Colorectal chemotherapy side effects: what to report and when

Know which medicines you are receiving

FOLFOX includes oxaliplatin with fluorouracil and leucovorin; CAPOX uses capecitabine with oxaliplatin. FOLFIRI includes irinotecan with fluorouracil and leucovorin. Additional targeted or immune medicines can add a different set of side effects.

Keep the generic names and treatment dates on your phone or on a card. Tell any clinician seeing you for an urgent problem when the last dose was given. If you use an infusion pump or oral tablets, ask for clear instructions about a device problem, a missed dose and when to contact the treatment unit.

Sources and references: [1] [2]

Report tingling before it affects everyday tasks

Oxaliplatin can cause sensory symptoms, including tingling or numbness. Describe their timing and whether they persist between cycles. Trouble fastening buttons, handling hot objects or walking safely tells the team more than simply saying the symptoms are mild.

The clinician may adjust treatment when nerve symptoms accumulate. At home, reduce fall risks and take care with heat if sensation is reduced. Ask the team about cold-triggered symptoms and its specific precautions for your regimen. Do not wait for the final cycle to mention a change in function.

Sources and references: [1] [3]

Diarrhea needs a plan matched to the cause

Irinotecan and fluoropyrimidines can cause diarrhea, and immune therapy or an infection can also cause it. Tell the team how many stools you are passing compared with your usual pattern, whether there is blood, and whether you can drink and urinate normally.

Follow the antidiarrheal instructions given for your regimen; different causes may need different treatment. Contact the team promptly for persistent or worsening diarrhea, and seek urgent assessment for severe pain, fever, faintness or dehydration. A patient with a stoma should also report a major increase in watery output.

Sources and references: [1] [4]

Treat fever during chemotherapy as urgent

Chemotherapy can lower neutrophils, the blood cells that help fight infection. Fever around 38°C or above, shaking chills or feeling suddenly very unwell needs an immediate call to the oncology team, following any stricter threshold it has given you.

If the team cannot be reached promptly or you are seriously unwell, seek urgent local medical care. Tell staff you are receiving chemotherapy. Check with the team before using fever-reducing medicine to mask a temperature, because it can hide an important sign of infection.

Sources and references: [5]

Mouth soreness and hand-foot symptoms are treatable

Fluoropyrimidines may cause mouth soreness or painful skin changes on the hands and feet. Report symptoms that interfere with eating, walking or using your hands. They can become more difficult to manage if the next cycle starts before the team knows about them.

Ask for a mouth-care and skin-care plan appropriate to your medicines. Keep up fluid intake as tolerated and seek advice if swallowing is painful or intake is falling. Discuss any supplements or over-the-counter products before using them, especially when mouth ulcers or broken skin are present.

Sources and references: [2] [6] [1]

Track how fatigue changes your day

Fatigue may follow a predictable pattern after each cycle, but a sudden worsening can reflect dehydration, infection, anemia or another problem. Record what you can do compared with your usual level: walking to the bathroom, preparing food or staying awake through a conversation.

Allow help with meals and transport, and ask the team what level of activity is appropriate. Persistent vomiting, inability to keep fluids down or marked weakness should be assessed promptly. Severe chest pain or breathing difficulty needs emergency care, including if it occurs during an infusion.

Sources and references: [2] [5]

Dose changes are part of ongoing treatment

The team may delay a cycle, reduce a dose, omit one drug or add symptom treatment. The choice depends on the side effect, treatment goal and response. Ask how a change affects the overall plan and what improvement is needed before treatment resumes.

A short symptom diary can guide that decision. Include onset, severity, bowel changes, temperature when unwell and medicines taken. For oral chemotherapy, follow the prescriber's hold instructions and contact route. Never take extra tablets to make up a dose without specific medical direction.

Sources and references: [2] [1]

Arrange local support during Shanghai treatment

If you are considering chemotherapy in Shanghai, establish where urgent assessment and between-cycle blood tests will happen. A colorectal service such as Fudan University Shanghai Cancer Center is one resource for a treatment inquiry.

EastMedGo can help coordinate practical questions about visits, records and communication with the treating service. Use contact to discuss the proposed schedule and where you will stay. Before treatment starts, obtain the clinical team's emergency instructions and identify a nearby hospital; urgent symptoms need medical care where you are.

Sources and references: [7] [5]

Common questions