Cancer Treatment Side Effects
It's true that standard cancer treatments can cause debilitating physical and emotional side effects. Some last days. Others—weeks or months. And still others can last years beyond the last treatment. However, choosing to proceed with chemotherapy, radiation, or targeted therapies, for example, doesn't guarantee a consistently poor quality of life.
It’s important to know that 100% of patients do NOT experience 100% of the possible side effects of cancer treatment. Keep in mind that your body is unique, your cancer is unique, and your body's response to these treatments is also uniquely yours.
Here are a few well-known and not-so-well-known treatment side effects:
- temporary loss of fingerprints
- first bite syndrome: jaw locks up for a few seconds, causing a painful sensation; triggered by opening mouth, biting down, and chewing; usually resolves within 1-2 days
- cold sensitivity in the mouth and hands: feels like you can't breathe or like you have shards of glass in your throat when you swallow cold/cool liquids or foods; intense "zapping" pain if you touch something cold (common with platinum-based chemo drugs and usually resolves within a few days of infusion)
- skin rashes, dryness, pain, discoloration (skin issues can occur in up to 90% of patients)
- nose bleeds due to broken capillaries in nasal passages
- longer, curly eyelashes
- super soft skin
- erectile dysfunction, vaginal dryness, reduction in penile length, inability to orgasm
- hiccups
- painful splitting fingertips, raw cuticles, red fingertips, cuticle pain (paronychia)
- "chemo brain"
- chemo cough
- development of a secondary/new cancer resulting from treatment-related tissue injury
Taking the time to understand the most common possible side effects related to your treatment plan may help you identify and begin managing and/or relieving unwanted side effects earlier.
Get a clear understanding of which side effects are most likely to occur with your specific treatment, how mild or severe they might be, when they are likely to appear, how long they will last, and what, if anything, can be done to help. Talk to your doctor about your options to reduce or eliminate problematic side effects. You may be able to relieve some with simple at-home or over-the-counter remedies, while others may require prescription medication, therapy, lifestyle changes, treatment dose reduction, or changing your treatment altogether.
Some other areas of your life that may be impacted include: sleep, appetite, interest in or ability to exercise, stress, anxiety, depression, self-esteem, spiritual connection, socializing, isolation, loss of sexual desire, lack of support, and finding joy in things that make you happy. Speak with your doctor openly about your emotions and your options to improve your mental health and well-being. You may feel a little better just by acknowledging it and talking about it. Perhaps talk therapy with a support group or a professional would be beneficial, or maybe a heart-to-heart with a loved one is all you need at that moment. You may also consider lifestyle changes (sleep, diet, exercise), mind-body modalities (yoga, meditation, breath work, journaling, mindfulness, or stress management techniques), and/or prescription medication to get some relief. Talk to your doctor about what’s best for you.
Not all side effects are manageable or tolerable. You do not have to suffer while you’re being treated for cancer. Speak up if something if too much for you.
Good to Know...
- You may not experience side effects immediately upon beginning treatment or even through the first few cycles. Some treatments (e.g. chemo) build up in your system over time which can intensify side effects as you move forward and complete more treatment cycles.
- Not all chemotherapy drugs cause hair loss.
- You are not vain for being worried about hair loss, weight changes, skin issues, scarring, and other visible signs of cancer and cancer treatments. How you feel about yourself is important, and asking for ways to avoid or reduce the severity of side effects as they relate to your appearance is healthy, acceptable, and encouraged.
If/when side effects appear, it's important to know what to do next.
Be sure to ask your oncologist how/when to report side effects before you begin treatment. Some practices have a patient app that allows you enter side effects (regardless of intensity) at your convenience, or a nurse line you can call to discuss your side effects and possible solutions. Other practices may require you to call them directly and/or set up an appointment to discuss how you're feeling in more detail. You'll want to find out which side effects can be tolerated without intervention, which side effects may need intervention (medication, dose change, etc.), which side effects require emergency attention, and to whom (and how) you should report these side effects.
- Record and track side effects (when did they start, what sensation do you feel/notice, how bad is it, did anything make it better, how long did it last, etc.).
- Report side effects to your doctor as directed and bring your side effects log to all appointments to review with your doctor .
- If a side effect persists for more than 24 hours, you may want to call your doctor and alert them before your next visit.
In the next few sections, we'll discuss common side effects, proactive side effect management, the connection between side effects and treatment effectiveness, and more. Please take advantage of the resource collection at the bottom of this page for additional information, support, and guidance for managing your side effects.
