The side effects of chemotherapy

Different strokes for different folks

While it is natural to be concerned about undergoing chemotherapy, not all people experience hair loss or nausea. The side effects of chemotherapy vary widely depending on the person receiving it, as well as the type of chemotherapy medication and dosage used. Some people experience fewer or milder effects, while others receiving the same chemotherapy have side effects severe enough to require preventative medications or other medical care. Your health care team will also try to lessen the chance that you experience a side effect commonly associated with some chemotherapy. For example, a person who is receiving a chemotherapy medication likely to cause nausea and vomiting will often be prescribed an additional medication to lessen or prevent nausea and vomiting.

The goal of experts is to eventually create chemotherapy medications that target the cancer directly, without affecting the non-cancer areas of the body. But current chemotherapy medications are not specialized enough to recognize which areas of the body have cancer and which do not. Instead, these medications result in side effects when non-cancer areas are affected. Talk to your doctor if you experience unpleasant side effects, because often the benefits of treatment are much greater than the discomforts and risks. There may also be ways to minimize or prevent chemotherapy side effects.

They come and they go

Not all side effects appear at the same time. Some side effects start right away (if they occur); others take some time to develop. In some cases, the side effects will go away as your body adjusts to the medication.

The side effects that most commonly come first are nausea and vomiting. If these occur, they usually start soon after the treatments begin. Typically, they last a few hours, though they may last longer with some kinds of chemotherapy. A few chemotherapy regimens are associated with nausea and vomiting that starts a few days later.

Other side effects usually arrive during the first few weeks of treatment, though they may show up even later. These include hair loss, as well as diarrhea or constipation and mouth sores. You may also be more prone to infections, as your body's usual defenses are weaker than usual.

Some people recover completely from the side effects of chemotherapy. Some kinds of chemotherapy medications may have longer-term consequences, however. Some medications can permanently affect the heart, lungs, reproductive organs, nerves or other parts of the body. Talk to your doctor about your chemotherapy so you know what to expect.

Many side effects can be prevented, and those that come can often be treated effectively - talk to your doctor, pharmacist, nurse or dietitian about ways of dealing with side effects. Some will gradually go away after the treatment is over or even during the course of treatment. Your overall physical health is an important factor - the healthier you are, the easier it will be for you to handle the side effects. Having a good attitude and emotional support also makes a difference, since people who are overly concerned about side effects will generally have more than those who learn to relax. And, of course, the type and dose of medication will make a difference. Ask your health care team for information on your treatment so you can be prepared.

Managing nausea and vomiting

For many people undergoing chemotherapy, feeling nauseous and having no appetite are frustrating side effects. Fortunately, there are many ways of dealing with this. Several medications can be used to lessen or prevent nausea and vomiting, including:

  • ondansetron
  • granisetron
  • dolasetron
  • metoclopramide
  • dexamethasone
  • dronabinol
  • haloperidol
  • prochlorperazine
  • dimenhydrinate
  • ginger

Some people prefer to use cannabis (marijuana) in order to control nausea and restore appetite; this has been a controversial issue in law and health care. But you may be able to deal with nausea and loss of appetite without turning to any sort of medication – the right eating habits and attitude can go a long way to help.

How to eat

The key to avoiding nausea is not to overwhelm your body – don't try to eat too much all at once. But you do need to eat, and if you don't have much appetite, here are some tips:

  • Don't eat too much in one sitting.
  • Have lots of small meals and snacks during the day rather than one to three big meals.
  • Eat and drink slowly.
  • Try drinking liquids at least an hour before or after meals rather than at mealtime.
  • Avoid foods that are too hard on your system, for example:
    • spicy foods
    • fatty or greasy foods
    • fried foods
  • Vary your diet. Try new foods and recipes to simulate your interest. But be sensible about it.
  • Go for a stroll before and after meals – before to help stimulate your appetite, and after to help digest.
  • Make eating a social occasion when you can: eat with family or friends.
  • Do things you associate with eating. Some people find that doing certain things makes them hungry – watching sports or a video, reading or working on hobbies. Think about what activities you usually associate with snacking.

Ways to deal with nausea

Try the following suggestions to help settle your stomach:

  • Drink cool, clear liquids – apple juice, tea, flat ginger ale.
  • Nibble on sour candies, mints or ice chips (to suck on, not to swallow in large pieces).
  • Eat small amounts of dry foods such as crackers, toast, or cereal – if you feel nauseous in the morning, try having some of this by your bed to eat before you get up (avoid this if you have a dry mouth or sores in your mouth or throat).

Keep your mind over matter, and focus on something else to help control nausea:

  • Get your mind onto something other than being nauseous – focus on a hobby, or relax by listening to music, watching TV or talking with friends.
  • Breathe slowly and deeply to calm your system.
  • Meditate. There are many different ways to meditate, and you can meditate without any religious purpose.

Coping with fatigue

Fatigue is a very common effect of cancer - and of cancer treatments. It doesn't help that you're probably eating less, you may be experiencing considerable stress and possibly a fair amount of pain, and you may not have enough red blood cells circulating.

Fatigue is usually most noticeable at the beginning and end of a chemotherapy medication treatment cycle, but you may have to deal with it at any time - even people who are not going through chemotherapy can sometimes get very fatigued. Fortunately, there are ways to cope with fatigue and revive your energy.

