A cancer diagnosis can turn a person’s life upside down. Dealing with chemotherapy side effects is one of the many challenges you may face, but symptoms can usually be managed to help improve your quality of life.

Traditional, or cytotoxic, chemotherapy is the mainstay of treatment for small-cell lung cancer (SCLC). Unfortunately, this type of treatment kills not only cancer cells but also fast-growing healthy cells throughout the body, such as those in the mouth, gut, hair follicles and bone marrow, which can lead to a wide range of side effects.

Fatigue is one of the most common symptoms of cancer as well as a side effect of many types of treatment, so it can be difficult to pinpoint an exact cause. People with cancer often feel tired, weak or run-down and may be unable to do some of their usual activities. In some cases, other cancer symptoms or medication side effects can interfere with good sleep, making the problem worse. It may be helpful to schedule more strenuous activities or events around your chemotherapy cycles. Fatigue is often worse soon after administration and then improves during the time off treatment. Moderate physical activity and a healthy diet can help maintain energy levels.

But cancer and its treatment can affect the desire and ability to eat. Many people experience loss of appetite, or anorexia, which can lead to weight loss and missing out on important nutrients. Nausea, vomiting and diarrhea are also common, with severity and duration varying widely from person to person. Chemotherapy can also cause mouth sores (stomatitis), which can make eating painful. What’s more, some medications can alter the sense of taste, known as dysgeusia. Many people report a metallic taste, while others find that everything tastes bland. It’s easy to find tips about what to eat or avoid as well as home remedies for improving appetite, such as peppermint, ginger or cannabis . But the best approach may be experimenting with different foods and drinks to find out what works best for you. If you’re losing more weight than you want, focus on calorie- and nutrient-rich foods to make every bite count.

Pain is another common symptom of cancer and its treatment. Not everyone living with cancer experiences pain, and it is more likely in those with advanced cancer that has spread throughout the body. Some chemotherapy drugs cause peripheral neuropathy, or nerve damage in the extremities, resulting in pain, burning, tingling or numbness in the hands and feet. Pain management depends on its specific cause. Sometimes it can be relieved with over-the-counter medications, but severe or chronic pain may require stronger medications, and your doctor may refer you to a pain specialist.

Blood Cell Deficiencies

One of the most serious side effects of chemotherapy is myelosuppression, or damage to the bone marrow, which can lead to blood cell deficiencies. Stem cells in the bone marrow give rise to all the different types of blood cells, including red blood cells, white blood cells and platelets. Loss of blood cells can cause a wide variety of symptoms. In some cases they may require interruption or discontinuation of treatment and may even be life-threatening.

Red blood cells transport oxygen throughout the body. Loss of red blood cells and their oxygen-carrying hemoglobin protein is known as anemia. Anemia is one of the most common causes of fatigue. Other symptoms may include shortness of breath, headache, irregular heartbeat and dizziness or fainting.

Platelets are cell fragments that enable the blood to clot. Platelet deficiency, known as thrombocytopenia, can lead to easy bruising, prolonged bleeding or even life-threatening hemorrhage. People with low platelets may experience headaches, nosebleeds or bleeding gums, bloody vomit or stools (a sign of internal bleeding) and heavy menstruation.

White blood cells are the soldiers of the immune system. Neutropenia, or loss of immune system first responders known as neutrophils, can leave people susceptible to infections. Loss of B cells, which produce antibodies, can lead to weakened immune function and poor response to vaccines.

Around half of people treated with chemotherapy will have some level of neutropenia, according to the American Society of Clinical Oncology. Neutrophil counts generally start to fall several days after starting each round of chemotherapy, reach a low point after one to two weeks and then begin to rise again. But it can take a few weeks to return to a normal level. Your doctor may order lab tests to monitor your neutrophil level.

People with low white blood cells should take precautions to avoid infections. These include following safety guidelines for handling and preparing food and taking precautions to avoid respiratory diseases, such as influenza and COVID-19. It may be necessary to limit contact with other people—or spend time in the hospital—when white blood cell counts are very low. Even minor infections can quickly become serious when immune function is impaired, so it’s important to tell your care team about symptoms such as fever.

Breaks in chemotherapy cycles allow time for blood cells to recover, but sometimes other measures may be needed. In severe cases, patients may require blood transfusions to replace red blood cells or platelets. Growth factors are chemical messengers (cytokines) that stimulate blood cell production and maturation. Erythropoietin may be administered to spur red blood cell production, interleukin 11 stimulates platelet production and colony-stimulating factors, such as filgrastim and sargramostim, encourage white blood cell production. Another type of medication, known as a kinase inhibitor, may be used prior to certain types of chemotherapy to protect the bone marrow and prevent myelosuppression.

Cancer and its treatment can also affect your mental health. Stress, anxiety, grief and depression are common, especially among people facing advanced or recurrent cancer that is unlikely to be cured. Mental health concerns can often be addressed with counseling, medications or a combination approach.

To prepare for chemotherapy, ask your doctor about what side effects you can expect during and after treatment, but keep in mind that these differ widely from person to person. Your care team can also discuss what steps you can take to prevent or manage side effects and improve your overall well-being.