The Effects of Chemotherapy on Your BOdy
Image source: https://www.healthline.com/health/cancer/effects-on-body
COmmon Cancer Treatment-Related Side Effects
N/V/D/C
Hair Loss/Alopecia
Hair Loss/Alopecia
Many cancer treatments are rough on the digestive system, commonly leading to nausea, vomiting, diarrhea, and/or constipation.
Hair Loss/Alopecia
Hair Loss/Alopecia
Hair Loss/Alopecia
Some lose a little, some lose none, some lose it all, and some thin a bit.
Fatigue
Hair Loss/Alopecia
Neuropathy
Fatigue and chronic fatigue, insomnia and sleeplessness, sleep disturbances and restless sleep
Neuropathy
Memory, Concentration & Chemo Brain
Neuropathy
Numbness, tingling, loss of sensation, loss of balance, and/or pain due to nerve damage, most often occurs in the hands and feet; can be temporary or permanent.
Skin Toxicities
Memory, Concentration & Chemo Brain
Memory, Concentration & Chemo Brain
Rashes, Hand & Foot Syndrome, loss of fingerprints, splitting fingertips, nail loss, skin infections, red/painful/cracking fingertips and cuticles, skin discoloration
Memory, Concentration & Chemo Brain
Memory, Concentration & Chemo Brain
Memory, Concentration & Chemo Brain
Forgetfulness, lack of focus, attention, or concentration, feels like brain isn't working at maximum efficiency, difficulty processing information, confusion, chemotherapy-related cognitive impairment
Oral Toxicities
Emotional & Mental Health
Emotional & Mental Health
Metallic taste, mouth sores, weakened gums, loss of taste buds, dry mouth, first-bite syndrome, cold sensitivity
Emotional & Mental Health
Emotional & Mental Health
Emotional & Mental Health
Anxiety, depression, fear, grief, denial, self-isolation, feelings of hopelessness, decreased capacity to cope
Sexual Health & Fertility
Emotional & Mental Health
Sexual Health & Fertility
Erectile dysfunction, vaginal dryness, inability to climax, lack of desire/interest in sex, loss of fertility, early onset menopause, urinary incontinence, painful intercourse, loss of breasts, testes, prostate, ovaries, uterus, or related organs and tissues
Paraneoplastic Syndromes
Paraneoplastic Syndromes
Sexual Health & Fertility
A collection of symptoms/side effects brought about by cancer-induced antibodies or hormones circulating in the blood; more common in lung cancer, kidney, liver, leukemia, lymphoma, breast, ovarian, brain, stomach, and pancreatic cancers.
Loss of Appetite
Paraneoplastic Syndromes
Loss of Appetite
May be caused by metallic taste, mouth sores, weakened gums, loss of taste buds, nausea, vomiting, diarrhea, constipation
Lymphedema
Paraneoplastic Syndromes
Loss of Appetite
" Lymphedema is an abnormal collection of lymphatic fluid in the tissues just beneath the skin. This swelling commonly occurs in the arm or leg, but it may also occur in other body areas including the breast, chest, head and neck, and genitals."
Feeling Better With Proactive Side Effect Management
We've had enough surprises!
Get ahead of potential side effects by learning more in advance and planning for prevention, reduction, or full alleviation of certain side effects.
