Side Effects of Chemotherapy

You might have some idea about chemotherapy. You might have heard that it is one of the cancer treatments. Chemotherapy is a cancer treatment that uses chemo drugs to kill fast-growing cancer cells. It may get rid of cancer so that it won't come back. It may also alleviate the symptoms of cancer patients and you might be aware of its adverse side effects like hair loss. The fear of the side effects is more widespread than the complications of the chemotherapy itself. However, the side effects manifest in every patient differently and largely depend on the type of chemo drugs. We will discuss the side effects in more detail here.

Why does chemotherapy cause side effects?

Chemotherapy utilizes a drug that targets all the active cells of the body. All the cells that grow and divide are active. Hence, the healthy cells also become the target of the chemo drugs apart from the cancer cells. The cells such as blood, mouth, digestive system, and hair follicles can be affected by chemotherapy. When the healthy cells are affected, the side effects emerge.

Treatment of side effects

The good news is that the side effects are treatable. You can talk to your medical team to deal with the side effects. Ask your specialist about the possible side effects of the chemo drug and what you can do the prevent or reduce the side effects. Remember that the side effects of chemotherapy are different for every patient. Even if anyone goes through the same process again, the side effects might still vary. So, you must inform your team about all your problems and symptoms during the chemotherapy. You can also keep track of your side effects so that you can use them later.

Also Read: Managing Side Effects of Chemotherapy

Some common side effects

Chemotherapy has several side effects. Some of them are:

Fatigue and low or low energy level:

Often fatigue is confused with tiredness, but fatigue is not the same as just being tired. It is fatigue if you are tired for a very long time and your condition doesn't improve even after resting. It is a common side effect of chemotherapy.

Hair loss:

Not all chemotherapy causes hair loss, it depends on the type of chemo drugs and whether you will lose hair or not. You can experience thinning of your hair to balding and your hair might become brittle, lose its colour, and even fall out slowly or in clumps. Hair loss usually starts a few days after the chemotherapy and lasts for some days after the last treatment. This side effect is temporary. So, your hair will regrow.

Pain:

Pain is another side effect of chemotherapy. You may have headaches, muscle pain, and stomach pain. Most pain is treatable and goes away eventually. You can ask your doctor to prescribe painkillers and other drugs to cope with pain.

Nausea and other eating problems:

You may have eating problems like nausea, vomiting, loss of appetite, and trouble swallowing. These side effects can occur after getting chemotherapy and even later. Dietary changes, supplements, and avoiding specific foods can help you with these side effects. You can also ask your medical team to help you with some medications.

Neuropathy:

When the nerve endings get damaged, it can cause a lot of pain in your hands and feet. Neuropathy occurs when the nerves get damaged. You may feel numbness, tingling feeling and burning sensations in your limbs. Neuropathy might be intense in the case of a few drugs, as per a study.

Mouth and throat sores:

You may develop mouth and throat sores. These sores may be painful, and you have trouble eating and swallowing food. It usually occurs after 5 to 14 days after the chemotherapy starts. You should be careful and avoid getting any infections related to these sores. Inculcate a healthy eating habit and clean your mouth regularly to lower the risk of mouth sores. Mouth sores are only temporary and go away once the treatment is over.

Diarrhea and constipation:

You may have digestion-related problems like diarrhoea and constipation. Chemotherapy may affect the cells of your digestive system, hence such symptoms. It can result from a change in your diet too. Maintain a healthy diet and drink plenty of fluids to keep yourself hydrated. Have a diet that doesn't irritate your stomach and includes roughage to cope with constipation. You can also seek medical attention to treat these side effects.

Rashes and other skin conditions:

Your immune system may get affected too. It can lead to rashes and other skin conditions. Moisturizing your skin can help you to manage these skin conditions. If not, you can always ask for help from your doctors.

Breathing problems:

You can have breathing problems. Chemotherapy can damage the lungs and make it harder to breathe. Try to stay calm and practice breathing exercises. It will help cope with breathing problems.

Dry Mouth/throat:

Dry mouth is a common side effect of cancer treatment and is caused due to damage to the salivary glands. It is common in patients taking chemo or radiotherapy in the head and neck regions.

