Chemotherapy is a treatment that uses powerful drugs to destroy cancer cells. These drugs circulate the body via the bloodstream, targeting cancer cells. Chemotherapy works by damaging the cancer cells, which eventually die, and the cancer may shrink or go away completely.
Unfortunately, chemotherapy drugs do not affect cancer cells only. They can damage any cells that are actively growing and dividing for example, cells in the mouth and hair roots. This can cause side-effects such as sore mouth or hair loss. Normal cells recover quite quickly, so any damage to them is usually temporary, and most side-effects go away once treatment ends.
There are many different chemotherapy drugs. Some are given on their own, but several drugs are often given together (‘combination therapy’).
Your first chemotherapy appointment
At your first appointment, you will not usually begin treatment immediately. Instead, this visit is to discuss your treatment plan and help you understand the process. You will meet with your doctor and your named nurse, who will help prepare you and answer any questions you may have and explain the side effects that your chemotherapy is likely to cause. If you are happy to proceed with the chemotherapy, you will be asked to sign a consent form.
During this visit, you will have your height and weight measured and a blood test will be taken. If your chemotherapy is to be given through your veins, we will look at your arms to check them and assess the best way to give you chemotherapy. It is important you bring a list of any medications you are taking. A nurse will also assess your needs for any practical, social or spiritual support and provide you with factsheets about your treatment. We can also give you a more detailed booklet or audiobook called ‘Understanding Chemotherapy’ or you can order it for yourself free of charge from Macmillan Cancer Support.
Preparing for chemotherapy
Some people will need a PICC line inserted in preparation for their chemotherapy.
It is essential that any dental work or checkups are up to date before you start chemotherapy. If you need to visit the dentist while on chemotherapy, or in the six weeks after it finishes, contact us first.
If you need to be vaccinated while on chemotherapy, or in the six weeks after it finishes, contact us first.
If any close family members are due to receive any vaccines, please contact your medical team first.
Alternative medicines and complementary therapies
If you are taking supplements, vitamins or herbals medicines or are thinking about doing so, please inform your medical team. Some commonly taken supplements, vitamins and herbal remedies may interfere with cancer treatments.
If you are considering having any complementary therapies, for example, aromatherapy, please discuss with your medical team. Should it be safe to proceed, you should check that the therapist is suitably qualified to work with people with cancer.
Alternatively, you may want to contact the Macmillan Information and Support Service. The service can signpost you to charities that provide complementary therapies.
Read more about support for people affected by cancer.
Receiving chemotherapy
You may receive chemotherapy in Laurel House Chemotherapy Unit at Antrim Area Hospital, or at Belfast City Hospital.
Each visit can take a few hours. A blood test is often required beforehand to ensure it is safe to proceed with treatment. This can be done at your GP practice, phlebotomy hubs or at Laurel House. If done in the unit, it can take up to an hour for your results. Depending on your results, it may be safer for you if we delay your chemotherapy for a few days and if so, you will be given a new appointment.
Your chemotherapy drugs are specially prepared for you by the pharmacy, which may take additional time. When your drugs are ready, your nurse will administer your treatment.
Once you are finished your treatment session, we will give you your next appointment details. It is very important that you bring your appointment card to each visit.
It is recommended that you do not drive yourself home as you may feel tired after your chemotherapy, so try to bring someone with you who can accompany you home.
Possible side effects of chemotherapy
Chemotherapy can cause a variety of side effects, which will differ depending on the drugs used. Most side effects are short term and usually stop or gradually go away when chemotherapy is over.
It is important that you tell us how you have been feeling since your last appointment. Contact the Triage Helpline if you have any concerns.
Feeling sick (nausea)
Some chemotherapy drugs can make you feel sick (nauseous) or be sick (vomit). Not all drugs cause sickness and many people have no sickness at all. There are very effective treatments to prevent and control sickness, such as anti-sickness drugs. If your chemotherapy is known to cause sickness, you will be given anti-sickness drugs by injection or as tablets before your chemotherapy and you will also be given tablets to take at home afterwards. You should take these regularly, even if you do not feel sick, and exactly as your doctor has prescribed them. It is easier to prevent sickness than to treat it once it has started.
Contact the Triage Helpline if you are being sick and are not able to drink enough fluids and you cannot keep down tablets.
Try to have a small meal a few hours before chemotherapy but not just before it. If you are managing to eat well in between treatments, do not worry if you cannot eat much for a couple of days after chemotherapy.
