Leukaemia Foundation

Leukaemia, Lymphoma, Myeloma & Related Blood Disorders.

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Chemotherapy

Chemotherapy literally means therapy with chemicals. Many chemotherapy drugs are also called cytotoxics (cell toxic) because they kill cells, especially ones that multiply quickly like cancer cells. Chemotherapy often involves a combination of drugs (combination chemotherapy). These drugs act together and in different ways to destroy the blood cancer cells. Chemotherapy is usually given in several cycles (or courses) with a rest period of a few weeks between each cycle. This is to allow the body to recover from the side-effects of the treatment.

Side-effects of chemotherapy

Chemotherapy kills cells that multiply quickly, such as cancer cells. It also causes damage to fast-growing normal cells, including hair cells and cells that make up the tissues in your mouth, gut, bone marrow and reproductive organs.. The side-effects of chemotherapy occur as a result of this damage.

The type of side-effects and their severity varies from person to person, depending on the type of chemotherapy used and how an individual responds to it.

There is no doubt that side-effects can be very unpleasant at times but it's good to remember that most of them are temporary and reversible. It is important that you report any side-effects you are experiencing to your nurse or doctor because many of them can be managed successfully, reducing any unnecessary discomfort for you.

Effects on the bone marrow

Blood Cancers prevent your bone marrow from functioning properly and producing adequate numbers of red blood cells, normal white blood cells and platelets. Chemotherapy also affects the bone marrow's ability to produce adequate numbers of blood cells. As a result, your blood count (the number of white cells, platelets and red cells circulating in your blood) will generally fall within a week of treatment. The length of time it takes for your bone marrow and blood counts to recover mainly depends on the type of chemotherapy given.

Platelets

Your platelet count may also be affected by your disease and by the chemotherapy you are receiving and you may become thrombocytopenic (a reduction in the number of platelets circulating in the blood). When your platelet count is very low you can bruise and bleed more easily. During this time it is helpful to avoid sharp objects in your mouth such as chop bones or potato chips as these can cut your gums. Using a soft toothbrush also helps to protect your gums. In many cases a transfusion of platelets is given to reduce the risk of bleeding until the platelet count recovers.

Red cells

If your red blood cell count and haemoglobin levels drop below normal, you will be anaemic. When you are anaemic you feel more tired and lethargic than usual, and may easily become short of breath. If your haemoglobin level is very low, your doctor may prescribe a blood transfusion.

White cells

The point at which your white blood cell count is at its lowest is called the nadir. This is usually expected 10 to 14 days after having your chemotherapy. During this time you will be at a higher risk of developing an infection. At this stage you will also be neutropenic, which means that your neutrophil count is low. Neutrophils are important white blood cells that help us to fight infection. While your white blood cell count is low you should take sensible precautions to help prevent infection. These include avoiding crowds, avoiding close contact with people with infections that are contagious (for example colds, flu, chicken pox) and only eating food that has been properly prepared and cooked.

Your doctor and nurse will advise you on how to reduce your risk of infection while your white cell count is low. If you do develop an infection you may experience a fever, which may or may not be accompanied by an episode of shivering where you shake uncontrollably. Infections while you are neutropenic can be quite serious and need to be treated with antibiotics as soon as possible.

Sometimes your doctor may decide to use a drug like Granulocyte – Colony Stimulating Factor (G-CSF) to help the recovery of your neutrophil count. This drug works by stimulating the bone marrow to increase the production of neutrophils. G-CSF is given as an injection under the skin (subcutaneous).

Nausea and vomiting

Nausea and vomiting are often associated with chemotherapy and some forms of radiotherapy. These days however, thanks to significant improvements in anti-sickness (antiemetic) drugs, nausea and vomiting are generally very well controlled. You will be given anti-sickness drugs before and for a few days after your chemotherapy treatment. Be sure to tell the nurses and doctors if the antiemetics are not working for you and you still feel sick. There are many different types of antiemetics that can be tried. A mild sedative may also be used to help stop you feeling sick. This will help you to relax but it might make you a little sleepy.

