How to Manage the Side Effects of Chemotherapy

Chemotherapy works by killing fast-growing cancer cells, but as these powerful drugs destroy the cancer, they can also wipe out rapidly dividing healthy cells, particularly those in the hair follicles, digestive tract, mouth, and bone marrow. This damage can then cause side effects like nausea, fatigue, and hair loss.

Which symptoms you experience — and how severe they are — will depend on which drugs are included in your regimen and how your body reacts to them, says Keith Eaton, MD, PhD, an oncologist and associate professor of medicine at the University of Washington School of Medicine in Seattle. (And, in fact, not all chemo drugs cause side effects.)

Fortunately, as the science of cancer has progressed, so, too, has the science of managing and mitigating the unwanted effects of chemotherapy. Below are some of the most common symptoms of chemo and what you can do to feel better.

1. Counter Chemo-Induced Fatigue With Exercise

“Tiredness is probably the most universal side effect of chemo treatment,” says Dr. Eaton. Chemo-induced fatigue tends to be cyclic. You’re likely to feel the most tired on the days right after treatment. Fatigue then tends to decrease until the next treatment.

As counterintuitive as it may sound, one of the best ways to feel less drained while undergoing treatment is to exercise, says Eaton. “It doesn’t have to be going to the gym. Just taking a walk can be extremely helpful,” he explains.

Other ways to ease exhaustion include taking short naps or rest breaks (under 30 minutes) during the day, sticking to a regular sleep-wake schedule, eating a balanced diet that includes protein, and drinking 8 to 10 glasses of water every day, according to the American Cancer Society (ACS).

Fatigue can sometimes be a sign of anemia — having too few red blood cells to carry oxygen to the body — which can also result from chemotherapy, Eaton points out. If you experience extreme fatigue, shortness of breath, or dizziness, let your cancer team know. Treating this underlying condition can help ease your exhaustion.

2. Take Medication to Quell Nausea and Vomiting

One of the most common — and dreaded — effects of chemo is nausea and vomiting. But you may not need to be so fearful. Doctors now have an arsenal of effective antinausea drugs, known as antiemetics, at their disposal. “We are at a point where we can control nausea and vomiting very well,” says Eaton. “In many cases, we can even eliminate the problem.”

In addition to taking an antinausea medication, you can help quell chemo-induced queasiness by eating several small meals (instead of three large meals) a day, avoiding greasy or spicy foods, and keeping your head elevated for an hour after eating. Some research suggests that acupuncture and relaxation techniques — deep breathing, listening to music, meditation, reading a book — can also help ease chemo-related nausea, according to the ACS.

3. Consider Using a Cooling Cap to Minimize Hair Loss

Some chemo drugs kill off cells in the hair follicles, causing your hair to thin or, in some cases, fall out completely. If your chemo regimen includes drugs that might cause hair loss, talk to your cancer team about whether wearing a cooling cap during treatment might help lower your risk. Known as scalp hypothermia, the theory behind it is that cooling tightens up, or constricts, blood vessels in the scalp, reducing the amount of the chemo drug that reaches the cells of the hair follicles, according to the Mayo Clinic.

You can also minimize hair loss by being extra gentle with your hair during and after treatment. Use a wide-tooth comb instead of a brush, avoid too much pulling (ponytails) and styling (using a hair dryer or iron), and take a break from chemical treatments. Continue to baby your hair and scalp as your strands grow back, since your new hair is likely to be fragile, advises the ACS.

4. Beat Mouth Sores With Ice Chips

Chemo drugs sometimes harm the healthy cells in the lining of the mouth, which can result in small, often painful sores inside your mouth or on your lips. There’s no sure way to prevent the problem, but sucking on ice chips during treatment may reduce your risk. One study published in 2019 found that when people with cancer kept ice chips in their mouths for as long as possible during certain chemotherapy sessions, they experienced significantly fewer mouth-related side effects following treatment than those who didn’t use ice chips.

If you develop a sore, rinse your mouth before and after meals and at bedtime with a solution of 1 teaspoon of baking soda and 1 teaspoon of salt, to 1 quart of water, recommends the National Cancer Institute (NCI). If you’re still having pain, especially if it makes it difficult to eat and drink, ask your doctor for a more powerful pain-relieving rinse or a topical medication.

5. Wash Your Hands Often to Avoid Infection

Chemotherapy can suppress immune function by lowering the number of white blood cells produced by the bone marrow. These cells play a key role in fending off viral and bacterial invaders. Stress, eating poorly, and not getting enough sleep can also take a toll on immune function during chemotherapy, notes the NCI.

To reduce your chances of getting sick during treatment, become extra-vigilant about handwashing. Suds up before and after eating and before touching your eyes, nose, or mouth, and carry an alcohol-based hand sanitizer to clean your hands when you’re out, recommends the ACS. If you experience any warning signs of infection, such as fever, cough, or diarrhea, alert your cancer team right away. The sooner an infection is detected, the easier it is to treat.

6. Tell Your Doctor About Tingling in Your Hands or Feet

Some chemotherapy harms the nerves that control sensation and movement in the arms, legs, hands, and feet. This complication, known as chemotherapy-induced peripheral neuropathy (CIPN), affects roughly half of people undergoing chemo, according to a report from 2018.

While it may not be possible to prevent CIPN, it’s important to let your doctor know if you experience any of the signs of nerve damage in your hands or feet, such as tingling (or a “pins and needles” feeling), discomfort, pain, numbness, weakness, or a lessened ability to feel hot or cold, as soon as possible. “We can then evaluate whether the drugs we are using can be changed, delayed, or reduced in dose,” says Eaton.

Your doctor can also provide treatments to reduce your discomfort, such as numbing creams or patches, steroids, vitamin supplements, or anticonvulsant or antidepressant medication (in doses designed to ease chronic pain). Physical therapy, acupuncture, biofeedback, and relaxation therapy can also help ease nerve-related pain, according to the ACS.