Chemotherapy is a lifesaving mainstay of many cancer treatments but it can be a rough ride.
Knowing what’s round the bend in chemo treatment can make it easier for patients and carers alike, according to Jenny Schneider, a pharmacy expert from the University of Newcastle.
“Having really good conversations with the oncology team and support people can mean that side effects don’t take people by surprise,” Dr Schneider said.
So, what are the common side effects chemo patients face? What is it about chemo that causes these effects in the body? And how can you help your loved one get through?
Why does chemo make your hair fall out?
It’s the chemotherapy stereotype: hair loss.
Loss of hair can mean patients feel a sense of identity loss, and for friends and family it is a physical sign of just how sick their loved one is. But why does it happen?
A feature of cancer cells is that they divide rapidly, Dr Schneider said. So chemo drugs are designed to target cancer cells by destroying rapidly dividing cells.
Unfortunately, cancer cells aren’t the only cells that rapidly divide. Cells in our immune system, gut, and crucially, our hair follicles, all rapidly divide.
Chemo can damage cells in the hair follicles, hair growth can slow, and hair falls out.
The impact of hair loss on someone’s emotional wellbeing is often underestimated, according to Laura Kirsten, a psychologist who specialises in working with cancer patients, and chair of the Clinical Oncology Society of Australia (COSA).
“Hair loss is not just an issue for women — it’s also an issue for men,” Dr Kirsten said.
Why doesn’t everyone’s hair fall out?
Chemotherapy does not always lead to hair loss; many chemo patients retain a full head of hair or experience hair thinning rather than full-blown loss.
This can be luck of the draw, with some people less prone to hair loss because of chemo than others, according to Dr Schneider.
Different treatments and doses can also impact whether hair is lost or not, she said.
It is important to be aware that someone on chemo can have a full head of hair and look healthy, but still be feeling very unwell, Dr Kirsten said.
Everyone will have a different reaction to either losing or maintaining their hair, so discussing it with sensitivity is important.
“Check in with the person about how they want to discuss their hair.”
Why does chemo upset people’s stomachs?
Nausea and vomiting are hallmarks of chemo treatment, but it can be hard to pin down why someone might be feeling sick at any given moment, Dr Schneider said.
We have a “vomiting centre” in the brain, which exists to detect things that may be toxic to us.
“This vomiting centre or centres in the body are being triggered by the chemotherapy agent,” Dr Schneider said.
Nausea often strikes again a few days or so after treatment. This can be a result of the drugs breaking down cancer cells and other rapidly diving cells in the body.
As cells break down, they release byproduct chemicals that can also trigger the vomiting centre.
Another factor that can contribute to vomiting is the disruption of the cells which line the gut. This is, again, because they are cells that divide rapidly.
Treatment can also cause other gastrointestinal symptoms, such as diarrhea or constipation, Dr Schneider said.
Nausea and vomiting can have a bigger effect than just feeling rotten, Dr Kirsten pointed out.
It can impact a person’s role within the family by interfering with caring responsibilities, making cooking hard and making it difficult to share meals.
Why does chemo change a person’s sense of taste?
A change in senses is not as visible other side effects, but changes to taste can affect someone’s sense of wellbeing because enjoying food has a central role in our lives, Dr Schneider said.
“The whole experience of eating a favourite food may be different on chemo,” she said.
Tastebuds can be damaged or destroyed by the treatment, Dr Schneider said. As the tastebuds renew, they may send different signals to your brain than they usually would, changing how flavours are experienced.
Some chemo drugs get into the saliva, producing a bitter taste, she said.
Chemo can also affect saliva production, making a person’s mouth dry. Saliva is important in how we perceive taste, so a dry mouth can change the experience of food.
This is something for loved ones and carers to keep in mind when supporting someone undergoing chemo, Dr Schneider said.
If they are struggling with food, Dr Kirsten suggested making meals that can be frozen. This way they can heat them up in their own time, when they feel like eating.
Why does chemo make you tired?
Fatigue, like nausea, can be caused by a variety of factors.
As chemotherapy kills off cancer cells, other process in the body get disrupted, causing tiredness, Dr Schneider said.
“Drugs that combat other chemo side effects can cause drowsiness,” she said.
“The body is also dealing with the cancer itself, and this can cause fatigue.”
Anxiety can also be big energy drain. The stress of diagnosis and treatment can wear people out and lead to disrupted sleep.
“If they can, getting some physical activity can actually help with that fatigue,” Dr Schneider said.
Feeling fatigued may last longer than the chemo treatment itself.
It’s important for friends, family and colleagues not to expect them to fire on all cylinders as soon has chemotherapy as stopped, Dr Kirsten said, instead, give them time to recover from the treatment.
“When someone’s no longer able to participate in their usual roles that can also impact on their sense of self and self-worth,” she said.
Why do people on chemo have to be careful not to get a cold?
The immune system can become collateral damage in cancer treatment.
White blood cells that help fight infection are produced in the bone marrow — another region in the body were cells divide rapidly that’s targeted by chemo.
This means fewer white blood cells are produced, resulting in usually benign infections such as the common cold becoming extremely dangerous.
Chemo patients are told to monitor themselves for signs of infection and are usually advised to get to a hospital for monitoring if any occur, Dr Schneider said.
Vulnerability to infection is important for supportive friends and family to remember.
If you are planning to visit a loved one undergoing chemo but have any symptoms of infection, it is best to stay away, she said.
Why does chemo impact libido?
People often experience a dip in their libido while undergoing chemotherapy.
Feeling sick and fatigued is a major factor in reduced sex drive, Dr Kirsten said.
“With hair loss, the sense of identity can change, that can affect libido and willingness to engage in intimacy,” she said.
“Sometimes that physical relationship needs to be renegotiated.”
Chemo is delivered in cycles, so depending on where someone is on their cycle may impact their libido and capacity for intimacy.
What impact can chemo have on fertility?
A variety of factors including age, type of chemo treatment and cancer diagnosis can influence what effect chemo has on fertility.
Sometimes fertility is only affected in the short term, Dr Schneider said. But sometimes chemo can result in permanent fertility challenges or infertility.
For both men and women, cancer treatment can damage reproductive organs.
Sperm quality, quantity and motility can be degraded, particularly in older men whose sperm production may already be decreasing.
The drugs can impact hormones across the sexes, according to Dr Schneider, and some chemo regimes can trigger menopause.
Patients who may want to have children in the future should talk to their treatment team about their options, she said.
“For younger people this can be quite confronting, being hit with a cancer diagnosis and then having to consider fertility options.
“There are counsellors people can talk to about their options while working through their feelings and planning for the future.”
Dealing with the unknown
Embarking on chemotherapy can be a time of great uncertainty.
Coming in for their first chemotherapy session can be an anxiety-provoking time for the patient, their families and friends, she said.
“Friends and family can help someone about to go through chemotherapy by offering to take them to treatment and to keep them company. Distracting them with conversation will help them to avoid getting stuck in the cycle of worry.”