Side effects of Chemotherapy

The bacteria residing on and inside our bodies, especially the skin, nose, throat, stomach, and bowels are generally harmless and do not cause problems. 

However, chemotherapy can cause a reduction in the number of white blood cells that help fight infection (neutrophils). A low neutrophil count in the blood is called neutropenia.

Most of the infections caused by neutropenia occur due to the bacteria which are already present on or within your body. The risk of infections due to exposure to another infected person is comparatively lower. So no matter how careful you are, some infections are unavoidable.

Your exposure to bacteria and viruses could be reduced by adopting the following precautions:

• Avoid crowded places like buses, MRT, cinemas, and supermarkets.
• Avoid close contact with people who have coughs or colds, and anyone who has got or has been in contact with infectious diseases like shingles, chickenpox, or measles.
• Use an electric or battery shaver instead of a razor.
• Avoid the use of heavily scented talc, soaps and perfumes, as it may irritate your skin.
• Try to prevent injuries as broken skin allows bacteria to enter the body.
• Use a gentle moisturiser to prevent dryness and cracks in your skin.
• Wash your hands before eating food, preparing food and after going to the bathroom. 
• Bath or take a shower daily.
• Women should avoid using tampons, and wipe from front to back after bowel movements.

Chemotherapy affects the rapidly dividing cells in the body. These drugs can not differentiate between cancer cells and other rapidly dividing cells like skin cells, hair, bone marrow, and the epithelial cells in the mouth, throat, intestine, and stomach.

Some chemotherapy drugs are more likely to cause discomfort in the oral cavity. Hence, it is advisable for patients receiving chemotherapy to maintain mouth hygiene, especially during periods of neutropenia.

Here are some practical ways to maintain oral hygiene:

• Use a small soft toothbrush. Brush your teeth gently after each meal. If you wear dentures, clean them regularly after meals and soak them in a mouthwash overnight.
• Replace your toothbrush regularly to minimise the risk of infections.
• Use vaseline, lip balm or a similar product to prevent dryness of your lips.
• Check your mouth for sores and inform your doctor or nurse if you are concerned.

Chemotherapy may cause nausea and vomiting. Your doctor will prescribe drugs to prevent these symptoms.

Apart from drugs, the following suggestions may also help:

• Drink small quantities of fluids regularly. Sucking ice cubes or ice pops can be refreshing.
• Avoid carbonated drinks.
• Chilled drinks sipped through a straw may help.
• Eat smaller meals at frequent intervals.
• Avoid spicy, fatty, fried, strong-flavoured, and strong-smelling foods. Cold and bland foods are often well tolerated.
• Wear loose clothing and avoid tight waistbands.
• Try to rest for a while after you have eaten but avoid lying flat.

Tension and anxiety can worsen nausea and vomiting. However, it is not always easy to control these feelings. If you can relax, your symptoms may reduce to some extent, and your overall well being will improve.

Loss of appetite is common due to the cancer itself as well as chemotherapy. Maintaining your weight is important in your recovery and therefore you should try to avoid excessive weight gain.

• Eat small frequent meals (every 2 -3 hours).
• Eat slowly, chew food thoroughly before swallowing, and relax for a short time between courses and after each meal.
• Keep nutritious snacks handy for sudden hunger in between the meals.
• Make use of pre-packed meals and accept any offer of help if you do not prefer to cook.
• Avoid caffeinated, cordial or syrup drinks, and water as they have poor nutritional value. Replace these with milk or a nutritious supplement drink such as Ensure or Enlive. Ask the dietician or one of our nurses for advice.

Change of taste is common during and after chemotherapy treatment. Some foods and beverages may taste metallic or bitter.  Although unpleasant, these side effects are usually temporary.

• Try to eat more during breakfast as taste changes are often worse towards the end of the day.
• If you have an unusual taste in your mouth while the chemotherapy is being given, try sucking a boiled sweet.
• Choose cool or lukewarm food instead of hot food
• Try adding extra flavour to your food by using seasoning, herbs or spices to give stronger flavours.
• Create a pleasant meal experience, and enjoy the food you crave and love.

Soreness and dryness in the mouth and throat are common side effects of chemotherapy. If your mouth becomes sore, your doctor will prescribe pain killers.

• Drink plenty of water to keep your mouth moist. Drink with a straw and use a small spoon (e.g. teaspoon) to help you take smaller bites.
• Avoid rough-textured foods such as dry toast, crackers, granola and raw fruits and vegetables
• Choose foods that are easy to chew such as porridge, scrambled eggs, steamed fish, ice cream and custard.
• Avoid acidic, spicy or salty beverages and foods.

You may experience constipation during and after chemotherapy. Diet changes, reduction in fluid intake, reduced physical activities, taking painkillers like morphine, and some chemotherapy agents can cause constipation.

If left untreated, it can cause pain and discomfort. Your doctor can prescribe tablets, liquids, or suppositories to relieve constipation.

Here are some tips you can try to avoid constipation:

• Drink at least two litres of fluid daily.
• Light exercises such as walking may sometimes help stimulate bowel movements.
• Eat fibre-rich foods such as brown bread, potatoes, cereals, baked beans, fresh fruits, and vegetables.
• Avoid foods that can cause constipation, such as chocolates, cheese, and eggs.

