What are side effects?
Side effects are the unwanted effects of blood cancer treatment. Some people experience these effects as a result of the cancer itself, even if they aren't having treatment.
Side effects can be temporary and stop during or after your treatment, but sometimes they can last longer or be permanent.
Treatment affects everyone differently. Even two people that have the same treatment can have different side effects.
You might not get all, or even any, of the side effects associated with your treatment. But below are some examples of more common side effects, along with things you can do to manage them.
We also have some important information on staying safe if you’ve got blood cancer, covering things like risk of infection and vaccinations.
Risk of infection
Infections are caused by tiny living things (organisms) such as bacteria, viruses and fungi. Some of these organisms live inside your body without causing problems, and can even be good for your health. But others can be harmful, and if your immune system isn’t able to fight them off, you may become unwell.
Both blood cancer itself and treatments for blood cancer can weaken your immune system and increase your risk of infection. It’s important to know how to look after yourself so you can reduce this risk.
Your healthcare team will advise you on the steps you can take to minimise your risk of infection. Some simple steps include:
- cleaning your hands frequently
- making sure your food is stored and cooked properly
- avoiding people who have infections or are sick
- avoiding crowded places like public transport, festivals and shopping centres.
It’s important to recognise the signs of an infection, so you can get help quickly. Not everyone will get all, or even any, of the symptoms listed − so if you feel unwell, even without any symptoms, let your nurse or doctor know.
Symptoms of infection include:
- fever (temperature higher than 38°C)
- low temperature (less than 36°C)
- feeling confused
- sore throat or cough
- rashes or swelling
- frequent watery poos (diarrhoea)
- a burning or stinging feeling when weeing
- fluid with an unusual smell, colour or texture coming from your vagina (unusual vaginal discharge), or itching in that area
- unusual stiffness of the neck
- achy, flu-like symptoms
- generally not feeling well.
If you spot any of these signs, you should let your healthcare team or hospital know straight away.
If you do get an infection, there are things your healthcare team can do to help. This might involve you taking antibiotics (which treat bacterial infections), anti-viral medicines (which treat viruses) or anti-fungal treatments (which treat fungal infections).
These can all be given as tablets or through a vein (intravenously). Anti-viral medicines and anti-fungal treatments can also be given as a cream.
There's more about infection and ways to lower your risk in our Understanding infection fact sheet.
If your immune system is significantly weakened, you may develop a condition called neutropenia. This is where your body doesn’t produce enough healthy white blood cells called neutrophils, making it harder for your body to fight infections.
Neutropenia can happen as a result of blood cancer itself, or as a result of certain blood cancer treatments.
Your doctors will be able to tell if you’re neutropenic by taking a blood sample and looking at the number of neutrophils in your blood. What’s considered ‘neutropenic’ can vary between different doctors, healthcare teams and hospitals, but the most common neutropenic ranges are:
- Between 2.0 and 7.5 x 109/ L: Not neutropenic
- Less than 2.0 x 109/ L: Neutropenic
- Less than 0.5 x 109 / L: Severely neutropenic
If you’re ‘neutropenic’ or ‘severely neutropenic’, you’ll need to take extra care to avoid infections that you might get from food, because your body won’t be able to destroy germs as easily. Always follow ‘use by’ dates and always keep cooked and raw meat separate in the fridge. You should also avoid people with infections, cold and flu symptoms, or stomach bugs (viral gastroenteritis).
Changing to a neutropenic diet
Your healthcare team may recommend that you make some changes to your diet to lower your risk of getting an infection from food. This is sometimes called a ‘neutropenic diet’ or a ‘clean diet'.
There’s some debate about whether you need to adapt or change your diet when you’re neutropenic. Some healthcare professionals believe that it’s very important to follow a neutropenic diet, but others give less strict advice and instead encourage people to eat a balanced diet.
If you’re unsure about what to do, speak to your doctor, dietitian or clinical nurse specialist. They will be able to advise you. Remember, you shouldn’t make any changes to your diet without getting advice from your healthcare team first.
For more information about neutropenia, including a list of foods to avoid and some helpful recipes, order or download our booklet Eating well with neutropenia.
If you get an infection while you’re neutropenic, you’ll be at risk of a serious condition called neutropenic sepsis, which can be life-threatening. If you develop this complication, you’ll need to go to hospital straight away, so it’s important that you talk to your doctor about how to spot the symptoms of neutropenic sepsis and follow their advice.
You’re at most risk of neutropenic sepsis if you have neutropenia and:
- you have a temperature above 38°C or below 36°C,
- or you’ve had any type of anti-cancer treatment in the last four weeks.
Sickness and vomiting
Feeling sick (nausea) and being sick (vomiting) is very common in people with cancer. About half of people with cancer are affected by this side effect.
You might feel sick or vomit if blood cancer causes these symptoms:
- liver and kidney damage
- too much calcium in your blood
- pressure in the brain.
Treatments for blood cancer can also cause sickness and vomiting. You may feel sick or vomit if your treatment includes:
- anti-cancer drugs such as chemotherapy or a biological therapy
- treatment with radiation (radiotherapy).
Treatment-related sickness can happen at different times:
- immediately or within a few hours of having anti-cancer treatment (acute onset)
- more than 24 hours after treatment (delayed onset)
- before treatment (anticipatory).
Other possible causes of feeling sick or vomiting are having mucositis (a sore mouth or gut) caused by cancer treatment, having an infection, or feeling anxious about cancer or the treatment.
