Getting sick with chemotherapy is a common concern for cancer patients starting treatment. Chemotherapy works by attacking rapidly dividing cells, like cancer cells. But it also affects healthy rapidly dividing cells in places like the lining of your mouth, intestines, and hair follicles. This can lead to side effects that may make you feel unwell.
However, getting sick with every chemotherapy treatment is not a given. Whether you experience side effects, and how severe they are, depends on many factors. These include the type and dose of chemo drugs used, your overall health, and how your body reacts to the medications.
Many side effects of chemotherapy can be prevented or managed so you can continue your treatment safely and effectively. Understanding why you may feel sick and what can be done about it can help give you peace of mind as you start chemo.
What causes sickness with chemotherapy?
Chemotherapy targets all rapidly dividing cells in the body. This includes cancer cells, but also hair cells, the cells lining your mouth and intestines, and cells involved in the production of blood cells. Damaging healthy cells leads to common chemo side effects like:
– Hair loss
– Mouth sores
– Nausea and vomiting
– Fatigue
– Increased risk of infection (from low white blood cell counts)
– Bruising or bleeding (from low platelet counts)
Different chemo medications affect the body in different ways. Some are more likely to cause certain side effects than others. You may also have a higher risk of side effects based on:
– The dose and combination of chemo drugs used
– The chemotherapy schedule (how often you receive it)
– Your overall health and resiliency
– Previous or existing medical conditions
– Your age
– Genetics and how your body processes medications
It’s impossible to predict exactly how any one person will respond to chemotherapy. Some sail through treatment with minimal side effects. Others struggle with multiple difficult side effects that necessitate changes to their chemo regimen.
Do side effects happen with every chemo treatment?
For most people, chemotherapy side effects don’t happen with every single treatment. Some exceptions include:
– Fatigue – Tiredness often starts early and builds up over successive treatments.
– Hair loss – Most chemo drugs cause at least some hair loss that worsens with each cycle.
– Nerve damage – Some chemo drugs can cause peripheral neuropathy that persists and progresses with continued exposure.
Side effects like nausea, vomiting, diarrhea, mouth sores, low blood cell counts, and susceptibility to infections tend to come and go with each treatment cycle. They flare up shortly after chemo is administered, then improve by the end of the cycle before the next round.
There are also commonly used medications given before chemotherapy starts to help prevent side effects like:
– IV fluids – Prevent dehydration and kidney problems
– Anti-nausea drugs – Prevent nausea and vomiting
– Steroids – Help prevent allergic reactions, reduce inflammation, and improve appetite
– Antihistamines – Prevent allergic reactions
– Antibiotics – Prevent infections in immune-suppressed patients
Your oncology team can optimize these preventative medications based on your previous responses. This can help reduce the severity of side effects with each successive treatment.
What determines if you’ll have side effects?
According to the American Cancer Society, factors that influence an individual’s risk of chemotherapy side effects include:
– Age – Older adults tend to experience more severe side effects than younger, healthier people.
– Gender – Some side effects are more common in men or women due to differences in metabolism. For example, men tend to have more nausea.
– Genetics – Genetic differences affect how well your body can break down and excrete chemo drugs.
– Dose – Higher chemo doses are more toxic and likely to cause side effects.
– Combinations – Using multiple chemo drugs increases side effect risk.
– Delivery method – IV chemo tends to have more acute side effects than oral chemo.
– Overall health – People with other health conditions or impaired organ function have reduced reserves to handle side effects.
– Previous treatments – Prior radiation, surgery, or other therapies can increase sensitivity.
– Emotional state – Anxiety around treatment can exacerbate some physical side effects.
– Motion sickness – People prone to motion sickness have higher rates of chemo-induced nausea.
While some variables are out of your control, there are still many ways to reduce your risks. Working closely with your oncology team is key. Don’t hesitate to speak up about side effects so steps can be taken to keep you as comfortable as possible during treatment.
Common side effects and how to manage them
Some of the most common chemotherapy side effects and ways patients and doctors can help control them include:
Nausea and Vomiting
– Take anti-nausea medication as prescribed. Stay on schedule rather than taking it only when nauseated.
– Avoid spicy, fatty, or overly sweet foods during cycles.
– Drink fluids regularly to avoid dehydration.
– Practice relaxation techniques like meditation and deep breathing.
– Ask about Syrian rue as an anti-nausea folk remedy.
Fatigue
– Schedule daily rest periods.
