PCRI
24 Aug 2026

Chemotherapy Side-Effects and its Management

Chemotherapy is a type of treatment used to kill rapidly growing cancer cells. Chemotherapy drugs are used to treat many types of cancer.

Side Effects of Chemotherapy

Chemotherapy helps the body kill rapidly growing cells, but it can also damage healthy cells, which may cause side effects. Some side effects are mild and can be managed easily, while others may cause serious complications. Common side effects of chemotherapy include:

Nausea and Vomiting
Hair Loss (Alopecia)
Diarrhoea and Constipation
Fatigue
Infection
Loss of Appetite
Change of Taste
Peripheral Neuropathy (Nerve Damage)
Infertility and Sexual Health Changes
Mouth Sores and Ulcers (Mucositis)
Hand-Foot Syndrome

1. Nausea and Vomiting

Anti-cancer treatment or chemotherapy can cause nausea and vomiting. These are common side effects of cancer treatment and can often be managed. The following suggestions may help:

Drink plenty of fluids to help prevent dehydration.
Eat light meals and avoid spicy or greasy foods if they worsen your symptoms.
Eat smaller meals at frequent intervals.
If you experience nausea, try sipping fluids slowly and frequently.
Your doctor may prescribe anti-nausea medicines to help prevent or control symptoms. Examples include ondansetron (Emeset) and metoclopramide (Perinorm).

Always consult your treating physician before taking medicines or herbal products.

2. Hair Loss (Alopecia)

Hair loss due to chemotherapy, medically known as alopecia, is a common side effect of certain chemotherapy drugs. Hair loss is often temporary, and hair may grow back after treatment is completed. Depending on the drugs used, hair loss may affect the scalp, face, underarms, legs, and other parts of the body.

The following measures may help you manage hair loss:

Cooling Cap: A scalp-cooling cap may help reduce hair loss during certain chemotherapy treatments by reducing blood flow to the scalp. Ask your oncologist whether scalp cooling is suitable for your treatment.
Short Hair: Consider cutting your hair short when hair loss begins. Some people prefer to shave their heads to make hair loss easier to manage.
Wigs: You may choose to purchase a wig before hair loss begins to find a closer match to your natural hair colour and style.
Soft Hairbrush or Comb: Gently comb your hair using a soft brush or wide-toothed comb to reduce pulling and breakage.
Avoid Harsh Hair Products: Avoid harsh chemical treatments, hair dyes, and heat styling if they irritate your scalp.
Scarves and Caps: Wear a scarf or cap outdoors to protect your scalp from sunlight and cold weather.

3. Diarrhoea and Constipation

Chemotherapy may cause changes in bowel movements, resulting in diarrhoea or constipation. Constipation involves difficulty passing stools or having hard stools, whereas diarrhoea involves frequent loose or watery stools.

Inform your doctor if either condition develops, worsens, or does not improve. The following measures may help, depending on your symptoms:

S. No.	Constipation	Diarrhoea
1	Drink adequate fluids, unless your doctor has restricted your fluid intake.	Drink fluids frequently to prevent dehydration. Oral rehydration solution (ORS) may be recommended.
2	Eat fibre-rich foods, such as fruits, vegetables, and cereals, if appropriate for your condition.	Avoid foods that worsen your symptoms, including greasy or spicy foods.
3	Engage in light physical activity, such as walking, if your doctor permits.	Choose easily tolerated foods and maintain adequate nutrition.
4	Your doctor may recommend a suitable laxative, depending on your symptoms and treatment.	Eat small, frequent meals and snacks throughout the day, if tolerated.
5	Your doctor may recommend a stool softener or laxative when necessary.	Your doctor may prescribe an anti-diarrhoeal medicine, such as loperamide, when appropriate.
6	Discuss the use of dietary fibre or other supplements with your doctor.	Ask your doctor whether probiotics or other supplements are appropriate for you.

Important: Do not start laxatives, anti-diarrhoeal medicines, probiotics, or other treatments without consulting your oncology team. Diarrhoea during chemotherapy may sometimes indicate a serious complication and requires prompt medical assessment, particularly if accompanied by fever, blood in the stool, severe abdominal pain, or dehydration.

