Chemotherapy can reduce the number of blood cells produced by the bone marrow. Bone marrow is a spongy material that fills the bones and produces the cells (called stem cells) which develop into the three different types of blood cells:

• red blood cells, which carry oxygen to all parts of the body.
• white blood cells, which are essential for fighting infection.
• platelets, which help the blood to clot and control bleeding.

All these cells normally stay inside the bone marrow until they are mature enough to perform their functions properly. They are then released into the bloodstream so that they can circulate around the body.

Increased chance of infection

If the number of white cells in your blood is low you are more likely to get infections as there are fewer white cells to fight off bacteria.

If your temperature goes up, or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital straight away. Most hospitals consider a temperature above 38ºC (100.5ºF) to be high, although some hospitals use a lower or higher temperature. The doctors and nurses will advise you when you need to contact the hospital.

Your regular blood tests will show the number of white cells in your blood. If you get an infection when your white blood cell level is low, you will need to have antibiotics. These may be given as an injection at hospital or you may be given antibiotic capsules or tablets to take at home. You may need to be admitted to hospital for the antibiotic treatment.

Blood cells are usually at their lowest level from 7–14 days after the chemotherapy treatment, although this will vary depending on the type of chemotherapy.

Helpful hints - infection

• Tell your doctor at once if you develop a temperature as you may need to have antibiotics.
• Keep clean. Always wash your hands thoroughly before preparing your food.
• Stay away from crowded places and from people who you know to have an infection such as a cold.
• Read our information on avoiding infection when your immunity is low

Sometimes, after chemotherapy, a drug called G-CSF will be used to help your bone marrow make white blood cells more quickly and so reduce the risk of infection. G-CSF is a protein made naturally in the body that can now be produced in the laboratory.

Red blood cells contain haemoglobin, which carries oxygen round the body. If there are fewer red blood cells in your bloodstream because of the chemotherapy, the level of haemoglobin in your blood will be low (anaemia).

This means you may feel very tired and lethargic, and may also feel breathless as there is less oxygen being carried around your body. People with anaemia can also feel dizzy and light-headed, and have aching muscles and joints.

The blood tests will measure your haemoglobin. If it is low you may be offered a blood transfusion. The extra red cells in the transfusion will pick up oxygen from your lungs and take it around the body. You will feel more energetic and any breathlessness will be eased.

Platelets are cells which are important in blood clotting. If you have a low number of platelets in your blood you may bruise very easily, and may have nosebleeds or bleed more heavily than usual from minor cuts or grazes. If you develop any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin (petechiae) or bleeding gums, you should contact your doctor or the hospital straight away. You may have to be admitted to hospital for a platelet transfusion. This is given by drip into your blood. The platelets will start to work immediately, to prevent bruising and bleeding.

Your regular blood tests will count the number of platelets in your blood. If your platelets are low, take care to avoid injury; for example, if you are gardening, wear thick gloves. You can use a soft toothbrush to clean your teeth to reduce the risk of scratching your gums and making them bleed.

Some drugs do not make your hair fall out, or the amount of hair lost is so slight it is hardly noticeable. Some chemotherapy can damage the hair and make it brittle. If this happens, the hair may break off near the scalp a week or two after the chemotherapy has started. Some chemotherapy drugs can make all of your hair fall out and this can be very upsetting.

The amount of hair that falls out, if any, depends on the type of drug or combination of drugs used, the dose given and how the drug affects you personally.

If your hair falls out, it usually starts within a few weeks of beginning treatment, although very occasionally it can start within a few days. Underarm, body and pubic hair may be lost as well. Some drugs also make the eyelashes and eyebrows fall out. If your hair does fall out due to the chemotherapy, it will grow back over a few months once you have finished your treatment.

Helpful hints – your hair

• If your drugs are likely to make your hair fall out, it can help to have your hair cut quite short before treatment. The weight of long hair pulls on the scalp and may make your hair fall out earlier.
• Use gentle hair products.
• Avoid perming or colouring your hair if it is brittle or if your scalp is dry and itchy.
• If you colour your hair, use a mild vegetable-based colourant and ask your hairdresser or chemotherapy nurse for advice.
• Try not to brush or comb your hair too roughly – use a soft or baby's brush.
• Avoid using hair dryers, and other items like tongs and straighteners. Pat your hair dry gently after washing it.
• If it is likely that your hair will fall out, ask your doctor or nurse about wigs early on, so that the wig can be as close a match as possible to your normal hair.
• You may like to wear a hat or scarf when you go out. There are also turbans which can be worn in the house.
• See our section on coping with hair loss.

