Managing Side Effects of Chemotherapy

Chemotherapy remains one of the most common treatments for bowel cancer, especially when the cancer is more advanced or has spread to other parts of the body. While it’s designed to target fast-growing cancer cells, chemo can also affect healthy cells, especially those that divide quickly, like those in your gut, hair follicles, and bone marrow. This can lead to a range of side effects that impact your day-to-day life, both physically and emotionally.

Understanding and managing these side effects can make a significant difference in how you cope with treatment. Whether you’re newly diagnosed with early-onset bowel cancer or navigating another round of chemotherapy, here’s a comprehensive guide to managing common side effects in an Australian context.

What to Expect from Chemotherapy for Bowel Cancer

Chemotherapy drugs used for bowel cancer may include:

• 5-Fluorouracil (5-FU)
• Capecitabine (Xeloda)
• Oxaliplatin
• Irinotecan

These drugs may be used alone or in combination (such as FOLFOX or FOLFIRI regimens). Each combination comes with a slightly different side effect profile. Your oncologist will personalise your treatment plan based on the stage of your cancer, your overall health, and your treatment goals.

Common Chemotherapy Side Effects and How to Manage Them

Fatigue

Fatigue is one of the most common and persistent side effects. It can feel like a deep, bone-heavy exhaustion that doesn’t improve with rest.

• Prioritise rest but don’t stay in bed all day, light activity like a short walk can actually boost your energy
• Accept help from friends, family, or carers for tasks like groceries or childcare
• Maintain a balanced diet to help your body recover
• Speak with your care team about fatigue that’s interfering with your daily life, sometimes it’s linked to anaemia or other treatable conditions

For additional resources on fatigue, visit Bowel Cancer Australia.

Nausea and Vomiting

• Take prescribed anti-nausea medications even if you feel fine, prevention is more effective than treatment
• Eat small, frequent meals rather than large ones
• Avoid strong smells and spicy or greasy foods
• Stay hydrated, even if that means sipping water, ginger tea or electrolyte drinks throughout the day

Ask your oncologist about options like ondansetron, metoclopramide, or aprepitant, which are commonly used in Australia.

Diarrhoea and Constipation

For diarrhoea:

• Stay hydrated with clear fluids and oral rehydration solutions
• Eat low-fibre, bland foods like white rice, toast, and bananas
• Take anti-diarrhoeal medication like loperamide (Imodium), as advised by your care team

For constipation:

• Increase fibre intake with fruits, vegetables, and wholegrains if your gut can tolerate them
• Stay active, even short walks can help stimulate digestion
• Use stool softeners or laxatives under medical guidance

Peripheral Neuropathy (Nerve Damage)

Oxaliplatin, in particular, can cause tingling, numbness, or pain in the hands and feet. This can become permanent if not managed early.

• Report symptoms early, dose adjustments can be made
• Avoid cold exposure, including cold drinks and ice.
• Use protective gloves and warm socks
• Acupuncture helped reduce my neuropathy
• Cold cap therapy, though less common in bowel cancer regimens, it may help in some cases
• Speak to a physiotherapist for exercises that can improve circulation and nerve function

Mouth Sores and Taste Changes

• Use a soft-bristled toothbrush and rinse your mouth with saltwater or baking soda solutions
• Avoid acidic or spicy foods
• Try cold or room temperature foods which may be easier to tolerate
• Experiment with textures and flavours to find what’s most palatable

Dietitians familiar with cancer treatment can help you adjust your meals (Bowel Cancer Australia). You can ask your care team for a referral to a nutrition specialist familiar with bowel cancer.

Hair Thinning or Loss

• Consider scarves, hats, or wigs, many cancer centres offer these for free or at a discount
• Use gentle hair care products and avoid heat styling
• Similar to neuropathy, though less common in bowel cancer regimens, cold cap therapy may help in some cases

More information can be found at Look Good Feel Better Australia.

Low Immunity (Neutropenia)

• Washing your hands regularly and using hand sanitiser
• Avoiding large crowds or anyone who’s unwell
• Cooking meats thoroughly and avoiding raw seafood or eggs
• Calling your doctor immediately if you develop a fever (over 38°C)

Your oncologist may prescribe growth factor injections like filgrastim (Neupogen) to boost white cell production.

Cognitive Changes (“Chemo Brain”)

• Use a daily planner or reminder apps
• Break tasks into small steps and avoid multitasking
• Prioritise rest, fatigue worsens cognitive symptoms
• Do brain-training games or puzzles to keep your mind active

Emotional Health and Anxiety

• Speak with a psychologist or counsellor, your cancer centre likely has one on staff
• Try mindfulness or meditation using Australian-based apps like Smiling Mind
• Connect with others via local or online bowel cancer support groups
• Ask your GP about a Mental Health Treatment Plan, which gives you access to Medicare-subsidised psychology sessions

You can also visit Bowel Cancer Australia’s support services.

Menstrual and Fertility Changes

• Egg or sperm preservation before starting chemotherapy
• Seeing a fertility specialist with experience in oncofertility
• Discussing contraceptive needs, pregnancy during chemo should be avoided

Fertility preservation is available through services like Genea or public fertility clinics, and you may be eligible for rebates or funding support.

Skin and Nail Changes

• Use gentle, fragrance-free moisturisers
• Wear gloves when washing dishes or using cleaning products
• Avoid prolonged sun exposure, chemo can make your skin more sensitive to UV rays
• Speak with your care team if you notice severe rashes or peeling

Practical Tips for Managing Chemotherapy Day-to-Day

• Pack a chemo bag with snacks, water, headphones, and a good book or podcast
• Keep a symptom journal to track side effects and bring it to appointments
• Organise your medications using a pillbox or medication tracking app
• Ask for help, many Australians are eligible for home care support or transport assistance
• Schedule around your “good days” if you notice a pattern in how you feel during each cycle

When to Call Your Doctor

It’s always better to be cautious. Contact your medical team right away if you experience:

• Fever over 38°C
• Uncontrolled vomiting or diarrhoea
• Chest pain or shortness of breath
• Confusion or sudden weakness
• Signs of infection (sore throat, chills, pain when urinating)

The Power of Self-Advocacy

You have every right to ask questions, push for more information, and explore second opinions. If something doesn’t feel right, don’t hesitate to bring it up with your oncologist or care team. Managing chemo side effects is a team effort, your voice matters.

Final Thought

Managing chemotherapy side effects takes preparation, support, and self-awareness. Everyone responds to treatment differently, and what works for one person might not work for another. But you are not alone, there are tools, resources, and people ready to help you every step of the way.

Be kind to yourself. Celebrate the little wins, and never underestimate the power of rest, laughter, and connection. There’s life beyond chemo, even if it doesn’t always feel that way when you’re in the thick of it.