4. Fatigue

Fatigue is one of the most common side effects of cancer and its treatment. It can affect quality of life and interfere with everyday activities. The following tips may help you cope with fatigue during cancer treatment:

Maintain a regular sleep schedule and limit daytime naps if they interfere with nighttime sleep.
Schedule periods of rest throughout the day and prioritise important activities.
Engage in gentle exercise or other physical activity as recommended by your healthcare team.
Maintain adequate nutrition. If eating large meals is difficult, try smaller, more frequent meals and consult a dietitian if needed.
Spend some time outdoors or in a quiet, relaxing environment to support emotional well-being.
Discuss persistent fatigue with your doctor, who may check for treatable causes and recommend appropriate management.

5. Infection

Chemotherapy can increase the risk of infection by lowering the number of white blood cells in the body. White blood cells help fight infections. A low level of certain white blood cells, particularly neutrophils, is known as neutropenia.

The following precautions may help reduce the risk of infection during chemotherapy:

Maintain Hygiene: Practise good personal hygiene. If you have a PICC line or chemotherapy port, follow your healthcare team's instructions for keeping the area clean and dry. Watch for signs of infection, including redness, swelling, fever, or chills.
Avoid Exposure to Infection: Avoid close contact with people who are sick and follow your doctor's advice about crowded places.
Wash Your Hands: Wash your hands thoroughly before eating, after using the toilet, and after touching potentially contaminated surfaces.
Follow Food Safety Practices: Eat properly prepared food, store food safely, and avoid food that may be contaminated or undercooked.

Important: Fever during chemotherapy, particularly when white blood cell counts are low, can be a medical emergency. Contact your oncology team immediately if you develop a temperature of 38°C (100.4°F) or higher, or follow the specific emergency instructions provided by your treatment centre.

6. Loss of Appetite

You may not feel like eating during chemotherapy. Loss of appetite can occur because of the treatment itself or because of cancer. The following measures may help:

Eat small, frequent meals instead of large meals.
Eat when you feel hungry and choose foods that you can tolerate.
Drink adequate fluids throughout the day to help prevent dehydration.
Choose nutritious snacks and easy-to-eat meals, particularly on treatment days.
Your doctor may consider appetite-stimulating medicines, such as megestrol, in selected cases. Do not take these medicines without medical advice.
Talk to your doctor or dietitian if your appetite loss persists, you are losing weight, or you cannot eat or drink enough.

7. Change of Taste

Changes in taste are a common side effect of chemotherapy. Food may taste different, bitter, metallic, or less flavourful. These changes may improve after treatment, although the duration varies from person to person.

The following tips may help manage changes in taste:

Add herbs, mild seasonings, or other flavours to food according to your tolerance.
Maintain good oral hygiene by brushing your teeth gently and regularly.
Rinse your mouth with water before eating to help freshen your mouth.
Try different foods and temperatures to identify what tastes and feels most comfortable.

If taste changes make it difficult to eat or drink enough, contact your treating physician or dietitian for advice.

8. Peripheral Neuropathy (Nerve Damage)

Certain chemotherapy drugs and other cancer treatments can damage the nerves responsible for movement and sensation in the hands, arms, legs, and feet. This condition is known as peripheral neuropathy.

Symptoms may include tingling, burning, numbness, pain, or a pins-and-needles sensation in the hands or feet. Some measures that may help manage symptoms include:

Gentle Exercise: Appropriate physical activity and exercises recommended by your healthcare team may help maintain mobility and balance.
Physiotherapy: A physiotherapist may recommend suitable exercises to improve movement, strength, and balance.
Massage: Gentle massage may provide temporary relief for some people. Avoid massage if the affected area is painful, injured, or has reduced sensation unless your healthcare professional approves it.
Avoid Alcohol: Discuss alcohol use with your doctor, as alcohol may worsen some nerve-related conditions.

If symptoms persist or worsen, your doctor may recommend medicines or other treatments to manage nerve pain. Always consult your healthcare team before taking medication or starting a new exercise programme. Report new numbness, weakness, balance problems, or difficulty walking promptly.

