Chemotherapy Side effect: Normal Vs Urgent|IDCC

This guide explains:

• What’s common and expected

• What you can do at home

• What symptoms need urgent medical attention

Important: Different chemo medicines have different side effects. Always follow your oncologist’s instructions and your prescription plan. Do not self-medicate with antibiotics, steroids, or herbal products without medical advice.

1) Why side effects happen

Chemotherapy medicines circulate in the bloodstream and can affect:

• Bone marrow → low WBC (infection risk), low Hb (anemia), low platelets (bleeding risk)

• Gastrointestinal lining → nausea, vomiting, diarrhea, mouth sores

• Hair follicles → hair loss

• Nerves → tingling/numbness (neuropathy) with certain drugs

• Kidneys/liver/heart → specific monitoring for specific medicines

Side effects can start:

• Within hours–days (nausea, allergic reactions)

• After 7–14 days (low blood counts, mouth sores)

• After multiple cycles (fatigue, neuropathy)

2) A simple rule: “Expected vs Emergency”

Common and expected (usually manageable)

• Mild nausea or reduced appetite

• Tiredness/fatigue

• Mild constipation or mild loose stools

• Mild mouth soreness

• Hair fall (depends on regimen)

• Body aches for 1–2 days after growth factor injections (if given)

Potentially dangerous (needs urgent evaluation)

• Fever or signs of infection

• Breathing difficulty or chest pain

• Uncontrolled vomiting/diarrhea leading to dehydration

• Bleeding, black stools, blood in urine, large bruises

• Confusion, severe weakness, fainting

• Severe allergic reaction during/soon after infusion

• Pain/redness/swelling at IV/chemo injection site (possible extravasation)

Keep reading for exact “red flags” and what to do.

3) Fever and infection: the #1 emergency during chemotherapy

Chemotherapy can reduce white blood cells (neutropenia). Even a small infection can become serious quickly.

What is “fever” during chemo?

Treat as urgent if you have:

• Temperature ≥ 100.4°F (38.0°C) even once, OR

• Chills/rigors, feeling very unwell, or suspected infection even without high temperature

What to do

• Call your oncology team immediately or go to the nearest emergency facility.

• Do not take leftover antibiotics or “fever medicines” and wait.

• Avoid delaying evaluation—early treatment saves lives.

Possible warning signs of infection

• Burning urination

• Cough with breathlessness

• Throat pain with high fever

• Skin boils, redness, pus

• Loose stools with fever

4) Nausea and vomiting: what’s normal, what’s not

Many patients worry about vomiting, but modern anti-nausea medicines are effective when taken correctly.

What’s common

• Mild nausea for 1–3 days after chemo

• Occasional vomiting that improves with prescribed medicines

• Taste changes

Home measures

• Take anti-nausea medicines exactly as prescribed, even if you feel okay

• Small frequent meals; avoid oily/spicy foods on chemo days

• Sip fluids frequently; oral rehydration solutions can help

• Ginger/lemon can help some patients (only as supportive, not as a replacement)

Urgent red flags

Seek urgent care if:

• You vomit more than 3–4 times in 24 hours

• You cannot keep liquids down

• You have dizziness, very low urine, or fainting (dehydration)

• Vomit looks like coffee-grounds or contains blood

• Severe abdominal pain or distension occurs

5) Diarrhea or constipation: how to manage safely

Diarrhea (loose stools)

Common: 1–3 loose stools/day without fever and with good hydration.

Home care

• Increase fluids: water, ORS, soups

• Eat bland food: curd, rice, khichdi, banana, toast

• Avoid raw salads, street food, very spicy/oily foods during chemo days

• Use medicines only if prescribed

Urgent red flags

• ≥ 4–6 watery stools/day

• Diarrhea with fever

• Blood/mucus in stool

• Severe abdominal pain

• Signs of dehydration (dizziness, low urine)

Constipation

Often caused by chemo, anti-nausea drugs, pain medicines, low activity.

Home care

• Warm fluids, fiber as tolerated, fruits (papaya), light walking

• Use stool softeners/laxatives only as advised

Urgent red flags

• No stool/gas for 2–3 days with pain/vomiting

• Severe abdominal swelling or cramping

6) Mouth sores (mucositis): common but needs early care

What’s common

• Mild mouth pain, ulcers, burning sensation

• Throat discomfort and difficulty swallowing

Prevention and home care

• Soft toothbrush; gentle brushing

• Regular mouth rinses (as advised)

• Avoid tobacco, alcohol, spicy/acidic foods

• Choose soft foods: curd, dal, soups, smoothies

Urgent red flags

• You cannot swallow liquids

• Severe pain preventing food intake

• Bleeding ulcers or high fever

• White patches with burning (possible fungal infection—needs treatment)

7) Fatigue: very common, usually improves

Chemo fatigue can feel different from normal tiredness.

