Side Effects

When cancer treatments affect healthy tissues and organs, they can cause side effects. Not everyone experiences the same issues, even when they have the same type of sarcoma or the same type of treatment, and how you respond to them will be unique to you. Before you start treatment, ask your medical team about the side effects to expect so you can be prepared if they occur. Preventing and managing them is extremely important for the success of your treatment because the better you feel, the more likely you’ll be able to complete your treatment as planned.

Alopecia (hair loss)

Hair loss occurs most commonly among people receiving chemotherapy and/or radiation therapy. Some targeted therapy drugs may also cause hair loss. Typically, chemotherapy and targeted therapy drugs cause hair loss on the head and body, whereas radiation therapy causes it only in the area being treated. However, not all people treated for cancer will lose their hair even when they take the same drug or have the same treatment.

Cognitive Dysfunction (“chemo brain”)

People being treated for cancer may refer to “chemo brain” when they can’t think clearly or have trouble remembering details, such as names and dates. Cognitive dysfunction is often associated with chemotherapy, but it can occur in people receiving many types of treatments, such as radiation therapy, during or after treatment. Research has shown that patients who haven’t had chemotherapy can also develop cognitive dysfunction as a result of stress or hormone depletion (for those on anti-hormonal therapy drugs).

There are many ways to help manage cognitive dysfunction. Use a daily planner to help keep track of tasks, and make a list each day of things to do. As you complete each task, draw a line through it and go on to the next item. Solve crossword puzzles or number games to strengthen your mental ability. Don’t multitask. Instead, focus on one thing at a time. Let others know you are having difficulties, and ask for their help.


Diarrhea is most likely to occur in people who receive radiation therapy to the abdomen or take certain chemotherapy or targeted therapy drugs. Cancer treatment-related diarrhea is a short-term side effect, but it can be an inconvenience and affect your quality of life. Try to track when it typically occurs so you can plan accordingly. Changes to your diet can help prevent or lessen diarrhea. A diet of only clear liquids may help the lining of your intestines heal. Clear liquids include water, cranberry juice, ginger ale, clear broth, popsicles, decaffeinated tea and gelatin. As diarrhea begins to improve, you can slowly add solid foods back into your diet, starting with low-fiber foods, such as white rice and boiled potatoes.

In addition, over-the-counter medicines are available to control diarrhea, but be sure to talk to your doctor before taking any of them, as instructions may differ from those on the drug label. If your diarrhea is severe, your doctor may also prescribe other medications or temporarily stop treatment with chemotherapy or targeted therapy and restart it when your diarrhea is controlled.


Regardless of the type of cancer you have or the type of treatment you receive, almost everyone treated for cancer experiences fatigue at some point. Fatigue can be caused or worsened by several factors:

  • The extra energy your body needs to repair healthy tissues damaged during treatment
  • Treatment side effects, such as pain, nausea and vomiting
  • Medications to relieve side effects
  • The interaction of two or more medications

If your fatigue is severe, your doctor may prescribe something to help improve your alertness and raise your energy during the day, while also decreasing fatigue. Managing fatigue is an essential part of your health care, so be sure to discuss with your doctor.

Nausea and Vomiting

Prevention is the key to managing nausea and vomiting, as these symptoms are easier to prevent than to control once they’ve started. If your treatment plan includes chemotherapy, radiation therapy or targeted therapy, nausea and vomiting are potential side effects. Antiemetics are drugs that can help prevent and control nausea and vomiting.

Vomiting can be prevented with the appropriate medications, but some people may still have nausea without vomiting. Medications to prevent vomiting should be taken as prescribed before treatment, and they should be continued as directed by your doctor because the risk of vomiting may continue for several days after treatment.

It’s important to let your doctor know if you’re still experiencing nausea and vomiting even after taking an antiemetic as prescribed. This type of nausea and vomiting is known as “breakthrough,” and you may need a different antiemetic drug or a higher dose to control these symptoms.


Neutropenia is most likely to occur in people receiving a combination of radiation therapy and chemotherapy, but it’s also common in those who receive either of these two treatments alone. Neutropenia is a low number of neutrophils, a kind of white blood cell that helps fight off infection. Therefore, neutropenia increases the risk of infection. Neutropenia cannot be prevented, so it’s important to take steps to reduce your risk for infection. Studies have shown that the most effective way to prevent infection is to wash your hands frequently.

Your doctor will keep a close watch on your white blood cell count throughout your treatment period. If your neutrophil count is extremely low, your doctor may delay your next treatment until the count has increased. In the meantime, he or she will likely have you follow “neutropenic precautions,” which are extra measures to prevent infection:

  • Taking your temperature four times each day
  • Not eating uncooked foods
  • Staying away from fresh flowers, plants and gardening
  • Avoiding enemas, rectal suppositories and rectal thermometers
  • Delaying dental work

Certain growth factors may help people with an extremely low neutrophil count. These growth factors are special proteins that can stimulate the bone marrow to produce more white blood cells, and they’re usually given as an injection under the skin. For people who have a high risk for infection, preventive antibiotics or antifungal medications may be used as well. If an infection develops, antibiotics are usually given immediately because cancer-related infections are considered emergencies.

