Side Effects of Chemotherapy and Coping Methods

What Are the Side Effects of Chemotherapy?

While the drugs used in your treatment damage tumor cells, they also affect the normal cells of the body. The normal body cells most affected by chemotherapy are the cells that divide most rapidly, such as bone marrow cells (white blood cells, red blood cells and platelets), cells lining the gastrointestinal tract and hair follicle cells. The most common side effects are therefore nausea, vomiting, fatigue and hair loss. For chemotherapy, drugs are used alone or in combination. It is therefore difficult to predict a specific side effect for a patient. It is also important to remember that due to the unique nature of each person, side effects that may occur during chemotherapy may not be the same for everyone or may not occur at all.

Nausea and Vomiting 

Some chemotherapy drugs can affect the vomiting center in the brain and the stomach, causing nausea and vomiting. These effects usually start immediately or 8-12 hours after treatment and may last for several hours or days. Some people may also feel nausea before treatment, which is called “anticipatory nausea or learned nausea”. Nausea and vomiting can be controlled or reduced with the powerful anti-nausea medications available today. Not all patients complain of nausea and vomiting during chemotherapy. Not all medicines cause nausea. 

Your doctor may ask you to take certain medicines before chemotherapy to prevent nausea and vomiting. Sometimes you may need to take more than one different medicine. The effect of the medicines may vary according to the individual. If your symptoms persist despite treatment, you should never give up and try to find the most suitable medication or method together with your doctor and nurse. 

You can also follow the recommendations below: 

• If you experience nausea and vomiting despite all precautions, do not eat for 1-2 hours before and up to 3 hours after treatment. A cold, lightly sweetened lemonade about 30 minutes before starting treatment will keep your taste buds intact and help prevent nausea.
• Eat small and frequent meals, increasing the number of meals to 5-6 instead of 3 a day.
• Prefer cold foods, as the smell of hot foods can increase the feeling of nausea. Choose foods that can be served at room temperature or cold, such as sandwiches, cheese, fat-free toast, cereals, desserts.
• Eat a liquid and soft diet to reduce nausea. Liquids such as apple juice, fruit juices, tea, lemonade and foods such as puree, crackers, toast and cheese are usually well tolerated. However, these liquids can cause a feeling of fullness in the stomach and nausea and vomiting if drunk quickly, so sip them slowly.
• If you do not have a sore mouth, try sour foods and drinks such as lemon, pickles, hard candies or lemonade and rinse your mouth with a mixture of lemon juice and water after vomiting. Avoid very sweet, fatty, spicy and strong-smelling foods as they can increase nausea.
• Avoid bad odors, people who are vomiting, people who are eating or places where food is being cooked, as these can trigger nausea.
• Try to get someone else to help you cook when you are nauseous. If this is not possible, you can prepare a variety of meals before you have chemotherapy, store them in the fridge or freezer and heat them up and eat them after chemotherapy when you feel nauseous.
• Try eating hard or soft, minty or sour sweets that help to reduce the unpleasant, metallic or medicinal taste in your mouth during chemotherapy.
• It is important to avoid your favorite food when you have intense nausea to avoid developing an aversion to it later.
• To reduce nausea and vomiting, try to distract yourself from nausea by concentrating on activities you enjoy, such as music, television programs, electronic games and reading books.
• Try to relax your muscles by breathing deeply with the music, and try to sleep during periods of extreme nausea.
• You can do enough exercise to tire you out and try walking outdoors if you are not feeling tired.
• Regular oral care will prevent sores from developing in your mouth and give you relief.
• If you feel nauseous when you wake up, you can eat crackers, chickpeas and toast or take the recommended antiemetic (anti-nausea) medicine without getting out of bed. Have breakfast after resting for 30-60 minutes. After taking the medicine, record the name of the medicine and how long it took to work on your nausea.
• If, despite all this, your nausea and vomiting persist and you cannot take any fluids by mouth for 24 hours, or if you have complaints such as dry mouth or decreased urine output, please call your doctor or nurse.
   

