| Anemia |
- Low red blood cell (RBC) production in the bone marrow
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- Provide rest between activities.
- Encourage proper nutrition, for example foods high in protein and iron.
- Erythropoietin-stimulating agents (ESAs) foster production of RBCs, but may increase risk for thromboembolism (Shapiro, 2021).
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| Appetite changes |
- Mouth and throat sores
- Change in sense of taste or smell
- Nausea and vomiting
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- Ensure adequate hydration.
- Encourage a healthy, high-nutrient diet.
- Promote exercise.
- Treat oropharyngeal sores.
- Provide adequate mouth care.
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| Bleeding and bruising |
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- Avoid aspirin or ibuprofen.
- Instruct patient to brush teeth gently with a soft toothbrush.
- Avoid use of razors; use electric shaver.
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| Constipation |
- Chemo and medications such as opioids
- Changes in diet
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- Encourage high fiber foods.
- Increase fluid intake.
- Increase activity.
- Administer stool softeners and/or laxatives as needed.
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| Dehydration |
- Appetite changes
- Nausea and vomiting
- Diarrhea
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- Increase fluid intake.
- Intravenous (IV) fluids may be needed.
- See measures to manage nausea, vomiting, and diarrhea below.
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| Diarrhea |
- Chemo affects the smooth muscles in the GI tract (NCI, 2015)
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- Dietary modifications such as the BRAT diet; avoidance of milk, alcohol, and caffeine; avoidance of fatty, spicy and high fiber foods; eating smaller meals more frequently.
- Antidiarrheal medication.
- Increase fluid intake (8-12 cups per day).
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| Edema |
- Fluid build-up in the tissues due to chemotherapy or heart, liver, or kidney failure
- Poor nutrition or blockage of veins or the lymph system
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- Avoid tight clothing and shoes; avoid crossing legs when sitting; compression stockings and sleeves may be needed.
- Promote exercise.
- Limit salt intake.
- Consider diuretics for severe swelling.
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| Fatigue |
- Chemo-induced anemia and/or vasomotor symptoms that result in sleep difficulties and depression
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- Typically resolves when chemo is discontinued
- Assess patient for causative factors such as anemia, pain, depression, hypoxia or fluid and electrolyte imbalances.
- Provide rest between activities.
- Discuss proper nutrition and encourage foods high in protein and iron.
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| Flu-like symptoms |
- Some types of chemo can cause flu-like symptoms within a few hours after treatment and may last for 2 to 3 days.
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- Encourage hydration for diarrhea and foods high in calories and protein for appetite loss.
- Medicate for chills or body aches.
- Contact provider before administering medication to lower a fever.
- See treatment below for nausea and vomiting.
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| Hair loss |
- Some types of chemo cause hair to fall out
- Hair thinning may begin after the second or third cycle of treatment
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- Treat hair gently: use a soft brush; avoid hair dryers, irons, gels, clips; use a mild shampoo and wash less frequently.
- Protect the scalp with sunscreen or a hat when outside.
- Reassure the patient that hair often grows back in 2 to 3 months after treatment has ended.
- Suggest head wraps, hats, or wigs.
- Scalp cooling devices used before, during and after treatment may reduce or prevent hair loss by restricting blood flow to the scalp and activity of hair follicles (ACS, 2019).
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| Hepatotoxicity (Shapiro, 2021) |
- Elevated bilirubin, alkaline phosphatase (ALK), aspartate transaminase (AST), and alanine transaminase (ALT) levels may result from chemotherapy.
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- Usually mild
- Treatment may not be needed, instead adjust dose.
- If severe, discontinue treatment.
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| Infection |
- Chemo may decrease white blood cell production leading to neutropenia which increases risk of infection (Shapiro, 2021).
- Neutropenia may occur 10 to 14 days after each cycle and typically resolves prior to the next chemo treatment.
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- Monitor for signs of infection (fever, cough, sore throat, pain, rash, sores on mouth or tongue, swelling, redness).
- Encourage good hand hygiene.
- Avoid crowds, people who are sick and people that have recently received a live vaccine.
- Encourage patients to use a mask when out in public.
- Follow food safety guidelines.
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| Memory or concentration changes |
- Exact cause is unknown.
- Symptoms include forgetfulness; difficulty concentrating; memory issues; trouble multi-tasking or remembering common words.
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- Exercise the brain with puzzles; encourage a class to learn something new.
- Advise patient to get adequate rest and sleep.
- Encourage physical activity.
- Teach patient to follow a daily routine.
- Encourage use of planners or smart phone applications to set reminders and stay organized.
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| Mouth and throat problems |
- Chemo may cause a chemical or metallic taste, a change in taste or smell, dry mouth, infections, mouth sores, pain/swelling, sensitivity to hot or cold, dysphagia, cavities, and mucositis (inflammation of the oral mucosa).
- Low platelet count may cause bleeding in the mouth.
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- Tell patient to have a dental check-up and cleaning before treatment begins.
- Promote good oral hygiene.
