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NCCN Guidelines for Patients


Adolescents and Young Adults with Cancer, Version 1.2017


Coping with side effects

How do I cope with side effects?

How do I cope with side effects?

There are some side effects that occur with many

types of cancer treatment. Although a full list is

beyond the scope of this book, the following pages

offer tips for coping with some of the most common

side effects.

Nausea and vomiting

Why it happens

The nausea and vomiting that happens during cancer

treatment has more to do with your brain than with

your stomach. Cancer treatment can wake up a

section of the brain called the CTZ (






one), which helps the body recognize and get

rid of toxic or dangerous substances. (If you’ve ever

had food poisoning or felt queasy, you’ve experienced

the CTZ in action.) Since most cancer treatments are

toxic, they tend to trigger the CTZ.

What you can do

The basic rule of dealing with nausea is to stay ahead

of it. It’s a lot easier to prevent vomiting than it is to

stop vomiting once you’ve started. So be sure to let

your treatment team know if you have nausea or

vomiting right before treatment—a condition known as

anticipatory nausea.

Medicine can be given to prevent the “puke

now” signals from reaching the CTZ. This can

include: ondansetron, granisetron, dolasetron,

prochlorperazine, promethazine, metoclopramide, and

aprepitant. When given before chemotherapy, they can

prevent nausea for up to 24 hours.

Other medicine that can help prevent or ease nausea

and vomiting include:


Steroids such as dexamethasone


Tranquilizers such as lorazepam


Antihistamines such as diphenhydramine



If the medicine isn’t working, you might want to

consider asking your doctor to prescribe medical

marijuana. The active substance in marijuana—a

chemical called THC (







relieve nausea and get the appetite going.

There are also some natural and complementary

therapies used to prevent and calm nausea and

vomiting. They can be used with anti-nausea and

vomiting medicine, including acupuncture and ginger

root (as candy or tea). Staying well hydrated and

eating frequent, small meals can also help.

Hair, skin, and nail changes

Why it happens

Because the cells of your hair follicles, skin, and

nails divide quickly, they can be damaged by some

chemotherapy drugs. In addition to the classic cancer

side effect of hair loss (alopecia), cancer treatment

can cause changes in the appearance of your nails

and leave them weak and brittle. It can also cause

skin problems such as dryness and, rarely, painful

inflammation of the palms and soles of the feet called

hand-foot syndrome.

What you can do

If your treatment can cause hair loss, you’ll want to

make plans on how to deal with it before treatment

starts. Some people find it helpful to shave their

heads or cut their hair short. If you’d rather save as

much of your hair for as long as possible, be gentle

with it—baby shampoo, no harsh chemicals or blow


Being gentle is equally important when caring for your

nails and skin. As your nails may be much more likely

to catch and tear, consider keeping them short and

well-trimmed and steer clear of fake nails and tips.