Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.
The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.
Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.
Immunotherapy may cause serious immune reactions against your own body. These are called immune-related adverse events. They may occur during your treatment, or after your treatment has ended. Immunotherapy can affect many parts of your body. Some side effects can cause severe or life threatening conditions, so even mild side effects must be reported immediately. Some side effects are more common; examples: fatigue, thyroid gland problems, diarrhoea, joint pain and skin rash. Some side effects are less common; examples: pituitary gland problems, bowel inflammation, arthritis and kidney problems. Some side effects are rare but can be serious or life threatening; examples: heart problems, blood problems, lung problems, eye problems and nervous system problems. Do not try to treat any of these symptoms yourself without talking to your doctor or nurse first. You will be given an information pack at the start of your treatment. This contains an alert card which you should carry with you at all times. Bring this alert card with you to hospital, especially if you are unwell or attending the emergency department.
This treatment uses both chemotherapy and immunotherapy. These drugs work in different ways, but can cause similar side effects.
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Immune related side effects
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Heart problems
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- You may get:
- chest pain or tightness
- shortness of breath
- swelling of your ankles
- an abnormal heartbeat.
- Heart problems are uncommon but potentially fatal. If heart problems were to occur, symptoms usually start within the first 3 months of treatment, but can happen at any time even after the treatment has finished.
- Tell your doctor if you have a history of heart problems or high blood pressure.
- Before or during treatment, you may be asked to have a test to see how well your heart is working.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.
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Bowel and stomach inflammation
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- You may get:
- bowel motions (stools, poo) that are more frequent or more liquid (diarrhoea)
- blood or mucous in your stool
- dark, tarry, or sticky bowel motions
- bloating, cramping, pain or tenderness in your stomach area.
- Inform your doctor or nurse immediately if you get diarrhoea
- Take your anti-diarrhoeal or steroid medication as directed by your doctor.
- Drink plenty of fluids (unless you are on a fluid restriction).
- Eat and drink small amounts more often.
- Avoid spicy foods, dairy products, high fibre foods, and coffee.
- Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled despite taking anti-diarrhoea medicine, severe stomach pains and bloating, and/or if you feel dizzy or light-headed.
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Blood problems
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- Blood problems are infrequent but can be serious.
- You may feel dizzy, light-headed, tired, weak and appear more pale than usual.
- You may get:
- dark, tarry bowel motions (stools, poo)
- blood in your urine or not urinating as often
- dark-coloured urine
- yellowing of the whites of your eyes, and/or your skin
- pinpoint red spots on your skin
- unexplained bleeding
- major bruising
- a fever
- shortness of breath
- a severe headache
- confusion
- faster heartbeat than normal
- Tell your doctor or nurse immediately or go to the nearest hospital Emergency Department if it has been longer than 12 hours since you have emptied your bladder or if you get any of the symptoms listed above.
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Liver damage
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- You may get:
- fatigue
- severe nausea and vomiting
- weight loss
- bruising or bleeding more easily
- pain or tenderness on the right side of your stomach area
- dark coloured urine
- yellowing of the whites of your eyes and/or your skin
- itchy skin
- drowsiness
- You will have regular blood tests to check how well your liver is working.
- Take your steroid medication as directed by your doctor.
- Tell your doctor or nurse as soon as possible if you notice that your urine is a dark colour, the whites of your eyes or skin look yellow, if you have unexplained bruising or bleeding or if you have severe stomach pain.
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Muscle and joint problems
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- You may get:
- muscle or joint stiffness, especially after a period of rest
- muscle weakness
- pain in your muscles or joints
- joint swelling
- tiredness
- headaches
- Take your pain relief or steroid medication as directed by your doctor.
- Tell your doctor or nurse as soon as possible if you get any of the symptoms listed above.
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Nervous system problems
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- Nervous system changes are rare, but can be serious.
- You may get:
- headaches
- fever
- stiff neck
- confusion or difficulty concentrating
- dizziness or drowsiness
- loss of consciousness
- muscle weakness or pain
- numbness or tingling in your hands or feet
- jerky movements.
- Take your steroid medication as directed by your doctor.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.
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Eye problems
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- You may get:
- eye pain
- itchy eyes
- red or swollen eyes
- blurred or change in vision
- change in colour vision
- watery or gritty eyes
- dry eyes
- sensitivity to light.