Wigs

You are entitled to a free wig if you are an inpatient when your wig is fitted; or if you or your partner are claiming Income Support, Family Credit, Income-based Jobseeker’s Allowance or Disability Working Allowance. Children, and young adults up to the age of 19 in full-time education, are also entitled to free wigs following cancer treatment. If you are not entitled to a free wig you can get one on the NHS at a subsidised price.

Scalp cooling

Some people having certain types of chemotherapy may be able to prevent hair loss by using a 'cold cap'. This works by temporarily reducing the blood flow and the amount of the drug reaching the scalp. Unfortunately, the cold cap only works with certain drugs and does not always prevent hair loss. You can ask your doctor or chemotherapy nurse whether one would be useful for you. See our section on scalp cooling.

Your digestive system can be affected in a number of ways by chemotherapy.

Nausea and vomiting

Some chemotherapy drugs can make you feel sick (nausea), or actually be sick (vomit). Not all chemotherapy drugs cause sickness and many people have no sickness at all, as there are now very effective treatments to prevent and control it. Nausea and vomiting is much less of a problem than it was in the past.

If you do feel sick, it may start from a few minutes to several hours after the chemotherapy is given, depending on the drugs you are having. How long the sickness lasts varies.

Helpful hints – eating and digestion

• If you feel sick or are sick, tell your doctor as soon as possible. Anti-sickness drugs can be prescribed which usually work well.
• Avoid eating or preparing food when you feel sick.
• Avoid fried foods, fatty foods or foods with a strong smell.
• Eat cold or warm food if the smell of hot food makes you feel sick.
• Eat several small snacks and meals each day and chew the food well.
• Peppermints or peppermint tea may help.
• Have a small meal a few hours before treatment, but not just before it.
• Drink plenty of liquid slowly, taking lots of small sips.
• Ginger, either as ginger biscuits, ginger tea or ginger beer can reduce feelings of sickness.
• Avoid filling your stomach with fluid before you eat.
• Some complementary therapies (such as homeopathy, acupuncture or sea-bands) may help.

Your doctor will prescribe anti-sickness drugs (anti-emetics) to help. If your chemotherapy is known to cause sickness, you will be given anti-sickness drugs by injection or tablets before your chemotherapy. You will also be given tablets to take at home afterwards. It is important to take the anti-sickness medicines as advised by your doctor or chemotherapy nurse as it is easier to stop sickness from coming on than treating it once it has already started.

Steroids are often given to reduce nausea and vomiting. They often give a sense of well-being, as well as helping to reduce feelings of sickness and loss of appetite.

If the chemotherapy you are having does not usually cause sickness, you will be given anti-sickness medicine that you can take if you need to.

Diarrhoea and constipation

Some chemotherapy drugs can affect the lining of the digestive system and this may cause diarrhoea for a few days. Some chemotherapy drugs (or anti-sickness drugs) can cause constipation.

If you have any diarrhoea or constipation, or are worried about the effects of chemotherapy on your digestive system, you can talk to your doctor or chemotherapy nurse, or ask them to arrange for you to see a dietitian. If you have severe diarrhoea (eg more than 4–6 times a day), contact your nurse or doctor at the hospital.

Helpful hints – diarrhoea and constipation

• If you have diarrhoea, eat less fibre, and avoid cereals, raw fruits and vegetables.
• Drink plenty of liquid (up to two litres a day) to replace the fluid lost with diarrhoea.
• If you are constipated, eat more fibre, raw fruits, cereals, and vegetables. Fruit juice and warm drinks can help.
• Try to take gentle exercise, if possible.

Loss of appetite

Some chemotherapy drugs can affect your appetite. Our section on eating well has information to help if your appetite is low.

Chemotherapy can affect your sense of taste; food may taste more salty, bitter or metallic. Your normal sense of taste will come back after the chemotherapy treatment finishes.

Helpful hints – changes to sense of taste

• Eat only the foods that you like and ignore those that do not appeal to you.
• Use seasonings and herbs to flavour your cooking.
• Try marinating food, or using strongly flavoured sauces to go with food.
• Sharp-tasting foods such as fresh fruit can be refreshing and leave a pleasant taste in the mouth.
• Some people find that cold foods taste better than hot foods.
  

Some drugs can cause a sore mouth, which may lead to mouth ulcers. If this happens it is usually about 5–10 days after the drugs are given and will clear up within three to four weeks. You can be given mouthwashes to help.

Mouth ulcers can become infected. Your doctor or specialist nurse can give you treatment to help prevent or clear any infection. Cleaning your teeth regularly and gently with a soft toothbrush will help to keep your mouth clean. It may be helpful to see your dentist before you start your treatment. Dental treatment sometimes needs to be delayed when you are on chemotherapy because of the risk of infection and a sore mouth.