There are different types of drugs that can help treat sickness and vomiting. These are called anti-sickness (or anti-emetic) drugs and may be given as:
- a small solid pill pushed gently into your bottom (back passage), called a suppository
- patches you stick on your skin.
Your doctor will discuss appropriate treatments with you. It’s important to take the medication your healthcare team recommends, as this can help prevent sickness and vomiting.
Ways to manage eating and drinking
Some people find the following tips can be helpful:
- If strong smells make you feel sick, try avoiding hot food – many people find it smells stronger than food that’s cold or room temperature.
- Try to avoid cooking when you’re feeling sick. Cook and freeze meals in advance or ask someone else to cook.
- Avoid fried, spicy and very sweet foods. Plain, bland foods may be easier to eat.
- Prepare small meals and eat little and often.
- Chew your food well and sip drinks slowly.
- Avoid drinking a lot before you eat.
- Try to make sure you drink enough fluids. If you don’t feel like drinking, you might find it easier to suck on ice cubes.
- Some people find peppermint tea, peppermints, ginger beer or ginger biscuits helpful.
If you’re worried you’re not eating or drinking enough, speak to your healthcare team who will be able to help. They may offer you high-calorie drinks to make sure your body gets what it needs. Or they may refer you to a dietitian.
Other tips to help you feel more comfortable
- Wear loose fitting clothing.
- Avoid nasty smells as much as possible.
- Open a window or go outside to get fresh air.
- Distract yourself with activities such as reading a magazine or watching a film.
For more information on how to deal with sickness and vomiting, see our fact sheet on managing sickness and vomiting.
Sore mouth or gut (mucositis)
Mucositis is a common side effect of chemotherapy and radiotherapy for blood cancer. It causes soreness in the lining of your gastrointestinal (GI) tract, which includes your mouth, food pipe, stomach and gut.
This page explains the symptoms of mucositis in the mouth and gut, the treatments available things you can do to help yourself.
Mucositis can be painful, but it can be treated and it gets better with time. Getting treated early can help, so tell your healthcare team if you have any symptoms.
Sore mouth (oral mucositis)
- A dry mouth, which can lead to gum infections
- Ulcers or blood blisters in your mouth, or on your tongue or lips
- A sore or painful mouth
- Bad breath
- Oral thrush – a fungal infection which causes white patches in the mouth
Symptoms normally appear within two weeks of starting treatment and get better three or four weeks after finishing treatment. More severe symptoms may take longer, and you may need to stay in hospital.
There are treatments that can lower the risk of mucositis and help with the symptoms:
- Painkillers – You might be offered tablets, mouthwashes, gels or sprays. If you’re in a lot of pain, you may be given drugs containing morphine.
- Benzydamine (Difflam®) – An anti-inflammatory mouthwash or spray that contains a local anaesthetic to numb pain.
- Antifungal medicines – Tablets or drops to stop oral thrush developing.
- Low level laser therapy – A laser treatment that can reduce pain and inflammation and encourage healing.
- Artificial saliva products – These can help with a dry mouth.
- Caphosol® – A rinse which cleans and moistens the mouth.
There are things you can do to help with oral mucositis:
- Brush your teeth and gums at least twice a day using a very soft child’s toothbrush and a mild fluoride toothpaste.
- Rinse your mouth with a mild alcohol-free mouthwash, plain water or saltwater throughout the day.
- Suck on ice cubes, crushed ice, ice cream or ice lollies, especially if you have a dry mouth.
- Avoid smoking, alcohol, hot drinks, spicy foods.
- Look out for signs of infection (see below).
Sore gut (GI mucositis)
Some of these symptoms can be upsetting and hard to talk about, but do tell your healthcare team about them, so they can get you the best treatment.
The main symptoms are:
- Diarrhoea (frequent, watery poos)
- Ulcers around your rectum or anus
- Bleeding from your gut, which you may notice as blood in your poo
- Trouble swallowing
- Feeling sick
- Constipation (difficulty pooing)
- Stomach cramps
Symptoms normally appear within two weeks of starting treatment and clear up a few weeks after your treatment finishes. Sometimes diarrhoea can continue for some months after radiotherapy.
Treatments for GI mucositis can include:
- Anti-sickness tablets – If you’re feeling sick.
- Drugs to reduce stomach acid or numb pain – If you have symptoms of indigestion.
- Drugs to relax your gut – If you have sharp stomach cramps.
- Loperamide – To treat diarrhoea.
- Octreotide – If loperamide doesn’t work, you may be given octreotide.
Your healthcare team can also give you things to make you feel more comfortable, such as incontinence pads or pants, or creams to soothe a sore anus.
There are things you can do to help with GI mucositis:
- If you have diarrhoea, it’s important to avoid dehydration. Drink at least two litres of water a day. You can mix in cordial or squash if you like.
- Avoid acidic foods such as tomatoes, oranges and lemons
- Avoid spicy foods
- Look out for signs of infection (see below)
Look out for signs of infection
If you have mucositis, you’re more likely to get an infection. This is because the lining of your gut, which normally acts as a barrier to stop germs getting into your blood, is damaged.
Tell your healthcare team straight away if you have signs of infection. Symptoms of infection include:
- Fever (temperature higher than 38°C)
- Shivering and sweating
- Achy flu-like symptoms
- Sore throat and cough
- Frequent watery poos (diarrhoea)
- Generally not feeling well
We have more detailed information about mucositis in our fact sheet, Mucositis (sore mouth or gut).
There's more about infection and ways to lower your risk in our Understanding infection fact sheet.
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