Hair Loss 

Some chemotherapy drugs can cause temporary partial or complete hair loss. Hair loss starts 2-3 weeks after receiving chemotherapy and starts to grow again 3-8 weeks after the treatment is stopped. Hair may sometimes start to grow even before the end of chemotherapy. However, it should be kept in mind that some changes in the structure and color of the hair may occur. Previously straight hair may become curly when it grows again. The hair will grow back some time after the chemotherapy is completed. At the same time, hair on other parts of the body (eyebrows, eyelashes, armpit, leg and pubic hair) may also fall out. It is not possible to prevent hair loss. There are some methods to prevent or reduce hair loss (such as applying ice caps or tourniquets to reduce blood flow to the scalp and prevent chemotherapy from reaching this area). However, it is very important that the chemotherapy reaches the scalp through the blood. In this respect, it is recommended not to use hair loss prevention methods today. Hair loss can affect you negatively emotionally. 

Here are some suggestions to help reduce hair loss during chemotherapy or the emotional distress you may experience due to hair loss: 

• Before you start chemotherapy or before your hair falls out completely, you can get a wig, bandana, beret, hat or scarf that suits you.
• If your medication will cause you to lose your hair as a side effect, cut your hair as short as possible before treatment. The weight of long hair can increase the rate of hair loss.
• Your hair should be cared for gently, without rough handling.
• Wear a hat and apply a protective cream to prevent sunburn, especially in summer.
• If necessary, you can use eyebrow pencil or false eyelashes.
• Please note that hair loss is a temporary side effect.

Skin and Nail Changes

Chemotherapy can affect the skin, causing redness, rashes, peeling, dryness, acne, increased sensitivity to the sun. Some drugs can cause darkening of the skin, along the vein where the drug is applied and on the nails. Medications may also cause breakage and discoloration of the nails. It develops in 2-3 weeks after the start of treatment and resolves in 10-12 weeks after the end of treatment. There is no need for additional treatment to eliminate this problem, it is a temporary condition. Some medicines may cause mild painful reddening of the palms of the hands or soles of the feet. Be sure to report this to your doctor. 

• If your skin becomes dry and itchy, you can use a moisturizing cream.
• Use sunscreen with a high protection factor when going out in the sun.
• Do not apply alcohol-containing solutions such as cologne to the vein and around it. Because these solutions can cause burns in that area.
• If you notice any changes on your skin (redness, swelling, etc.), consult your doctor or nurse before applying anything.

Effects on Bone Marrow

Chemotherapy drugs suppress the production of leukocytes (white blood cells, white blood cells) that protect the body against infections, platelets that protect against bleeding and erythrocytes (red blood cells, red blood cells) that carry oxygen to the body. The life span of erythrocytes in the blood is 120 days, leukocytes 1-4 days and platelets 10 days. Since erythrocytes have a longer life span than leukocytes and platelets, fatigue, infection and bleeding occur later. Leukocytes, which have a short life span of 1-4 days, are the most affected, and the patient should protect himself/herself against infections as their levels drop significantly after 1-2 weeks following chemotherapy. Although bleeding is not common, it usually appears as bleeding from teeth in patients. 
In particular, the patient reports increased bleeding gums when brushing their teeth. Blood tests show the number of blood cells produced in the bone marrow. While you are receiving chemotherapy, your doctor will ask you to have a blood count at regular intervals. Your treatment may be delayed or your dose of medication may be reduced, especially if your white blood cell count is low. 

Infection

White blood cells (white blood cells, leukocytes) produced in the bone marrow play an important role in your body's defense against germs. This is why a low number of white blood cells can lead to infections. If your white blood cell count is lower than normal following chemotherapy, especially after 1-2 weeks, it is extremely important to take the following measures to prevent infection: 

• Make sure you wash your hands frequently with soap throughout the day. Make sure you wash your hands very well, especially before and after eating and before and after using the toilet.
• Stay away from people who you know have infectious diseases such as colds, flu, herpes, chickenpox or measles. Avoid crowded places (such as cinemas, markets, shopping malls, coffee houses).
• Do not get vaccinated without your doctor's knowledge.
• If your child has received live virus vaccines such as chickenpox, measles, oral polio vaccine, consult your doctor about the precautions you should take.
• Do not eat raw vegetables and fruits. Do not eat uncooked eggs, meat and seafood. Wash vegetables with plenty of water and cook them thoroughly. Wash fruits thoroughly with plenty of water and then peel or blend the peeled fruits and drink the juice or cook them and eat them as compote. Make sure that all your food is cooked thoroughly and avoid eating out as much as possible.
• Avoid foods made from pimemi milk. Choose pasteurized milk and yoghurt.
• Do not keep live flowers, houseplants, bird cages, aquariums, cats and dogs in your room as they can be a source of infection. Since animal feces contain large amounts of bacteria and fungi, you should stay away from areas contaminated with feces.
• Wear a mask outside your home when your white blood cells are low. 
  
