Treatment related side effects

Fatigue is tiredness that does not go away even by resting or having a good night's sleep. It is often described as a lack of energy or a decreased ability to complete your usual activities. Some people find they can't concentrate well or make decisions. Others say it makes them feel irritable or tearful. These are normal reactions to cancer-related fatigue. 

Fatigue can be due to: 

• The cancer itself 
• Cancer treatments 
• Low red blood cells (anaemia) 
• Loss of appetite or weight loss 
• Pain 
• Nausea 
• Emotional distress  
• Sleep problems 

It is the most common side effect of chemotherapy. 

Treatment related fatigue generally begins within one or two days of chemotherapy. It can take up to three to four months post treatment for energy levels to return to normal. 

For information about managing fatigue, speak to your treating team. 

Consult your doctor or nurse if you: 

• Feel overwhelmed by your illness and treatment 
• Are short of breath 
• Feel a loss of balance when walking or getting in and out of bed or a chair 
• Get dizzy often  

These symptoms may suggest your blood cell count is low (anaemia). We may need to treat you with a blood transfusion. Anaemia can make you feel very tired.

Shortness of breath is the feeling that you are having trouble breathing. This is a sign that the body is working hard to move air in and out of the lungs. Shortness of breath can be due to: 

• Some chemotherapy drugs or radiation therapy to the lungs 
• Reduced oxygen in the blood (anaemia) 
• Infection 
• Fluid in the lungs 
• Lung damage from smoking 
• Cancer that has affected the lungs 
• Asthma or any other chronic lung problems 

Anxiety can cause or worsen shortness of breath. It is normal to feel anxious about cancer and its treatments. 

Shortness of breath can frustrate you. If this is a new symptom to you, it is important that you speak to your treating team to find its cause. They can also help you with advice on how to avoid and manage shortness of breath. 

Alert your doctor, nurse or the hospital IMMEDIATELY if you: 

• Notice a worsening in your breathing or you become very short of breath very fast 
• Can't manage your shortness of breath with the techniques given by your treating team

Nausea is an unpleasant wave-like feeling in the back of the throat and/or stomach. It may or may not result in vomiting. Some people with cancer may have nausea due to their cancer. Or they may have it due to treatments, including chemotherapy. Memory of sickness-causing treatment can promote ‘Anticipatory’ nausea or vomiting. For others, anxiety about cancer and/or treatment can cause nausea and/or vomiting. 

It's fortunate we can often manage nausea by medication and other simple techniques. Your doctor may give you medication. We call these antiemetics. They can help prevent or control your nausea. Always follow your doctor’s instructions when taking these medications. 

Ask your treating team for advice about managing nausea and/or vomiting. 

Consult your doctor or nurse if: 

• Nausea is not controlled with antinausea drugs 
• You are unable to eat due to ongoing nausea 
• You are unable to take your medications 
• You cannot control the vomiting

You need good nutrition for general good health. During illness, it is important that you have a well-balanced diet. This diet should include proteins, fats, carbohydrates, vitamins and minerals. Having a balanced diet helps to support energy and keep your immune system strong. 

There may be a period due to your illness or treatments when you may not be able to eat in the same way as before though. You can lose interest in food due to the following: 

• Pain 
• Nausea 
• Vomiting 
• Diarrhoea 
• Mouth problems  
• A change in food preferences or taste 
• Depression 
• Anxiety  
• Stress associated with cancer and its treatment 

Speak to your treating team for advice if you are experiencing a loss of appetite. 

Consult your doctor, dietitian or nurse if you: 

• Are unable to drink fluids 
• Feel dizzy when standing or feel other symptoms of dehydration 
• Are unable to eat solid foods 
• Are continuing to lose weight

There may be times when you cannot eat as much as you usually do, and this can cause weight loss. Weight loss can cause extreme tiredness and fatigue. It can result in an inability to carry out everyday tasks. 

