Like all treatments, chemotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Before you start treatment, talk to your doctor or nurse about the side effects. Knowing what to expect can help you deal with them.
Most of the side effects are temporary and will gradually go away after you finish treatment.
As well as damaging cancer cells, chemotherapy can also affect some healthy cells, and this can cause side effects. These include the cells in:
- hair follicles – which are responsible for hair growth
- finger and toe nails
- bone marrow
- the lining of the mouth
- parts of the gut, such as the bowel.
Tell your doctor or nurse about any side effects you have as soon as you get them. There are treatments available to help improve them, and things you can do for yourself to help manage them.
Side effects can happen with all types of chemotherapy. The most common ones are described here. But there are others which are less common, and each type of chemotherapy can also cause its own particular side effects. Ask your doctor or nurse about the possible side effects of the chemotherapy you’re having.
Temporary bone marrow problems
Chemotherapy affects how well your bone marrow works. Bone marrow is the spongy material that fills some of our bones. It makes red and white blood cells and other cells called platelets. There may be a drop in the levels of any of these cells during chemotherapy, and this can cause side effects. This usually happens about 7-10 days after each treatment session.
- You may be more at risk of getting an infection. This is caused by a drop in the number of white blood cells, which help fight infection. You might hear this called neutropenia. If you get an infection while you’re on chemotherapy, you could become very unwell. See below for more about infections and when to contact your doctor or nurse if you think you might have one.
- You may feel breathless, tired or weak. This can be caused by a drop in the number of red blood cells, which means not enough oxygen is carried around the body. This is known as anaemia. If this happens, your doctor may delay your next treatment session to give your red blood cells time to recover. If your level of red blood cells falls very low, you may need to have a blood transfusion.
- You may bleed and bruise more easily. This can be caused by a drop in the number of platelets – which help your blood to clot. You may notice you have nose bleeds or bleeding gums. There are things you can do to lower the risk of bleeding, for example, using a softer toothbrush and an electric shaver, rather than a razor. Some men with advanced prostate cancer notice some blood in their urine, and cabazitaxel can make this worse.
Your doctor or nurse will be able to suggest ways to help prevent some of the problems caused by a low blood count.
During chemotherapy your body might be less able to fight off infections. It’s important to contact the hospital immediately if you think you might have an infection because it could make you very unwell.
In general it’s safe to be around other people when you’re having chemotherapy, including children and pregnant women. But you should try to avoid crowded places and contact with people who have an infection, to keep the chances of getting an infection down. Speak to your doctor about whether using swimming pools will be safe for you.
Speak to your doctor about any vaccinations you’re planning to have.
You should avoid having a type of vaccination called a live vaccine during your treatment and for at least six months afterwards. Shingles and yellow fever are both live vaccines, for example. It is safe to be around others who have had these types of vaccines.
Other vaccinations such as the flu jab or the pneumonia jab are safe, but may not give you as much protection as usual because your immune system may be weaker. It’s always best to check with your doctor or nurse before having a vaccination.
Extreme tiredness (fatigue)
Many people say that fatigue is the most difficult side effect to cope with. Fatigue is extreme tiredness or exhaustion, which makes it hard to carry out your daily activities. Some men describe feeling weak, lethargic, knackered or drained.
Fatigue is usually worse towards the end of your treatment. Most people find their energy levels improve after finishing treatment, but for some, fatigue can be long-lasting.
Sometimes there is a specific cause for your tiredness, like low levels of red blood cells (see above). And tiredness can be caused by things other than your treatment. For example, the cancer itself can make you feel tired, and so can feeling anxious or depressed.
Get help with fatigue.
Feeling and being sick (nausea and vomiting)
Chemotherapy for prostate cancer is not as likely to make you feel sick as some other types of chemotherapy. And there are a number of anti-sickness medicines (anti-emetics) that can help to control this side effect. If you do feel sick, your doctor or nurse can also talk you through other things you can try, for example foods to eat or avoid, and relaxation techniques .
If the smell of food is putting you off eating, try to avoid strong-smelling foods and go for cold foods more often as they don’t usually smell as much. If possible, ask someone to make your meals for you. You may also find it helps to avoid fried, greasy or very sweet foods. Some people find things flavoured with peppermint or ginger can help, such as flavoured teas or sweets.
Let your GP or doctor or nurse at the hospital know if you continue to feel or be sick.