If any of these are on the list of side effects you may experience with your treatment, consider asking about some of these possible remedies:
- Hair loss/thinning: ask about cold therapy caps, be sure to check with your insurance provider before committing to cold therapy
- Skin toxicities: ask about antibiotics, topical steroids, topical moisturizers, creams, balms, ointments
- Nausea & vomiting: ask about anti-nausea medications (called antiemetics). These can be given by mouth or by IV. Ask a dietician for recommendations on foods/drinks to avoid or incorporate into your diet to improve N&V
- Fatigue: ask about additional fluid infusions, acupuncture, nutrition, or making changes to your activity level
- Infertility: ask about fertility preservation before starting treatment
- Neuropathy: ask about nerve pain medication, topical pain-relief, compression therapy, or cold therapy (icing) during infusions
- Metallic taste in mouth: ask about mouth rinses specifically for this, be cautious of or avoid drinking from metal containers and using metal utensils
- Lymphedema: ask about physical therapy/lymphedema therapy
- Sexual Dysfunction and Infertility: visit our Sexual Health page for an in-depth look at these side effects and possible solutions
Patient Product Recommendations for Specific Side Effects
Dry Mouth (Xerostomia)
· Entertainer’s Secret Throat Relief Spray for Dry Throat and Hoarse Voice
· Moi-Stir Oral Spray
· Therabreath Dry Mouth Lozenges
· Mouth Kote Oral Moisturizer
· Mouth Kote Dry Mouth Spray
· Colgate Optimoist
· Salivart Oral Moisturizer
· Xero-Lube
· Biotene Oral Balance
· Biotene Dry Mouth Oral Rinse
· Biotene Gum
· Biotene Dry Mouth Oral Balance Gel
· Biotene Moisturizing Mouth Spray
· Biotene Dry Mouth Lozenges
· SmartMouth Dry Mouth Oral Rinse
· OraCoat XyliMelts Dry Mouth Stick-On Melts
· Acupuncture
· Prevention Oncology Mouthwash
· Cotton Mouth Candy Dry Mouth Lozenges
· PreviDent 5000 Dry Mouth Toothpaste (prescription)
· Dr. John’s Lemon Dry Mouth Drops
· Prevention Oncology Mouth Rinse
· Salagen (generic: pilocarpine) (prescription oral tablets)
Mouth Sores & Mouth Pain (Oral Mucositis)
· Colgate Peroxyl Mouth Sore Rinse
· GelClair (prescription) or other viscous lidocaine rinse
· Prevention Oncology Mouth Rinse
· “Magic” or “Miracle” Mouthwash solution (prescription)
Metallic Taste in Mouth
· MetaQil Metallic Taste Oral Rinse
· Marinol (prescription)
· Megestrol acetate
· George’s 100% Aloe Vera Fractionally Distilled Liquid (mouth rinse)
Loss of Appetite & Taste Changes
· Ensure Plus
· Carnation Instant Breakfast
· Boost
· Nutrament Energy Nutrition Drink
· Miracle Berries/Ledidi Fruit products
· Premier Protein
· Marinol (prescription)
· Acupuncture
· Kate Farms Nutrition Shake
Dry and Irritated Skin & Lips, Rashes
· Drunk Elephant Wonderwild Miracle Butter
· Drunk Elephant Virgin Marula Luxury Facial Oil
· Drunk Elephant Bora Barrier Repair Cream
· La Roche-Posay Lipikar Triple Repair Moisturizing Cream
· La Roche-Posay Cicaplast Balm B5 Soothing Therapeutic Multi-Purpose Cream
· La Roche-Posay Lipikar Gentle Foaming Cleansing Oil
· Mario Badescu Lip Mask with Acai and Vanilla
· Aquaphor Healing Ointment Advanced Therapy
· Eucerin Advanced Repair
· CeraVe Moisturizing Cream
· CeraVe Healing Ointment
· A&D Ointment
· Evian Natural Mineral Water Facial Spray
· Udderly Smooth Body Cream
· Bag Balm Skin Moisturizer
· O’Keefe’s Healthy Feet Cream or Heel Balm
· Miracle Foot Repair Cream
· Steroids/Antibiotics/Antihistamines (prescription or OTC, topical and/or oral)
· Facial Ice Masks
· Metrogel (prescription, metronidazole)
· Urea 20 Intensive Hydrating Cream
· Cetaphil Intensive Healing Lotion
· Nivea Essentially Enriched 48-Hour Body Lotion
· Vaseline Expert Care Extremely Dry Skin Rescue Therapy Cream
· Luxamend Wound Cream (prescription)
· Colloidal Oatmeal (bath soaks, cleansers, creams)
Radiation Burns
· Xeroform Petrolatum Dressing
· 100% Aloe gel
· Miaderm
· Silver Sufladiazine Cream/Silvadene (prescription)
· BroccoFusion Sulforaphane Ointment
· Egyptian Magic All Purpose Skin Cream
· Calendula-based cream/ointment
· DermaVeen
· Glaxal Base Moisturizing Cream
· Maizena flour
· Medline Silvasorb Gel
· Domeboro Powder Medicated Soak
· Silvex Wound Gel
· EtlaMD SilverGel Wound Gel
· Neosporin plus Pain Relief
· CeraVe
· Aquaphor
Sun Protection
· La Roche-Posay Tinted Mineral Anthelios Light Fluid Sunscreen (11% titanium dioxide)
· Think Sport 50 SPF (23.4% zinc oxide)
· Drunk Elephant Umbra Tinte Physical Daily Defense SPF 30 (20% zinc oxide)
· Drunk Elephant Umbra Sheer Physical Daily Defense SPF 30 (20% zinc oxide)
· Baby Bum Mineral 50 Sunscreen Lotion
· Sun Bum Mineral 30 or 50 Sunscreen Lotion
· Blue Lizard 30+ Sensitive Face Mineral Sunscreen
· Blue Lizard 50+ Sensitive Mineral Sunscreen
· Badger Face Mineral Sunscreen SPF 30
· Badger Daily Mineral Sunscreen SPF 30
· Badger Adventure Mineral Sunscreen Cream SPF 50
Nausea
· Prescription Oral & IV Anti-emetics (compazine, ondansetron, promethazine, prochlorperazine, olanzapine, fosaprepitant, etc.)