Tips to remain hydrated:

• Ensure that you drink enough fluids to prevent dehydration
• Carry a water bottle with you to stay hydrated
• Avoid Caffeine, alcohol, and sugars as they cause dehydration

Tips to increase saliva:

• Prepare foods in gravy form
• Avoid breathing through your mouth
• Take Ginger juice and Aloe vera juice
• Chewing on carrom (ajwain) or fennel (sonf) seeds can increase saliva
• Use citrus fruit juices or tamarind water in cooking
• Limit dry hard-to-swallow foods

Chewing and swallowing problems

Mouth cancer patients or patients undergoing chemotherapy on the head and neck usually face this trouble.

Choose foods that are easier to chew and swallow:

• Soft foods include khichdi, congee/gruels, oats, soups, and stews.
• Puree or blenderize foods you have difficulty chewing or swallowing.
• Cut food into small bites.
• Take your veggies and fruits in the form of smoothies, soups, and juice.
• Do not talk and swallow at the same time.
• Ensure to add softer proteins to your diet as nut butter, cooked sprouts, and dal soups.
• Take small meals at regular intervals. Large quantities of food will tire you.

Lack of appetite

Lack of appetite is quite common in cancer patients. It occurs due to the treatment of cancer itself. Additionally, patients feel stressed due to the disease, increasing their feelings.

Tips for managing Lack of appetite:

• Eat 5-6 small meals instead of 3 big meals throughout the day.
• Eat with friends or family or watch television while eating to take your mind off your lack of appetite.
• Keep an eating and drinking schedule and set the alarm to remind you to eat.
• Keep snacks next to you during chemotherapy or while in bed.
• Spices may improve appetite if loss of appetite is due to lack of taste. Spices are also loaded with antioxidative and anti-inflammatory properties.
• If not to eat, take your veggies and fruits as smoothies, soups, and juice and sip on them throughout the day.

Weight loss

Weight loss in cancer patients is quite common. Cancer patients tend to eat less as inflammation in the body leads to the release of proteins, making people lose their appetite, pain, anxiety, and stress; it takes away the feeling of eating anything. Also, inflammation in the body keeps their metabolic rate up, due to which they use up more calories than they usually would.

Tips for management

• Include more proteins in the diet. Include pulses, sprouts, nuts, and seeds
• Take protein-rich snacks, especially lentils, nuts, seeds, etc., which have specific amino acids glutamine, arginine, and lysine, which help prevent cachexia or unintentional weight loss in patients.
• Include good fats in your diet available from avocado, cold-pressed oils,
• Keep a weighing machine at home and regularly check your weight to see progress or catch any sudden dip in weight.
• Take small high-calorie high protein food at regular intervals.
• Keep small snacks beside you, for example, during chemotherapy or while travelling.

Changes in taste and smell that affect the intake

Chemotherapy can affect the taste receptors in the mouth, which could be sensitive to chemotherapy. This problem is more common in patients receiving radiotherapy or chemotherapy in the head and neck region or due to specific chemotherapy drugs and targeted therapy.

Tips for managing taste and smell changes

• Add intense flavours to foods.
• Use pickles, condiments, sauces, dressings, vinegar, or citrus if you dont have mouth or throat sores
• Add spices, herbs, and seasonings (such as onion, garlic, cinnamon, cardamom, fennel seeds, and mint) to enhance the flavour of your food.
• Clean your mouth with homemade baking soda and rinse.
• Use ceramic utensils instead of silverware/ stainless steel in case of a bitter taste.
• Avoid being in the kitchen when food is being prepared.
• Choose cold or room-temperature foods instead of hot foods with a strong smell.
• A low level of the mineral zinc in the body can cause a lack of taste sensation. Get the same checked and corrected if needed.

Gas and bloating

Chemotherapy can alter the digestive enzymes, which can affect digestion and cause gas or bloating ⁴. It can also change the good microbes in the gut, leading to more gas formation and the feeling of bloating.