Weight loss can be a result of other side effects of cancer and cancer treatments. These might be: 

• Fatigue 
• Nausea 
• Vomiting 
• Constipation 
• Diarrhoea 
• Mouth problems 
• Taste changes  
• Poor appetite 

You may be experiencing weight loss or any of the symptoms that cause weight loss. If so, speak to your treating team for advice on keeping your weight. 

Consult your doctor, nurse or dietitian if: 

• You continue to lose weight 
• Your weight loss is drastic 
• You experience nausea and vomiting that you cannot control with medication

Sometimes your illness or treatment can affect your mouth, lips or throat. This can cause them to become dry and sore. This can result in difficulties eating, chewing or swallowing and cause discomfort. 

A sore and dry mouth, lips and throat can be very frustrating. Your treating team can suggest products. These can include sprays and creams that act as artificial saliva. It is also important that you keep your mouth clean and healthy to help prevent infection. 

Please speak to your treating team for advice on treating mouth problems. They can also supply tips for good oral hygiene during your treatment. 

Please consult your doctor or nurse if: 

• You develop red/white areas in your mouth 
• The pain in your mouth is severe and you are finding it hard to swallow 
• You are avoiding eating and drinking all together because of your mouth problems 
• You have bleeding in the mouth

It is common to experience changes in your taste because of your illness and its treatment. Taste changes are often associated with chemotherapy or radiation therapy. The change is usually short term. A change in taste may result in you disliking certain foods that you like to eat. It can also cause a loss of appetite and lead to weight loss. 

Please speak to your treating team for advice on how to cope with taste changes. 

Consult your doctor, dietitian or nurse if you experience on going or rapid weight loss. 

During some treatments, the lining of the bowel may become irritated and sensitive. This can cause short-term changes to how your bowel works. Chemotherapy can lead to: 

• Discomfort in the stomach (cramps or wind pains) 
• Fluid and pale bowel motions  
• More wind than usual 

These symptoms may occur shortly after the start of treatment. They may also correct themselves within a week or so of its completion. 

Episodes of more frequent bowel motions and diarrhoea are common. This might be because of: 

• Radiotherapy to the pelvis 
• Some chemotherapy drugs 
• Other medications such as antibiotics 
• Anxiety 
• Infection 
• A change in diet  
• A food allergy 

Replace fluid that you may have lost through frequent bowel movements and diarrhoea. Your bowel movements will return to normal in time. It is then important that you return to a healthy diet. This should include fresh fruit, vegetables and whole grains. 

Speak to your treating team for advice on controlling and managing bowel changes. 

Consult your doctor, dietitian or nurse if: 

• You have unexplained diarrhoea that either: 
  • Persists for more than a couple of days 
  • Causes you discomfort or distress 
• Your diarrhoea persists for several days after follow advice from your treating team  
• You become very dehydrated and find it hard to replace your fluids

Constipation is when you either: 

• Are unable to move or open your bowels 
• Must push harder than normal to move your bowels 
• You use your bowels less often than is usual for you 

Bowel movements may be small, dry and hard. They could also resemble small amounts of diarrhoea like lose stool. You might feel like you are never completing your bowel movement. 

Many medications can cause constipation. A lack of activity or eating and drinking less than normal can cause or worsen constipation.  

Constipation can be painful, uncomfortable and very frustrating. It is important to watch your bowel movements and try to keep them as regular as possible. That way your bowel movements are easier to pass. Ignoring constipation can worsen its symptoms.  

Sometimes, eating a higher fibre diet can worsen your constipation. This is particularly if it is a side effect of the medications you are taking. It is important to speak to your treating team about your constipation. That way they can recommend effective management. We will often give medication to help manage medication-associated constipation. 

Speak to your treating team for advice on how to manage your constipation. Your medications can change or increase. If so, ask for advice on how to keep your bowel motions regular and prevent constipation. 

