Leading Cancer Care

Side Effects

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The treatment of cancer affects each individual differently. There are many possible side effects of treatment. The side effects you will have and the severity of those symptoms is unique to you as an individual and is also influenced by the treatment you are receiving. We will briefly review the common side effects of chemotherapy and some suggestions on side effect management. More information will be provided to you at your office visits. If you have questions or problems with treatment side effects, please talk to your health care provider.

Hair Loss (Alopecia)

Alopecia is the loss of hair associated with some chemotherapy agents. This hair loss could include scalp hair, facial hair or other parts of the body. Hair loss may begin two to three weeks after your first chemotherapy treatment. This side effect is usually temporary and varies in severity. Regrowth may occur during or shortly after completion of treatment. Some changes in the color or texture of your hair may occur during the regrowth process.

Coping with this temporary side effect:

  • Wearing scarves, turbans, caps, wigs or hairpieces may make you feel better.
  • If you decide to wear a wig, plan to purchase it prior to losing your hair. This allows you to match your own color and style.
  • It is okay to wear no head covering at all, as long as you protect your scalp from cold and/or sunburn.
  • Use mild shampoo and conditioner and avoid excessive shampooing to eliminate drying of your hair and scalp.
  • Limit the use of chemicals & hair dryers and avoid excessive brushing and combing.


Loss of Appetite

Good eating habits are important during cancer treatment. By eating nutritiously you can more effectively deal with side effects and fight infections. Some types of treatment can make you feel like not eating. Anxiety and depression can also cause loss of appetite.

Coping with this temporary side effect:

  • Eat frequent small meals.
  • Eat nutritious snacks throughout the day.
  • Eat when you are feeling your best; for some people this may be early in the morning and others may prefer to eat a good lunch.
  • You may use high calorie supplements (Boost, Ensure) to add calories to your diet.
  • Enjoy mealtime by eating with family or friends.
  • To help deal with changes in taste:
  • Serve meat cold instead of hot.
  • Use lemon flavored drinks to stimulate your taste buds.
  • Rinse your mouth before eating.
  • Use sugarless candy or sugar-free gum.
  • If food tastes metallic, use plastic utensils and dishes when possible.



Constipation is a decreased number of stools, stools that are dry or hard and/or increased straining with bowel movements.

Coping with this temporary side effect:

  • Drink plenty of fluids, especially water (1-2 liters per day).
  • Drinking fresh fruit juices and warm fluids can be helpful.
  • Increase the high fiber foods you eat. This includes whole grain products, fresh fruit and vegetables, nuts, raisins and prunes.
  • Use stool softeners or laxatives if recommended by your physician.
  • Contact your physician if you have not had a bowel movement in 3-4 days.



Diarrhea can be caused by chemotherapy and/or radiation and consists of stools of a liquid consistency.

Coping with this temporary side effect:

  • Drink plenty of fluids.
  • Weak tea, Gatorade or kool-aid may be helpful.
  • Increase your potassium intake by eating bananas, potatoes and oranges.
  • Avoid milk, milk products, coffee, carbonated beverages, alcohol and tobacco as they could make diarrhea worse.
  • Avoid spicy and sweet foods as they may make diarrhea worse.
  • Keep a record of the number, amount and consistency of stools. Notify your physician’s office if you have more than five stools per day.
  • Clean and dry carefully the rectal area each time you have a bowel movement. If you develop tenderness or pain, notify your physician’s office.


Nausea and Vomiting

This temporary side effect can be the result of the tumor itself, or from chemotherapy or radiation. Each person is different and not everyone who undergoes treatment is affected by nausea and vomiting. There are certain chemotherapy drugs, which may cause nausea and vomiting. In this instance, you will be given anti-nausea medications.

Coping with this temporary side effect:

  • Take your anti-nausea medication as directed.
  • Eat frequent small meals.
  • Avoid hot & spicy foods, sweets, and fried & fatty foods as they may make nausea worse.
  • Do not eat a large meal right after treatment; instead eat small, frequent meals.
  • Eat bland foots such as crackers, dry toast or cereal.
  • Do not lie down for at least two hours after a meal.
  • Drink small amount of water during the day instead of drinking large amounts at one time.
  • We suggest you do not eat your favorite foods on days you receive chemotherapy so you won’t associate them with nausea.


Mouth Sores (Stomatitis)

Chemotherapy can cause sores in the mouth and throat as well as causing the tissues of the mouth, sinuses and throat to become dry and irritated with possible bleeding. Signs of mouth sores include mild redness or swelling, a sensation of dryness , mild burning and a decreased amount of saliva.

Coping with mouth sores:

  • Check your mouth daily.
  • Brush your teeth with a soft toothbrush and non-abrasive toothpaste after each meal.
  • If you wear dentures, remove and clean them after each meal.
  • Avoid mouthwashes with alcohol. They can dry out your mouth and make the sores worse.
  • Use lip balm to keep your lips moist.
  • Avoid foods and liquids that are too hot, cold or spicy.
  • Avoid irritating foods that are acidic like citrus fruit and tomatoes, spicy or salty foods as well as dry foods like chips and crackers.
  • Coping with dry mouth:
  • Suck on ice chips, popsicles or sugar-free hard candy.
  • Sip water throughout the day.
  • Avoid alcohol and tobacco.
  • To stimulate saliva production, eat fruit with citric acids like oranges or suck on sugar-free lemon drops.



