Like other cancer treatments, chemotherapy can cause side effects. Patients regularly share that concern with us, and understandably so.
Fortunately, newer drugs are less toxic, and we continue to develop new agents, combinations and delivery methods that are even less burdensome. Medications to treat and even prevent associated problems like nausea, vomiting and diarrhea are also much more effective now.
Managing Chemotherapy Side Effects
Our doctors only recommend chemotherapy when they believe the benefits outweigh the risks. If side effects do occur, they are often mild, manageable and temporary. Our patients often continue to work, go to school and do many of their daily activities.
We work to anticipate and prevent side effects, then to treat them if needed. We offer:
24/7 support: Before asking you to commit to chemotherapy, we will discuss what side effects you might experience and how to prevent or counter them. Once treatment begins, a doctor or nurse is always available to speak you, either by phone or in person at our Cancer Center. You are not alone.
Flexibility: If you experience bad side effects, your doctor will do blood tests to determine if you should get lower doses of drugs or longer breaks between treatments. We also provide gentler options for older and frailer patients, though potentially with less potency.
Comprehensive services: Learn more about our range of services for patients undergoing chemotherapy:
Wig Bank, to help when getting drugs that can make your hair thin or fall out
Why Chemotherapy Causes Side Effects
Chemotherapy drugs are very effective at stopping cancer cells from growing and proliferating, but they also inadvertently target healthy cells that frequently replicate and replace themselves. That includes cells in the:
Most side effects show up in the days or weeks following treatment and go away soon after it ends. But there’s a chance some show up much later, take longer to go away or become permanent.
Types of Chemotherapy Side Effects
Each patient is unique in how they respond to chemotherapy — just because you know someone who had problems with the treatment does not mean you will, too, even if you receive the same drug(s).
Whether you experience side effects, and the kind and intensity, depends on:
Type and location of the cancer
Type of drug(s)
Frequency of treatments
Your overall health and fitness
Potential side effects include:
Appetite Loss and Taste Changes from Chemotherapy
Both chemotherapy and the cancer it is meant to treat can alter your sense of taste or smell. The change is usually temporary and is sometimes tied to problems with your teeth or gums. Some foods may seem like they have less taste, while others — especially meat and other high-protein items — might taste bitter or metallic.
The dieticians with our Nutrition Services for Cancer Patients can help. They may prescribe medications that increase your appetite or move food through your intestines more quickly. They can also talk to you about coping strategies:
Visiting your dentist to be sure you do not have any dental problems that may affect the taste or smell of food
If red meat tastes or smells strange to you, try poultry, eggs, dairy products or mild-tasting fish instead
Marinating meat, poultry or fish in sweet fruit juices, sweet wine, Italian dressing or sweet-and-sour sauce
Using small amounts of flavorful seasonings, such as basil, oregano or rosemary
Trying tart foods, such as oranges or lemonade, unless you are experiencing mouth sores
Avoiding the smell of food cooking, and serving it cold or at room temperature
Using bacon, ham or onion to add flavor to vegetables
Nearly all chemotherapy drugs suppress the bone marrow, the spongy tissues inside some bones that produce blood cells. That can mean fewer red and white blood cells and a lower platelet count, which can lead to:
Weak immune system and higher risk of infections
Clotting problems, including unusual bruising or bleeding
At Stanford, we check your blood before each chemotherapy treatment. When needed, we provide medications to boost the number of white and red blood cells. For more urgent cases, we can give blood transfusions.
Tips for handling anemia and fatigue include:
Plan time to rest during the day
Take short naps or breaks
Limit your activities to those that are most important
Try easier or shorter versions of activities you enjoy
Take short walks or do light exercise, if possible
Consider activities such as meditation, prayer, yoga, guided imagery or visualization
Drink plenty of fluids and eat well, in small amounts at a time
Join a support group (our staff can help you find one)
Limit caffeine and alcohol
Ask for help with daily responsibilities
Talk to your doctor about ways to conserve energy and reduce fatigue
Report any changes in energy level to your doctor
A number of patients tell us they have a hard time thinking clearly or concentrating during treatment — a problem known as “chemo brain,” or more formally, cognitive dysfunction. Causes include the chemotherapy, side effects like anemia or the cancer itself, though we do not know why some patients develop the problem and others do not.
Chemo brain usually clears after treatment, though for some it takes a year or more. If you notice any problems, please speak with a member of our team. We offer:
Consultations with a neuropsychologist
Medications such as stimulants normally used to treat attention deficit hyperactivity disorder (ADHD) or cognitive enhancers used to treat Alzheimer’s disease
Cognitive training, also called cognitive or neuropsychological rehabilitation
Occupational therapy and vocational rehabilitation, to help you with work and daily living
Counseling for depression and anxiety, which can make you more susceptible to chemo brain
Treatment for fatigue and sleep problems, which can worsen chemo brain
Recommendations on memory aids or physical exercises that can help
Constipation and Chemotherapy
Chemotherapy can cause constipation, or trouble passing bowel movements. The problem can also occur if you have become less active during treatment or have changed your diet so it does not include enough fluid or fiber.