- Swishing ice chips around mouth for 30 minutes may alleviate inflammation and sores (Shapiro, 2021).
- Topical diphenhydramine, oral antacids and lidocaine may soothe symptoms (Shapiro, 2021).
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| Myalgias (muscle pain); arthralgias (joint pain) |
- Muscle and joint pain are associated with certain chemo drugs such as biologic therapies and growth factors.
- Blood infections can cause muscle aches and fever.
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- Typically resolve when treatment is stopped.
- Medications that may alleviate symptoms (Shapiro, 2021):
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Gabapentin
- Glutamine
- Antihistamines
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| Nausea and vomiting |
- Symptoms vary from mild, moderate, or severe depending on the regimen.
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- Administer antiemetics/anti-nausea medications as prescribed.
- Tell patient to suck on ice, popsicles, or hard candy during chemo treatment.
- Teach patient to increase fluid intake but avoid drinking with meals, and to avoid greasy, fried, sweet or spicy food.
- Have patient sit up for 2 hours after eating.
- Instruct patient to avoid strong odors, caffeine, and smoking during chemotherapy.
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| Peripheral neuropathy |
- Chemotherapy-induced peripheral neuropathy (CIPN) may cause nerve damage resulting in motor and sensory symptoms such as pain, numbness, weakness, burning, tingling, or unusual sensation in arms and legs (Shapiro, 2021).
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- Symptoms usually resolve after treatment is discontinued.
- Duloxetine may be effective to treat chemotherapy-induced neuropathy (Shapiro, 2021).
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| Pulmonary toxicity |
- Some medications may cause pneumonitis which leads to dyspnea, cough, malaise, or fever.
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- Most symptoms resolve after treatment is discontinued.
- Oxygen therapy may be needed.
- Glucocorticoids may be used in severe cases (Shapiro, 2021).
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| Sexual health and fertility issues in men |
- Chemo may lower testosterone levels and libido.
- Traces of chemo may be found in semen after treatment.
- Chemo can damage sperm in men and germ cells in boys.
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- Discuss medications and procedures available to treat erectile dysfunction.
- Advise patients to use condoms to prevent partner exposure to chemo in semen.
- Refer to support groups or counseling.
- Discuss fertility preservation options (sperm banking).
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| Sexual health and fertility issues in women |
- Chemo may lower estrogen levels and affect ovarian function causing hot flashes, irregular or no periods, and vaginal dryness that can cause painful intercourse.
- Chemo may affect vaginal tissue and cause sores.
- Chemo can stop ovaries from releasing eggs and estrogen or lower the number of eggs in the ovaries.
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- Discuss medications to decrease pain during intercourse (i.e, vaginal gels, creams, lubricants).
- Teach patient to perform Kegel pelvic muscle exercises.
- Advise patients to use condoms to prevent partner exposure to chemo in vaginal fluids.
- Refer to support groups or counseling.
- Non-estrogen treatments: gabapentin, selective serotonin reuptake inhibitors (SSRI) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) (Shapiro, 2021).
- Discuss fertility preservation options (egg or embryo cryopreservation).
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| Skin and nail changes |
- Due to chemo; very common
- The cause is unknown but there may be a toxic or allergic basis.
- The severity and duration of allergic skin reactions may be independent of dose and may persist after the drug has been discontinued.
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- For dry, itchy, red skin, tell patient to:
- Use mild soap, lotions, and creams.
- Avoid products with alcohol or perfume.
- Apply lotion after bathing.
- Avoid hot water.
- Keep home cool and humid.
- For rash, instruct patient to seek medical attention immediately to rule out an allergic reaction.
- Administer anti-itch medications as needed.
- Tell patient to always use sunscreen when outdoors due to increased susceptibility to sunburn.
- For discolored, cracked, brittle nails, teach patient to keep nails clean and trimmed, and wear protective gloves for gardening and house cleaning.
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| Urinary and bladder problems |
- Chemo may affect or damage the bladder and kidneys.
- Chemo can cause a change in the color or smell of urine.
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- Monitor for signs of urinary tract infection: pain, burning on urination, red or cloudy urine, fever, back or abdominal pain, inability to urinate.
- Encourage patient to drink a minimum of 8 cups of fluid each day and avoid caffeine, alcohol, and tobacco.
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| Weight gain |
- Chemo may induce hormonal changes and alter adipose tissue causing insulin resistance (Shapiro, 2021).
- Chemo-related edema may increase weight.
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- Encourage a proper diet and physical activity.
- Teach patient to avoid salt intake and high-calorie foods.
- Refer to a nutritionist, as indicated.
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Weight loss
(ACS, 2019) |
- Poor appetite
- Mouth sores, bleeding
- Dysphagia
- Change in sense of taste, smell
- Diarrhea
- Vomiting
- Dehydration
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- Encourage high-calorie and high-protein foods including snacks.
- Recommend liquid food supplements.
- Ensure adequate hydration.
- Administer antiemetics and antidiarrheals as needed.
- Refer to a nutritionist, as indicated.
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