Fatigue or tiredness can be caused by chemotherapy, radiation, or the cancer itself. It may be short term, lasting less than a month or long term, lasting from one month to six months. This tiredness can be related to the tumor itself or from side effects of the treatment such as anemia, nausea, vomiting, pain or infection. Anxiety can also contribute to sleeplessness, increased energy demands and fatigue.

Coping with fatigue:

  • Identify activities that make you tired and pace yourself by scheduling these activities after periods of rest.
  • Be willing to share responsibilities such as cleaning and shopping with your spouse or a friend.
  • Drink adequate amounts of water to maintain hydration.
  • Eat a balanced diet.
  • Spend time doing activities you enjoy, both alone and with friends.
  • Continue exercise as tolerated; even a short walk can help can make fatigue better.
  • If needed, take several short naps during the day, but avoid long naps as this can affect night time sleep and actually make fatigue worse.
  • If you continue to have problems with fatigue, talk with your physician.


Low White Blood Count (Neutropenia)

Neutropenia is a decrease of the number of white blood cells. These cells fight infection and can be measured by a lab test called a Complete Blood Count (CBC). When you experience a low count, you should avoid people with colds or the flu. A drop in the white blood count will usually happen 1-2 weeks after treatment.

Call your physician if you experience any of the following:

  • Temperature about 101 degrees.
  • Sore throat, new onset of cough or change in existing cough.
  • Burning, increased frequency or difficulty passing urine.
  • Redness, swelling or tenderness around a wound, sore or catheter site.
  • Chills, flushing or shaking.
  • White patches in your mouth.


Low Platelet Count (Thrombocytopenia)

Thrombocytopenia is a decrease in the number of platelets, which are an important component in blood clotting. This side effect usually occurs 1-2 weeks after of treatment. A low platelet count increases the possibility of bleeding more easily.

Coping with this temporary side effect:

  • Brush your teeth with a soft toothbrush and avoid mouthwash with a high alcohol content.
  • Shave with an electric razor.
  • Avoid strenuous activity that may cause a fall, bruising or injury.
  • Avoid medications that may cause prolonged bleeding (aspirin, ibuprofen, quinidine)
  • Wear shoes, socks or slippers to protect your feet from cuts and bleeding.
  • Avoid forceful nose blowing.
  • Check with your physician prior to taking any over the counter medications.
  • Signs & Symptoms of low blood count:
  • Blood in your urine or stools.
  • Bleeding from gums, mouth or nose.
  • Bruising easily or bruises from unknown causes.
  • Vomiting or coughing up blood.
  • Headaches, dizziness or fainting.
  • Any bleeding that will not stop.
  • Call your physician office if you experience any of the following:
  • Prolonged or unusual bleeding that does not stop after you have applied pressure for 10-15 minutes.
  • Excessive bruising.
  • Persistent headache, blurred vision or change in level on consciousness such as excessive sleeping, confusion or difficulty being awakened.


Anxiety and Depression

The diagnosis and treatment of cancer can be a significant stressor in an individual’s life. Having some degree of anxiety or depression as you are diagnosed with cancer and start treatment is very common. Anxiety is often characterized by a vague, uneasy or unpleasant feeling. Symptoms of anxiety often vary from patient to patient, but may include restlessness, poor concentration, dizziness, palpitations or fast heart rate, insomnia, decreased appetite and being easily distracted. The symptoms of anxiety and depression often can be very similar. Many patients with cancer suffer from depression, and this is not necessarily abnormal. Feeling depressed can be part of the natural grief response that accompanies the diagnosis of cancer. Those with advanced disease, poor functional status, unrelieved physical symptoms, younger age, and disease recurrence seem to be at an increased risk for depression. Depression is characterized by gloom, emptiness, despair, sleep disturbances, poor appetite, concentration difficulties, irritability, loss of pleasure in activities and people, and in very severe cases thoughts of suicide.

At times anxiety and depression can be excessive and can interfere with all aspects of the patient’s life. If this is happening to you it is important that you talk to your health care provider about treatment of your symptoms. Untreated anxiety and depression can make treatment and coping with side effects harder. Treatments for anxiety and depression may include counseling, support groups, relaxation techniques or medications. Social support is very important in dealing with anxiety and depression. Open communication with family and friends about your thoughts, feelings and needs may accelerate your recovery.

Chemo Brain (Cognitive Dysfunction)

What is Chemo Brain?

Sometimes after cancer treatments such as chemotherapy people have problems with memory or concentration. Chemo brain is also referred to as chemo fog or cognitive dysfunction. No one is sure what causes chemo brain. There are some things that can make it worse, including low blood counts, stress, depression, anxiety, tiredness, not sleeping well, certain medications and changes in hormones.

This side effect can begin soon after treatment ends or may not appear until much later. For some patients, it is temporary and for others it is permanent. If you are concerned about your symptoms, talk with your physician.

Some symptoms include:

  • Memory loss
  • Trouble paying attention
  • Trouble finding the right words
  • Trouble learning new tasks
  • Trouble with math
  • Mood swings
  • Trouble managing day to day activities