can make you feel sick (nauseated) or cause you to vomit. such as walking. Not everyone feels sick during or after chemotherapy but. and/or keep up with your normal exercise routine.Do light exercise. reducing your hours or working from home. It may be available as: injections – usually given before chemotherapy tablets – can be taken regularly at home liquids – added to the chemotherapy wafers – dissolved under or on top of the tongue suppositories – placed in the rectum where they dissolve. . nausea or vomiting It is common for your appetite to change when you are going through chemotherapy. For a copy of Cancer Council’s Relaxation and Meditation CDs. Appetite changes. let your nurse or doctor know. If you still have nausea or vomiting after using the prescribed medication. Nausea may last for many hours and be accompanied by vomiting or retching. Anti-nausea (anti-emetic) medication helps most people avoid chemotherapy related nausea or vomiting. it usually starts a few hours after treatment. Sometimes nausea lasts for days after treatment. call 13 11 20. Regular exercise can help reduce fatigue and increase appetite. or you may not enjoy the foods you used to like or crave foods you don’t usually eat. This medicine can be taken before. if nausea affects you. Some workplaces may allow you to work flexibly during or after chemotherapy. Your medical oncologist will tell you if the drugs you are given are likely to cause nausea and vomiting. Sometimes you may not feel hungry. Try to eat a well-balanced diet with plenty of fruits and vegetables. Options include taking a few weeks off work. Finding a combination of anti-nausea medication that works for you can take time. and some drugs temporarily change the taste of foods. Discuss the impact of your treatment with your employer. Do relaxation or meditation exercises to see if they improve your sleep or give you more energy. during or after treatment.

eat a dry biscuit or a slice of toast rather than skipping food altogether or forcing yourself to have a full meal. Have small. others lose it after several treatments. try to keep your fluids up so that you don’t get dehydrated. Your sense of taste should return to normal after treatment ends. If the taste of certain types of food has changed. when you feel like it. If your stomach is upset. Chew your food well to make it easier to digest. Sucking on ice cubes. Prepare meals between treatments and freeze them for the days you don’t feel like cooking. For example. Eat and drink slowly. Hair loss Many people having chemotherapy worry about hair loss. Sip fluids throughout the day. If you aren’t able to keep fluids down. .g. Some people lose all their hair quickly. Speak to the hospital dietitian for advice about eating. but it may take some time. Breathe deeply and gently through your mouth if you feel like you’re going to vomit. If you wake up feeling sick. contact your doctor immediately. Avoid strong odours and cooking smells.Being unable to keep liquids down because of vomiting can cause you to become dehydrated. soup and dry biscuits or toast). or others may only lose a little hair or none at all. Eat a light meal before your treatment (e. Eat what you feel like. frequent snacks instead of large meals. If you are nauseous or have vomited a lot. rather than trying to drink a lot at once. try drinking fizzy drinks such as soda water or dry ginger ale. Ask your treatment team about taking a stool softener if the drugs make you constipated. don’t force yourself to eat them. have cereal at dinner time and a main meal at lunch. and drink as much fluid as possible. ice-blocks or jellies can also help to increase your fluid intake.

This can be less upsetting. When hair loss does occur. Check with your nurse before using any other hair or skin care products. tender or tingly. it may be a different colour or curly (even if you have always had straight hair). rollers and harsh products. especially if long. scarf or turban. arms. chest and pubic region. and they may develop pimples on their scalp. Although losing head hair is most common. Ask your doctor if hair loss is a possibility and how you can prepare. Test a small area of hair for a reaction before colouring your whole head. Before. or if you have a lot of discomfort and itchiness. In time your hair usually returns to its normal condition. It takes 4–12 months to grow back a full head of hair. legs. Talk to your hairdresser about making your hair look as good as possible even if it is thin or patchy. before it falls out. Do whatever feels the most comfortable and gives you the most confidence. It’s natural to feel this way. You may feel that your hair is part of your overall image and its loss can make you feel physically unattractive. Use a mild shampoo like baby shampoo. Tell your nurse or doctor if the skin on your scalp is very sensitive. or to collect hair. toupee. wear glasses or sunglasses to protect your eyes from the dust and sun while outside. Some people find that the skin on their head is extra sensitive. you may also lose hair from your eyebrows. When your hair first grows back. hat. Comb or brush your hair gently using a large comb or hairbrush with soft bristles. your scalp may feel hot. use sorbolene. Wear a wig. as nylon can irritate your scalp. eyelashes. and while your hair is falling out.based dyes or those low in chemicals. If you want to use lotion on your head. Use a cotton.Whether or not you lose your hair depends on the drugs you receive. If your eyelashes fall out. If you prefer to leave your head bare. Keep your hair and scalp very clean. vulnerable or sad. Limit the use of hair dryers. If you want to dye your hair. itchy. protect it against sunburn and the cold. Cut your hair. it usually starts 2–3 weeks after the first treatment and grows back when chemotherapy is completed. use vegetable. . Talking to your medical team may be helpful. polyester or satin pillowcase. Wear a light cotton turban or beanie to bed if you are cold at night. Many people find losing their hair very difficult. Some drugs don’t cause this side effect.

