Chemotherapy Side Effects
Different chemotherapy drugs cause different side effects, and some people may have very few. Cancer treatments cause different reactions in different people and any reaction can vary from treatment to treatment.

It may be helpful to remember that almost all side effects are only short-term and will gradually disappear once the treatment has stopped.

The main areas of your body that may be affected by chemotherapy are those where normal cells rapidly divide and grow, such as the lining of your mouth, the digestive system, your skin, hair and bone marrow (the spongy material that fills the bones and produces new blood cells).

Possible side effects of some chemotherapy drugs

Tiredness
Bone marrow
Alteration of kidney function
Nausea and vomiting
Loss of appetite

Diarrhoea
Constipation
Your mouth
Taste changes
Weakness

Hair loss
Effects on the nervous system
Changes in hearing
Skin changes
Effects on the nerves

Tiredness
While having chemotherapy and for some time afterwards you may feel very tired (fatigued) and have a general feeling of weakness. It is important to allow yourself plenty of time to rest. The tiredness will ease off gradually once the chemotherapy has ended, but some people find that they still feel tired for a year or more afterwards.

Bone marrow
Chemotherapy can reduce the number of blood cells produced by the bone marrow. Bone marrow is a spongy material that fills the bones and contains stem cells, which normally develop into the three different types of blood cell.

The cells produced by bone marrow:

►white blood cells are essential for fighting infections
►red blood cells contain haemoglobin to carry oxygen round the body
►platelets help to clot the blood and prevent bleeding.

White blood cells
If the number of white cells in your blood is low you will be more likely to get an infection as there are fewer white cells to fight off bacteria. If your temperature goes up, or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital straight away. Most hospitals consider a temperature above 38C (100.5F) to be high, although some hospitals use a lower or higher temperature.
Your regular blood tests will also show the number of white cells in the blood. If you get an infection when your white blood cell level is low you may need to have antibiotics.

These may be given intravenously (into the vein) in the chemotherapy day unit or as tablets which can be taken at home. You may need to be admitted to hospital for the antibiotic treatment.

In some circumstances, drugs called growth factors can help your bone marrow to make more white blood cells. Growth factors are special proteins, normally made in the body, which can now be produced in the laboratory.

Blood cells are usually at their lowest level from 7 to14 days after the chemotherapy treatment, although this will vary depending on the type of chemotherapy.

Red blood cells
If the level of red blood cells (haemoglobin) in your blood is low you may become very tired and lethargic. As the amount of oxygen being carried around your body is lower, you may also become breathless.
These are all symptoms of anaemia - a lack of haemoglobin in the blood. People with anaemia may also feel dizzy and light-headed, and have aching in their muscles and joints.

During chemotherapy you will have regular blood tests to measure your haemoglobin. A blood transfusion can be given if your haemoglobin is low. The extra red cells in the blood transfusion will very quickly pick up the oxygen from your lungs and take it around the body. You will feel more energetic and any breathlessness will be eased.

Sometimes a drug called erythropoietin can be used to stimulate the bone marrow to produce red blood cells more quickly. Erythropoietin is given as an injection just under the skin of the thigh or abdomen, from one to five times a week.

Platelets
If the number of platelets in your blood is low you may bruise very easily and may suffer from nosebleeds or bleed more heavily than usual from minor cuts or grazes. If you do develop any unexplained bleeding or bruising you need to contact your doctor or the hospital straight away, and you may need to be admitted to hospital for a platelet transfusion.

A fluid containing platelets is given by drip into your blood. These platelets will start to work immediately, to prevent bruising and bleeding.

Your regular blood tests will also be used to count the number of platelets in your blood. If your platelets are low, take care to avoid injury - for example, if you are gardening wear thick gloves.

Alteration of kidney function
Some chemotherapy drugs such as cisplatin and ifosfamide can cause damage to the kidneys. In order to prevent kidney damage, fluids may be given by drip into your vein for several hours before you have the treatment and your kidney function will be carefully checked by blood tests before each treatment.