Helpful advice
- If possible, let someone else cook or prepare food for you
- Eat cold or frozen foods that only need heating up (defrost thoroughly), if the smell of cooking bothers you
- Avoid fried, fatty foods or foods with a strong smell
- Try eating dry food, such as toast or crackers, first thing in the morning
- Ginger can help reduce feeling of sickness – try crystallised ginger, ginger tea or ginger biscuits
- Sipping a fizzy drink can help – try mineral water, ginger beer or ale, lemonade or soda water and sip slowly through a straw
Mouth problems
Chemotherapy can cause sore mouth, mouth ulcers or infection. Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems. You may get mouth ulcers about 5 to 10 days after treatment is given. Mouth ulcers can become infected, or you may develop an infection in your mouth.
The most common mouth infection is called thrush (or candidiasis). It shows as white spots on your mouth and tongue, or your tongue and mouth lining become red and swollen.
Always let your doctor or chemotherapy nurse know if you have mouth ulcers, or any problems with your mouth. They can give you mouthwashes, and gels to heal ulcers and medications to help clear or prevent any infection.
Helpful advice
- Clean your teeth or dentures gently every morning, evening and after meals using a soft-bristled or children’s toothbrush and rinse your mouth regularly with water.
- 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 pint (570mls) of warm water.
- If your doctor prescribes a mouthwash for you, use it regularly as prescribed to prevent soreness
- Keep your lips moist by using a lip balm
A sore mouth or ulcers can make eating and drinking uncomfortable. These tips may help you:
- Add gravies and sauces to your food to keep your mouth moist and make swallowing easier
- Try to drink at least 3 pints (1.5 litres) of fluid a day (water, tea, weak coffee and soft drinks)
- Avoid hot spices, garlic, onion, vinegar and salty food
- Avoid neat spirits, tobacco and acidic drinks (orange and grapefruit juice)
Diarrhoea and constipation
Some chemotherapy drugs can cause diarrhoea, usually in the first few days. Let your nurse or doctor know if this happens as they can prescribe medicine to help with this. Make sure you drink plenty of liquid (up to two litres a day) to replace fluid you are losing with diarrhoea and eat less fibre (cereals, raw vegetables and fruits) until the diarrhoea improves.
Sometimes diarrhoea can be more severe, and it is important to contact the Laurel House 24-hour Triage Helpline if this happens.
In addition, some chemotherapy drugs, anti-sickness drugs and painkillers can cause constipation. Let your nurse or doctors know if this happens so they can prescribe drugs to prevent or treat it. Try to eat more fibre (cereals, raw vegetables and fruits) and drink plenty of liquid. Gentle exercise, such as short walks, can help to improve constipation.
Fatigue
While you are on treatment you may feel more tired than normal. It can be very frustrating and difficult to cope with, especially for people who normally have a lot of energy. The hardest time may be towards the end of the course of chemotherapy.
Managing tiredness
- Try to cut down on things you do not really need to do
- Ask family and friends, who are often keen to help in any way they can, to help with tasks such as shopping, household jobs or gardening
- If you have children, ask for help looking after them when you have chemotherapy and for a couple of days after. Some people may need extra childcare help and a social worker can usually arrange this for you
- Try to take some gentle exercise, such as short walks or more if you feel up to it. This will give you more energy and helps to keep some of your muscles working
- Some people choose to, or need to, carry on working during chemotherapy. Most employers will reduce your hours and change work duties to make things easier for you the tiredness will get easier when chemotherapy is over. But it can be three or four months until you feel back to normal. Some people find that they still feel tired a year or so afterwards
Contact the Northern Trust Macmillan Information and Support Service to find out more about local fatigue management workshops.
Sex and contraception
Chemotherapy should not have a long-term effect on your sex life. The side effects will usually gradually wear off when your treatment is finished. Feeling low or anxious can also affect your sex life.
It is important to use effective contraception during chemotherapy to avoid a pregnancy as the drugs might harm a developing baby. Your doctor or nurse will advise you to use reliable contraception during chemotherapy and for a few months afterwards.
It is usually best to use ‘barrier’ methods such as condoms, the cap or the coil (non-hormonal if you have breast cancer). Chemotherapy side effects, such as sickness and diarrhoea, can make the contraceptive pill less effective. If you are taking it you need to check with your cancer doctor if it is okay to continue using it.
Fertility
Unfortunately, some chemotherapy drugs can cause infertility (inability to become pregnant or to father a child). It is important to discuss your infertility risk with your cancer doctor before you start chemotherapy. If you have a partner, it is a good idea to include them in this discussion. Although chemotherapy can affect fertility, it is still possible for a woman to get pregnant or for a man to get his partner pregnant during chemotherapy. It is important to avoid pregnancy when you are having chemotherapy as the drugs could harm a developing baby.
Hair loss
Some chemotherapy drugs cause all or most of your hair to fall out, which can be very upsetting. There are lots of ways you can cover up, if you choose to, such as using wigs, hats, turbans, scarves or bandanas.