  Even if you pay attention to all these things, it is still possible to get an infection. Therefore, regularly check your eyes, nose, mouth, genital and rectal areas for the following signs of infection
  If your temperature rises above 38°C during or after your chemotherapy, contact your doctor immediately. Do not wait until office hours to call your doctor or go to hospital. Also, be sure to learn how to use a thermometer. 
  
  Symptoms suggestive of infection: 
   
• Fever (rising to 38° C or higher), chills and a feeling of cold
• New cough, phlegm or sore throat
• Pain and/or burning sensation during urination
• Vaginal discharge or itching
• Watery stools more than three times a day
• Cold sores, sores/white areas in the mouth or on the lips
• Painful skin eruptions along a line on the skin, raised from the skin with water inside

Anemia

Hemoglobin in red blood cells carries oxygen to all tissues. When the number of red blood cells decreases, the number of hemoglobin carrying oxygen will also decrease. In this case, oxygen required for energy cannot be transported to the tissues and symptoms of anemia such as weakness, fatigue, shortness of breath, palpitations, intolerance to cold, chest pain, headache and dizziness are observed. During your chemotherapy, regular blood tests will be performed to monitor the number of red blood cells in your blood and blood transfusions will be given if necessary. It is not necessary to be afraid of blood transfusions because the blood given to you has been tested and analyzed for these risks.

To reduce the feeling of weakness and tiredness due to anemia; 

• Maintain your energy by trying to get plenty of rest.
• Limit your daily activities.
• Pay attention to a good and balanced diet. Especially try to consume plenty of iron-containing foods (such as green leafy vegetables, spinach, red meat).
• Standing up gradually while sitting or lying on your back will prevent dizziness or loss of balance. 

Bleeding

Chemotherapy drugs affect the bone marrow and reduce the number of platelets, which play an important role in blood clotting. If the number of platelets is insufficient, you may bruise or bleed more easily than normal, even with a minor bump or injury. In very severe cases, spontaneous bleeding can occur without any injury. 

If you have the following symptoms, you should contact your doctor immediately: 

• After starting the treatment, the person should not enter among crowded groups of people unless it is necessary (cinema, theatre, bazaar-market, public transport, etc.). When entering a crowded environment if it has become necessary, it should be finished as soon as possible, and a mask should be worn at that time. During the time spent outside, hands should never be contacted with the mouth and face, and hands should be washed after returning home. Shaking hands with people, hugging, and kissing should be avoided. People who show signs of influenza infection should be avoided.
• Another important source of germs is food and drink. During chemotherapy, foods cooked on the same day and under strict hygienic conditions should be consumed. Any food that can be peeled should be peeled before being consumed. Vegetables and fruits should be carefully washed with plenty of water. Raw meat and raw eggs should never be eaten.
• Eating out should be avoided unless it is necessary.
• Patients who have pets during the treatment should be very careful, we recommend that they send away their pets from the house temporarily, if possible.
• A digital thermometer should be kept at home and the physician should be contacted immediately when the patient feels feverish or chills and shivers start. No medication should be taken to reduce fever without consulting a physician.
• Men should prefer electric machines while shaving instead of razors.
• Gloves should be worn while dealing with garden work.
• Live vaccines should not be administered during chemotherapy, and the physician's instructions should be followed.
• After each defecation, the anal area should be cleaned without irritation, painful hemorrhoids should be reported to the physician.
• A warm shower and cleaning with soft sponges should be preferred without irritating the body.
• Pimples should not be squeezed, and proper dressings should be made for injuries that occur in the body.
• Symptoms that may be the focus of infection should be noticed and the physician should be informed. For example, in symptoms such as burning during urination, frequent urination, diarrhea, painful hemorrhoids or pain in the anus area, cough, expectoration, mouth and throat pain and sores, pain and swelling around the nails, vaginal discharge and itching, redness and pain around the catheter, pain in the sinuses, a physician should be consulted immediately.

How often should I have a complete blood count? 