At times, you may have loose or watery stools. A liquid diet, an infection, and some drugs can cause this side effect. If not managed properly, it may lead to dehydration.

You can try the following to manage your diarrhoea:

• Drink at least two litres of fluid a day and avoid carbonated drinks.
• Eat small, frequent meals and snacks during the day.
• Avoid high-fibre, high-fat (greasy/fried) and spicy foods.
• Eat foods high in proteins and calories such as white bread, rice, hard cheese, pasteurised yoghurt and cooked eggs.
• Wash your hands after opening your bowels.
• Inform your doctor if diarrhoea persists or worsens, or if your bottom becomes sore. Treatment is available to help your symptoms and prevent complications.

Hair loss is also medically known as alopecia. Hair loss may begin within three to four weeks after chemotherapy and continue for several weeks. Although this side effect is not painful, it may make the skin feel itchy and tender. It may occur on any part of the body, including the head, face, underarms and pubic area. The amount and pattern of hair loss differ from person to person depending on the type of treatment received, but this is usually a temporary effect of cancer treatment, and hair grows back after chemotherapy ends.

You can expect to have a healthy growth of hair after about three to six months after completing chemotherapy. There may be a change in texture or colour of your regrown hair, but this will return to normal after several years.

Hair loss can affect you, physically and emotionally. Hair is an integral part of your look and losing it may evoke feelings like rage and despair. Loss of hair can also act as a constant reminder that you have cancer and make you feel low. These reactions are normal and require time and strength to deal with them.

There are many practical ways to manage hair loss before, during and after your treatment, allowing you to cope better:

• Cut your hair short, so that it is easier to manage when it starts to fall out. A shorter hairstyle also makes your hair look fuller.
• Use gentle products such as baby shampoo to prevent dryness of the hair and scalp.
• Use a soft hairbrush and brush your hair gently. Stronger hair stays on longer during treatment.
• Choose a soft, comfortable covering for your pillow; cotton pillowcases are often more comfortable than nylon as cotton can absorb sweat easily. It also causes less friction against the scalp.
• Wear a hair net at night when you sleep to prevent getting hair over your bed and pillow
• If you lose hair from your underarms, use baby powder or similar products instead of using scented deodorants as these may cause irritation of the skin.
• Avoid treatments or products that may hurt your scalp (e.g. hair gels, hair dyes, perms, clips) during and for at least six months after chemotherapy.
• If your scalp is dry, flaky, itchy or tender, you may use a gentle, unscented moisturiser to soothe it.
• Protect your scalp. Use sunscreen or wear a scarf or hat when you are outdoors.
• To take the attention away from your hair, try to highlight other features. For women, applying a little make-up will brighten up your face. The most important thing is to do whatever feels comfortable and gives you the most confidence.
• Consider wearing a wig. Nowadays, there are different styles of wigs available for men and women. If you do not wish to wear a wig, try hats, scarves, and turbans as they are cheaper, comfortable, and protect from the sun.

You may feel tired and lethargic during chemotherapy. Here are a few tips you can try to reduce fatigue:

• Schedule time for rest.
• Maintain a regular sleeping pattern.
• Regular gentle exercises may help to reduce fatigue.
• Walkthrough any worries with someone who you know will listen.
• Accept help from family and friends.

Some chemotherapy drugs can cause infertility. Your doctor will discuss this with you before you start your treatment.

• Chemotherapy can reduce libido and cause impotence. Reduced libido is temporary and usually resolves with time. Your doctor will offer men the opportunity to bank sperm for future use.
• As chemotherapy can seriously harm your baby, it is essential to avoid pregnancy during your treatment. Prior to chemotherapy, pregnancy testing will be done for women of child bearing age.
• Women should discuss with their doctor if they are taking contraceptive pills or have an IUD (intrauterine device) in place.
• Use condoms to reduce the risk of getting an infection.
• A low platelet count may increase your risk of bleeding and bruising during sexual activity.

Certain chemotherapy drugs can affect the nerves outside of the brain and the spinal cord (peripheral nerves). This is called peripheral neuropathy.

Symptoms of peripheral neuropathy include sensations such as tingling, numbness and burning, or pins and needles in the hands and feet. There may also be difficulties with fine motor skills such as writing and buttoning clothes.

These symptoms can occur at any time after chemotherapy is commenced and may worsen as treatment continues.

You should inform your doctor if you experience these symptoms. If necessary, the dosage of chemotherapy can be adjusted, or alternative medication can be given. If the symptoms are left untreated and become more severe, the damage could become permanent. Generally, these symptoms improve after treatment is stopped although this may take some time.

If you develop any of these symptoms, consider the following advice:

• Use gloves in the kitchen when handling cold or hot objects.
• Protect your fingers when using a knife.
• Keep your rooms tidy, and ensure that the floor is clear of clutter so that you can see where you are going easily.
• Make sure rugs have a non-slip backing, particularly in the bathroom where it may be more slippery.
• Stay away from slippery and wet floors.
• Use handrails or shower grips to secure your balance.
• Check the temperature of the water you use with your elbow instead of your hands.
• Refrain from driving or operating any machinery.
• In the garden, wear gloves and ensure your feet are well protected by wearing shoes or boots.
• Wear socks and gloves when the weather is cold.
• Do not drink too much alcohol.