Hair loss usually starts within a few weeks of starting chemotherapy or, very occasionally, within a few days. You usually notice your hair coming out more when you brush, comb or wash it, and you may find hair on your pillow in the mornings. You may lose underarm, body and pubic hair as well. Some chemotherapy drugs also make the eyelashes and eyebrows fall out.
Your hair will usually grow back over a few months once you have finished treatment. It will be very fine at first and may be a slightly different colour or texture than before. You will probably have a full head of hair after 3–6 months. To begin with, you should try to look after the condition of your hair.
Look Good Feel Better are a charity that provide support for women and men who are experiencing cancer related hair loss. Their workshop ‘Hair Loss, Scalp Care and New growth’ is a practical workshop presented by partner charity, Cancer Hair Care, with expert advice and support on hair loss, how and when to safely colour your hair and what to expect with new hair growth. The session also covers advice on daily scalp care and moisturising, safe scalp massage and how to create an ideal platform for new hair growth whilst undergoing treatment.
Book a workshop through Look Good Feel Better.
Wig provision
We understand that dealing with health conditions or treatments that cause hair loss can be challenging and sometimes distressing. It may be that you wish to consider the option of a wig to help you feel more comfortable and confident. A wig referral can be made for you through your clinical team.
Wig fittings
When the current provider receives your referral, they must contact you to let you know it has been received. They can offer you a consultation appointment at that time. Any queries with the appointment times agreed should be directed to the wig provider. There is a clinic in Ballymoney or Belfast.
Tresses Hairpiece Boutique
Tresses Hairpiece Boutique are the current providers of the wigs in the Northern Trust. If you encounter any difficulties reaching them, please inform the Northern Trust promptly on the contacts provided below.
In the first instance you may wish to contact the healthcare team that made the referral on your behalf, or you may wish to call:
- Telephone: 028 9442 4000 (extensions: 334750 or 334271).
- Email: Referral@northerntrust.hscni.net.
Emotional support for hair loss
Many people see their hair as an important part of their appearance and identity. You may worry about how your different appearance will affect your relationships with family and friends. You may also feel uncomfortable about socialising and feel less confident.
Other people find their hair loss can act as a visible reminder to themselves and others that they have cancer. This may make you feel vulnerable and exposed, especially if you feel forced to tell people about your cancer diagnosis when you do not wish to do so. It can also be a shock if your eyebrows, eyelashes, beard or moustache and pubic hair fall out. You may feel even more vulnerable and this can affect the way you feel about yourself.
All these reactions are completely normal. It may take a while for you to come to terms with your hair loss, and to talk with others and deal with their reactions. Most people find that their family and friends are very supportive, and that it can help to talk through their feelings about losing their hair. In some cultures, hair is seen as a symbol of fertility and desirability, or a sign of health and status.
At the hospital, you will probably meet other people who have had hair loss, who can often give helpful advice and personal hints on how they have coped. You can also meet people at cancer support groups.
Some people find it easier to talk to someone they do not know. You can use our counselling service if you are finding it hard to cope with hair loss or other aspects of your cancer and its treatment.
Skincare
Some drugs can affect your skin and it may become dry or slightly discoloured. Chlorine in swimming pools can make this worse. Your skin may also be more sensitive to sunlight, during and after treatment.
Tell your cancer doctor or nurse if you develop any skin changes or rashes.
Helpful advice
- Avoid wet shaving – an electric razor is less likely to cause cuts.
- Use moisturising cream if your skin is dry or itchy but check with your nurse before using creams if you’re also having radiotherapy.
- If you are out in the sun wear a high factor suncream (at least SPF 30) on exposed areas
Drinking alcohol
For most people, having the occasional alcoholic drink should not affect your chemotherapy treatment, but it is best to check with your doctor or nurse first.
Breastfeeding
Breastfeeding during chemotherapy is not advised as the drugs could be passed on to a baby through breast milk. If you want to give your baby breast milk during chemotherapy, you may be able to express extra milk before treatment starts and freeze it. You may be able to express milk, which you cannot keep or use, throughout your chemotherapy so that you are still producing milk when chemotherapy finishes.
You may then be able to start breastfeeding after chemotherapy, but this will depend on whether you are having any other treatment that could interfere with breastfeeding.
Your cancer doctor and specialist nurse will advise you if this is possible and if so when it is safe to start. Having chemotherapy will not affect your ability to produce breast milk in the future.
Avoiding infections
Most chemotherapy drugs can affect your body’s resistance to infection. If the number of your white blood cells is low, you are more likely to get an infection.
Your resistance to infection is usually at its lowest 7 to 14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Helpful advice
- Keep clean and always wash your hands thoroughly after using the toilet and before preparing food
- Stay away from crowded places and from people who you know have an infection, such as a cold
- Make sure your food is thoroughly cooked, and ask your nurse if there are any foods you should avoid