Nausea and vomiting
Some chemotherapy drugs can make you feel sick (nausea), or actually be sick (vomit). Many people have no sickness, but for those who do there are now very effective treatments to prevent and control it, so it is much less of a problem than it was in the past.

If you do feel sick, it will usually start from a few minutes to several hours after the chemotherapy, depending on the drugs you are having. The sickness may last for a few hours or, rarely, for several days.

Your doctor can prescribe anti-sickness drugs (anti-emetics) to stop or reduce this side effect. Anti-emetics may be given by injection with the chemotherapy and as tablets to take at home afterwards.

Steroids can also be helpful in reducing nausea and vomiting. Given in this way, they often give a sense of well-being, as well as helping to reduce feelings of sickness and loss of appetite.

Diarrhoea and constipation
Some chemotherapy drugs can affect the lining of the digestive system and this may cause diarrhoea for a few days. Some chemotherapy drugs (or drugs given to control side effects such as nausea) can cause constipation.

If you have any diarrhoea or constipation, or are worried about the effects of chemotherapy on your digestive system, see your doctor or chemotherapy nurse to discuss any problems you may have.

Your mouth
Some drugs can cause a sore mouth, which may lead to mouth ulcers. If this happens it is usually about 5 to 10 days after the drugs are given and will clear up within three to four weeks. Your doctor can prescribe mouthwashes to help. The mouth ulcers can become infected, but your doctor can give you treatment to help prevent or clear infection. Cleaning your teeth regularly and gently with a soft toothbrush will help to keep your mouth clean.

If your mouth is very sore, gels, creams or pastes can be used to paint over the ulcers to reduce the soreness. Your cancer specialist can tell you about these.

Taste changes
Chemotherapy can cause your taste to change; food may taste more salty, bitter or metallic. Normal taste will come back after the chemotherapy treatment finishes.

Your hair
Complete or partial hair loss can occur with some chemotherapy drugs and can be very distressing. Some drugs cause no hair loss or the amount of hair lost is so slight it is hardly noticeable.
Some chemotherapy can damage hair and make it brittle. If this happens the hair may break off near the scalp a week or two after the chemotherapy has started. The amount of hair lost, if any, depends on the type of drug or combination of drugs used, the dose given and the person's individual reaction to the drug. If hair loss happens it usually starts within a few weeks of beginning treatment, although very occasionally it can start within a few days. Underarm, body and pubic hair may be lost as well. Some drugs also cause loss of the eyelashes and eyebrows. If you do lose your hair as a result of chemotherapy, it will grow back once you have finished your treatment. See 
HAIR LOSS page

Skin changes
Some drugs can affect your skin. These may make your skin become dry or slightly discoloured and may be made worse by swimming, especially if there is chlorine in the water. Any rashes should be reported to your doctor.

The drugs may also make your skin more sensitive to sunlight, during and after the treatment. Protect your skin from the sun by wearing a hat and sunglasses, covering skin with loose clothing and using sunscreen cream on any exposed areas.

Your nails
Your nails may grow more slowly and you may notice white lines appearing across them. Sometimes the shape or colour of your nails may change: they may become darker or paler. False nails or nail varnish can disguise white lines. Your nails may also become more brittle and flaky.

Effects on the nerves
Some chemotherapy drugs can affect the nerves in the hands and feet. This can cause tingling or numbness, or a sensation of pins and needles. This is known as peripheral neuropathy. Let your doctor know if it occurs.

Usually it gradually reduces when the chemotherapy treatment ends but if it becomes severe it can damage the nerves permanently. Your doctor will keep a close check on you and may need to change the chemotherapy drug if the problem is getting worse.

Effects on the nervous system
Some drugs can cause feelings of anxiety and restlessness, dizziness, sleeplessness or headaches. Some people also find it hard to concentrate on anything.