- Protect your eyes from the weather (sun and wind) by wearing sunglasses.
- Use your eye drops or take your steroid medication as directed by your doctor.
- Tell your doctor or nurse as soon as possible if you get any of the symptoms listed above.
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Hormone problems
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- Hormone changes are infrequent, but can be serious.
- You may get:
- headaches
- tiredness, dizziness or fainting
- abnormal heartbeat (faster than usual)
- a feeling of being hot or cold more easily
- excessive sweating
- weight changes
- a deepened voice
- irregular or absent periods
- nausea and vomiting
- thirsty and need to urinate more often than normal
- high blood sugar levels and increased risk of diabetes (requiring insulin therapy)
- pain in your stomach area
- muscle pain or weakness
- difficulty sleeping
- agitated more easily
- changes in your mood or behaviour, such as decreased sex drive or irritability.
- Take your hormone or steroid medication as directed by your doctor.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you feel confused, weak, dizzy, or faint, or get sudden pain in your lower back or legs.
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Lung problems
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- You may get:
- shortness of breath
- difficulty breathing
- faster heartbeat than normal
- chest pain
- new or worsening cough
- fever.
- Your doctor will monitor how well your lungs are working during your treatment.
- Take your steroid medication as directed by your doctor.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.
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Kidney damage
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- This treatment can cause changes to how your kidneys work.
- You may get:
- a feeling of needing to urinate less often than normal
- blood in your urine
- swollen hands and feet
- loss of appetite.
- You will have regular blood tests to check how well your kidneys are working.
- You may need to drink more fluids while you are having treatment. Your doctor or nurse will tell you if you need to do this.
- Take your steroid medication as directed by your doctor.
- Tell your doctor or nurse as soon as possible if you notice that your urine changes colour or you don't need to empty your bladder as often.
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Skin rash
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- You may get
- a red rash
- a bumpy rash
- dry and itchy skin
- skin peeling or blisters.
- if you have had previous radiation therapy to an area this effect may be worse
- Moisturise your skin with a gentle non-perfumed moisturising cream like sorbolene or aqueous cream.
- Avoid scratching your skin.
- Avoid wearing tight fitting clothing
- Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and sunscreen of SPF 50 or higher.
- Take your antihistamine medication or apply your steroid cream as directed by your doctor.
- Tell your doctor or nurse as soon as possible if you notice any changes to the rash like pain or pus forming.
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Thyroid problems
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Thyroid problems are common with this treatment. The most common problem is an underactive thyroid gland (hypothyroidism), occasionally you may get an overactive thyroid gland (hyperthyroidism).
- If you have an underactive thyroid, you may get:
- fatigue and low energy levels
- depression
- slow heart rate
- unexplained weight gain
- intolerance to cold temperatures
- fatigued and aching muscles
- dry, coarse skin
- puffy face
- hair loss
- constipation
- problems with concentration
- changes in your periods
- If you have an overactive thyroid, you may get
- abnormal heartbeat (faster than usual)
- a feeling of being hot or cold more easily
- excessive sweating
- difficulty sleeping
- anxiety, nervousness or agitated more easily
- diarrhoea
- changes in your periods
- You will have regular blood tests to check how well your thyroid is working.
- Take your hormone or steroid medication as directed by your doctor.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Chemotherapy immediate (onset hours to days)
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Nausea and vomiting
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- You may feel sick (nausea) or be sick (vomit).
- Take your anti-sickness medication as directed even if you don’t feel sick.
- Drink plenty of fluids (unless you are fluid restricted).
- Eat small meals more frequently.
- Try food that does not require much preparation.
- Try bland foods like dry biscuits or toast.
- Gentle exercise may help with nausea.
- Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.
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Taste and smell changes
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- You may find that food loses its taste or tastes different.
- These changes are likely to go away with time.
- Do your mouth care regularly.
- Chew on sugar-free gum or eat sugar-free mints.
- Add flavour to your food with sauces and herbs.
- Ask your doctor or nurse for eviQ patient information - Taste and smell changes during cancer treatment.
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Chemotherapy early (onset days to weeks)
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Infection risk (neutropenia)
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- This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening.
- Wash your hands often.
- Keep a thermometer at home and take your temperature regularly, and if you feel unwell.
- Do your mouth care regularly.
- Inspect your central line site (if you have one) daily for any redness, pus or swelling.
- Limit contact with people who are sick.