9. Infertility and Fertility Preservation

Some chemotherapy drugs may affect fertility by reducing sperm production, affecting egg supply, or causing other reproductive changes. The risk of temporary or permanent infertility depends on the medicines used, the doses given, age, and other individual factors. Not all chemotherapy treatments cause infertility.

Your doctor should discuss potential fertility effects before treatment begins. If you may wish to have children in the future, ask about fertility preservation options before starting chemotherapy.

For Males

Sperm freezing and storage (sperm cryopreservation) may be an option before treatment. Your doctor can refer you to an appropriate fertility specialist or authorised fertility centre.

For Females

Egg freezing (oocyte cryopreservation) or embryo freezing may be options for selected patients. Your doctor can refer you to a fertility specialist to discuss suitable approaches before treatment begins.

Note: Fertility preservation should be discussed as early as possible before chemotherapy starts. The most appropriate option depends on your health, age, treatment plan, and available time. Do not delay urgent cancer treatment without discussing the decision with your oncology team.

10. Mouth Sores and Ulcers (Mucositis)

Anti-cancer drugs are designed to destroy cancer cells, but they may also damage healthy cells lining the mouth and digestive tract. This can lead to mouth sores and ulcers, a condition known as oral mucositis.

Mouth sores may cause pain and discomfort and can affect the lips, tongue, gums, inner cheeks, roof of the mouth, and floor of the mouth. In some cases, inflammation may extend into the oesophagus, the tube that carries food to the stomach. Mucositis may be temporary, but its severity and duration vary. Chemotherapy and head-and-neck radiation therapy can cause mouth sores when used separately or together.

Examples of anticancer medicines associated with mouth sores include:

Intravenous Anticancer Drugs: Cisplatin, doxorubicin, etoposide, fluorouracil (5-FU), methotrexate, carboplatin, paclitaxel, and other medicines.
Oral Anticancer Drugs: Capecitabine, lenvatinib, lapatinib, sunitinib, sorafenib, cyclophosphamide, etoposide, and other medicines.

Symptoms of Mouth Sores and Ulcers

Common symptoms of oral mucositis include:

Redness and Swelling: Redness, swelling, or inflammation of the lining of the mouth.
Painful Ulcers: Pain or tenderness around sores and inflamed areas.
Mouth Bleeding: Bleeding from damaged or irritated oral tissues.
Mucus or Signs of Infection: Increased mucus or other changes in the mouth. Pus may indicate an infection and requires medical assessment.
Difficulty Eating or Swallowing: Pain that interferes with eating, drinking, or swallowing.
Burning Sensation: Burning or discomfort when eating or drinking, particularly with hot, acidic, or spicy foods.

Prevention of Mouth Sores and Ulcers

The following measures may help reduce irritation and support oral health during treatment:

Quit Smoking: Smoking can irritate oral tissues and delay healing. Ask your healthcare team for support with quitting.
Oral Cryotherapy: Sucking on ice chips during specific chemotherapy treatments may help reduce the risk of oral mucositis. This method is suitable only for certain treatments and should be used under your oncology team's guidance.
Maintain Oral Hygiene: Brush your teeth gently with a soft-bristled toothbrush and follow your dental or oncology team's instructions for oral care.
Stay Hydrated: Drink adequate water and other recommended fluids to help keep your mouth moist.
Avoid Alcohol: Alcohol may irritate damaged oral tissues. Avoid alcoholic drinks and alcohol-containing mouthwashes if advised by your healthcare team.

Treatment of Mouth Sores and Ulcers

Treatment depends on the severity of the sores and the cancer treatment being given. Options may include:

Saltwater or Baking Soda Rinses: Your healthcare team may recommend a gentle mouth rinse to help keep the mouth clean and comfortable. Avoid rinses that cause irritation.
Topical Products: Your doctor may recommend suitable protective gels or topical anaesthetic products to relieve pain. Use products such as oral gels only when approved for your condition.
Mouthwashes: A prescribed or recommended alcohol-free mouthwash may help with oral care. Chlorhexidine may be appropriate in certain circumstances but is not suitable for every case of mucositis.
Pain Relief: Your doctor may prescribe appropriate pain-relieving medicines. Do not take medicines such as naproxen, diclofenac, or paracetamol without checking with your oncology team, as some may be unsuitable during cancer treatment.
Avoid Irritating Foods: Avoid spicy, acidic, very hot, rough, or crunchy foods if they worsen the pain.
Choose Soft Foods: Soft, moist foods, such as yoghurt, mashed vegetables, and well-cooked cereals, may be easier to eat. Allow food to cool to a comfortable temperature before eating.
Review Cancer Treatment: If mucositis is severe, your oncologist may consider adjusting or temporarily delaying treatment when medically appropriate. Never stop or change chemotherapy without your oncology team's instructions.

