How to Reduce Chemo Side Effects

Chemotherapies are powerful medicines that damage cancer cells anywhere they might be in the body. In the process, chemo can harm healthy cells, too — resulting in side effects like nausea, constipation, fatigue, hair loss, mouth sores, and memory loss.     

Experts say it can be hard to predict what an individual’s experience with chemo side effects might be. Side effects can vary depending on the specific chemo medicines you’re receiving, the length of treatment, your age, and your overall health. They also vary a lot from person to person.

For instance, even when receiving the same chemo regimen, some people may have few or no issues while others may have very rough side effects, says Amy Tiersten, MD. Tiersten is the clinical director of breast medical oncology at the Dubin Breast Center of the Tisch Cancer Institute at Mount Sinai in New York City. 

Your oncology care team should go over the potential side effects of the chemo medicines they’re prescribing to you before you start treatment. They should also tell you how best to reach them if you have questions or are concerned about side effects you are experiencing between appointments. If they don’t, ask. It’s important not to wait to reach out for help.    

Read more of our special series on chemo side effects to learn about which breast cancers no longer need chemo and a brief history of why chemo doses are sometimes too high (and how you can talk to your doctor about lowering them).

“It’s also a good idea to gather some information about side effects and ways of managing them from other sources, such as patient advocacy organizations and moderated peer support communities,” advises Maryam Lustberg, MD, MPH, director of the Center for Breast Cancer at Smilow Cancer Hospital and chief of breast medical oncology at Yale Cancer Center. There may be things you can learn from peers who have lived experience with the side effects, says Lustberg.

A lot of progress has been made in minimizing chemo side effects over the past 20 years, and many of the strategies that can help are backed up by research. Some are surprisingly simple and low-cost or free; others require more effort and can be costly. Also, it’s still often the case that the person who is receiving chemo and their caregivers need to put in some legwork to find and utilize these strategies. The effort can be worth it, though.     

Here are 10 ways to make side effects more manageable and improve your quality of life during and after treatment. 

Side effects: nausea, vomiting, anxiety, and others

What to do: Ask your doctors if there are any medications they recommend you take to help prevent or reduce chemo side effects. Often called pre-medications or “pre-meds,” these can include, for example, medicines for nausea, heartburn, acid reflux, constipation, dry eyes, anxiety, and insomnia. Some pre-meds are available over-the-counter; others are only available by prescription. You’ll probably need to pick up some of your pre-meds at a drug store before starting chemo, and you’ll want to understand when and how to take them. Other pre-meds may be given to you at your treatment center before each infusion. You can also ask people who’ve received the same chemo regimen which pre-meds worked well for them. 

When to do it: Before your first chemo treatment.

The relevant chemos: Many chemo medicines can cause side effects that can be treated with over-the-counter and prescription medicines. 

Side effect: hair loss

What to do: Ask your oncology care team if you’re a good candidate for scalp cooling, which can significantly reduce hair loss from chemo. As part of your research, you’ll want to find out if your treatment center has a scalp cooling system you can reserve, or if renting manual cold caps might be a better option. Contact your insurance company to find out if they’ll cover some or all of the cost of scalp cooling and explore if you might be eligible for grants.

When to do it: Before your first chemo treatment. If you decide to do scalp cooling, you’ll need to make arrangements to rent manual cold caps or reserve a scalp cooling system that you can use at each chemotherapy appointment.

The relevant chemos: Many chemos can potentially cause hair loss. People treated with taxane chemos such as Taxol (chemical name: paclitaxel) and Taxotere (chemical name: docetaxel) tend to have more success with scalp cooling than those treated with other chemos. Learn more about research on the effectiveness of scalp cooling. 

Side effect: infertility

What to do: If you might want to have biological children after completing treatment, ask your medical team about ways to preserve your fertility before starting chemo. It’s also a good idea to ask for a referral to a fertility specialist, who can talk you through any risks to your fertility from your treatment plan and go over potential fertility-preservation options. These might include freezing eggs, ovarian tissue, or sperm, or taking a medicine like Zoladex that stops the ovaries from functioning temporarily to protect the eggs during chemo. 

When to do it: Ideally, when you’re first discussing your treatment plan with your doctors — and before you start chemo. Many fertility preservation procedures or treatments need to be done (or at least started) before you begin chemo. Learn more about fertility and pregnancy after breast cancer. 

The relevant chemos: Most chemo medicines can potentially affect fertility.

