Side Effects of Chemotherapy and Radiation

Chemotherapy and radiation can create difficult side effects. They may be severe or very mild, depending on the type and duration of treatment, as well as on individual body chemistry. According to the American Cancer Society, “Every person doesn’t get every side effect, and some people get few, if any.”

Once you know what to expect, you can begin conscientious self-care by stocking up on safe, non-toxic personal care products, adjusting your habits to accommodate the changes your body will experience, and above all, taking the time to truly nurture and express compassion for yourself.

Note: There are over 100 different chemotherapy drugs. We have listed some below that may be responsible for certain side effects, but be sure to ask your doctor or oncology nurse about specific side effects of your own treatment.

Protect Your Skin, Protect Your Health
No matter what type of compromised skin you may have, you’re more at risk from exposure to toxic chemicals. Since most personal care products and cosmetics contain potentially harmful ingredients, it’s important to always read labels and use only safe, nurturing formulas that will enhance the condition of your skin. Click here for a list of ingredients to avoid in your personal care products.

Bruising/Bleeding

• Increased bruising can occur as a result of medications that thin the blood
• Bruises may show up more easily in various locations over the body
• Even minor injuries create a bruise
• Small cuts can bleed more profusely than usual
• Read our post, Bruising and Bleeding: Be Careful During Chemotherapy

Drugs that cause it: adriamycin, Cytoxan, cisplatin, steroids, and any blood-thinning medication.

Chemo Brain

• Forgetfulness
• Difficulty multi-tasking or analyzing difficult data
• Difficulty concentrating and learning new skills
• Fatigue
• Short attention span
• Short-term memory problems
• Difficulty finding the right word
• Read our post, Chemo Over, but You’re Forgetting Things? You May Have “Chemo Brain”

Drugs that cause it: Radiation treatments (if near the brain), and potentially all chemotherapy drugs, though research is still unclear.

Dry Desquamation

• Dry, scaly, flaky skin
• Occurs on radiated skin
• May cause itching, peeling, and shedding

Drugs that cause it: Radiation treatments.

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Dry Eyes

• Excessive tearing
• Eyes feel overly dry, gritty, or itchy
• Sensitivity to light
• Difficulty wearing contact lenses
• Blurred vision
• Need to blink constantly
• Hard to open eyes after sleeping
• Wear sunglasses to protect your eyes from environmental factors and the wind
• Read our post, Side Effect: Dry Eyes-Simple Tips to Bring Back Some Comfort

Drugs that cause it: some medications like isotretinoin and tretinoin, cytarabine, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), and medications to reduce side effects.

Dry, Itchy Skin

• General itching
• Dry and flaky skin
• Bleeds easily if rubbed too hard or scratched
• Redness or rashes
• Peeling; feeling of tightness
• Thin or fragile skin
• Read our post, The Dangers (and Alternatives) to Petroleum Based Moisturizers
• · Read our post, Managing Compromised Skin-Steps to Reduce Dryness and Irritation
• · Read our post, Dry, Itchy Skin? You May be Sensitive to Gluten

Drugs that cause it: Most of them, as well as radiation treatments.

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Dry Lips

• Dry lip syndrome
• Cracked lips
• Often occurs simultaneously with dry mouth syndrome
• Read our post, Lip Care: How to Stay Nourished and Hydrated During Treatment

Drugs that cause it: fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), many others.

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Dry Mouth (Xerostomia)

• Occurs when the salivary glands don’t produce enough saliva
• Can be caused by radiation when salivary glands are exposed
• Dryness and elevated acidity in the mouth; may lead to tooth decay
• Thick or stringy saliva
• Change in your ability to speak clearly
• Drink plenty of water and avoid beverages that are dehydrating like caffeine
• Read our post, Side Effect: Dry Mouth-Get Some Welcome Relief with These Few Tips

Drugs that cause it: radiation (to exposed salivary glands); chemo drugs include Accutane, Acrylin, Ala-cort, Alkeran, Amifostine, Arimidex, Azacitadine, Kidrolase, Lanacort, Lapnitib, Lenalidomide, Leustatin, Mercaptopurin, Mylocel, Octreotide, Oxaliplatin, Proleukin, Retinoic Acid, Streptoizocin, Toxal, Thioguanine, Vectibix, Xeloda, Zanosar, Zevalin, Zolina Zorneta.