· Marinol (prescription)
· Medical Cannabis
· The Ginger People Gin-Gins Hard Candy
· Ginger Tea (made at home with fresh ginger root)
· Scopolamine Transdermal Patches
· Additional IV fluids
· Nauzene Chewable Tablets
· Liquid I.V. Hydration Multiplier
· Urban ReLeaf Chemo Relief Nausea & Side Effects Aromatherapy Inhaler
· Queasy Drops
· Tummydrops
Hair Care & Preservation
· Pura D’Or Anti Hair-Thinning Biotin Shampoo
· Pura D’Or Deep Moisturizing Biotin Conditioner
· Cold/Cool Capping
· Vanicream Shampoo & Conditioner for Sensitive Skin
· Bumble & Bumble Hair Powder (comes in several colors to match your hair and fill in thin spots)
· PhysAssist Oncology Delicate Shampoo
· Four Reasons No Nothing Sensitive Moisture Shampoo & Conditioner
· Nioxin Pro Clinical Shampoo & Conditioner
· MooGoo Natural Milk Shampoo & Natural Cream Conditioner
· MooGoo Natural Scalp Cream
· Bosely MD Defense Nourishing Shampoo & Volumizing Conditioner
· AG Tech Two Protein-Enriched Shampoo
· Tweak’d By Nature Restore Pure F.F. Strengthening Shampoo & Conditioner
· Actiiv Recover Thickening Shampoo & Conditioner
Neuropathy
· PharmaPulse Maximum Strength Neuropathy Nerve Relief Cream
· MagniLife Pain Relieving Foot Cream
· Nuturna Neuropathy Intensive Concentrate Cream
· HotHands Insole Foot Warmers or Toe Warmers
· Genius Cure Neuropathy Relief & Recovery Premium Soothing Nerve Formula
· Toe Spacers
· The Original Foot Alignment Socks
· Happy Feet Socks
· Compression socks/neuropathy socks
· Heated socks/gloves
· Ice booties/gloves
· Acupuncture
· Dr. Joe’s LivRelief Extra Strength Nerve Pain Relief Cream
· Mountain Ice Original Pain Relieving Gel
· Rowe Casa Organics All-Natural Muscle & Joint Pain Cream
· Vita Sciences Nervex Maximum Neuropathy Support Cream
· Nerve Pain Medication (prescription; Cymbalta, gabapentin, etc.)
· Vicks VapoRub on feet overnight
· Voltaren Gel (OTC)
· Vitamin B Supplementation
· Vitamin D Supplementation
· Alpha Lipoic Acid Supplementation
· Lidocaine cream
Don't forget that what works for someone else, may not work for you. It may require some trial and error before you find things that help you feel better., but keep trying. Refer to your doctor for individualized guidance.
"But You Look So Great!"
Was that eye roll audible?
This one's dedicated to all the friends, families, and caregivers out there...
When someone says, "well, I think you look great!", a patient may not receive it as it was intended.
Instead, they may be thinking:
- Do you just mean I look thinner? Well that's because I can't eat anything and I keep vomiting. Thanks for noticing.
- What looks great? My tired eyes? My thinning hair? My skin covered in a rash?
- I don't care how you think I look. I don't even care how I think I look right now.
- Well then how did I look before? Sheesh.
- I'm not pregnant. Let's not pretend I'm glowing.
- You sound like you're pitying me. Stop it.
- Oh, cool. Thanks. I'm super focused on my looks right now. Glad we're on the same page with that.
- How did you expect me to look? Terrible?
- Aww, that was nice. Thank you.
