Chemotherapy side effects

Any side effects you get will depend on the chemotherapy drugs you are having. Different drugs may cause different side effects. You may get some of the side effects mentioned, but you are very unlikely to get all of them.

Some side effects are mild and easily treated. Your doctor, nurse or pharmacist may prescribe drugs to help control them. It is very important to take the drugs exactly as they tell you. This makes them more likely to work for you.

Other side effects can be harder to manage. These can often be reduced or helped in some way. Your nurse will give you advice about this.

Most side effects stop or slowly go away when chemotherapy finishes. Some side effects can be unpleasant, but the benefits of chemotherapy usually outweigh this.

If you are having a single drug, you may not have as many side effects as someone having a combination of drugs. If you are having high doses of chemotherapy, you may have more side effects.

Steroids are drugs that are often given with chemotherapy treatment. They are usually only given for short periods of time. These also cause side effects. We have more information about steroids.

Macmillan is here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online.
• Visit our chemotherapy forum to talk with people who have had chemotherapy, share your experience, and ask an expert your questions.

Chemotherapy can reduce the number of blood cells made by the bone marrow. Bone marrow is a spongy material that is found in the middle of your bones. It makes special cells called stem cells. These develop into the different types of blood cells:

• red blood cells, which carry oxygen to all parts of the body
• white blood cells, which fight and prevent infection
• platelets, which help the blood to clot and prevent bleeding and bruising.

You will have regular blood samples taken to check the number of these cells in your blood. This is called a full blood count.

Chemotherapy can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection or find it harder to fight infection. A low white blood cell count is sometimes called neutropenia.

When are you most at risk of infection? 

Your resistance to infection is usually lowest 7 to 14 days after chemotherapy. The number of white blood cells will usually return to normal before your next treatment.

You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

Developing an infection when you have a low number of white blood cells can sometimes be a serious complication of chemotherapy. But most people do not have any serious problems with infection.

Some chemotherapy treatments are more likely than others to reduce the number of white blood cells. Your doctor may prescribe antibiotics and other medicines to take during chemotherapy, to prevent an infection. These are called prophylactic drugs.

Even a mild infection can delay your chemotherapy treatment. Your doctor may wait until the infection has gone and for your blood cell levels to go back up before you have more chemotherapy.

Your chemotherapy nurse will talk to you about infection and show you how to check your temperature.

You can have an infection without having a high temperature. Drugs such as paracetamol lower your temperature, so they can hide or mask an infection.

Contact the hospital straight away on the 24-hour contact number you have been given if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection
• your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) a lot or discomfort when you pass urine.

Chemotherapy units usually have a policy they follow when someone with low white blood cells has an infection. This is to make sure you get treatment with antibiotics straight away.

Some people may have to stay in hospital to have antibiotics given into a vein (intravenously). After a few days, you can usually have them as capsules or tablets to take at home.

After chemotherapy, your nurse may give you injections under the skin of a drug called G-CSF. This encourages the bone marrow to make more white blood cells and reduces the risk of infection.

We have more information about G-CSF and some tips for avoiding infection when your immunity is low.

Chemotherapy can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red cells is low, this is called anaemia. You may have symptoms such as:

• pale skin
• lack of energy
• feeling breathless
• feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion. It is the most common way to treat anaemia. Sometimes doctors prescribe a drug called erythropoietin. This helps the body to make more red blood cells. It is given as an injection under the skin. Some people may have erythropoietin and a blood transfusion.

Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

Tell your doctor or nurse if you have any unexplained bruising or bleeding. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red or purple spots on your skin that may look like a rash.

Some people may need a platelet transfusion. This is given by drip (infusion). The platelets will start working immediately to prevent bruising and bleeding.

Here are some tips for avoiding injury:

• Wear protective gloves when doing work around the house or in the garden.
• Be careful to avoid bumping into things or tripping.
• Use a soft toothbrush to protect your gums from bleeding and do not floss.

The digestive system is made up of the stomach and bowels. Chemotherapy can affect the digestive system in different ways.

Some drugs can affect your skin. It may become dry or slightly discoloured. Your skin may also be more sensitive to sunlight during and after treatment. Tell your cancer doctor or nurse if you develop any skin changes or rashes.

Chemotherapy can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. Sometimes nails can become loose or fall out. When treatment finishes, any changes usually disappear as the nails grow out.

Tell your doctor or nurse if you notice changes to your nails. They can give you advice or arrange for you to see a podiatrist for foot care advice if needed.

Some drugs can make you feel anxious, restless, dizzy, sleepy or have headaches. If you have any of these, it is important to tell your cancer doctor or nurse. They may be able to prescribe medicines that can help with some of these effects.

Some people find that chemotherapy makes them forgetful or unable to concentrate during or after treatment. Doctors sometimes call this cancer-related cognitive changes (CRCC) but it is sometimes known as chemo brain. If this happens, it is usually mild.

Some chemotherapy drugs can affect your hearing. You may have ringing in your ears, called tinnitus. You may also not be able to hear some high-pitched sounds. Rarely, your sense of balance may be affected. Any hearing loss and changes in balance may be permanent.

Tinnitus usually improves when treatment ends. You may have hearing tests before, during and after treatment with some chemotherapy drugs. Tell your cancer doctor or nurse if you notice any changes.

Having chemotherapy can sometimes affect your sex life. Side effects like tiredness or feeling sick or weak can reduce your sex drive and make having sex difficult. Feeling low in mood or anxious can also affect your sex life.

Some people continue to enjoy sex and want to keep their sex life as normal as possible. Your cancer doctor or nurse will tell you if you need to make changes to your sex life because of a treatment. For example, if you have had high-dose chemotherapy or a stem cell transplant your doctor may advise you not to have close physical contact with anyone for a while. This is to protect you from infection.

Chemotherapy should not have a long-term effect on your sex life. The side effects usually slowly improve after your treatment finishes.

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