Avoid chlorinated swimming pools as the water can make skin changes worse. tell your doctor or nurse immediately. gently pat your skin dry with a towel. ulcers or thickened saliva. This is more likely if you have had or are having radiation to the head. It is also likely to be more sensitive to the sun. Wear loose. Use a moisturising soap or sorbolene cream as a soap replacement. This advice applies to everyone. Try not to rub your skin too hard. or have white lines across them. Protect your skin from the sun – especially between 10am and 3pm – by wearing high-protection sunscreen (SPF 50+). If you notice any change in your mouth or throat. . contact your doctor. Stop shaving or waxing until your skin is completely healed. peel or become dry and itchy. a hat and protective clothing. but is especially important for people having chemotherapy. check with your fund if you are eligible for a rebate. Skin and nail changes Some chemotherapy drugs can affect your skin. Consider choosing a wig before chemotherapy starts. It can darken. neck or chest. Call Cancer Council Helpline 13 11 20 for assistance in finding a wig library or shop. After showering. Wash your clothing in mild detergent for people with sensitive skin.A fact sheet with more information about how to cope with and manage hair loss as a side effect of cancer treatment is available to download online. Mouth sores Some chemotherapy drugs can cause mouth sores such as ulcers or infections. You can borrow a wig from hospitals or treatment centres with a wig library. during and after treatment. such as sores. Some people find their nails also change and become brittle and dry. Choose cotton fabric instead of rough wool or synthetic fibres. or if you have dental or gum problems. develop ridges. If you want to buy a wig and you have private health insurance. non-restricting clothing. If your skin becomes red or sore in the area where the intravenous device went in. Use a moisturising lotion or cream containing the ingredient urea to stop the dryness. or if you find it difficult to swallow.

Moisten foods with butter and sauces. Blend foods to make them easier to eat. If you need any dental work. Learn something new. and spicy. exercise and memory games can help. Write down what you have to remember. (e. take up a new hobby. Avoid very hot foods. You may find that it takes you more time to process information. Sip fluids. This is called cognitive impairment or. birthdays. Choose activities that require less concentration. nuts or grains). as these can aggravate mouth sores. or you may experience short-term memory loss or have trouble concentrating for long periods. read magazines with short articles instead of books with several characters or complex storylines. make to-do lists or record where you parked the car. Don’t smoke or drink alcohol. especially water. For example. or do crosswords or number puzzles. Try a homemade mouthwash (1 tsp bicarbonate of soda or salt in a glass of warm water) at least four times a day. and eat moist foods such as casseroles or soups if you have a dry mouth. as this irritates the mouth.Discuss any dental problems with your doctor before seeing the dentist. tell your dentist you are having chemotherapy. sometimes.g. . acidic or coarse foods. Try sucking on ice while you’re having intravenous chemotherapy to reduce mouth ulcers. Use a soft toothbrush to clean your teeth twice a day. There is some evidence that self-help techniques such as relaxation. For example. social commitments. etc. Keep your mouth clean and use a mouthwash to help heal mouth sores.‘chemo brain’. Use a calendar to keep track of tasks. Memory and concentration changes Some people say they have trouble thinking clearly following chemotherapy. Don’t use commercial mouthwashes containing alcohol as they may dry out or irritate your mouth. Start when treatment commences to prevent mouth ulcers occurring. Tell your doctor if this issue is affecting your day-to-day life. Soothe tender gums and mouth sores with plain yoghurt. appointments.