Erythema

• Reddening of the skin, usually in patches
• Caused by dilation in the blood capillaries
• Can occur as a result of exposure to the sun in combination with medications
• May be accompanied by fever and fatigue
• May occur around the radiation treatment site after 5-10 treatments
• Can be itchy, irritating, and/or painful
• A sign of inflammation or infection
• Also acral erythema, which is known as hand-foot syndrome (see below)
• Read our post, What You Can Expect from Radiation Treatments

Drugs that cause it: Radiation treatments, possibly chemotherapy drugs that create photosensitivity.

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Flushed Skin

• Temporary redness of the skin
• May feel hot or burning
• Usually occurs on the face and neck

Drugs that cause it: asparaginase, bleomycin, carboplatin, carmustine, cisplatin, cyclophosphamide, dacarbazine, diethylstilbestrol, docetaxel, doxorubicin, fluorouracil, inerleukin-2, lomustine, paclitaxel, plicamycin, procarbazine, teniposide; can also occur as an allergic reaction to a medication.

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Folliculitis

• Red, bumpy welts that form on the scalp
• Welts can be irritating and painful
• An infection and inflammation of the hair follicles
• Welts may form pus-filled lesions that look like pimples
• Somewhat resembles acne
• Caused by bacteria, fungal, and viral infections
• Read our post, Chemo Side Effect: Red, Painful Welts On My Scalp-What Can I Do?

Drugs that cause it: Actinomycin D, epidermal growth factor receptor inhibitors like gefitinib and cetuximab.

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Hand and Foot Syndrome (Palmar Plantar Erythrodysesthesia or PPE)

• Hands and feet become red, inflamed and irritated
• Caused by chemo medications leaking out of small blood vessels in the palms of the hands and soles of the feet
• Cracking and peeling may occur
• Excessive dryness of the skin
• Hands feel numb, lose feeling in the fingertips
• Tingling sensations
• Also known as acral erythema-painful redness on the palms
• Read our post, Dealing with Side Effects Like Hand and Foot Syndrome? These Natural Remedies May Help

Drugs that cause it: Can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer; examples include bleomycin (Blenoxane), capecitabine (Xeloda®), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), continuous-infusion doxorubicin, docetaxel (Taxotere), epirubicin (Ellence), etoposide (VePesid, VP-16, Etophophos), 5-Flurouracil (5FU), idarubicin (Idamycin), high-dose Interleukin-2, irinotecan (Camptosar), mitoxantrone (Novantrone, DHAD, DHAP), oxaliplatin, paciltaxel (Taxol), plicamycin (Mithracin), procarbazine (Matulane), topotecan (Hycamtin), valrubcin (Valstar), vinblastine (Velban), vincristine (Oncovin), vinorelbine (Navelbine).

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• Rescue + Relief Spray: water lily helps cool skin, while valerian and comfrey provide anti-inflammatory benefits. BUY NOW!
• Body Repair Lotion: deeply hydrating body lotion replenishes and soothes dry, inflamed skin. BUY NOW!
• Restorative Skin Balm: Tri-Rescue Complex provides calming benefits to the skin, while vitamin E aids in wound healing. BUY NOW!

Hair Loss or Thinning (Alopecia)

• Hair loss may include scalp, facial, eyelashes, eyebrows and body hair
• Radiation may cause loss of hair at the treatment site
• Some people experience hair loss, others don’t-it depends on the drugs and dosages used
• Usually begins within 2 weeks of starting chemo and may worsen 1-2 months after the start of therapy
• Hair often comes out in clumps rather than in an even pattern
• May be addressed with wigs, scarves, or hats, though many find going bald to be more comfortable
• Read our post, I Hate My Hair! Tips on Post-Cancer-Treatment Care
• Read our post, Perming or Coloring Hair: Safe During Chemotherapy?
• Read our post, Where to Buy Your Wig? Tips on Choosing a Savvy Salon
• Read our post, Treatments are Over, and My Hair’s Coming Back Curly. Will it Stay this Way?
• Read our post, The Beauty in Scarves: Getting Your Hair Loss Under Wraps

Drugs that cause it: All chemotherapy drugs have the potential to cause at least some hair loss; drugs known to cause the most extensive include cytoxan, taxol, taxotere, and adriamycin; also the regimens AC (Adriamycin and Cytoxan) and ACT (Adriamycin, Cytoxan, and Taxol).