Some people find that eating smaller meals more frequently during the day, rather than a few large meals, helps to reduce nausea and vomiting. Many find that eating cool or cold food is more palatable, for example jelly or custard. Drinking ginger ale or soda water and eating dry toast may also help if you are feeling sick. Getting plenty of fresh air, avoiding strong or offensive smells and taking the prescribed anti-sickness drugs as recommended by the nurse and doctor should also help.

Changes in taste and smell Both chemotherapy and radiation therapy can cause changes to your sense of taste and smell. This is usually temporary but in some cases it lasts up to several months. During this time you may not be able to enjoy the foods and drinks that you used to love and this can be very disappointing, but it will pass. Some people find that adding a little more sugar to sweet foods and salt to savoury foods can help.

Mucositis

Mucositis, or inflammation of the lining of the mouth, throat or gut is a common and uncomfortable side-effect of chemotherapy and some forms of radiotherapy. It usually starts about a week after the treatment has finished and goes away once your blood count recovers, usually a couple of weeks later. During this time your mouth and throat could get quite sore. Soluble paracetamol and other topical drugs (ones which can be applied to the sore area) can help. If the pain becomes more severe, stronger pain killers might be needed.

It is important to keep your mouth as clean as possible while you are having treatment to help prevent infection. It is particularly important to do your mouth care regularly while your mouth is sore. Your nurse will show you how to care for your mouth during this time. This may include using a soft toothbrush and mild toothpaste.

Always check with your nurse if you use commercial mouthwashes, like the ones you can buy at the supermarket. These are often too strong, or they may contain alcohol, which will hurt your mouth.

Bowel changes

Chemotherapy can cause some damage to the lining of your bowel wall. This can lead to cramping, wind, abdominal swelling and diarrhoea. Be sure to tell the nurses and doctors if you experience any of these symptoms. If you develop diarrhoea, a specimen will be required from you to ensure that the diarrhoea is not the result of an infection. After this you will be given some medication to help stop the diarrhoea and/or the discomfort you may be feeling.

It is also important to tell the nurse or doctor if you are constipated or if you are feeling any discomfort or tenderness around your anus when you are trying to move your bowels. You may need a gentle laxative to help soften your bowel motion.

Hair loss

For most of us, the thought of losing our hair is very frightening. Hair loss is unfortunately a very common side-effect of chemotherapy and some forms of radiotherapy. It is, however, usually only temporary. The hair starts to fall out within a couple of weeks of treatment and tends to grow back three to six months later. In the meantime there are certain things that you can do to make yourself feel more comfortable.

Avoiding the use of heat or chemicals and only using a soft hairbrush and a mild baby shampoo can help reduce the itchiness and scalp tenderness which can occur while you are losing your hair. When drying your hair, pat it gently rather than rubbing it with a towel. Some people find it more comfortable to simply have their hair cut short when they notice that it is starting to fall out.

You need to avoid direct sunlight on your exposed head (wear a hat) because chemotherapy (and radiotherapy) makes your skin even more vulnerable to the damaging effects of the sun (i.e. sunburn and skin cancers). Remember that without your hair your head can get quite cold so a beanie might be useful, especially if you are in an airconditioned environment like a hospital. Hair can also be lost from your eyebrows, eyelashes, arms and legs.

Look Good ... Feel Better is a free community service that runs programs on how to manage the appearance-related side-effects of cancer treatments. The volunteer beauty therapists who run these programs give useful advice and demonstrations on how to manage hair loss including the use of hats, wigs, scarves or turbans. You might like to visit their website at www.lgfb.org. au or free call them on 1800 650 960.

Fatigue

Most people experience some degree of tiredness in the days and weeks following chemotherapy and radiotherapy. Having plenty of rest and a little light exercise each day may help to make you feel better during this time. Getting out into the fresh air and doing some gentle exercise is important for your general feeling of well being and it also may help to reduce your fatigue. It is important to listen to your body and rest when you are tired.

Fertility

Some types of chemotherapy and radiotherapy may cause a temporary or permanent reduction in your fertility. It is very important that you discuss any questions or concerns you might have regarding your future fertility with your doctor if possible before you commence treatment.

In women, some types of chemotherapy and radiotherapy can cause varying degrees of damage to the normal functioning of the ovaries. In some cases this leads to menopause (change of life) earlier than expected. In men, sperm production can be impaired for a while but the production of new sperm may become normal again in the future.