Your health care team will do regular blood tests to make sure your blood cells return to normal levels before your next treatment. infections and bleeding problems. If the number of neutrophils (a type of white blood cell that help protect against infection) drop during chemotherapy. You may need a blood transfusion to build up your red blood cells and treat the anaemia. such as in the morning. which is the soft and spongy material inside the bones. lethargic. The bone marrow makes three types of blood cells: red blood cells – carry oxygen throughout the body white blood cells – fight infection platelets – help blood to clot and prevent bruising. Deep sleep is important for memory and concentration. Infections If white blood cell numbers drop during chemotherapy. When chemotherapy affects the bone marrow. Talk to your partner. The count may fall with each treatment. This can make you feel tired. your blood count is reduced. depending on the type of blood cell affected.Plan activities so you do things that require more concentration when you are fresher. it can make you more prone to infections. This may help you to clear your mind and sleep better. Eating a nourishing diet with foods rich in iron and B vitamins is also important if you are anaemic. This can cause problems such as anaemia. This can help prevent misunderstandings and frustration. lean meat and green leafy vegetables. Your doctor or nurse will . Sometimes doctors recommend taking antibiotics as a precaution against infection. Good sources include wholegrain breads and cereals. Anaemia A low red blood cell count is called anaemia. The bone marrow’s job is to maintain normal levels of blood cells (your blood count) to keep you fit and healthy. Get plenty of sleep. Effects on the blood and immune system Some chemotherapy drugs affect the bone marrow. family or friends about how you’re feeling. you may be given an injection of granulocytecolony stimulating factor (G-CSF) after chemotherapy. Do light exercise each day. dizzy or breathless.

soapy water. Wash your hands with soap and water before preparing food and eating. constipation or diarrhoea unusual bleeding redness or swelling around the site of the intravenous chemotherapy device any serious unexpected side effects or sudden deterioration in health. Wash fruits and vegetables well.speak to you about possible side effects. Put leftover food in airtight containers in the fridge as soon as possible. unpasteurised dairy products and soft-serve ice-creams. raw or rare fish. contact your GP or treating specialist if you experience other symptoms that may be due to an infection. Some people may experience bone pain or tenderness at the injection site. Don’t eat food or drinks past their use-by or best before dates. or easy bruising. Try to eat freshly cooked or prepared foods. or show signs of an allergic reaction. Avoid pre-made sandwiches. Store raw and cooked foods separately. burning or stinging on passing urine. When to contact your doctor Contact your doctor or treatment centre urgently if any of the following occur: chills or sweats a temperature of 38°C or more persistent or severe vomiting severe abdominal pain. . Also. sweating. soft cheeses. Cook food thoroughly to reduce the risk of bacteria developing. sore throat. For example. meat and eggs. and after using the toilet. Managing the risk of infections when your immunity is low Check your temperature every day. See your doctor if you are unwell. Use separate chopping boards and utensils for raw and cooked foods. especially at night. salads and takeaway. or peel where possible. mouth ulcers. even if you just have a cold. and clean thoroughly with hot.

While these changes are usually temporary. . if appropriate. knives or razors. which contains bacteria. You may be at risk of losing the ability to hear high-pitched sounds. shopping centres or public pools to reduce the risk of picking up an infection. Tell your doctor or nurse if your bowel habits have changed. measles. This is not always practical. pain relief medicines and anti-nausea drugs can cause constipation or diarrhoea. mumps. Avoid crowded places such as public transport during rush hour. conjunctivitis. let your doctor know if you notice any change in your hearing. Use a soft toothbrush to avoid irritating your gums. Small cuts or nicks can harbour germs where an infection can start. If you have problems with bleeding. Your doctor may recommend that you have a hearing test before you start treatment.Avoid people who are unwell. You may need a platelet transfusion if they are low. Chemotherapy can also cause a continuous ringing noise in the ears known as tinnitus. Use an electric razor when shaving to reduce the chance of nicking yourself. apply pressure for about 10 minutes and bandage. or to bruise more easily. Wear thick gloves when gardening to avoid injury. If you bleed. talk to your doctor Change in hearing Some chemotherapy drugs can affect your hearing. Check with your doctor about having the flu vaccine if you are having chemotherapy in winter. Bleeding problems A decrease in platelets can cause you to bleed for longer than normal after minor cuts or scrapes. so use your commonsense. and to prevent infection from soil. Constipation or diarrhoea Some chemotherapy drugs. Let your doctor know if you think you have been in close contact to someone with chicken pox. needles. Be careful when using scissors. especially if they have the flu. a cold sore or chickenpox.

