Because cancer cells grow and divide rapidly, anticancer drugs are made to kill fast-growing cells, but certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. When it does, side effects may result. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract, reproductive system, and hair follicles. Anticancer drugs can also damage cells of the heart, kidney, bladder, lungs and nervous system. The most common side effects of chemotherapy include nausea and vomiting, hair loss and fatigue.
Most normal cells recover quickly when chemotherapy is over, so most side effects gradually disappear after treatment ends and the healthy cells have a chance to grow normally. The time it takes to get over some side effects and regain energy varies from person to person. How soon you will feel better depends on many factors, including your overall health and the kinds of drugs you have been taking.
While many side effects go away fairly rapidly, certain symptoms may take months or years to disappear completely. Sometimes, the side effects can last a lifetime, as when chemotherapy causes permanent damage to the heart, lungs, kidneys or reproductive organs. And certain types of chemotherapy may occasionally cause-delayed effects, such as a second cancer, that show up many years later.
It is important to remember that many people have no long-term problems due to chemotherapy. It is also reassuring to know that doctors are making great progress in preventing some of chemotherapy’s more serious side effects. For instance, they are using many new drugs and techniques that increase chemotherapy’s powerful effects on cancer cells while decreasing its harmful effects on the body’s health cells.
The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment’s ability to destroy cancer. People getting chemotherapy sometimes become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor. It may be that your medication or the treatment schedule can be changed. Or your doctor may be able to suggest ways to reduce side effects or make them easier to live with.
Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or permanent damage to the kidneys. Be sure to ask your doctor if your anticancer drugs are among the ones that have this effect, and notify the doctor if you have any symptoms that might indicate a problem. Signs to watch for include:
- Pain or burning when you urinate
- Frequent urination
- A feeling that you must urinate right away (urgency)
- Reddish or bloody urine
- Fever
- Chills
In general, it’s a good idea to drink plenty of fluids to ensure good urine flow and help prevent problems; this is especially important if your drugs are among those that affect the kidney and bladder. Water, juice, coffee, tea, soup, soft drinks, broth, ice cream, popsicles and gelatin are all considered fluids. Your doctor will let you know if you must increase your fluid intake.
You should also be aware that some anticancer drugs cause the urine to change color (orange, red or yellow) or to take on a strong or medicine-like odor. The color and odor of semen may be affected as well. Check with your doctor to see if the drugs you are taking have this effect.
Fluid Retention
Your body may retain fluid when you are having chemotherapy. This may be due to hormonal changes from your therapy, the effect of drugs themselves, or your cancer. Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen. You may need to avoid table salt and foods with high sodium content. If the problem is severe, your doctor may prescribe medicine to help your body get rid of excess fluids.
Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy. Possible side effects include redness, itching, peeling, dryness and acne. Your nails may become brittle or cracked or develop vertical lines or bands.
You will be able to take care of most of these problems yourself. If you develop acne, try to keep your face clean and dry and use over-the-counter medicated creams or soaps. For itching, apply cornstarch as you would a dusting powder. To help avoid dryness, take quick showers or sponge baths rather than long hot baths. Apply cream and lotion while your skin is still moist and avoid perfume, cologne, or aftershave lotion that contains alcohol. You can strengthen your nail with the remedies sold for this purpose, but remain alert to signs of a worsening problem because these products can be irritating to some people. Protect your nails by wearing gloves when washing dishes, gardening, or performing other work around the house. Get further advice from your doctor if these skin and nail problems don’t respond to your efforts.
Certain anticancer drugs, when given intravenously, may produce a fairly dramatic darkening of the skin all along the vein. Some people use makeup to cover the area, but this can become difficult and time-consuming if several veins are affected, which sometimes happens. The darkening areas will usually fade on their own a few months after treatment ends.
Exposure to the sun may increase the effects some anticancer drugs have on your skin. Check with your doctor or nurse about using a sunscreen lotion with a skin protection factor of 15 to protect against the sun’s effects. He or she may even suggest that you avoid being in direct sunlight or you use a product, such as zinc oxide, that blocks the sun’s rays completely.
Some people who have had radiation therapy develop “radiation recall” during their chemotherapy. During or shortly after the treatment is given, the skin over the area that was treated with radiation turns a shade of red from light to very bright and may itch or burn. This reaction may last hours or even days. You can soothe the itching and burning by putting a cool, wet compress over the affected area. Radiation recall reactions should be reported to your doctor or nurse.
Most skin problems are not serious, but a few demand immediate attention. For example, certain drugs given intravenously can cause serious and permanent tissue damage if they leak out of the vein. Tell your doctor or nurse immediately if you feel any burning or pain when you are getting intravenous drugs. These symptoms don’t always mean there is a problem, but they always must be checked at once.
You should also let your doctor or nurse know right away if you develop sudden or severe itching, if your skin breaks out in a rash or hives, or if you have wheezing or any other trouble breathing. These symptoms may mean you are having an allergic reaction that may need to be treated at once.
Nerve and Muscle Effects
Your nervous system affects just about all your body’s organs and tissues, so it’s not surprising that when chemotherapy affects the cells of the nervous system- as the drugs sometimes do- a wide range of side effects can result. For example, certain drugs can cause peripheral neuropathy, a condition that may make you feel a tingling, burning, weakness, or numbness in the hands and/or feet. Other nerve-related symptoms include loss of balance, clumsiness, difficulty picking up objects, problems walking, jaw pain, hearing loss, stomach pain, and constipation. In addition to affecting the nerves, certain anticancer drugs can also affect the muscles and make them weak, tired, or sore.