Diarrhea and Chemotherapy
Chemotherapy can temporarily damage the cells lining the intestine, at times causing diarrhea (loose or watery stools).
Please let us know if you have diarrhea that lasts for more than 24 hours and/or is accompanied by pain and cramping. While your doctor may prescribe medication to control your symptoms, please do not take over-the-counter treatments before speaking with us first.
Emotions and Chemotherapy
Receiving a cancer diagnosis and then undergoing chemotherapy and other treatments can weigh on your emotions, leading to friction in your relationships, stress, anxiety and depression.
We provide a full range of support services for you and your family, including:
Counseling with social workers, psychologists and chaplains
The most common side effect of chemotherapy is fatigue, the feeling that you are too tired to do the things you would normally do. While we do not know all the ways chemotherapy causes fatigue, potential sources include:
Anemia from low counts of red blood cells
Lack of sleep
Cancer-related fatigue is not completely relieved by sleep or rest, unlike the kind some healthy people experience. It is usually most intense in the days following treatment, getting better during the break between appointments. While the problem usually goes away once treatment is completely over, it can last for months or years afterward.
We offer a number of ways to help relieve fatigue and its burden:
Medications for anemia, pain or depression
Yoga and other exercises
Recommendations on how to temporarily adjust your diet and routine
Most patients can continue with work and other aspects of their normal, daily life with some modest modifications.
Hair Loss and Chemotherapy
Some chemotherapy drugs (though not all) can cause your hair to thin or fall out, usually starting one to three weeks into treatment. This can happen slowly or all at once, anywhere on the body — including the:
Your hair usually begins to grow back about six weeks after chemotherapy is over, though it can turn a different color or texture. Until it returns, many patients wear hats, scarves, hairpieces, wigs and other head coverings. Learn more about our Wig Bank.
Organ Damage and Chemotherapy
Certain chemotherapy drugs can irritate the liver, bladder or kidneys, or cause temporary or permanent damage. Other agents can harm heart cells.
Our doctors carefully weigh the use of these drugs, assessing whether the likely treatment benefit outweighs the risk for side effects. We also regularly assess organ function before, during and after treatment. In some cases, we can prescribe special medications called chemoprotective agents to provide some organ protection.
Mouth Sores from Chemotherapy
Chemotherapy can sometimes cause inflammation in the upper gastrointestinal tract, from the stomach to the mouth. This is called mucositis (or stomatitis when it happens to the mouth and esophagitis when it affects the esophagus).
The swelling, irritation and sores can last a few days and interfere with eating, talking, tasting, chewing and swallowing. It can also lead to ulcers and infections if not addressed, with vomiting (another possible side effect) possibly making it worse.
Mucositis is often controllable with basic steps like sucking on ice chips before and during treatment sessions (though this is not recommended for some chemotherapy agents). If necessary, your doctor can also prescribe a special solution to help numb your mouth.
Nausea and Chemotherapy
Patients have long associated chemotherapy with nausea and vomiting, but some agents are more likely to cause these side effects than others. Medications for these problems have also gotten much better — either to control the nausea and make it much less burdensome than in the past, or prevent it in the first place.
We will help you maintain a proper electrolyte balance and nutrient level if you do end up vomiting. We may also recommend combining anti-nausea medications with alternative therapies or other steps:
Relaxation methods such as yoga, meditation and/or music
Acupuncture and acupressure
Some patients experience pain from chemotherapy, in the form of headaches, muscle pain or stomach pain that typically goes away after treatment. Damage to the nerves, usually temporary, can also cause pain. If that happens, you may experience:
Shooting pain (often in the fingers or toes)
Pain specialists and other members of our staff work to prevent pain, then manage symptoms when they do occur. Our techniques include:
Spinal treatments and nerve blocks that stop pain signals sent to the brain
Electric nerve stimulation
Recommendations for particular exercises
Skin and Nail Changes from Chemotherapy
In some cases, chemotherapy can cause changes to your skin or nails. While these changes are temporary and usually minor, occasionally tissue damage or an allergic reaction can occur. We will help watch for these problems and prepare you, so you know what to look for.
Sex, Fertility and Chemotherapy
It is normal to feel less sexual desire when you’re undergoing chemotherapy, whether you are male or female. Chemotherapy can also interfere with sexual function (depending on your age and overall health) and reproduction, sometimes permanently.
Learn more about the comprehensive range of services at our Fertility Preservation Program for patients with cancer. We also offer counseling about whether you should use birth control during your treatment, and which kind.