Chemotherapy Treatment Side Effects

Chemotherapy is one of the most common treatments for cancer. It’s typically used to kill cancerous cells in the body, but it can also be used to control the growth of cancer cells and relieve disease-related symptoms.

Due to its powerful nature, chemotherapy can cause side effects in patients. We spoke with medical oncologist Adaeze Iheme, M.D., to learn more about chemotherapy side effects, how long they can last and how to manage them.

Common chemotherapy side effects

“Chemotherapy kills bad cells and good cells in the body,” says Iheme. “When chemotherapy kills the good cells, that’s when side effects occur.”

Some common side effects from chemotherapy include:

• Nausea: upset stomach
• Fatigue: intense exhaustion
• Hair loss: loss of hair on the scalp and other parts of the body
• Neuropathy: nerve damage that causes tingling, burning, weakness or numbness in the hands and/or feet
• Diarrhea and/or constipation: disruptions or changes to bowel functions
• Low blood count: A low red blood cell count can put you at risk for conditions like anemia and infections.  
• Chemobrain: difficulty remembering or processing information

The side effects from chemotherapy tend to be the worst the day after it’s administered.

“If you’re on a strong chemo regimen, usually the day after is when you’ll experience the worst symptoms,” says Iheme. “By worst, I mean you’ll experience the most fatigue, weakness and nausea. Normally, three or four days after chemo, your symptoms will get better.”

Most side effects last just for the duration of your chemotherapy treatment. However, some side effects, such as fatigue, neuropathy, hair loss and heart damage, can last a lifetime.

“But that’s rare,” says Iheme. “The good news for symptoms like fatigue is that a few weeks or months after you complete chemo, your body gets used to not receiving treatment and your fatigue will start to go away.”

How can chemotherapy side effects be managed?

Most times, the side effects from chemotherapy can be managed with medication or adjustments to your chemo dosage.

Nausea, vomiting and fatigue can be managed with medication. To manage neuropathy, physicians will often lessen a patient’s dosage and prescribe medications to help restimulate the growth of your nerves.

“That’s why it’s important to see your physician before every chemo cycle, especially if you’re on a very strong chemo regimen,” says Iheme. “We have to know if your symptoms get worse, so we can cut your dosage, if necessary.”

Patients should disclose their full medical history before beginning chemotherapy.

“We tailor your chemo treatments based on your current health status,” says Iheme. “We have to make sure we administer the right dosage – not giving you too much or too little – to prevent long-term side effects.”

For example, diabetic patients can receive chemotherapy, but it’s done with caution to prevent more nerve damage and other side effects that are more common in diabetics.

To help manage symptoms at home, Iheme advises patients to do the following:

• Stay hydrated by drinking 1 to 2 liters of water every day.
• Keep items you use frequently, like your phone, close by to cut down on having to move back and forth in your house. Less back-and-forth movement can help curb fatigue.
• Make a daily task list and use your smartphone or alarms to alert you of important things if you’re experiencing chemobrain.
• Go to sleep and wake up at the same time every day, so your body gets used to a routine.

What resources does MD Anderson offer patients undergoing chemotherapy?

MD Anderson offers several resources to chemotherapy patients.

One of these is MD Anderson’s Chemotherapy Guide, which is available to every patient who is about to begin chemotherapy. “It has information about everything, including side effects, hygiene and what to expect during chemotherapy,” Iheme says.

The Integrative Medicine Center also offers therapies and clinical services, such as nutrition counseling and health psychology, to help patients deal with the stress and anxiety of cancer treatment. Many patients say integrative medicine also helps curb their chemotherapy side effects.

Why is follow-up care after chemotherapy so important?

Aside from making sure the cancer doesn’t return, follow-up care after chemotherapy is important to check for any changes in your health.

“For example, if your blood counts are low, that could cause serious infections because your body no longer has a defense system,” says Iheme. “Follow-ups would include getting bloodwork and doing exams so that we can catch it early and intervene before serious or long-term side effects occur.”

What else should we know about chemotherapy side effects?

Iheme stresses the importance of taking every side effect seriously, especially diarrhea, which could indicate a serious infection. Your physician should be aware of any changes to your body or health.

If you are undergoing chemotherapy, you should contact your care team if you:

• have a fever of 100.5 degrees Fahrenheit or higher
• have diarrhea lasting more than two days
• are bleeding or have bruises anywhere on your body

Remember, side effects are common during and right after chemotherapy. If you begin to experience any side effects, speak with your care team, so they can determine the best way to manage your symptoms.  

