Chemotherapy: what to expect and how to look after yourself

What it is

Chemotherapy is the name for medicines that attack cells that multiply quickly, such as cancer cells. It can be used before surgery, to shrink the tumor; after surgery, to lower the risk of it coming back; or as the main treatment, to control the disease. It is often combined with other medicines, such as immunotherapy or targeted therapy.

There is no single chemotherapy. Each type of tumor has its own regimens: combinations of medicines, doses and intervals that have been studied for that disease. Your oncologist will choose the best regimen for you based on the type and stage of the tumor, the goal of treatment and your overall health.

Each medicine also has its own side-effect profile. One may cause more nausea, another more tingling, another hair loss, and many don't cause some of these effects at all. That is why two people on chemotherapy can have very different experiences, and your care team's advice always outweighs any general rule, including the ones in this guide.

How it is given

• Into a vein, at a clinic or hospital, over anything from a few minutes to several hours. Some regimens continue at home, with a small infusion pump that you carry for a day or two.
• As tablets, taken at home at set times.
• Through a port: many patients have a port fully implanted under the skin of the chest. It protects the veins in the arm and makes each session simpler.

Premedications

Before chemotherapy, you usually receive a few supportive medicines, either into a vein or as tablets: the premedications. They don't treat the cancer. They are there to prevent side effects, and include anti-nausea medicines, steroids, antihistamines and, in some cases, IV fluids for hydration. This is why a session can take a little longer than the chemotherapy infusion itself. Sometimes the team also prescribes medicines to take at home over the following days. Stick to the schedule, even if you feel well.

How a cycle works

Chemotherapy is given in cycles: a period of treatment followed by a rest period so the body can recover. The main symptoms usually appear between days 2 and 7 after treatment and then gradually improve. With many regimens, the blood's defenses drop about one to two weeks after treatment and recover before the next cycle.

Before each cycle, you have blood tests. If your defenses or other values haven't recovered yet, treatment may be postponed by a few days or the dose adjusted. This is common and part of safe treatment.

The most common side effects, and what helps

• Fatigue. This is the most frequent effect. Gentle walks and adapted physical activity help more than lying down all the time. Respect the days when your body asks for rest.
• Nausea and vomiting. Today there are very effective medicines to prevent them. Take them on time, even if you feel fine. Small, frequent meals and cold or room-temperature foods are usually better tolerated.
• Mouth sores. Brush your teeth with a soft toothbrush and rinse your mouth as your team advises. Avoid mouthwashes that contain alcohol.
• Diarrhea or constipation. Drink plenty of fluids. Severe diarrhea, with several bowel movements a day, should be reported the same day.
• Tingling and sensitivity to cold. Some medicines used for gastrointestinal tumors, such as oxaliplatin, make the hands, feet and throat sensitive to cold for a few days. Avoid iced drinks and wear gloves to take things out of the fridge. Tingling that doesn't go away between cycles should be reported.
• Hair loss. This depends on the medicine: many regimens don't cause hair loss. Ask before you start, so you can prepare. See below for what a cooling cap can do.
• Skin and nails. A daily moisturizer and sunscreen make a difference, because the skin becomes more sensitive to the sun.

Cooling caps: can hair loss be prevented?

A cooling cap, or scalp cooling, chills the head during treatment. The cold makes the blood vessels in the scalp narrow, so less medicine reaches the hair roots. The cap is worn shortly before, during and for a while after each session.

• It works for many people, but not for everyone. In the two studies that led to its approval in the United States, carried out in women with breast cancer, about 50% to 66% kept more than half of their hair. Without the cap, almost no one did.
• The result depends on the medicine. It works best with taxanes, such as paclitaxel, which has the best results: close to 70% in a 2024 review of more than 2,000 patients. With anthracyclines, such as doxorubicin, the result is usually much more modest.
• Most people who use it are glad they did. In the same review, about 8 in 10 patients were satisfied.
• The downsides: cold, headache and a longer session. It rarely has to be stopped.
• Is it safe? Studies have not shown a higher risk of cancer appearing in the scalp. Even so, it is not recommended in some cases, such as leukemias and lymphomas.
• Tips that help: wash your hair less often, use a mild shampoo, and avoid hot hair dryers, flat irons and chemical treatments during treatment.

Not every center offers cooling caps, and coverage by health insurance varies. If hair loss worries you, talk to your team before your first session.

When to contact your team right away

Fever is an emergency during chemotherapy. If your temperature reaches 37.8 °C or higher, or the threshold your team gave you, seek care immediately, even if you feel well and even in the middle of the night. Don't take any medicine to bring the fever down before speaking to your team.

• Chills, shortness of breath or chest pain.
• Vomiting that stops you from eating or taking your medicines.
• Severe or bloody diarrhea.
• Bleeding or bruises that appear for no reason.
• Pain, redness or swelling around the port.
• Confusion, excessive drowsiness or severe weakness.

Everyday care

• Keep your hands clean and be careful in crowds, especially in the week when your defenses are lowest.
• Well-cooked, properly washed food. Avoid raw meat, undercooked eggs and food from questionable sources.
• Vaccines: talk to your team before getting any. Vaccines such as the flu shot are recommended, but some live-virus vaccines should be avoided during treatment.
• Medicines, teas and supplements: tell your team about everything you take, including natural products. Some of them interfere with chemotherapy.
• Pregnancy: use effective contraception during treatment, and ask how long to continue it afterwards.
• Emotional health: feeling fear, sadness or irritability is common. Talking about it with your team, your family or a psychologist is part of your care.

On treatment day

• Eat something light beforehand, unless your team tells you otherwise.
• Wear comfortable clothes, ideally with easy access to the chest if you have a port.
• Bring a book, headphones or someone you trust: some sessions are long.
• Bring the list of medicines you take and write down your questions.

One last piece of advice

Keep a note, in a notebook or on your phone, of how you feel each day: symptoms, temperature, what you ate, what helped. This diary helps the team adjust your treatment and prevent side effects in the following cycles. No question is too small to ask.

For information only. Your care team's advice about your specific treatment always takes priority.