Hyperpigmentation, Sallow Skin

• Blotchy skin
• Hyperpigmentation (darkening of the skin, overall or only in places)
• Sallow skin-may appear ashy and dull (due to low white-blood-cell count)
• Can occur particularly in areas of pressure, such as underneath tape or dressings
• Some chemo drugs (fluorouracil, vinorelbine) given intravenously can cause darkening of the venous pathways up the arm
• Usually occurs within 2-3 weeks after starting treatment; typically goes away within 10-12 weeks after stopping
• Read our post, You’re a Survivor…Chemotherapy Left You with Dark Spots and Skin Discoloration-What to Do?

Drugs that cause it: bleomycin, busulfan, cyclophosphamide, cisplatin, docetaxel, etoposide, hydroxyurea (Hydrea), ifosfamide, methotrexate (MTX), prednisone (Apo-Prednisone, Orasone, Deltasone, Predisone), thiotepa

Immune System Compromised (anemia, low blood platelet count [neutropenia], higher risk of infection)

• White-blood-cell count can decrease, hampering the immune system and lowering the body’s ability to fight off infection
• Infections can be serious for cancer patients; different germs, bacteria and viruses may all be factors
• Fever of 100.5? is often the first sign
• Other signs include fatigue, sore throat, shortness of breath, redness, pain, swelling, or a sore/wound that doesn’t heal
• Avoid large crowds of people who are sick and do not share drinks, foods or personal items to avoid spreading bacteria
• Read our post, How to Keep your Personal Care Products Bacteria-Free
• Read our post, Can a Trip to the Spa Can Help Build the Immune System?
• Read our post, Going Through Chemotherapy? Protect Yourself During Low-Blood-Count Days
• Read our post, What is the Drug Neulasta? What Does it Do? Will it Make My Hair Fall Out?

Drugs that cause it: 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin), CCNU (Lomustine), cis-platinum (Platinol), fludarabine(Fludara), hydroxyurea (Hydrea), irinotecan (CPT-11), methotrexate (MTX), semustine (Methyl-CCNU), topotecan (Hycamtin), vinblastine (Velban).

Injection Site Reactions

• Irritation or local allergic reaction
• Can be minor or major
• Minor reaction causes redness, itching, tenderness, and perhaps swelling-usually the result of an allergic reaction to the injection
• Major reaction starts out like a minor one, then becomes blistered and painful-may cause skin damage if not treated-and is the result of chemo medicine leaking from the blood vessel to the area under the skin
• Usually occurs 6-12 hours after treatment
• Severity of reaction depends on drugs used, dosage, and how quickly the problem is treated
• Read our post, Chemotherapy Injection Site Reactions-When to Seek Help

Drugs that cause it: bleomycin, carboplatin, doxorubicin, etoposide, mitomycin, vinblastine, and others.

Moist Desquamation

• Reddened, weeping skin
• Warm and tight to the touch
• Skin looks shiny with clear/cloudy fluid
• Some crust or scales
• Usually occurs on radiated skin
• Read our post, Oucchhh! Products to Help Cool and Soothe Painful Radiation Burns

Drugs that cause it: Radiation treatments.

Mouth Fissures or Ulcerations (Oral Mucositis or Stomatitus)

• Particularly common with patients who have head and neck cancers
• Fissures may appear at the corner of the mouth
• Ulcers (painful swellings with white centers) may appear anywhere inside the mouth, including gums
• Pain can make it difficult to eat, chew, and swallow
• Read our post, Suffering from Mouth Fissures or Canker Sores? Try Some of Our Natural Remedies

Drugs that cause it: bevacizumab (Avastin), busulfan (Myleran), bleomycin, bortezomib (Velcade), busulfan (Myleran), capecitabine (Xeloda), carboplatin (Paraplatin), cetuximab (ERBITUX), chlorambucil (Leukeran), cyclophosphamid, cytarabine, daunorubicin, doxorubicin (Adriamycin), erlotinib (TARCEVA), etoposide (Etopophos, VePesid), fluorouracil (Adrucil), geftinib (IRESSA), idarubicin, ifosfamide, imatinib (Gleevac), melphalan (L-PAM; Alkeran; L-Sarcolysin), mechlorethamine (Nitgrogen Mustard), methotrexate, oxaliplatin (Eloxatin), paclitaxel (Taxol), panitumumab (Vectibix), sunitinib (Sutent), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex), vinblastine (Velban).