You should have a complete blood count before each medication. Because some medicines reduce the number of blood cells. The most important of these is a decrease in the number of white blood cells. If your white blood cell count is low (usually below 3500/mm3 or the absolute neutrophil count is below 1500/mm3) or if there is a significant decrease in other blood cells, your rest period will be prolonged and your blood cells will be expected to reach the desired value. If this happens, your nurse or doctor will explain it to you.

Mouth Gum and Throat Problems

Some chemotherapy drugs can irritate your mouth and throat and sometimes cause small mouth sores or mouth problems called “mucositis”. Be sure to tell your doctor about any sores in your mouth.  They usually start 5-10 days after treatment and heal completely after 3-4 weeks. Mouth sores are not only painful, but also pose a great risk of infection. Bleeding can also occur due to dryness and irritation in the mouth. Some chemotherapy drugs can change your sense of taste. Food may taste saltier, sour and metallic. Your sense of taste will return to normal when the chemotherapy is over.
nfections during chemotherapy can cause serious problems and should be prevented before they occur. If you have problems such as tooth decay or pain, you should visit your dentist at least two weeks before starting chemotherapy. Good oral care is very important to prevent mouth sores and mucositis. 

Follow the recommendations below for good oral care: 

Brush your teeth with a soft toothbrush regularly, after every meal and before going to bed. It is better to use toothpaste containing fluoride and baking soda. 

Gargle after brushing your teeth. 

You can use any of the following mixtures: 

• A mixture prepared by adding half a teaspoon of salt to one cup (about 200 ml) of boiled and cooled water,
• You can use a mixture prepared by adding a teaspoon of baking soda to a glass of boiled and cooled water (approximately 200 ml). 
   

Commercial mouthwashes should not be used unless recommended by your doctor, and you should make sure that the alcohol content of the mouthwash you use is not more than 6%.

You should gargle at least four times a day (morning, lunch, after dinner and before going to bed at night) using any of the above mixtures. 
Do not brush your teeth when your white blood cells and platelets are low (especially 7-10 days after chemotherapy) because you are at risk of bleeding gums and infection.
Instead of brushing, clean your mouth with mouthwashes and carbonated mouthwash (you can mix 1 teaspoon of baking soda in 1 cup of warm water).
If toothpaste makes your mouth hurt or you feel nauseous when brushing your teeth, clean your mouth with mouthwashes and carbonated mouthwash instead of brushing. 
If you use them, clean your dentures regularly by taking them out of your mouth in the morning, evening and after every meal. Do not use dentures that do not fit your palate well and consult your dentist. Do not forget to take your dentures out at night. 
Moisturize your lips with Vaseline or lip oils. 
Prefer liquid foods to help you swallow easily. Drink at least two liters of fluid per day. If mouth sores start, notify your doctor. 
If your teeth absolutely need treatment and especially extraction, do this before chemotherapy starts while your blood values are within normal limits. 
Acidic, very hot and very cold drinks that can cause irritation, alcohol and tobacco use should be avoided. 
If any sores or mucositis are observed in the mouth, gargle should be done every 2 hours. 
If there is a change in the appearance, feel or taste in your mouth despite all these precautions, you should notify your doctor or nurse. 

Loss of Appetite 

Chemotherapy drugs can cause a decrease in appetite. One of the most important things you should emphasize during treatment is to maintain your ideal weight. Take care not to gain or lose weight. A 10 percent weight loss or gain may result in a dose change. Nausea and changes in your sense of taste caused by chemotherapy can lead to loss of appetite. Decreased desire to eat can lead to weight loss, which can lead to weakness and fatigue. 

To increase appetite; 

• Try to eat small and frequent meals 5-6 times a day.
• Do not fill your stomach with liquid before eating. Since it will cause a feeling of fullness and satiety in the stomach, fluid intake should be reduced with meals and gas-forming foods should be avoided.
• Choose protein foods such as cheese, milk, yogurt, eggs, meat and milk desserts. Try to eat high-calorie and protein foods between meals.
• Some people may lose the desire to eat red meat during chemotherapy due to changes in their taste buds. If you have a loss of appetite due to such a change in taste, you can use different sauces. 

If you continue to lose your appetite and lose weight despite all this, you should consult your doctor or nurse immediately.