Sure, compliments can be lovely to hear, but it's not always necessary or welcomed to comment on someone's appearance even if you have good intentions. It can come across as impersonal, meaningless, and inauthentic. Consider complimenting your friend or family member on something more sincere and relevant, aside from how they look. Focusing on the superficial can minimize or exclude more important details about their life and their cancer experience from your conversation. Open the door to talk about something of more significance. You may be one of the few who does this for them.
Please be aware that your loved one may not look like a "typical" cancer patient (whatever that means), and just because they have their hair, some energy, an appetite, or can continue working doesn't mean they feel well or they're handling their treatment with ease. Check in, step up, offer to remove responsibilities from their shoulders, or give them space to rest privately. Don't assume a smile, a peppy step, or a full head of hair means something it doesn't. In the same spirit as "not all disabilities are visible," those going through cancer treatment may not appear to be negatively impacted by their cancer, but it's a near certainty they are.
"Looking good" =/= feeling good or doing well.
Also, please allow your loved one to complain, vent, and let it out. We want to do our best not to make our loved ones feel like they have to be strong, and tough, and never utter a word of discomfort, frustration, or pain. They don't need us to remind them they are "luckier than others who have it much worse." This isn't about how they feel in comparison to others; its just about how they feel. Period. Let them feel, and express, their real thoughts and emotions without judgment or dousing them with "the bright side."
The Relationship Between Side Effects & Effectiveness
Feels worse, works better?
Has either of these thoughts popped into your head?
- "I feel fine so it must not be working."
- "I feel terrible so it must be working."
Are side effects and efficacy tied to one another?
I was curious so I set out to discover if these thoughts have any medical or scientific validity behind them, and the answers are a little scattered depending on the type of therapy causing the side effects. Take a look for yourself.
- For most chemotherapy drugs, the presence or intensity of side effects does not indicate how well the drug is working. You will need imaging, blood work, tumor marker tests, and/or a physical exam to determine if and how well the chemotherapy is working.
- According to the National Cancer Institute (NCI), "You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer."
- Healthline stated "Some people may experience more severe side effects than others. However, side effects are not an effective way to tell that your chemotherapy is working. Even severe side effects don’t necessarily mean that your treatment is effectively killing cancer cells."
- In regard to how to tell if immunotherapy is working, Moffitt Cancer Center shared "Although treatment side effects such as inflammation may be a sign that immunotherapy is affecting the immune system in some way, the precise link between immunotherapy side effects and treatment success is unclear. Many patients who respond positively to immunotherapy have no side effects."
- There may be an exception to this principle according to City of Hope. "“Chemo rash” simply refers to the various types of rashes that may develop in response to cancer treatment. This may occur not only with chemotherapy, but also targeted therapy, immunotherapy, radiation therapy and bone marrow transplant. It tends to look like acne or measles, and in some cases, it’s a sign that treatment is working."
- A journal article published in Current Oncology detailed an example of side effect intensity correlating to efficacy in regard to EGFR-targeted monoclonal antibodies (cetuximab and panitumumab) for metastatic colorectal cancer (mCRC). "Available retrospective evidence suggests that the appearance and severity of skin rash is positively correlated with objective tumour response to EGFRI therapy and with OS in mCRC. Data suggest that skin rash may serve as a surrogate marker of EGFR-targeted mAb efficacy. In several analyses, both the presence and intensity of skin toxicity predicted objective tumour response in patients treated with cetuximab or panitumumab in mCRC."
- A systematic review article published in 2021 in Frontiers in Oncology found "In our meta-analysis focusing on lung cancer, the results demonstrated that the occurrence of irAEs (immune-related adverse events) was significantly associated with ORR (overall response rate), OS (overall survival), and PFS (progression-free survival) of patients treated with ICIs (immune checkpoint inhibitors). In addition, patients who experienced dermatological, endocrine, and gastrointestinal irAEs had longer OS and PFS than those who did not. Nevertheless, pulmonary and hepatobiliary irAEs and high-grade (≥3) irAEs were not correlated with OS and PFS. As mentioned previously, not all irAE occurrences are related to the efficacy of immunotherapy. "
- A systematic review article published in 2019 in Melanoma Research found that "IrAEs are side effects because of activation of the immune system and may be signs of successful immune checkpoint blockade. In 66% of the analyses, irAEs were a sign that treatment was effective, indicating that having an irAE is no guarantee for treatment benefit. Rash and vitiligo, however, correlated significantly with favorable response to therapy in all studies."