Consult your doctor or nurse if you: 

• Have questions about your medication 
• Have not opened your bowels for 48 hours (about 2 days) and this is not normal for you 

Chemotherapy can cause hair loss, which we call 'alopecia'. It may begin as early as the first few days of your treatment or may take up to a few weeks to occur. Hair loss usually begins with the hair on your head, but you may experience hair loss on the rest of your body. 

The amount of hair loss is different for everyone. Some people may experience thinning, while others may lose all their body hair. Your hair loss is dependent on the type of chemotherapy you are receiving. 

Hair loss is not permanent. Some regrowth may occur during treatment. Full regrowth will usually start about six weeks after your chemotherapy has finished. The colour and texture of your hair may be different from what it was before treatment. 

It is important to know that not all chemotherapy will cause hair loss. Your treating team will let you know if you are likely to experience this. 

Speak to your treating team about coping with hair loss and give advice around skin care for these areas. 

We also offer a range of support services to help manage hair loss.  We have a headwear and wig library and have Look Good, Feel Better workshops.

Menopause refers to a woman's final menstrual period. You may experience menopausal symptoms from chemotherapy to treat breast cancer. Many women who get cancer will go through treatment-related menopause. In fact, around two thirds of women who are younger than 50 when they get cancer experience this. It is possible that your periods will not return.  

The likelihood of the symptoms of early menopause will depend on: 

• Your age  
• The type of chemotherapy you are having 

Symptoms of early menopause may include: 

• Irregular menstrual periods 
• Hot flushes 
• Night sweats 
• Vaginal dryness 
• Painful sexual intercourse 
• Loss of sex drive 
• Difficulty sleeping 
• Difficulties with bladder control 
• Tiredness and mood swings 
• Skin and breasts becoming less supple and less firm 
• Brittle bones, which means they are more likely to fracture 

If you are at risk of early menopause it is important that you: 

• Seek support from your treating team  
• Be open with your partner and other loved ones 

Please speak to your treating team for advice on how to manage the symptoms of early menopause. These symptoms can be both physical and emotional.

Weight gain may occur with some cancer treatments. This is especially common for women receiving treatment for breast cancer. Excess weight can affect your health and the way you feel. 

You may experience weight gain because of side effects. These could be from: 

• Chemotherapy 
• Other treatments and medications that may cause inactivity 
• Swelling due to fluid (called oedema) 
• An increased appetite  
• Early menopause 

Speak to your treating team for advice about keeping your weight during treatment. 

Consult your doctor or nurse if you have signs of fluid retention (oedema). That can include: 

• Swelling around your wrists and ankles 
• Feeling that your watch, rings or other jewelry or the skin itself feels tight 
• If indentations stay when you press on swollen skin 

Peripheral neuropathy refers to the damaging of nerves in your body. This can cause a feeling of pins and needles in your hands and feet. 

You may notice that you have trouble doing up buttons or picking things up. You may feel weaker or not feel cold and hot as well as you did before treatment. These changes in sensation can build up over time. Often, they will not disappear until several months after your chemotherapy.  

Consult your doctor if you experience any loss of sensation. Your treating team will then keep watch. They can track how much the loss of sensation is affecting you and your everyday activities.

Treatment can cause changes to your skin. It can make your skin irritated and more sensitive to the sun. You might become more sensitive to products that didn't cause irritation before treatment. Skin may become: 

• Red 
• Dry 
• Itchy 
• Discolored 

It may also gain pimples.  

It is important to be aware of sun sensitivity during treatment. Always take precautions when going outside including sunscreen and protective clothing. 

You may also experience changes in the strength and look of your finger and toenails. 

The Look Good, Feel Better program can help you manage changes to your skin and appearance. 

Speak to your treating team for advice on managing skin changes during treatment.

Cancer treatments may cause birth defects. Women should avoid becoming pregnant and men should not father a child: 

• While you are having treatment 
• For a while after completing treatment 

Treatment can pose a risk to the unborn child. Use effective contraception during this time (such as condoms).