Diarrhea 

Since chemotherapy drugs affect the cells in the intestinal mucosa, diarrhea may occur. You should tell your doctor if your diarrhea persists for more than 24 hours or if it is accompanied by abdominal pain or cramps. In very serious cases, the doctor may recommend antidiarrheal medicines. 

Here are some suggestions to help you control your diarrhea: 

• Drink water, apple juice, light tea, etc. to replace the fluid lost due to diarrhea. However, make sure that these are at room temperature or lukewarm.
• Choose low-fiber foods such as white bread, rice or pasta, bananas, peeled and mashed or cooked fruit, cheddar cheese, yogurt, eggs, boiled/crushed potatoes without skin, chicken, turkey or fish with the skin removed, instead of high-fiber foods as these may increase your diarrhea and cramping.
• Eat foods high in potassium such as bananas, potatoes, peaches and pears to regain the potassium lost due to diarrhea.
• Avoid coffee, tea and alcoholic drinks.

Constipation 

Some people receiving chemotherapy may become constipated because of the drugs they are taking. Some people may also get constipated because they eat less than usual or are inactive. In such cases, you should not use laxatives or laxatives on your own without the advice of your doctor. First of all, you should try to solve this problem with diet and exercise.

• Try to drink plenty of fluids to increase your bowel movements. Warm and hot water will be especially good. Drink warm water in the morning on an empty stomach.
• Since fibrous foods stimulate bowel movements, choose foods rich in fiber such as whole wheat or oat bread, fresh vegetables, beans, nuts, corn, fresh and dried fruits.
• Try to increase your movement by walking or doing light exercises.

Urine Changes 

If you are taking colored medicine, your urine may be the color of that medicine. The color of your urine will lighten over time. For example, if you are taking the red medicine Adriamycin, your urine may be red, and if you are taking the blue medicine Mitomycin, your urine may be blue. In addition, if you have bloody or painful urination, you should consult your doctor.

How Long do Chemotherapy Side Effects Last? 

The recovery time for side effects depends on the medication you are taking and your general state of health. As most normal cells recover quickly after receiving chemotherapy, many side effects disappear with them. Some side effects disappear quickly, while others take longer. 

How Does Chemotherapy Affect the Reproductive System? 

Some chemotherapy drugs can affect sexual organs and functions in men and women. These effects may vary depending on the drug used, the age and general condition of the individual. Before starting chemotherapy, you should discuss the effect of chemotherapy on fertility with a specialist and take the necessary precautions if you want to have children in the future. 

For men; 

Some chemotherapy drugs can reduce the number and motility of sperm cells or cause other cell abnormalities. This can result in permanent or temporary infertility. Infertility can affect a man's ability to have children but not his ability to have intercourse. Because chemotherapy drugs have a detrimental effect on chromosomes, men receiving chemotherapy should use effective contraception during treatment and make sure that their partner does not become pregnant. 

For women;

Some chemotherapy drugs affect a woman's ovaries and can reduce hormone production. Women receiving chemotherapy may have irregular menstrual cycles or may stop menstruating while taking the medication. Permanent or temporary infertility can occur as a result of damage to the ovaries. Infertility can affect a woman's ability to become pregnant, but this depends on the woman's age, the drug she is taking and the dose of the drug. Due to the harmful effects of chemotherapy on the developing baby in the womb, it is not recommended to become pregnant, so birth control must be continued. Women may also experience menopause-like symptoms such as hot flushes, vaginal dryness or burning due to the hormonal effects of chemotherapy. 

Chemotherapy and Sexual Life 

For most patients undergoing chemotherapy, the treatment does not affect their sex life. However, some patients may notice some temporary changes in their sex life during their treatment. These are usually minor, short-term changes. There is no long-term effect on your sex life. It is not advisable for a woman whose husband or wife is undergoing chemotherapy to become pregnant during treatment. This is because the drugs affect the baby. Your doctor will therefore advise you to use a safe method of contraception during treatment. As long as the blood levels are appropriate, sexual intercourse is not a problem. Your doctor may recommend a cream if vaginal dryness due to menopause in women who enter early menopause due to chemotherapy makes sexual intercourse difficult.

What are the Other Effects of Chemotherapy? 

If you experience any other side effects (burning when urinating, blood in the urine, numbness and tingling in the hands and feet), please consult your doctor. Very rarely, some previously unknown side effects of chemotherapy may occur.