Changes in hearing
Some chemotherapy drugs can cause loss of the ability to hear high-pitched sound. They can also cause a continuous noise in the ears known as tinnitus, which can be very distressing. Let your doctor know if you notice any change in your hearing.

Social life

You may be able to go to work and carry on with your social activities as usual, but may need to take rests during the day or shorten your working hours.

Some people feel very tired during chemotherapy. This is quite normal and may be caused by the drugs themselves and your body fighting the disease, or may simply be because you are not sleeping well.

For someone who normally has a lot of energy, feeling tired all the time can be very frustrating and difficult to cope with. The hardest time may be towards the end of the course of chemotherapy.

Try to cut down on any unnecessary activities and ask your family or friends to help you with jobs such as shopping and housework. It is important not to fight your tiredness. Give yourself time to rest and if you are still working see if it is possible to reduce your hours while you are having treatment.

If you are having problems with sleeping, your GP may be able to prescribe some mild sleeping tablets for you.

While you are having chemotherapy you may find that you cannot do some of the things you used to take for granted. But you needn't stop your social life completely.

Depending on how well you feel, there is no reason to stop going out or visiting friends, especially if you can plan ahead for social occasions. For example, if you are going out for the evening, you could make sure that you get plenty of rest during the day so you have more energy for the evening.

If you are planning to go out for a meal, you may find it helpful to take anti-sickness tablets before you go and to choose your food carefully from the menu.

If you have an important social event (such as a wedding) coming up, discuss with your doctor whether your treatment can be altered so that you can feel as well as possible for the occasion.

Alcohol
For most people, having the occasional alcoholic drink will not affect their chemotherapy treatment, but it is best to check with your doctor beforehand.

Holidays and vaccinations
If you are going abroad on holiday, it is important to remember that you should not have any 'live virus' vaccines while you are having chemotherapy.

These include polio, measles, rubella (German measles), MMR (the triple vaccine for measles, mumps and rubella), BCG (tuberculosis), yellow fever and typhoid medicine. There are, however, vaccines which you can have, if necessary.

If you are travelling abroad ask your doctor whether you should have other vaccines such as diphtheria, tetanus, flu, hepatitis B, hepatitis A, rabies, cholera or typhoid injection.

Sometimes people who have, or have had, cancer can find it difficult to get travel insurance to travel abroad.

Will chemotherapy affect my sex life?

Some people go through their chemotherapy with their usual sex lives unaffected. On the other hand, some people find that their sex lives are temporarily or permanently changed in some way due to their treatment.

Any changes that occur are usually temporary, and should not have a long-term effect on your sex life. For example, there may be times when you just feel too tired, or perhaps not strong enough for the level of physical activity you are used to during sex.

If your treatment is making you feel sick, you may not want to have sex at all for a while. Anxiety may also play a large part in putting you off sex. Often this anxiety may not seem directly related to sex; you may be worried about your chances of surviving your cancer, or how your family is coping with the illness, or about your finances. Stresses like these can easily push everything else, including sex, to the back of your mind.

Any such changes are usually short-term and not serious. There is no medical reason to stop having sex at any time during your course of chemotherapy. It is perfectly safe, and the chemotherapy drugs themselves will have no long-term physical effects on your ability to have and enjoy sexual activity. Any changes in your sex life are unlikely to last long.

It is thought that chemotherapy drugs cannot pass into semen or vaginal fluids. However, for people having chemotherapy most hospitals advise the use of condoms during sexual activity for up to a few days after the treatment has been given. This is to prevent any possible problems for their partner.

It is important to take good contraceptive precautions whilst having chemotherapy, as chemotherapy drugs can harm the baby if pregnancy occurs. For this reason, your doctor will advise you to use a reliable method of contraception (usually 'barrier' methods - such as condoms or the cap) throughout your treatment and for a few months afterwards.