To increase your energy

Avoid quick fixes like coffee and candy bars - you might get a little burst of energy, but it won't last that long. Deal with fatigue at the source:

  • Eat a well-balanced diet.
  • Drink plenty of water.
  • Work on relaxation - try to reduce your stress level. Talk to your health professional or a counsellor about stress reduction techniques.
  • Talk to your doctor about doing light exercise. Exercise is good for keeping healthy and lively, and it also helps in dealing with stress. But you need to make sure you don't do too much.
  • If you are fatigued because you don't have enough red blood cells circulating (a condition known as anemia), talk to your doctor about your options for dealing with it. Treatment options range from increasing the iron in your diet to taking medication to blood replacement or transfusion.

To cope with fatigue

You may not be able to avoid feeling tired some of the time. So be kind to yourself - don't make yourself even more tired than you already are. Give yourself a break.

  • Don't go, go, go - instead, pause, pause, pause. Stop every so often during the day to take a break, have a nap, read a book or magazine, or just sit in the park or in a comfortable chair.
  • Prioritize. Do the important things first, and get around to the rest when you're less tired.
  • Get a little help. Ask your family and friends to help you with chores and errands such as shopping and cleaning. If you have children, get family members to look after them every so often.

Cosmetic concerns

What many people fear most about chemotherapy is not only how sick it will make them feel – it's how sick it will make them look. You may worry about losing your hair, getting bad skin, and losing or gaining weight. Skin and nails can change colour and you may worry about how others will react.

Not everyone experiences these side effects. But for those who do, there are ways of dealing with them.

Keeping up appearances

Here are some things to do to minimize the effects of changes to your appearance caused by chemo:

  • If your clothes don't fit, have some of them altered, or buy a few new items.Check out some new colour choices as the tone of your skin may change – look for colours that brighten your face. Go with a friend and make it an enjoyable distraction.
  • Accessorize. Add a trendy scarf, tie or pin – a small item can really add sparkle.
  • Treat yourself. Have a spa day, a manicure, a massage. If there was ever a time you could justify it, it's now.
  • Take care of your skin. Ask your doctor, dermatologist or pharmacist about skin creams and facial treatments to use. But be gentle. If you shave, you may want to use an electric razor to prevent breaks in the skin.
  • Exercise. Ask your doctor to help you determine how much you can manage. Keeping active will keep you looking and feeling healthier.

If you're losing your hair, you may want to get a wig. If so, get one while you still have hair, so you can match the colour. Not everyone gets a wig. Some people prefer caps, hats, or scarves instead.

Support groups

There are many support groups and resources to help people undergoing chemotherapy to deal with appearance changes. One group that's focused on this is Look Good, Feel Better ( They're dedicated to promoting a positive self-image for women with cancer. They have support from private companies as well as many volunteers who can help you with techniques and answer questions.

You can also turn to the Canadian Cancer Society ( for information and contacts. They have support groups for men and women dealing with cancer. They also have a wealth of resources on their website, as do the American Cancer Society ( Go for help and support – you'll be glad you did.

Chemotherapy and your emotions

When you're undergoing chemotherapy, it can feel as if your life has been turned upside down. You're fighting cancer, you may feel tired and nauseous, your appearance may change, your daily routines are disrupted... It's natural to feel shaken up. People undergoing chemotherapy often experience many emotions: fear, sadness, anger, frustration, anxiety. How do you deal with these? Turn to others for support, and deal with your emotional ups and downs by talking about them.

  • Talk to family and friends. The people who love you are there to support you, and they can often help and comfort you in ways that no one else can. But they may be worried about what to say or do - they might not make the first move for fear of making the wrong move. Call them up. Go out for coffee or dinner or a stroll with friends. You'll be glad you did, and so will they.
  • Talk to health care professionals. Information is crucial in maintaining a sense of control and security. Ask your doctor, nurses, pharmacist, and any other members of your cancer care team about the medication, how it works, what to expect - and also about how to deal with your fears and anxieties. They have experience with a lot of chemotherapy patients, and they will have good advice.
  • Talk to counsellors, psychologists or other mentors. There are people who are professionally trained at helping people through emotional difficulties. Your doctor will be able to recommend some. You may want to talk with a psychologist, a psychiatrist, a social worker, a therapist or another member of the counselling professions. If you belong to a religious community, your priest, minister, rabbi, imam or similar leader will have experience and training in helping to keep body and soul in harmony.
  • Talk to support groups. There's nothing like talking to someone who knows - by experience - what you're going through. Support groups will give you common ground and shared experience so you can face common challenges together. As well, support groups can be excellent sources of practical information. To find a support group near you, start with our Community Support database.

There are also some other things you can do to help get through your difficult times:

  • Learn. Learn about your disease and treatment. Know what is happening, what to expect, and what you can do about it. Your health care team will give you a starting base of accurate, personal information. Ask your health care professionals and support groups for advice on additional reliable resources and read as much as you want. But always make sure your information is coming from a trustworthy source. The Canadian Cancer Society ( has a library of resources to get you started.
  • Write. Keep a journal or diary. This will give you another outlet for your thoughts and feelings - one where you can express things you can't express to anyone else. You can also use it to record your side effects so that you can talk about them in detail with your health care team.
  • Play. Do things you enjoy - try new hobbies and go out with family and friends. Get exercise, too, if your doctor approves. Exercise is an excellent way of reducing stress and feeling better.
  • Plan. Look to the future. Keep your treatment goals in mind, and "keep your eyes on the prize."