Side effects: nausea, vomiting, appetite loss, and dehydration

What to do: If your chemo meds could cause nausea or vomiting, it makes sense to be prepared. Many people who’ve been through chemo say prevention is the best strategy for nausea. That means picking up your prescription and over-the-counter anti-nausea medicines before chemo starts, and taking them even if you’re not sure you need them. If one anti-nausea medicine or a combination of several doesn’t work, ask your healthcare team about other options until you find relief. “No one should be throwing up from chemo these days,” wrote melissaga, a member of the Breastcancer.org Community. “If you start, call your docs right away and they'll change your [anti-nausea] drugs.” Other ideas for reducing nausea include eating small but frequent meals throughout the day, choosing cold foods instead of hot ones, and consuming ginger-based foods and drinks. 

When to do it: The timing can vary, depending on the specific anti-nausea medicine, your chemo regimen, and how you are reacting to it. 

The relevant chemos: Most chemo medicines can potentially cause nausea. 

Side effect: fatigue 

What to do: The research is mixed, but fasting (consuming little or no food) before, during, and after chemo treatments may help lower side effects. A 2023 study in Germany showed that eating only about 200 calories a day (in the form of vegetable juices and broths) for two days before and for one day after receiving chemo for early-stage breast cancer prevented fatigue and improved quality of life. If you want to try short-term fasting during chemo, be sure to work with your health care team to make sure it’s safe for you; staying hydrated and getting enough calories are important during chemo treatment.

When to do it: 36 to 48 hours before and 24 hours after chemotherapy treatment

The relevant chemos: Most of them can potentially cause fatigue. But the chemos in the German study were Adriamycin, Ellence (chemical name: epirubicin), and Taxol.

Side effects: dry mouth, fatigue, weakness, constipation, headaches, nausea, vomiting, diarrhea, dry skin 

What to do: Drink plenty of fluids to prevent dehydration. Try aiming for 64 to 96 ounces of liquids (or 8 to 12 8-ounce glasses) over the course of the day. Water (with or without flavorings), smoothies, sports drinks containing electrolytes, coconut water, pasteurized fruit juices diluted with water, milk, low-sodium broth or soup, popsicles, and ice chips are all good choices. Avoid drinks that contain caffeine or alcohol. Staying well hydrated has many benefits: It reduces the severity of side effects, helps your body flush out toxins, and makes your veins easier to access for drawing blood or starting an infusion. 

When to do it: Before, during, and for the first two days after each chemo treatment.

The relevant chemo: Most chemos can potentially cause dehydration. 

Side effects: mouth and throat sores (also called mucositis) 

What to do: There are several types of mouthwashes that work well, and you may want to use more than one of them. Options include over-the-counter Biotène rinse; a homemade solution of baking soda, salt, and warm water; a solution of hydrogen peroxide and water; and prescription “magic mouthwash.” Ask your healthcare team for their recommendations. Keeping your mouth moist, by sucking on ice chips, drinking lots of fluids, and chewing gum, can help, too. Avoid oral rinses that contain alcohol, as they can make sores worse. 

When to do it: Several times each day, during chemo treatment and as long as any symptoms last.

The relevant chemos: Many chemo medicines, such as Adriamycin, Ellence, Taxol, and Xeloda (chemical name: capecitabine), can cause mouth and throat sores.

Side effects: pain and numbness linked to nerve damage (called neuropathy) and nail changes   

What to do: If you’re receiving certain chemos that can cause neuropathy and nail changes — especially taxane chemos — wear cooling gloves and socks during infusions. Studies show that cold therapy can lower the risk of developing those symptoms. Some treatment centers offer supplies for icing hands and feet, but many people find that they have to buy some or all of the supplies themselves. You can order the gloves and socks from online retailers (search for “cold therapy socks and mittens”). Or you can use ice packs or bags of ice that your healthcare team will tape to your feet and hands. Keep in mind that you’ll probably need to bring multiple sets of socks, mittens, or ice packs to your infusion sessions, since you’ll need to swap them out when they start to melt. 

When to do it: For about 15 minutes before each infusion, during the whole infusion, and then for at least 15 minutes afterwards. 

The relevant chemos for neuropathy: Abraxane, carboplatin, Halaven, Navelbine, Taxol, and Taxotere.

The relevant chemos for nail changes/loss: Adriamycin, Doxil (chemical name: doxorubicin), Ixempra (chemical name: ixabepilone), Taxotere, and Taxol.  

Side effects: chemo brain, anxiety, depression, nausea, pain, and insomnia

What to do: Practice meditation techniques that can calm and focus your mind. Research has shown that meditation and other mindfulness practices are among the most effective ways to ease the cognitive side effects of chemo, including problems with memory, concentration, and mood. There are lots of ways to meditate, and getting started can be relatively easy thanks to meditation apps, free online videos, and online meditation classes. 