The only exception may be women whose chemotherapy has brought on an early menopause. These women will experience symptoms usually associated with the menopause, which may include dryness of the vagina and a decreased interest in sex.

If you are worried that the chemotherapy could affect your sex life, try to discuss your worries with your cancer specialist before your treatment starts. Your doctor should be able to tell you about the side effects your treatment may cause and you can then talk about the main effects of these, if any, on your sex life.

You need to know about all aspects of your treatment, and if sex is an important part of your life, it matters that you should be fully aware of any possible changes. It may help if you can discuss your feelings and any worries with your partner. Even though it is unlikely that chemotherapy will cause any problems with sex, your partner may still have some anxieties and may have been waiting for a sign from you to show that it is all right to discuss them. Perhaps your partner could join you if you decide you want to talk to your doctor.

Overcoming any problem, sexual or otherwise, may seem like an uphill struggle when you are also trying to come to terms with your cancer and cope with chemotherapy. Remember that most side effects from chemotherapy that may affect your sex life, such as tiredness or sickness, will gradually wear off once your treatment is finished.

Will chemotherapy make me infertile?
Unfortunately some chemotherapy treatments may cause infertility. Infertility is the inability to become pregnant or to father a child and may be temporary or permanent, depending on the drugs that you are having.

It is strongly advised that you discuss the risk of infertility fully with your doctor before you start treatment. If you have a partner he or she will probably wish to join you at this discussion so you can both be aware of all the facts and have a chance to talk over your feelings and options for the future.

Although chemotherapy can reduce fertility it is quite possible for a woman having chemotherapy to become pregnant during the treatment. The side effects of chemotherapy, such as sickness and diarrhoea, can make the pill less effective. Female partners of a man having chemotherapy may also become pregnant. Pregnancy should be avoided during chemotherapy in case the drugs harm the baby.

Female fertility
Some drugs will have no effect on your fertility, but some may temporarily or permanently stop your ovaries producing the eggs which can be fertilised by the sperm during sex.

If this happens it means, unfortunately, that you can no longer become pregnant and it will also bring on symptoms normally associated with the change of life (the menopause).

During chemotherapy your monthly periods may become irregular and stop and you may have hot flushes, dry skin and dryness of the vagina. Some women's ovaries will start producing eggs again once the treatment ends. If this is the case, the infertility will have been short-term. Your periods will return to normal after the treatment finishes.  This happens in about a third of women. Usually, the younger you are, the more likely you are to have normal periods again and still be able to have children once the chemotherapy has ended.

Depending on the type of cancer you have, your doctor may be able to prescribe hormone tablets  to help relieve the menopausal side effects. The hormones, unfortunately, will not enable you to start producing eggs again and so cannot prevent infertility.

Pregnancy and cancer
If you are pregnant before your cancer is diagnosed and your chemotherapy starts, it is very important to discuss with your doctor the pros and cons of continuing with your pregnancy.

It is sometimes possible to delay starting chemotherapy until after the baby is born, depending on the type of cancer you have, the extent of the disease, how advanced the pregnancy is and the particular chemotherapy you will be having.

You will need to talk to your doctor about your pregnancy and be sure you are fully aware of all the risks and alternatives before making any decisions.

Male fertility
Some chemotherapy drugs will have no effect at all on fertility, but some may reduce the number of sperm produced or affect their ability to reach and fertilise a woman's egg during sex.

Unfortunately, this means you may no longer be able to father children. However, you will still be able to get an erection and have an orgasm as you did before you started your treatment.

You should use a reliable barrier method of contraception all through your treatment.

If you have not completed your family before you need to start chemotherapy, you may be able to bank some of your sperm for later use.

If this is possible in your case, you will be asked to produce several sperm samples over a few weeks. These will then be frozen and stored so that they can be used later to try to fertilise an egg and make your partner pregnant.

The pregnancy should then carry on as normal. You may be charged a fee for  sperm storage, and also for the infertility treatment.