In some cases, nerve and muscle effects, though annoying, may not be serious. In other cases, nerve and muscle symptoms may indicate serious problems that need medical attention. Be sure to report any suspected nerve or muscle symptoms to your doctor.
Caution and common sense can help you deal with nerve and muscle problems. For example, if your fingers become numb, be very careful when grasping objects that are sharp, hot, or otherwise dangerous. If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs, and using bathmats in the bathtub or shower. Do not wear slippery shoes.
Managing Side Effects
General Instructions
Patients receiving chemotherapy are susceptible to infections and bleeding problems. These instructions will help you prevent possible problems.
To Prevent Infection:
- Avoid Persons with colds or other infections (flu, chickenpox, measles, etc.)
- Avoid large crowds (such as Disney World or the mall), especially if you feel weak or have a cold.
- Observe yourself daily for signs of infection (redness, swelling, soreness).
- Take your temperature daily and keep a record if your doctor asks you to do so.
- Practice good personal hygiene. Wash your hands often, especially before eating and after using the bathroom.
- Avoid working in the garden unless you are wearing gloves so you don’t get cuts and scrapes.
Skin Care
- Avoid cuts and scratches by protecting yourself.
- Cleanse scratches with soap and water, and then apply Betadine ointment.
- Avoid excessive exposure to summer sun. Use a sunscreen.
- Do not tear or cut your nail cuticles. Use creams and removers.
- Use electric razors rather than blade-type razors.
Mouth Care
- Brush your teeth gently with toothettes or a very soft tooth brush four times a day (after meals and bedtime)
- Examine your mouth daily. Notify your doctor if white patches occur.
- Check with your doctor before having dental work done.
Rectal/Urinary Tract Care
- Avoid straining at stool to prevent bleeding or skin breaks.
- If rectum is sore, tub baths with warm water or warm compresses to the rectum may give relief.
- Report changes in your normal bowel habits (such as constipation, diarrhea, black or bloody stools).
- Burning on urination or blood in urine may mean problems; report these symptoms to your doctor.
Symptoms to Report to Your Doctor
- Fever greater than 100.5 degrees F
- Shaking, chills, sweating
- Pain in a new place
- Pain unrelieved by present pain medications
- Nausea, vomiting, inability to eat for more than two days
- Coughing, chest pain on breathing, or shortness of breath
- Headache (that is not relieved by Tylenol)
- Stiff neck, blurred vision, or dizziness
- Bleeding from anywhere
- Inability to eat and continued weight loss
- Diarrhea for over 24 hours
- Increased weakness, such as inability to get out of bed
- Sores in mouth
- Any sore which will not heal
Other Ways to Help Yourself
- Keep active within limits of your strength and fatigue tolerance. It is important for you to try to continue doing activities, which interest you or keep you active.
- Continue to eat! Less spicy or greasy foods are tolerated better. Eat high fiber foods, such as green leafy vegetables or whole grain breads.
- Drinking an adequate volume of fluids is very important to maintain your renal (kidney) function. You should drink at least 8 glasses of liquids each day. If you are taking Methotrexate, Cytoxan, or Cisplatinum, you must drink even larger amounts of fluid. Avoid juices and foods that have a high acid content (such as orange or grapefruit juice).
- Do not drink alcoholic beverages.
- Some over the counter drugs may interfere with the drugs you are taking to treat your cancer. Check with your doctor before taking any non-prescription medications.
- If you have any questions or are unclear as to some matter concerning your treatment, always ask your nurse or doctor.
Nerve Changes
Some chemotherapy drugs may cause changes in your nerves. The drugs that usually cause these changes are vincristine (Oncovin), vinblastine (Velban), and possibly Cisplatin. These nerve changes may include:
- Numbness and/or tingling in your hands and feet
- Not being able to move your fingers easily (for example, to button shirts or tie shoes)
- Changes in your ability to walk smoothly (you may have trouble picking up your feet)
- Stomach pains or cramps
- Constipation
- Difficulty urinating
- Jaw and throat pain
Be sure to tell your doctor or nurse if you notice any of these changes. Although these changes may bother you, it is important to remember that after you stop taking these drugs, these nerve problems will usually go away in most patients.
Living With Nerve Changes
Safety Measures
Follow these precautions:
- Avoid exposing fingers and toes to very hot or very cold temperatures. Take lukewarm baths and do not use heating pads.
- Wear sturdy shoes or slippers that fit well at all times to protect your feet. Avoid shoes that are floppy and loose or too tight. Do not go barefoot.
- Wear gloves when doing work with your hands (washing dishes, gardening)
- Wear warm boots and gloves in cold weather.
- Use potholders in the kitchen.
- Remove throw rugs or other objects in your home that you might trip on.
- Use a walker or cane if you are unsteady on your feet.
Constipation
If you have problems with constipation as a result of these drugs:
- Eat a high fiber diet.
- Ask your doctor about taking stool softeners or laxatives.
- Ask your nurse for information on how to deal with constipation.
Urination
If you have difficulty with urination, drink 8 to 10 glasses of water or other fluids each day, and notify your doctor or nurse if this problem continues.