Nail Changes

• Skin on fingertips may split open
• Nails can become brittle, darken in appearance, become black, or fall off
• Nails can form horizontal depressions on the nail bed or white, horizontal discolorations; stripes
• In severe cases, may disrupt daily activities
• Read our post, Have Your Nails Become Brittle and Weak? All They Need is a Little Attention

Drugs that cause it: bleomycin, busulfan (Myleran), carboplatin (Paraplatin), chlorambucil (Leukeran), cisplatin (Platinol), cyclophosphamide (Cytoxan), daunorubicin, decarbazine (DTIC), doxorubicin, fluorouracil, ifosfamide (Ifex; Isophosphamide), mechlorethamine (Nitgrogen Mustard), melphalan (L-PAM; Alkeran; L-Sarcolysin), methyl CCNU (Semustine), oxaliplatin (Eloxatin), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex).

Nausea/Vomiting

• Upset stomach
• Feeling queasy, sick to your stomach
• Throwing up, retching
• Dry heaves
• Read our post, Chemo Side Effect: Nausea & Vomiting-We Have Natural Solutions
• Read our post, Nausea, Vomiting, Mouth Sores or Radiation Dermatitis? Homeopathy May Help

Drugs that cause it: altretamine (Hexalen), dacarbazine, doxorubicin (Adriamycin), epirubicin (Ellence), cyclophosphamide (Cytoxan), mechlorethamine (Mustargen), procarbazine (Matulane), streptozocin (Zanosar), carmustine (Bicnu), cisplatin, carboplatin, oxaliplatin, cyclophosphamide (Cytoxan).

Neuropathy

• Nerve damage, typically to the “peripheral” nerves outside the central nervous system
• Most often effects fingers and toes, though can move up the hands and feet
• More rarely affects the bowels, face, back, and chest
• Feeling of pins and needles
• Numbness, typically in hands and/or feet
• Loss of sensation to touch
• Weakness and cramping in hands and/or feet
• Difficulty buttoning clothes, opening jars, picking things up
• Burning in the hands and/or feet
• Read our post, Chemo Side Effect: Neuropathy-Some Tips to Help
• Read our post, Chemotherapy: Lingering Side Effects on the Hands
• Read our post, Chemotherapy and Sore Feet: Some Tips That May Help

Drugs that cause it: vinca alkaloids (vincristine), cisplatin, carboplatin, paclitaxel, docetaxel, metronidazole, procarbazine, cytarabine, and the podophyllotoxins (etoposide and tenoposide).

Photosensitivity

• Enhanced skin response to sunlight
• Redness, swelling, blistering, peeling
• Itchy rashes
• Exaggerated sunburn
• Read our post, Photosensitivity: How Can We Protect Ourselves During Chemotherapy?

Drugs that cause it: capecitabine (Xeloda), cladribine (Leustatin), clofarabine (Clolar), cytarabine(ara-C, cytosar-U), floxuridine (FUDR), fludarabine(Fludara, 2-fluora-ara-AMP), fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), gemcitabine (Gemzar), hydroxyurea (Hydrea), mercaptopurine (6-MP, Purinethol), methotrexate (Amethopterin, Folex, Folex PFS, Mexate, Mexate-AQ, MTX, Abitrexate, Rheumatrex), nelarabine (Arranon), pemetrexed (Alimta), pentostatin (Nipent), thioguanine (6-TG, 6-Thioguanine, Tabloid), vinblastine (Velban).

Radiation Burns

• Damage to the skin caused by exposure to radiation
• Skin is red, raw
• Burns, feels hot
• Skin starts to slough off, and may turn black
• Can be very painful
• Blisters may form, or open sores on the area of treatment
• Sores can be oozing at times
• May feel too irritated or raw to touch
• Shooting pain from the inside
• Read our post, What You Can Expect from Radiation Treatments
• Read our post, Oucchhh! Products to Help Soothe and Calm Radiation Burns
• Read our post, Yummy Indian Food…Did You Know It Can Reduce Skin Damage from Radiation?

Drugs that cause it: Radiation treatments.

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Radiation Dermatitis

• Inflammation of the skin in response to radiation treatments
• Red, itchy, peeling
• In extreme cases, blistered skin
• Tender, fragile skin
• May look similar to a light case of sunburn

Drugs that cause it: Radiation treatments.

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• Rescue + Relief Spray: water lily helps cool skin, while valerian and comfrey provide anti-inflammatory benefits. BUY NOW!
• Body Repair Lotion: deeply hydrating body lotion replenishes and soothes dry, inflamed skin. BUY NOW!
• Restorative Skin Balm: Tri-Rescue Complex provides calming benefits to the skin, while vitamin E aids in wound healing. BUY NOW!