If the chemotherapy does cause infertility, some men will remain infertile after their treatment has stopped while others will find their sperm returns to normal levels and their fertility comes back.

Sometimes it may take a few years for fertility to return. Your doctor will be able to do a sperm count for you when your treatment is over to check your fertility.

Teenage boys should also be aware of the infertility risk so that, if possible, their sperm can be stored for later years.

Your feelings about infertility
Some people are devastated when they discover that the treatment they need for their cancer will also mean they can no longer have any children. If you had been planning to have children in the future or to have more children to complete your family, infertility will be very hard to come to terms with.

The sense of loss can be very painful and distressing for people of all ages. Sometimes it can feel as though you have actually lost a part of yourself.

You may feel less of a man or less feminine because you can't have children. Women especially may be distressed, and resentful that the drugs may cause bodily changes, such as the menopause, which can further undermine their self-confidence.

People vary in their reactions to the risk of infertility. Some people may shrug it off and feel that dealing with the cancer is more important. Others may seem to accept the news calmly when they start treatment and find that the impact doesn't hit them until the treatment is over and they are sorting out their lives again.

There is no right or wrong way to react. You may want to discuss the risks and all your options with your doctor before you start treatment. You may also need an opportunity to talk to a trained counsellor about any strong emotions which threaten to become too much for you.

Your partner will also need special consideration in any discussions about fertility and future plans. You may both need to speak to a professional counsellor or therapist specialising in fertility problems. They can help you to come to terms with your situation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hair Loss

Hair loss (alopecia) can be one of the most devastating and emotional experience, as it is the most visible side effect of cancer treatment.  When our hair falls out, it affects or self-image and quality of life.  

It is important to know that hair loss is not permanent, and your hair will grow back normally once the treatment is complete.

Treatments and Hair Loss

In addition to affecting the cancerous cells, radiation and chemotherapy treatments can affect normal cells, including the cells responsible for hair growth.   

Hair loss occurs with many chemotherapy drugs, but not all; and sometimes the loss is slight and not noticeable.  Hair loss from chemotherapy occurs because the hair follicles are weakened by the treatment, which causes your hair to fall out much more quickly than it would normally.  Hair loss from chemotherapy can occur in all parts of the body head, face, legs, armpits, arms and pubic hair.  Depending on the type of treatment you receive, hair loss may start anywhere from seven to 21 days after treatment begins. Your hair will start to grow back when you are finished with chemotherapy but it may take six to 12 months to grow back completely. It may even have a different texture for example, curly hair can grow back straight and dark hair can become lighter.

Unlike chemotherapy, radiation therapy causes hair loss only in the area being treated.  For example, if you are receiving radiation to your head, you will lose scalp hair only.  As mentioned above, hair loss is usually not permanent, however, radiation to the head or scalp can cause permanent hair loss.  The hair will sometimes come back within two to three months if lower doses of radiation are used. 

What You Can Do to Help with Hair Loss?

  • Use mild shampoos, like baby shampoo, to avoid dryness of the scalp 
  • Cut hair short (its easier to deal with short hair falling out than longer hair) 
  • Avoid heated rollers and hairdryers, but if you must, use the low setting 
  • Use a wide-tooth comb and soft hairbrushes 
  • Do not colour or perm your hair 
  • Avoid plaiting your hair or wearing it too tight 
  • Sleep on sating pillows 
  • Protect head from the sun wear a hat, scarf or wig.

Obtaining and Wearing a Wig

  • Buy a wig before all of your hair falls out sot that you will have a good match to your own hair colour and will be prepared when hair-loss starts 
  • Keep in mind that there are full-service wig salons that fit and style wigs, some of which specialize in hair loss from cancer treatments.. 
  • Have fun with it.  Wig salons also sell turbans and scarves that come in a variety of colours and fabrics that are stylish.   
  • Wear stickies to keep your wig on.  They are so effective that youll forget you are wearing a wig. 

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