Skin Reactions

Skin reactions are likely for people who receive chemotherapy, radiation therapy or targeted therapy. Reactions caused by treatments can range from mild to severe. If a rash develops and spreads over a larger area and causes itchiness or pain, your doctor may prescribe a mild corticosteroid cream or an antibiotic gel. Severe rashes are usually treated with an oral antibiotic and perhaps an oral corticosteroid.

The acne-like rashes caused by some treatments also can be treated with topical and oral antibiotics and corticosteroids. If your rash is severe, your doctor may reduce the dose of the drug or temporarily stop treatment, restarting it if the rash gets better within two weeks.


Managing Pain

One of the most common side effects of cancer and its treatment is pain. For many people, pain is related to the cancer itself. But cancer treatments, such as surgery, can sometimes cause pain by damaging healthy cells, which can result in side effects such as a burning sensation, mouth sores, diarrhea, nerve damage and more. Be sure to talk to your doctor openly about any pain you experience so it can be controlled. You should not avoid treatment because of pain.

There are numerous options for managing cancer pain, and it can be helpful to think of them as tools in a toolbox. Sometimes just one tool can fix the problem, but other times, you may need a combination. In addition, you’ll sometimes need to use tools in a particular sequence or switch back and forth between tools.

The following descriptions of pain relief techniques provide a general overview of what’s available. If your doctor doesn’t mention one or more of them for your care, don’t be afraid to ask whether they might be right for you.

  • Pharmacotherapy is the treatment of cancer pain with medications, including non-opioid drugs, opioids (narcotics), adjuvant drugs (drugs not typically used for pain but that may be helpful for managing some types of pain) and topical analgesics.
  • Percutaneous pain techniques are procedures that enable access to inner organs and tissues through needle punctures into the skin. These procedures include ablative techniques (radio-frequency ablation or cryotherapy), nerve blocks, kyphoplasty, vertebroplasty and sacroplasty.
  • Neurosurgical approaches to pain relief lessen pain at its source by interrupting pain signals between the spine and brain.
  • Intrathecal drug delivery, also called a “pain pump,” sends pain medication directly to your spinal cord through the action of a small pump that’s implanted in the body through an incision in the abdominal wall.
  • Supportive oncology usually involves a team of doctors who use palliative surgery, radiation therapy and chemotherapy to help relieve cancer pain.
  • Physiatry, or physical medicine and rehabilitation, helps relieve pain through customized therapy programs designed to enhance mobility, overcome disabilities and avoid painful activities when cancer or its treatments have affected how you move and function. Anti-inflammatory injections are also a part of this technique.
  • Complementary strategies include yoga, acupuncture, reflexology, massage therapy, aromatherapy, art therapy, music therapy and animal therapy. These strategies do not single-handedly resolve cancer pain, but they can often contribute to managing pain.
  • Psychobehavioral strategies involve activities such as deep relaxation and meditation. They are useful in calming psychological symptoms, such as anxiety and depression, which often accompany cancer pain and can get in the way of its treatment.

All of the ways to relieve pain are associated with certain risks and benefits, so always review them with your medical team before taking any approach.



Strategies for Managing Common Side Effects

Side Effect Related Treatment Ways to Manage

Alopecia (hair loss)

Chemotherapy, radiation therapy, targeted therapy
• Use a cooling cap
• Wear a wig, scarf or hat
• Use a wide-toothed comb
• Sleep on a satin pillow case
• Ask your doctor for a prescription for a wig because it may make it eligible for insurance coverage

Anemia (low red blood cell count)

• Get plenty of rest
• Participate in regular physical activity

Changes in appetite

Chemotherapy, radiation therapy, surgery
• Eat when you have the most hunger
• Eat high-calorie and high-protein foods
• Eat small meals
• Keep high-calorie snacks on hand

Cognitive dysfunction (“chemo brain”)

Chemotherapy, radiation therapy
• Take notes
• Keep lists
• Use a daily planner
• Don’t multitask


Chemotherapy, radiation therapy, targeted therapy
• Take antidiarrheal medicine
• Drink plenty of fluids
• Eat several small meals
• Avoid greasy foods


Chemotherapy, radiation therapy, surgery, targeted therapy
• Balance activity and rest
• Take short naps
• Sleep regularly
• Participate in regular activity


• Wear a compression garment
• Elevate the swollen limb

Mouth sores

• Brush teeth often with a toothbrush with soft bristles
• Eat soft foods
• Drink plenty of fluids

Nausea, vomiting

Chemotherapy, radiation therapy
• Take antiemetics as prescribed
• Eat several small meals
• Drink plenty of fluids
• Avoid unpleasant odors


• Avoid tight clothes or shoes
• Keep hands and feet warm
• Avoid standing for long periods of time

Neutropenia (low white blood cell count)

Chemotherapy, radiation therapy
• Wash hands frequently
• Avoid crowds
• Wash fruits and vegetables carefully

Skin reactions

Chemotherapy, targeted therapy, radiation therapy
• Use mild soap
• Use thick cream (with no alcohol, perfume, or dye) to moisturize skin

Additional Resources


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