Contact your oncology team promptly if mouth sores prevent you from drinking, you develop a fever, or you experience severe pain, bleeding, or signs of infection.

11. Hand-Foot Syndrome

Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia, is a side effect of certain chemotherapy and targeted cancer medicines. It can cause redness, swelling, pain, tingling, or itching on the palms of the hands and soles of the feet.

Examples of anticancer medicines associated with hand-foot syndrome include:

Intravenous Anticancer Drugs: Fluorouracil (5-FU), including continuous infusions, doxorubicin, docetaxel, and other medicines. The risk depends on the specific drug and treatment regimen.
Oral Anticancer Drugs: Capecitabine, lenvatinib, cabozantinib, axitinib, pazopanib, and other medicines.

Symptoms of Hand-Foot Syndrome

Symptoms may range from mild discomfort to severe skin changes that interfere with everyday activities. Common symptoms include:

Redness of the Hands or Feet: Redness that may resemble sunburn, particularly on the palms and soles.
Swelling and Pain: Tenderness, swelling, or inflammation in the affected areas.
Tingling or Burning: A burning, tingling, or pins-and-needles sensation in the hands or feet.
Blisters, Ulcers, or Sores: Skin changes that may cause discomfort or significant pain.
Difficulty with Daily Activities: Pain or sensitivity that makes walking, holding objects, or performing routine tasks difficult.

Prevention of Hand-Foot Syndrome

The following precautions may help reduce irritation and protect the skin of your hands and feet:

Avoid very hot water when bathing, showering, or washing dishes.
Use cool or lukewarm water for bathing when comfortable.
Protect your skin from excessive heat. Do not apply ice directly to your skin.
Avoid excessive sun exposure and other sources of heat that aggravate symptoms.
Avoid activities that cause repeated pressure or friction on the hands and feet, such as jogging, strenuous exercise, or lifting heavy objects, if these worsen symptoms.
Wear protective gloves when handling household cleaning products or detergents.
Avoid prolonged pressure from tools or objects that place stress on your palms.
Wear comfortable, well-fitting shoes and soft slippers. Avoid walking barefoot if your feet are sensitive.
Apply a gentle moisturising cream regularly to help keep your skin hydrated. Avoid vigorous rubbing of affected areas.

Treatment of Hand-Foot Syndrome

Treatment depends on the severity of symptoms and the medicine causing the condition. Your doctor may recommend:

Pain Relief: Appropriate pain-relieving medicines or topical products may be recommended to reduce discomfort. Consult your doctor before using lidocaine, naproxen, or other medicines.
Moisturising Creams: Creams containing ingredients such as urea may help manage dry or thickened skin. Ask your healthcare team which formulation is suitable, especially if your skin is cracked or broken.
Topical Steroids: Your doctor may prescribe a corticosteroid cream, such as hydrocortisone, in selected cases to manage inflammation.
Treatment Adjustment: If symptoms become severe, your oncologist may consider temporarily interrupting treatment, reducing the dose, or changing the medicine when appropriate. Never stop or adjust anticancer medicines without medical guidance.

Contact your oncology team if you develop worsening redness, painful swelling, blisters, open sores, or difficulty walking or using your hands.

Conclusion

Chemotherapy can cause several side effects, and their severity varies depending on the medicines used and individual health factors. Many side effects can be managed with appropriate supportive care and timely medical advice. Inform your treating physician about any new or worsening symptoms, and always consult your oncology team before taking medicines, supplements, or making changes to your treatment plan.

If you have any questions or concerns regarding your treatment, speak with your treating physician for personalised guidance.