What’s common

• Low energy for several days after chemo

• Need for more sleep

• Reduced stamina

What helps

• Light activity (short walks)

• Balanced nutrition and hydration

• Good sleep routine

• Discuss anemia, thyroid issues, or depression if fatigue is severe

Urgent red flags

• Breathlessness at rest

• Palpitations, chest pain

• Fainting or severe weakness

• New confusion

8) Low blood counts: what patients should know

A) Low WBC (neutropenia)

• Main risk: infection

• Emergency sign: fever

B) Low hemoglobin (anemia)

Symptoms: breathlessness on exertion, dizziness, palpitations, extreme fatigue.

C) Low platelets (thrombocytopenia)

Symptoms: easy bruising, nosebleeds, gum bleeding, tiny red spots on skin.

Urgent red flags

• Nosebleed that won’t stop

• Vomiting blood, black stools, blood in urine

• Heavy menstrual bleeding

• Severe headache or vision changes (rare but serious)

Your doctor may advise blood tests on specific days; follow those instructions strictly.

9) Hair fall: common, temporary (in many regimens)

Hair loss depends on the drug. It often begins 2–3 weeks after the first cycle.

Practical tips

• Use mild shampoo; avoid harsh chemicals and heat styling

• Consider short haircut before it starts (many patients find it easier emotionally)

• Scarves/caps/wigs are personal choices

• Hair usually regrows after treatment ends (texture may change initially)

10) Neuropathy (tingling/numbness): do not ignore

Some chemo drugs cause nerve irritation.

Symptoms

• Tingling, numbness, burning in hands/feet

• Difficulty buttoning clothes, imbalance

• Sensitivity to cold (with certain medicines)

When to report urgently

• Sudden worsening

• Weakness, falls

• Severe pain affecting daily activities

Early reporting allows dose adjustments to prevent long-term damage.

11) Allergic reactions during infusion: uncommon but urgent

Most reactions happen during or soon after infusion.

Warning signs

• Itching, rash, hives

• Breathlessness, wheeze

• Swelling of lips/face

• Chest tightness, dizziness

Tell the nurse immediately if any of these occur during infusion. Do not try to “tolerate it.”

12) Chemo leak into the skin (extravasation): a true emergency

If chemo medicine leaks outside the vein, it can damage tissues.

Warning signs at the injection site

• Burning pain during infusion

• Swelling, redness, blistering

Inform staff immediately. Early management prevents complications.

13) Practical home safety checklist (chemo days and beyond)

Food and infection safety

• Prefer freshly cooked home food

• Avoid street food and raw/unwashed fruits/vegetables

• Hand hygiene for patient and family

• Avoid close contact with sick people

Medicine safety

• Take anti-nausea and supportive medicines exactly as prescribed

• Do not start antibiotics, steroids, painkillers, or herbal products without advice

• Keep a list of all medicines and allergies

Monitoring

• Record temperature if you feel unwell

• Track bowel movements, oral intake, and urine output

• Maintain weight (weekly)

14) “Urgent care” list (save this)

Go to emergency / call your oncology team immediately if you have:

1. Fever ≥ 100.4°F (38°C), chills, or suspected infection

2. Breathing difficulty, chest pain, or severe cough

3. Uncontrolled vomiting or inability to drink

4. Severe diarrhea (≥ 4–6/day), diarrhea with fever, or blood in stool

5. Bleeding (nose/gums), black stools, blood in urine, large bruises

6. Severe weakness, fainting, confusion, severe headache

7. Severe mouth/throat pain preventing drinking

8. Pain/swelling/redness at IV site during/after infusion

9. New severe allergy symptoms (rash, swelling, wheeze)

15) Frequently asked questions

Can I take paracetamol for fever?

Do not self-treat fever during chemotherapy. Fever may signal neutropenia and needs urgent evaluation. Take fever medicine only after speaking to your oncology team.

Should I stop chemo if I have side effects?

Most side effects are manageable. Do not stop or delay cycles on your own. Report symptoms early—your team can adjust supportive medicines or doses if needed.

Can I travel during chemo?

It depends on blood counts, infection risk, and the schedule. Ask your oncologist before planning travel.

Need help or a second opinion?

If you are unsure whether your symptom is normal or urgent, it is safer to contact your oncology team.