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

If you're about to have chemotherapy for the first time, you might be wondering what to expect from this type of cancer treatment.

We asked our patients and caregivers to share their best advice for getting ready for chemotherapy – and the side effects that can sometimes come with it. Here’s what they had to say.

1. Get some rest

Fatigue is the most common side effect experienced by cancer patients, especially those undergoing chemotherapy. So, get plenty of rest and avoid pushing yourself too hard, even if you're feeling good.

Be patient with yourself and others, too, since it may take some time to get back your regular energy levels. And, remember: it’s OK to ask for help so that you can take it easy.

“Fatigue from chemotherapy is unlike any other,” says Joan Corson, a former ER nurse and triple-negative breast cancer survivor. “The closest I can compare it to is when kids are babies, and you’re so tired you can barely put one foot in front of the other.” 

2. Stay hydrated 

Diarrhea, vomiting and other chemotherapy side effects can leave you feeling dehydrated. Not only can this deplete your energy levels; it can also lead to other health issues. So, be sure to drink plenty of water during treatment. Decaffeinated tea, juices and milk can also help. If you’re having trouble getting enough liquids to stay hydrated, talk to your care team.

“Working as a pair helped us stay accountable,” explains Carrick Terhune, a young adult who helped her mother stay hydrated during treatment for a rare granular cell tumor. “If I noticed my mom starting to slow down, I reminded her to have some water. Hot temps and blazing sun? Bottoms up. Cozying up on the couch with a good movie? You guessed it: drink up, my friend. And every time she drank water, so did I.” 

3. Eat when you can

Chemotherapy can cause nausea and appetite loss, so it’s important to eat when you can to avoid becoming malnourished. Keep in mind that many foods may taste different as you go through treatment. For some patients, food can have a metallic aftertaste both during and after chemotherapy.

“My appetite was hearty right up until the end,” remembers Glen Haubold, a salivary gland cancer survivor. “Then the taste of food disappeared altogether, and everything started tasting like metal. I’d made it a point to eat normally until then, but I had to switch to liquid meals for the last two weeks.” 

4. Prepare for possible hair loss 

Most cancer patients who undergo chemotherapy experience  hair loss, usually starting around one to three weeks after their first treatment. For some, hair falls out gradually, while others wake up to big clumps on their pillow. Whether you lose your hair or not depends on the type and dosage of chemotherapy you’re receiving.  

Talk to your doctor about what to expect before starting treatment, then make plans for what you’ll do if and when you lose your hair. You might consider cutting your hair short or shaving your head, for instance, or decide to try out wigs, scarves, turbans or hats. 

“I always had long hair, but I wasn’t super attached to it,” recalls Gretchen Lee Herrera, a breast cancer survivor. “When it started coming out in clumps, I had my sister shave it off, so it wouldn’t be so scary. I felt beautiful at first. Other days, I felt like, ‘There is nothing attractive about this at all.’ After a while, though, I just embraced it, because it seemed symbolic of the seasons of life: how sometimes things can die off and then come back even stronger. My hair’s thicker now than it used to be.” 

5. Create a sense of normalcy

Stick to your normal daily routines as much as possible. This could be something as small as getting up and getting dressed every morning, or having a meal with your family each day. These rituals can help take your mind off cancer.

“I gave my days some structure by working on a huge paint-by-numbers project while I was in the hospital,” says David Saba, a double-hit lymphoma survivor. “It was totally mindless, but instead of trying not to vomit, I could focus on staying inside the lines. The bonus was that everyone started coming by to see how it was going.” 

6. Look to your support and care teams to have your back throughout treatment 

Going through chemotherapy is tough, so turn to your family, friends and care team for support. Our doctors and nurses will do everything they can to keep you comfortable. But it’s important to ask questions and voice concerns, so they can help when you're not.

“The teachers and staff at my elementary school prepared dinner for me and my family for over a month,” says Reneata Benjamin, a pancreatic cancer survivor. “The school counselor coordinated it all and made sure everything ran smoothly. And it truly was such a blessing. My mind was willing, but my body just wasn’t able to cook. Thanks to my colleagues, I didn’t have to worry about what my family was going to eat while I was going through cancer treatment.”   

7. Keep things around that bring you comfort

Bring your favorite blanket, a tasty snack, your best friend, a good book or whatever brings you the most comfort and keeps you busy while you wait. 

“The best gift I received was a custom-made blanket with my family’s names on it,” says Mark Teague, a throat cancer survivor. “It kept me warm while I was receiving chemo because sometimes the infusion rooms were very cold. And seeing all those names written out made me feel like my family was right there with me, even when they were up to 12 hours away.” 