Tips for managing gas and bloating

• Sit in an upright position while eating.
• Chew food well and do not eat very fast.
• Do not lie down soon after having a meal.
• Walk for a while post-meal.
• Avoid consuming a very spicy meal.
• Some foods help relieve gas and bloating,
  • Ajwain (carom seeds) can be consumed with palm jaggery, or the same can be added to boiling water and consumed throughout the day. Just chewing on carom seeds will also be helpful.
  • Hing (Asafoetida) can also help prevent gas formation; add these to gas-forming food preparation, such as dals, potatoes, etc.
  • To improve the gut, add plenty of prebiotics ¹ including onion, shallots, garlic, beans, legumes, and probiotics in plant-based curd, kefir, ragi Ambala, etc.
  • Some people will be prone to gas formation when they eat specific foods and maintain a diary to note down which foods, when consumed, cause more gas or bloating.
  • Avoid dairy products as they can cause bloating.

Constipation

Constipation is reduced frequency of bowel movements and dry hard stools, which are difficult to pass. It can occur as a side effect of cancer treatment, as chemotherapy may cause changes in the lining of intestinal walls.

Tips for managing constipation

• Choose high-fibre foods, such as whole grains, fruits, vegetables, nuts, and beans.
• Try prunes and other dried fruits and juices in moderation, such as prunes or apple juice.
• Drink hot beverages, such as herbal tea
• Make sure you drink enough water.
• Avoid refined products like maida, sooji, sabudana (sago), etc
• Move more if you are able - walk, stretch, or do yoga.
• Get enough sleep.

Diarrhoea

Diarrhoea is a frequent passage of runny stools. It can happen soon after the treatment or a week after. Some patients, when given medications for constipation, may develop diarrhoea later. It can also lead to loss of fluids, electrolytes, and overall calories.

Tips for managing Diarrhoea ³

• Avoid high-fibre and fat foods, such as raw vegetables and excess fruits.
• Avoid foods that have a high content of sugar.
• Avoid oily, fried, and spicy foods, milk, alcohol, and caffeinated drinks.
• Eat easy-to-digest foods like steamed apples, congee, stews, etc.
• Consume a lot of fluids with electrolytes, such as coconut water, ORS, broth, lemon juice with salt, and diluted and stained fruit/vegetable juices.
• Carry a water bottle to stay hydrated.
• Include probiotics such as plant-based yoghurt, kefir, and fermented foods in your diet.

Nausea and vomiting

Treatment-related nausea and vomiting are severe complications of chemotherapy and radiotherapy. Usually, nausea and vomiting are induced soon after the treatment and subsides in weeks. In most cases, preventive medications are given. But food can help prevent and manage nausea and vomiting.

Tips for managing nausea and vomiting

• An empty stomach can induce the feeling of nausea and vomiting.
• Take small meals at regular intervals; viewing a large amount of food can again induce nausea.
• Avoid foods that can increase symptoms like lactose and gluten.
• Eat and drink slowly. Take your time and chew your food well.
• Drink plenty of fluids like water, clear juices without sugar, and soups.
• A lemon shot made with the juice of a lemon and dry ginger powder helps subside nausea.
• Use ginger in cooking; it can also be added to your tea and lemon juice.
• Consume a light snack before going for chemotherapy and dehydrated snacks like a biscuit (gluten-free/sugar-free) to help with nausea.
• Avoid deep-fried, spicy, and strong-smelling foods.
• Take foods in average or cold temperatures instead of hot.

Some rare side effects:

Apart from the above side effects, some rare side effects may occur. These include hypersensitivity, extravasation, neutropenic typhlitis, pancreatitis, and acute hemolysis.

Summing up

Chemotherapy can cause several side effects. Such side effects can vary from patient to patient. Notably, some side effects can be less pronounced and moderate to acute in others. But most side effects are temporary and go away eventually. The side effects of chemo depend mainly on drug type and dosage. So, you can ask your doctor about possible side effects and how you can manage them. Don't hesitate to share any information with your medical team. You can always seek medical support to help you cope with the side effects.

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Reference:

1. Altun ?, Sonkaya A. The Most Common Side Effects Experienced by Patients Were Receiving First Cycle of Chemotherapy. Iran J Public Health. 2018 Aug;47(8):1218-1219. PMID: 30186799; PMCID: PMC6123577.
2. Nurgali K, Jagoe RT, Abalo R. Editorial: Adverse Effects of Cancer Chemotherapy: Anything New to Improve Tolerance and Reduce Sequelae? Front Pharmacol. 2018 Mar 22;9:245. doi: 10.3389/fphar.2018.00245. PMID: 29623040; PMCID: PMC5874321.