Changes in sexuality Many people have a range of worries that cause them to lose interest in sex while they’re having treatment. Drink water to help replace the fluids lost through diarrhoea. as these may further stimulate the bowel. wholegrain products. baked beans or lentils). nuts and legumes (For example. fruit juice. Do some light exercise. They may change your medication or give you other medication to relieve it. or there may be a physical reason for not being able or ready to have sex. Aside from feeling tired and unwell. Try prune. Drink plenty of other fluids. Limit alcohol. it can cause dehydration and you may need to be admitted to hospital. fruit and vegetables. soft drinks. This can lead to a temporary or permanent effect on your ability to have children (your fertility). bran. Don’t use enemas or suppositories.Constipation Eat more high-fibre foods. Let your doctor or nurse know if you have constipation for more than a couple of days. Diarrhoea Choose bland foods such as clear broth or boiled rice. both warm and cold. Sex and fertility Chemotherapy may impact on your desire or ability to have sex. . fatty or fried foods. such as walking. Talk to your pharmacist for advice about using over-the-counter medications to treat diarrhoea at home. and raw fruits or vegetables with skins or seeds. you may feel less confident about who you are and what you can do. If the diarrhoea becomes severe. apple or pear juice. to help loosen the bowels. They are not recommended for people having chemotherapy. Ease constipation by drinking fruit juice. Avoid spicy foods. such as wholegrain bread and pasta. It may also affect sexual organs and functioning in both women and men. vaginal dryness or erection difficulties are common issues after treatment. rich gravies and sauces. For example. strong tea or coffee and dairy products.

women can’t have children. and men should not father a child. it is still possible for some women to become pregnant while having chemotherapy. This is called osteoporosis. but closeness and sharing can still be a part of your relationship. in the long term. and a man having chemotherapy could still make his partner pregnant. sweating – especially at night – and dry skin. The ability to get and keep an erection may also be affected but this is usually temporary. Effects on men Chemotherapy drugs may lower the number of sperm produced and reduce their ability to move. Talk to your doctor about ways to manage menopausal symptoms.Partners may also feel concerned about having sex – they might fear injuring the person with cancer or feel uncomfortable with the changes in their partner. Effects on women For some women. If the problem is ongoing. . Chemotherapy drugs can harm an unborn baby. Talk about how you’re feeling with your partner. periods become irregular during chemotherapy but return to normal after treatment. Menopause – particularly if before age 40 – may. cause bones to become weaker and break more easily. After menopause. Women may be able to store eggs (ova) or embryos and men may be able to store sperm for use at a later date. chemotherapy may cause periods to stop completely (menopause). This needs to be done before chemotherapy starts. For others. mind and personality) instead of focusing only on what has changed. and take time to adapt to any changes. Contraception Although chemotherapy reduces fertility. you should take safety precautions. seek medical advice. This can sometimes cause infertility. which may be temporary or permanent. Changes in fertility If you want to have children in the future. If you have sex after receiving chemotherapy. talk to your doctor about how chemotherapy might affect you and what options are available. Try to see yourself as a whole person (body. Signs of menopause include hot flushes. so women should not become pregnant during the course of chemotherapy. Sexual intercourse may not always be possible.

condoms). tell your doctor or nurse before your next treatment. and muscle weakness in your legs. . Your treatment may need to be changed or the problem carefully monitored. Nerve and muscle effects Some drugs can cause tingling and loss of sensation in your fingers and/or toes.Should you or your partner become pregnant.g. which provide protection against any cytotoxic drug by-products that may be secreted in body f luids. Young women may be prescribed the Pill as a contraceptive and to help protect the ovaries from the effects of chemotherapy. The type of birth control you choose will depend on what you and your partner are comfortable using. Some people use barrier contraception (e. talk to your treating doctor immediately. If this happens.