“There’s a menu of meditation and mindfulness options to try, and personal preference is important,” says Ashley Henneghan, PhD, RN, FAAN, an associate professor at the School of Nursing at the University of Texas at Austin. Henneghan studies ways to reduce the cognitive side effects of cancer treatment. “Try one style or type of meditation for a month, for short periods, like just 10 minutes each day. That can be pretty effective and might be more sustainable than trying for 20 minutes or more.”  

When to do it: Every day, during and after treatment. 

The relevant chemos: Most chemos can cause chemo brain.

Side effects: fatigue, chemo brain, nausea, anxiety, heart problems, bone and joint pain, bone loss, and insomnia

What to do: It might seem counterintuitive, but exercising multiple times a week during chemo can help you feel better overall and give you more energy, stamina, and a quicker recovery. Research shows that it’s safe to stay active during treatment, as long as you take any necessary precautions. In a study from the Netherlands, people who started an exercise program while receiving chemo had less severe side effects and got back to regular physical functioning faster than people who started exercising after finishing chemo. 

When to do it: Several times per week (or as often as you feel up to it), during and after chemo treatment. But don’t worry if you can’t get to that level. “Be as active as you can, when you feel up for it,” says Evanthia Roussos Torres, MD, PhD, a medical oncologist and researcher at the Keck School of Medicine of USC, in Los Angeles. “Whatever your practice is that gets the endorphins going, do that, and that will continue to help you recover at the end much faster.”

The relevant chemos: All of them.

Ongoing studies highlight many other options for managing chemo side effects.  

• Sponsor Message

  Try Diclofenac gel to prevent hand-foot syndrome that can be a side effect of Xeloda.

• Sponsor Message

  Get your vitamin D levels checked before you receive Taxol and talk with your doctor about whether vitamin D supplements make sense for you.

• Sponsor Message

  Consider medical cannabis to ease peripheral neuropathy, and improve sleep and chemo brain.   

• Sponsor Message

  Listen to classical music tracks every day to improve chemo brain and mood.

Recommendations from other people who have been through chemo can be invaluable. Just remember to discuss any side effect remedies with your healthcare team.

“I took extra steroids to help with nausea and appetite. Worked very well for me!” —mncteach

“I found these great wristbands [that] are made for motion sickness. I wear them to chemo and for 2 days after. They cut the nausea for me.” —1973vwbus

“Take Zofran every 8 hours on the dot for the first 5 days after  [receiving the taxotere and cyclophosphamide chemo regimen]. I did that and never had any nausea the first round.” —halyy2024

“Get Imodium AND stool softeners. You may need both.” —Anniemomofthreee

“My oncologists listed Lactoferrin (ordered from Amazon) [to help with] ‘metal mouth.’ I've taken that daily since chemo day and so far, just had a couple of days where I seemed to not be able to taste well.”  —grammie2

“Having been sent into menopause with the chemo, my oncologist suggested taking fish oil to help with the hot flashes. It really seems to tame the symptoms of menopause.” —mkw1 

“Chemo nurse told me to soak my hands and feet in white vinegar and water for a few minutes each night. It prevents infections from starting in nail beds, which get damaged from the chemo.” —shore1

“I went through a small insomnia period. There is an OTC called Simply Sleep. It is like Tylenol PM without the Tylenol. Very safe to use and non addictive. I also cut caffeine totally during that time. It helped, and after a while I was so tired from chemo that I was asleep before my head hit the pillow.” —kingcour

“Medical marijuana…helps me the most with depression and appetite stimulation on regular days and helps with chemo side effects, like dizziness and nausea, on chemo days. I use edibles and a vaporizer for THC and I ingest CBD oil in a dropper daily.” —NBee

“My doc suggested sipping sage tea to help prevent and soothe mouth sores. The sage has an antibacterial effect, thus keeping the mucous membrane inside the mouth (as well as the throat) clean. Even simply swishing the tea around inside the mouth will rinse off and disinfect.”—stella  

“Both my oncologist and a friend who was both a survivor and oncology nurse recommended eating a popsicle, or something else very cold, while being given adriamycin. Apparently there has been some inconclusive research indicating it prevents mouth sores. I never got a single mouth sore so maybe it is effective.” —sirsmom

“Aquaphor is great for dry hands and feet.” —snowyday

“For constipation — warm prune juice and a little sprite, I was given this in the hospital after a few days of constipation. Worked like a charm! Lol” —tangandchris  

“Sleep naked. This helped with hot flashes, which I developed after round 3, and also apparently prevents yeast infections by helping maintain air circulation down there.” —tshire

 

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