Radiation Recall Dermatitis

• Inflammation of the skin at the treatment site triggered by chemotherapy
• May also occur years after treatment is over
• Thought to occur when skin cells are damaged by chemotherapy drugs

Drugs that may cause it: gemcitabine, methotrexate, docetaxel, etoposide, doxorubicin, (in the location of the prior radiation treatment).

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• Rescue + Relief Spray: combination of valerian and comfrey soothe skin while reducing inflammation. BUY NOW!
• Body Repair Lotion: deeply hydrating body lotion replenishes and soothes dry, inflamed skin. BUY NOW!
• Restorative Skin Balm: Tri-Rescue Complex provides calming benefits to the skin, while vitamin E aids in wound healing. BUY NOW!

Rash (Tarceva Rash, acne-like rash, macular and papular, or hives)

• Some common chemotherapy drugs can cause a myriad of different types of rashes on the skin:
  • An acne-like rash looks like acne, but is instead a reaction to treatment, where the drugs increase the activity of oil glands in the skin; skin can form pimples that are papular and pus-filled
  • A macular rash looks like small, flat red spots and can appear anywhere on the body
  • A papular rash looks like small, raised solid bumps
  • A macularpapular rash is the most common type of drug-induced skin rash, and looks like a combination of the two
  • A Tarceva rash is a skin reaction to the medication Tarceva
  • Hives are raised, itchy, red blotches that usually occur within a day or two of drug exposure
  • Avoid harsh acne medications as they can burn or damage sensitive skin
  • Do not squeeze the pimples-you may spread bacteria
  • Speak to your dermatologist regarding options
  • These rashes typically occur within the first few weeks of treatment, and usually develop in the face, neck, chest, back, and scalp
  • Can be like a sunburn-red and hot/flushing-or appear as itchy, dry skin that flakes
  • May result in sore, tender, irritated skin
• Read our post, Tarceva Drug Side Effect: This Rash is Driving Me Nuts-Help!

Drugs that cause it: steroids (prednisone, dexamethasone or decadron), Cetuximab (Erbitux), aminoglutethimide (Cytrdren, Elitpen), bevacizuman (Avastin), bleomycin Blenoxane), bortezomib (Velcade), cetuximab (ERBITUX), cisplatin (rare-Platinol, Platinol-AQ), cytarabine (Ara-C), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), docetaxel, epirubicin (Ellence), erlotinib (TARCEVA), erbitux, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), geftinib (IRESSA), idarubicin (Idamycin),  imatinib (Gleevac), L-Asparaginase, methotrexate (Folex, Folex PFS, Mexate, Mexate-AQ, Abitrexate, Rheumatrex), mitoxantrone (Novantrone, DHAD, DHAQ), paclitaxel, panitumumab (Vectibix), plicamycin (Mithracin), sorafenib (Nexavar), sunitinib (Sutent), tamoxifen (Nolvadex, taxomifen citrate), valrubcin (Valstar), 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin)

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Scarring or Scar Tissue (from radiation or surgery)

• Scar tissue remains on damaged tissue after it heals
• The amount of scar tissue depends on the size, depth, and location of the wound
• Surgery can leave scars at the incision points
• Chemotherapy and radiation can leave scars in the skin from wounds, burns, and acne and/or skin rashes
• Radiation can also leave hardened, stiff tissue known as radiation fibrosis
• Read our post, Surgery and Treatments Are Over…How Do I Take Care of My Scars?

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• Restorative Skin Balm: provides deep penetrating, nourishing moisture on scar tissue and stiffened, hardened skin. BUY NOW!

Taste Loss (Dysguesia)

• Sometimes described as “metal mouth”
• Bitter taste, or loss of taste
• Decreased ability to taste sweet foods; lower tolerance for bitter foods
• Can interfere with you getting the nutrition you need
• Starts a week or two after the beginning of treatment
• It’s estimated that about 50% of patients getting chemotherapy experience taste changes

Drugs that cause it: bleomycin (occasionally), cyclophosphamide (Cytoxan, Neosar, Endoxan), paclitaxel (Taxol, Abraxane), rituxin (Rituximap), sunitinib (Sutent), vincristine (Oncovin, Vincasar PFS, leurocristine).

Thin, Fragile, Paper-Like Skin

• Skin feels thin and fragile
• Fatty layers decrease, while collagen production is interrupted
• Skin seems to have lost its thickness
• Skin is more susceptible to bruises and tears
• Blood vessels under the skin are more visible
• Fine lines and wrinkles seem pronounced

Drugs that cause it: Most all the drugs that cause dry skin can cause thin skin.

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For more information on chemotherapy and radiation side effects, check any of the resources below.

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