– Save your energy for most important activities.
– Take short walks or do gentle exercise like yoga.
– Ask friends and family for help with errands, chores, and childcare.
– Eat a balanced, nutritious diet.
Mouth Sores
– Use a soft toothbrush. Avoid alcohol-based mouthwash.
– Rinse and coat mouth with baking soda, salt water, or special mouthwash.
– Avoid spicy, acidic, crunchy, or hot foods that could irritate sores.
– Drink with a straw if mouth sores are severe.
– Ask about numbing topical ointments or anti-viral medications.
Diarrhea
– Drink plenty of water, ginger tea, or clear broths.
– Follow the BRAT diet: bananas, rice, applesauce, toast.
– Take anti-diarrheal medication.
– Avoid high fiber foods that can worsen diarrhea.
– Ask about probiotic supplements.
Constipation
– Drink lots of fluids. Warm liquids, prune juice, and caffeine may stimulate bowels.
– Eat high fiber foods and avoid processed foods.
– Exercise daily. Even short walks can stimulate bowel movements.
– Ask about stool softeners or laxatives if diet changes aren’t enough.
Numbness or Tingling
– Be vigilant about safety in kitchens, bathrooms, and on uneven surfaces.
– Don’t expose hands or feet to extreme hot or cold.
– Wear gloves or socks to bed.
– Talk to your doctor about vitamin supplements that may help.
– Ask about discontinuing or lowering dose of chemotherapy causing neuropathy.
Hair Loss
– Use gentle shampoos and soft hairbrushes. Avoid blow drying or harsh styling products.
– Cut long hair short prior to starting chemo. Use cooling caps if available.
– Cover your head with a scarf, hat, wig or other headwear you feel good in.
– Consider donating your hair to organizations like Locks of Love before it falls out.
| Side Effect | Prevention Tips | Management Tips |
|---|---|---|
| Nausea and Vomiting | – Take anti-nausea meds as scheduled – Avoid fatty/spicy foods – Stay hydrated |
– Relaxation techniques – Ginger, mint, Syrian rue – Report uncontrolled nausea ASAP |
| Fatigue | – Nap and rest – Accept help from others – Light exercise |
– Schedule important tasks – Eat nutritious foods – Report uncontrolled fatigue |
| Mouth Sores | – Soft toothbrush – Avoid irritants |
– Salt water, baking soda rinses – Coating agents, numbing gels – Avoid acidic, hot, crunchy foods |
| Diarrhea | – Stay hydrated | – BRAT diet – Anti-diarrheals – Avoid fiber, eat bananas, rice, applesauce, toast |
| Constipation | – Drink warm/caffeinated liquids | – High fiber diet – Exercise – Stool softeners, laxatives |
| Numbness/Tingling | – Prevent injuries | – Wear gloves & socks – Vitamin supplements – Report severe neuropathy |
| Hair Loss | – Gentle hair care – Cut hair short |
– Hats, scarves, wigs – Donate hair if desired |
When to call your oncology team about side effects
It’s important to communicate regularly with your cancer care team about any side effects you experience during chemotherapy. Don’t try to just tough it out. Many side effects can be prevented or minimized with early intervention.
Let your providers know immediately if you experience:
– Difficulty eating or drinking for over 24 hours
– Diarrhea lasting more than 48 hours
– Fever of 100.4 F or higher
– Signs of allergic reaction or anaphylaxis
– Excessive or abnormal bleeding
– Chest pain or trouble breathing
– Blurred vision or severe, persistent headache
– Changes in mental status like confusion or fainting
Routine side effects like fatigue, mild nausea, minor rashes, or lack of appetite can often be managed at home. But report them too so adjustments can be made for your next cycle if needed. Don’t hesitate to call any time you feel unwell or need advice coping with treatment effects.
How to reduce your risk of side effects
While you can’t control everything about how your body responds to chemotherapy, some proactive steps you can take to reduce side effect risks and severity include:
– Staying hydrated before, during, and after each infusion. Dehydration exacerbates many side effects.
– Eating a healthy, balanced diet. Avoid empty calories. Ask your team for tips to combat fatigue, nausea, mouth sores, diarrhea, and constipation.
– Getting moderate physical activity, like walking 30 minutes a day. This keeps up your energy and strength.
– Practicing relaxation techniques such as meditation, deep breathing, journaling, or prayer. Anxiety exacerbates side effects.
– Organizing help from family and friends. Don’t try to do it all yourself.