8. Stay ahead of your nausea

Many patients experience nausea during and after chemotherapy. So, get your nausea prescriptions filled before you start, and take them exactly as directed before each treatment – so that they'll kick in before the nausea does.

“Some patients might think, ‘Well, I’m not feeling nauseated today, so I’ll just skip a dose,’” says Arthur Hamberger, M.D., a six-time cancer survivor. “But then, by the time nausea hits you, you’re having to play catch-up and wait out the discomfort. That’s no fun.”

If your nausea medications don’t work, ask your doctor for a different prescription. It might take a few tries to find the one that works best for you.

Sitting outside and getting some fresh air may also provide a little nausea relief. Popsicles, mints and gum may, too.

9. Stay positive

Sometimes our fears are worse than the reality, and each day of treatment can surprise us. Seek out the positives in your day – small and insignificant as they might seem – to keep your spirits lifted.

“My boyfriend and I celebrated when I reached the halfway point in my treatment schedule,” notes Mallory Parrish, a Hodgkin lymphoma survivor. “We celebrated each time a scan showed that the tumor was getting smaller. And we celebrated when I managed to get up, get dressed, and take a short walk outside, especially on the days when I really didn’t want to.” 

10. Take oral care advice seriously

Because chemotherapy works by attacking rapidly growing cells, it can also target healthy cells by mistake, including those that line the gastrointestinal tract. When that happens, painful mouth sores can sometimes be the result. So, it’s important to take any suggestions from your care team for their prevention seriously. 

“One side effect I managed to avoid completely was mouth sores,” says Connie Porter, Ph.D., a breast cancer survivor. “I’d heard about the horrors of those, so I rinsed my mouth out with a mixture of baking soda and water multiple times a day during chemotherapy.” 

11. Stay alert for signs of neuropathy 

Many chemotherapy drugs cause a side effect known as peripheral neuropathy, or pain, numbness or a tingling sensation in the hands and feet. Sometimes, neuropathy can be moderated with a dose adjustment or a pause in treatment. But your care team can’t address it if you don’t let them know you have it. So, stay alert and notify them right away if you start to experience those sensations. 

“I still have some residual neuropathy today,” says Robert Harris, a three-time cancer survivor. “So, I have to be very careful when paying for things in cash. Otherwise, I might hand over more money than I intend to, especially if the bills are new and crisp. I also have to be very mindful when going up and down stairs, and make sure I’m holding onto something because the normal connection between my brain and feet isn’t always there.”  

12. Remember that everyone’s experience with chemotherapy is different

You may get lots of advice from other patients, but remember: your experience with chemotherapy won’t necessarily be the same as anyone else's.

Some people might want to stay in bed for days after an infusion, while others can go about their business in just a few. And while some patients lose their hair quickly, others keep their hair for much longer – or don’t lose it at all.

“I was really mad when I was admitted to the hospital,” recalls oral cancer survivor Jeannie Hopper. “I thought I’d failed because I wasn’t strong enough. I’d heard all these stories about people who were still working while on chemotherapy and felt totally fine. That was not my experience.” 

So, go easy on yourself, pay attention to your side effects and share your questions and concerns with your care team.

Request an appointment at MD Anderson online or call 1-877-632-6789.  

If you’re receiving chemotherapy as a part of your cancer treatment, you’ve probably already learned a few tricks to make the experience easier. 

Whether it’s carrying hard candies in your pocket to counteract nausea or bringing warm socks to stay comfortable during an infusion, most people learn these simple hacks by talking to their care teams or watching other patients. 

But is there anything you should not be doing while undergoing chemotherapy? And is there anything you should be actively trying to avoid? We asked general oncologist Amy Hassan, M.D. Here’s what she wants patients in active cancer treatment to know.

1. Don’t eat raw meat or seafood

Eating uncooked animal matter at any time can increase your risk of contracting salmonella, E. coli and other food-borne illnesses. The risk of infection is even greater when you’re undergoing cancer treatment, because the medicines used to treat it can suppress the immune system.

Fortunately, heat kills many of the food-borne pathogens that can make us sick. That’s why it’s best to pass on raw and undercooked foods like sushi, oysters, or rare steaks, until you’ve finished cancer treatment.

For many patients, eating uncooked vegetables and fruits is allowed, as long as they are washed. But if you're undergoing more intensive chemotherapy, such as for leukemia or lymphoma, you may also be instructed to avoid raw produce. If you have any questions, discuss it with your care team.

