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Managing Chemotherapy Side Effects (Nausea, Fatigue, Mouth Sores)

What is chemotherapy?

Chemotherapy is used to treat cancers. It is used either alone or in combination with other drugs. The aim of this treatment is to destroy the cancer cells. Chemotherapies work by killing cells that divide rapidly, be it cancer cells or healthy cells.

Chemotherapy that damage cells at the hair roots or follicles, leads to hair loss. Whereas, damage to healthy blood cells lead to low red blood cells (anemia), fatigue and infections. Damage to cells that line the mucous membrane can cause inflammation of mouth, throat and stomach.

Common Side Effects of Chemotherapy

People with cancer react differently to chemotherapy and its various side effects.There are many ways to reduce and prevent these side effects with medication. In addition to medical treatments, there are also other ways to ease the side effects. Here are some common side effects encountered and ways in managing it.

  1. Nausea and Vomiting

    Common medicines that cause nausea and vomiting are cisplatin, epirubicin and cyclophosphamide. There are many options available to help manage nausea and vomiting from occurring in the first place. These medicines are called as anti-emetics.

    • Treating Nausea and Vomiting

      The aim of anti-emetic therapy is to prevent nausea and vomiting throughout the entire period of emetic risk (risk of emesis usually persist up to 3 days). The most common anti-emetic medication is:

      1. Corticosteroid (e.g. dexamethasone)
      2. Prokinetic agent (e.g. metoclopramide)
      3. Serotonin blocker (e.g. granisetron, ondansetron)
      4. Neurokinin antagonist (e.g. aprepitant)
      5. Benzodiazepine (e.g. lorazepam)

      Usually, doctors recommend using combination of anti-emetics before and after treatments to prevent delayed nausea and vomiting.Your doctor will decide on which anti-emetics best for your treatment. It is important to take this medication even if you don’t feel nausea and vomiting at the time.

    • Coping with Nausea and Vomiting

      Along with anti-emetics, there are few things listed below to prevent or reduce the severity of nausea and vomiting, which include:

      • Eat frequent, small meals throughout the day instead of 3large meals (breakfast, lunch and dinner).
      • Drink plenty of clear liquids (at least 2 liters). Do not drink at meal times because it may cause bloating andincrease nausea.
      • Eat and drink slowly.
      • Chew food well for better digestion.
      • Avoid sweet, fried, spicy, fatty foods and foods with strong odour. Eat foods cold or at room temperature to help avoid strong smells.
      • Avoid alcohol and coffee.
      • Rest in a chair after eating.Don’t lie flat for at least 1-2 hours after meal.
  2. Fatigue

    Fatigue is one of the most common side effects of cancer treatment. Itis a persistent feeling of physical, mental or emotional tiredness or exhaustion related to cancer and/or its treatment. Usually, the side effect goes away after chemotherapy ends.

    • Treating Fatigue

      The first step in managing fatigue is to treat any medical cause that is contributing to fatigue.It is common for fatigue to appear a few days after chemotherapy.Education and counseling are part of the treatment. There is no specific medicine to treat fatigue.

    • Coping with Fatigue

      Fatigue usually goes away over time after treatment ends. Lifestyle changes can help better in coping with fatigue.The following are some steps to reduce fatigue.

      • Balance rest and activities. A few short rest periods are better than long rest.
      • Limit your activities. Try to do the important ones first, when you have the most energy.
      • Reduce stress by meditating, praying, talking with others or any other activity that gives you pleasure.
      • Eat a well-balanced diet and drink plenty of liquids (at least 2 liters).
      • Get help when you need it from family members, friends and neighbours.
      • Get up slowly to help prevent dizziness after sitting or lying down.
  3. Mouth Sores (Mucositis)

    Chemotherapy such as cisplatin and fluorouracil can cause mouth sores (mucositis)in the mouth, throat and digestive tract. It can cause pain, inflammation and infections, which making it difficult to eat, drink and swallow.

    • Treating Mucositis

      The best way to manage mucositis is to prevent it before it starts or to treat it early.Usual treatments are:

      1. Mouth rinse that contain saltor sodium bicarbonate (baking soda). However, if you are taking high blood pressure medication, you may need to avoid mouth rinses with salt.
      2. Anasthetic in the form of mouth rinse (e.g. lidocaine).
      3. Medicine to treat pain (e.g. benzydamine gargle, diclofenac).
      4. Antibiotics, antiviral,or antifungal medicine to treat infections.
      5. Sucking ice chips before and during each chemotherapy treatment may prevent mucositis caused by certain types of chemotherapy such as fluorouracil.
    • Maintaining Oral Health

      Start mouth care at the beginning of treatment to minimise side effects. Here are ways to keep your mouth, and throat healthy:

      • Avoid smokingand alcohol intake because these may cause dry mouth and reduce the effectiveness of treatment.
      • Gently brush teeth with soft bristle toothbrush twice a day and floss regularly.
      • Avoid commercial mouthwashes. They often contain irritants such as alcohol.
      • Minimize the use of dentures. Avoid wearing at night. Consider removing them between meals to help minimize irritation.
      • Eat foods cold or at room temperature to ease pain.
      • Choose soft, soothing foods, such as ice cream, mashed potatoes, custards and others.
      • Avoid acidic, spicy, salty, coarse and dry foods.
      • Drink plenty of liquids.
      • Chew sugarless gum if mouth is dry.


  1. (NCCN, 2014). Cancer Related Fatigue. Version 1.
  2. American Cancer Society (2013). http://www.cancer.org/
  3. British Columbia Cancer Agency (2013). http://www.bccancer.bc.ca/default.htm
  4. Cancer Care (2012). Understanding and managing chemotherapy side effects. http://www.cancercare.org
  5. eviQ Cancer Treatments Online (2014). Cancer Institute NSW. https://www.eviq.org.au
  6. National Comprehensive Cancer Network [NCCN]. (2014). Antiemesis. Version 2.
  7. Rudolph, N.V. (2007). Overview of the update antiemetic guidelines for chemotherapy induced nausea and vomiting. Community Oncology. 4, 3-11
Last Reviewed : 06 November 2014
Writer/Translator : Kamarun Neasa Begum bt. Mohd Kassim
Accreditor : Rozita bt. Mohamad