If your mouth is very sore, gels, creams or pastes can be used to reduce the soreness. Your cancer specialist can tell you about these.

Helpful hints – your mouth

• You might find eating fresh pineapple helps keep your mouth fresh and moist.
• Clean your teeth or dentures gently every morning, evening and after each meal.
• Use a soft-bristled or child's toothbrush.
• If your toothpaste stings or brushing your teeth makes you feel sick, try using a mouthwash of one teaspoon of bicarbonate of soda dissolved in a mug of warm water.
• If your doctor prescribes a mouthwash for you, use it regularly as prescribed to prevent soreness.
• Rinse your mouth regularly with salt water.
• Gently use dental tape or floss each day.
• Keep your lips moist by using Vaseline, or a flavoured lip balm.
• Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food. These may irritate your mouth.
• Keep your mouth and food moist. Add gravies and sauces to your food to make swallowing easier.
• Try to drink at least 1.5 litres (3 pints) of fluid a day (water, tea, weak coffee, and soft drinks).
• Avoid acidic drinks such as orange and grapefruit juice. Warm herbal teas may be more soothing.
• Let your doctor know if you have mouth ulcers, as you may need medicines to help heal the ulcers and clear any infection.
• Sucking crushed ice while the chemotherapy drugs are being given may help to prevent a sore mouth.
• Read our section on mouth care during chemotherapy.

Some people feel very tired during chemotherapy. This is quite normal. For someone who normally has a lot of energy, feeling tired all the time can be very frustrating and difficult to cope with. The hardest time may be towards the end of the course of chemotherapy.

Try to cut down on any unnecessary activities and ask your family or friends to help you with jobs such as shopping and housework. It is important not to fight your tiredness. Give yourself time to rest and, if you are still working, see if it is possible to reduce your hours while you are having treatment. If you are having problems with sleeping, your GP may be able to prescribe sleeping tablets for you.

The tiredness will ease off gradually once the chemotherapy has ended, but it can often be three or four months until you feel back to normal. Some people find that they still feel tired a year or so afterwards.

Our section on coping with fatigue gives helpful tips on dealing with tiredness during chemotherapy treatment.

Some drugs can affect your skin. Your skin may become dry or slightly discoloured, which may be made worse by swimming, especially if there is chlorine in the water. Any rashes should be reported to your doctor.

Your skin may also be more sensitive to sunlight, during and after the treatment. Protect your skin from the sun by wearing a hat, sunglasses, and loose clothing that covers your skin. Use sunscreen cream (at least factor 15) on any exposed areas.

Helpful hints – skin changes

• Avoid wet shaving − an electric razor is less likely to cause cuts.
• If your skin becomes dry or itchy, you can use some moisturising cream. If you are also having radiotherapy, check with your doctor before using any moisturisers.
• Wear a hat, loose clothing and high-factor suncream if you are going out in the sun, to prevent your skin burning.

Your nails

Chemotherapy may make your nails grow more slowly, or become brittle or flaky. You may notice white lines appearing across them. False nails or nail varnish may disguise these. Sometimes the shape or colour of your nails may change.

Effects on the nerves

Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, or a sensation of pins and needles. This is called peripheral neuropathy. It is important to let your doctor know if this occurs. They may need to change the chemotherapy drug if it gets worse. Usually, it gradually gets better when the chemotherapy treatment ends. Very occasionally it can damage the nerves permanently.

Effects on the nervous system

Some drugs can make you feel anxious, restless, dizzy, sleepy or have headaches. Some people also find it hard to concentrate. If you have any of these effects let your doctor know, as medicines can often be given to help. Cancerbackup nurses can give you advice on how to cope with these effects.

Change in kidney function

Some chemotherapy drugs can affect how well your kidneys work (kidney function). In order to prevent this, fluids may be given by drip into your vein for several hours before you have the treatment. Your kidney function will be carefully checked by blood tests before each treatment. The nurses may ask you to drink plenty of fluid and it is important to do this. They may also ask you to measure the amount of urine you pass.

Changes in hearing

Some chemotherapy drugs can affect your hearing. You may lose the ability to hear some high-pitched sounds. Some people find they have a continuous noise in the ears known as tinnitus, which can be very distressing. Let your doctor know if you notice any change in your hearing. They can arrange a hearing test for you.

Second cancer

Some chemotherapy drugs can increase the risk of developing particular types of cancer or leukaemia later in life. This is extremely rare and your doctors will weigh up the small increase in risk of cancer or leukaemia, against the benefit of the chemotherapy in treating your current cancer. If the chemotherapy you are having may cause a second cancer, your doctors will discuss this with you.