“In addition, if a dish is meant to be served hot, it should be eaten while hot, not after it's been sitting at room temperature for a while,” says Hassan. “There really aren’t too many restrictions beyond that.”

2. Avoid foods that may aggravate cancer treatment side effects

Hard, spicy and acidic foods can aggravate the mouth sores that are sometimes a side effect of chemotherapy. So, you may want to skip these types of foods during treatment.

“Grapefruit in particular reacts with a lot of different things, including some medications,” Hassan says. “So, it’s always a good idea to avoid that. But eating an orange or drinking a glass of lemonade is not going to harm you. You just may want to pass on citrus fruits for a while, if your mouth is especially sensitive or sore.”

You may also want to avoid cold drinks and frozen treats like smoothies and sorbet with certain types of chemotherapy, as they can cause discomfort if you have chemo-related cold sensitivity.  

3. Don’t start taking any new medications or supplements

It’s fine to take a nutritional supplement if your doctor prescribes it. Sometimes cancer patients need these to correct a vitamin deficiency or help them digest their food properly. But don’t start taking anything new without talking to your care team first.

“Supplements may seem harmless,” Hassan says. “But CBD oil, herbal supplements and even melatonin could potentially interact with other medications, including those used to treat cancer. This could make them less effective or even dangerous. So, it’s really important to discuss anything you might be considering taking with us before you start.”

4. Don’t smoke or drink alcohol

Avoiding alcohol is one of the simplest things you can do at any time to lower your cancer risk. The less you drink it, the better off you are. This is especially true during cancer treatment.

“We actively discourage the intake of alcohol during chemo because it is processed by the liver,” says Hassan. “So are many chemo medications. That combination can cause additional strain on the organ, which is something we’d rather avoid. Alcohol also causes dehydration, which can make nausea worse and chemo harder to tolerate.” 

If you must indulge, she says, try not to drink alcoholic beverages either during or right before or after a chemo infusion. 

“It really should be a rare occurrence,” Hassan explains, “something that’s saved for a very special occasion.” 

Smoking, vaping and other tobacco products are also hard on the body, so it’s best to avoid them entirely. MD Anderson patients who need help quitting can find it here for free.

5. Avoid excessive UV exposure

It’s wise to wear protective clothing and SPF 30 sunscreen when outside during the day, and to avoid peak exposure times, when the sun’s rays are at their strongest. This is particularly true for some cancer patients.

“Many chemotherapy agents increase susceptibility to sunburns,” explains Hassan. “So, limit the amount of time you spend outdoors during daylight hours.” 

Tanning beds should be avoided altogether.

6. Don’t risk pregnancy or chemotherapy exposure with sexual partners

Chemotherapy can damage both sperm and human egg cells, so it’s important to use effective birth control while in cancer treatment to avoid conception. It’s also prudent to use a form of barrier protection, such as condoms, to prevent sexual partners from being exposed to chemotherapy drugs. 

“Most chemotherapy agents clear the system within 48 hours,” Hassan says. “But they may still be present in small amounts in various body secretions within that timeframe.” 

7. Caregivers should take precautions when doing laundry and cleaning 

Depending on your living situation, you may need to change your household cleaning habits during cancer treatment, too.

“If someone else is doing your laundry, and you’re receiving chemotherapy, they should put on gloves before touching your soiled clothes or linens,” Hassan says. “The same goes for chemotherapy at home. If a caregiver is handling your pills, they should be using gloves. Otherwise, they run the risk of absorbing the medications themselves.”

8. Don’t socialize with sick people

When you’re undergoing chemotherapy, your immune system may not work as well as it normally does. That can make you more vulnerable to infection. So, it’s a good idea to wear a mask, especially when circulating levels of respiratory viruses like RSV, flu and COVID-19 are higher.

“And if someone is clearly ill, stay away from that person until they’re totally symptom-free,” notes Hassan. “Washing your hands thoroughly and frequently is very effective at decreasing infections, too, so keep doing that as well.”

9. Avoid trying to do too much

One of the most common side effects of chemotherapy is fatigue. Some patients are able to keep up with many of their usual activities despite it, including moderate exercise. Others may have more difficulty completing household tasks.

“It can be helpful to stay active during your treatment, but if you’re feeling tired, listen to your body and stop and rest,” says Hassan. “This is not the time to power through it.”

10. Don’t keep your questions or concerns to yourself

The key to a smooth course of chemotherapy is good communication between you and your care team. 

“Things that affect your cancer treatment might not even occur to you,” says Hassan. “So, anything you’re thinking about doing, it’s always a good idea to ask.” 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.