- Learn how to recognise the signs of infection.
- Ask your doctor or nurse for eviQ patient information - Infection during cancer treatment.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
- a temperature of 38°C or higher
- chills, shivers, sweats or shakes
- a sore throat or cough
- uncontrolled diarrhoea
- shortness of breath
- a fast heartbeat
- become unwell even without a temperature.
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Low platelets (thrombocytopenia)
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- This treatment lowers the amount of platelets in your blood. Platelets help your blood to clot. When they are low, you are at an increased risk of bleeding and bruising.
- Try not to bruise or cut yourself.
- Avoid contact sport or vigorous exercise.
- Clear your nose by blowing gently.
- Avoid constipation.
- Brush your teeth with a soft toothbrush.
- Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to.
- Tell your doctor or nurse if you have any bruising or bleeding.
- Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if you have any uncontrolled bleeding.
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Tiredness and lack of energy (fatigue)
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- You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
- Do not drive or operate machinery if you are feeling tired.
- Nap for short periods (only 1 hour at a time)
- Prioritise your tasks to ensure the best use of your energy.
- Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
- Try some gentle exercise daily.
- Allow your friends and family to help.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Mouth pain and soreness (mucositis)
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- You may have:
- bleeding gums
- mouth ulcers
- a white coating on your tongue
- pain in the mouth or throat
- difficulty eating or swallowing.
- Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks.
- Try bland and soft foods.
- Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so.
- Rinse your mouth after you eat and brush your teeth, using either:
- 1/4 teaspoon of salt in 1 cup of warm water, or
- 1/4 teaspoon of bicarbonate of soda in 1 cup of warm water
- Ask your doctor or nurse for eviQ patient information - Mouth and throat problems during cancer treatment.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Appetite loss (anorexia)
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- You may not feel like eating.
- Try to avoid drinking fluids at meal times.
- Try to eat small meals or snacks regularly throughout the day.
- Try to eat food that is high in protein and calories.
- If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.
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Nerve damage (peripheral neuropathy)
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- You may notice a change in the sensations in your hands and feet, including:
- tingling or pins and needles
- numbness or loss of feeling
- pain.
- You may find it difficult to do everyday activities, such as doing up buttons or picking up small objects.
- Test water temperature with your elbow when bathing to avoid burns.
- Use rubber gloves, pot holders and oven mitts in the kitchen.
- Wear rubber shoes or boots when working in the garden or garage.
- Keep rooms well lit and uncluttered.
- Ask your doctor or nurse for eviQ patient information – Nerve problems during cancer treatment.
- Tell your doctor or nurse if you get any of the symptoms listed above.
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Kidney damage
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- This treatment can cause changes to how your kidneys work.
- You will have blood tests to make sure your kidneys are working properly.
- You may need to drink more fluids while you are having treatment. Your doctor or nurse will tell you if you need to do this.
- Tell your doctor or nurse as soon as possible if you notice that your urine changes colour or you don't need to empty your bladder as often.
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Low blood magnesium, potassium and calcium levels (hypomagnesaemia, hypokalaemia, hypocalcaemia)
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- This may be found from your routine blood tests and treated by your doctor.
- If it is severe you may get:
- muscle cramps or twitches
- numbness or tingling in your fingers, toes or around your mouth
- constipation
- an irregular heartbeat
- sleepy, drowsy or confused
- Tell your doctor or nurse as soon as possible if you get any of the signs or symptoms listed above.
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Hearing changes (ototoxicity)
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- You may get ringing in your ears or loss of hearing.
- You may have your hearing tested before and during your treatment.
- Tell your doctor or nurse as soon as possible if you notice any changes to your hearing.
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Chemotherapy late (onset weeks to months)
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Low red blood cells (anaemia)
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- You may feel dizzy, light-headed, tired and appear more pale than usual.
- Tell your doctor or nurse if you have any of these signs or symptoms. You might need a blood transfusion.
- Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.
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Hair thinning
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- Your hair may become dry and may break easily.
- You may lose some of your hair.
- Use a gentle shampoo and a soft hairbrush.
- Take care with hair products like hairspray, hair dye, bleaches and perms.
- Protect your scalp from the cold with a hat or scarf.
- Protect your scalp from the sun with a hat and sunscreen of SPF 50 or higher.
- Ask your doctor or nurse about the Look Good Feel Better opens in a new tab or window program (www.lgfb.org.au)
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