Loss of appetite
You might lose your appetite during chemotherapy. This can happen because of some of the side effects of treatment such as feeling sick or having a sore mouth (see below). Chemotherapy can also make food taste different – it might taste more salty, bitter or metallic, or it might lose its taste.
Some people find sucking on boiled sweets can leave a pleasant taste in their mouth. And if you don’t feel like eating much, it’s important to drink plenty of fluids and to find foods that are more appealing to you. Eating small meals and having regular snacks that are high in calories and protein might also help you to get the energy and nutrients you need, and help to reduce weight loss.
The steroids you take with your chemotherapy should help improve your appetite. But if you’re having problems eating a balanced diet or if you’re losing weight, talk to your doctor or nurse. You might be referred to a dietitian who specialises in helping people with cancer.
Some chemotherapy drugs can make your mouth sore, but this is uncommon. You may develop ulcers or inflamed gums , which can be painful. This is because you’re less able to fight infection than normal. There are things that might help to prevent and relieve a sore mouth.
- Brush your teeth gently twice a day with a soft toothbrush, and use mouth washes regularly.
- Be very careful when flossing, and avoid using tooth picks. You can ask your doctor or dentist about whether it’s safe to floss and what to use.
- Try making small changes to your diet such as choosing soft, moist foods and avoiding foods that are acidic, spicy, very hot or very cold.
- Try drinking through a straw.
Your nurse can give you more information about taking care of your mouth. If it gets very sore, your doctor might prescribe pain-relieving drugs to help.
Some types of chemotherapy may make your stools loose and watery (diarrhoea). This usually happens in the first few days after treatment. Other chemotherapy drugs and some anti-sickness medicines can make it difficult to empty your bowels (constipation). Bowel problems can usually be controlled with medicines or changes to what you eat, so let your doctor or nurse know about any problems you’re having.
Make sure you’re drinking enough water – about eight glasses (two litres) a day. This will help to replace the water that’s lost with diarrhoea, and will also help to prevent constipation. It might also be a good idea to avoid fatty, fried, and spicy foods, as some men find they can make diarrhoea worse.
Hair loss is a temporary side effect of some chemotherapy drugs. It happens gradually and tends to start two or three weeks after treatment starts. Your hair will usually begin to grow back after you’ve finished treatment. Some men choose to wear a hat or wig until their hair has grown back.
To help reduce hair loss, scalp cooling may be suitable for some people. Scalp cooling involves wearing a special cap during each treatment session. The cap is filled with a chilled gel or connected to a small refrigerated cooling system. It doesn’t work for everyone and may not be available in every hospital. If you’re interested in scalp cooling, speak to your doctor or nurse.
This can cause your ankles or legs to swell or you might feel a bit bloated . This can also be a side effect of steroids. If it does happen, it should improve after you finish treatment.
Numbness or tingling in the hands and feet
Chemotherapy can affect your nerves. This can cause numbness or tingling in your hands and feet (peripheral neuropathy). This usually improves slowly a few months after treatment finishes.
It’s important to tell your doctor or nurse if you get this. If it’s severe, your doctor might decide to reduce the amount of chemotherapy you have at each treatment session (reduce the dose). Or they might offer a different treatment.
Numbness and tingling can have other causes, including the cancer itself. You may need to have some tests to check what’s causing it.
You may find that your finger nails and toe nails grow more slowly, or become hard, brittle or flaky. The shape or colour of your nails might also change. These changes are temporary and should improve after treatment, though it can take a few months.
There are ways to protect your nails during chemotherapy. For example, you can keep your nails trimmed short and wear protective gloves while doing jobs around the house.
Your eyes might produce more tears than normal. This isn’t common and won’t last long. If your eyes feel sore, inflamed or watery, let your doctor know – they can prescribe eye drops if necessary.
Changes to your mood
Some people say they feel down at certain times during their chemotherapy. This is natural and should usually only last a short time, but some men find they still feel low after their treatment finishes. If you’re feeling really low and finding it hard to deal with things, do speak to your doctor or nurse – there are things that can help and there is support available.
Side effects of steroids
You may get side effects from the steroids you take with your chemotherapy. Possible side effects include indigestion and irritation of the stomach lining, feeling irritable or restless, and fluid retention – which can cause swollen hands and feet. Other less common side effects will be listed in the leaflet that comes with your medicine.
Speak to your doctor or nurse about the side effects of steroids.