– Avoiding herbal supplements unless approved by your oncologist. Some interact with chemo.
– Communicating openly with your care team. Report all side effects early so they can adjust medications accordingly.
– Focusing on the positive. Remind yourself the nausea, fatigue, and other side effects are temporary and mean treatment is working.
When side effects become severe
For a small percentage of patients, chemotherapy side effects become severe enough that cancer treatment must be changed or delayed. This is more common in people undergoing very intensive regimens, like before a bone marrow transplant.
Possible changes if side effects become too severe include:
– Lowering the chemotherapy dose
– Lengthening the time between treatments
– Switching to less toxic chemo drugs
– Temporarily discontinuing treatment until side effects resolve
Only make changes to your chemotherapy plan under your oncologist’s supervision. Never skip or alter scheduled doses on your own. Doing so allows cancer cells to recover and reduces treatment effectiveness.
If side effects are so severe that your oncologist recommends discontinuing chemotherapy altogether, there are still other treatment options available. These include:
– Targeted therapy drugs that specifically attack cancer cells
– Immunotherapy that helps the body’s immune system fight cancer
– Hormone therapy for hormone-sensitive cancers
– Radiation therapy to shrink tumors
– Surgery to remove remaining cancerous growths
– Clinical trials testing new medication combinations
Coping mentally and emotionally with side effects
Experiencing difficult physical side effects for weeks or months takes a toll both physically and emotionally. Some tips to help you cope mentally with the challenges of chemotherapy include:
– Allowing yourself to feel frustrated or sad sometimes. Don’t bottle up emotions.
– Joining a support group to exchange tips with other patients.
– Talking openly with friends and family about what you’re going through.
– Practicing mindfulness and living in the moment rather than dreading future side effects.
– Celebrating small milestones like getting through each cycle.
– Staying positive and focusing on the fact treatment is working.
– Reminding yourself side effects are temporary and worth enduring to get well.
– Thinking about how you’ll feel when treatment is over and you’re in recovery.
Seeking professional counseling is also a good option if anxiety or depression related to side effects becomes overwhelming. Your oncology team likely has mental health resources available. Remember you don’t have to tough this out alone.
Long term risks and side effects
Most chemotherapy side effects resolve within weeks or months after treatment ends. But there are some potential long term risks to be aware of:
– Heart damage – Some chemo drugs like anthracyclines rarely cause permanent heart muscle damage. Lifelong monitoring is necessary after high cumulative doses.
– Lung damage – Drugs like bleomycin can cause long term lung toxicity. This also requires monitoring after treatment.
– Kidney damage – Cisplatin, methotrexate, and some other drugs can affect kidney function. IV fluids help prevent this. Kidney tests are needed after treatment.
– Infertility – Some chemotherapy regimens damage ovaries or sperm cells leading to infertility. Not all regimens carry this risk. Speak to your oncologist about fertility preservation options beforehand.
– Peripheral neuropathy – Nerve damage in the hands and feet caused by some drugs like taxanes, platinums, and vinca alkaloids can become permanent. Symptoms sometimes improve over time.
– Cognitive dysfunction – Some patients report “chemo brain” with foggy thinking and impaired memory. This often improves with time.
Stay in close follow up with your oncology team for at least 5 years after chemotherapy ends. Report any concerning lingering side effects you experience. Together you can determine appropriate testing and specialty referrals if needed to manage long term effects.
Second cancers
There is a small increased risk of developing a secondary cancer due to chemotherapy’s effect on DNA. Factors include:
– The type and cumulative dose of chemo drugs received
– Other cancer treatments like radiation therapy
– Age when first treated
– Time elapsed since treatment
– Lifestyle factors like smoking
Follow up care should include screening for second malignancies. Make healthy lifestyle choices and follow your survivorship care plan to minimize risks. Speak with your doctor about any new or concerning symptoms. But try not to worry excessively about second cancers – for most people the benefits of chemotherapy still far outweigh this small risk.
Summary
It’s normal to worry about getting sick with each chemotherapy treatment. But side effects don’t happen with every cycle for most people. There are many ways to prevent and manage common problems like nausea, fatigue, low blood counts, mouth sores, diarrhea, and constipation. Work closely with your oncology team and be vigilant about reporting side effects early. Stay focused on the fact treatment is working and these are temporary effects. Seek support from other patients, friends and family. With preparation, good communication, and a positive outlook, you can get through chemotherapy successfully.