Side effects of chemotherapy for brain tumours

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An in-depth description of the potential side effects of chemotherapy for children suffering from brain tumours.

Key points

  • Your child may start to experience several side effects within 30 minutes to a day of having chemotherapy, followed by more side effects within two or three weeks.
  • Your child's doctor can prescribe medication to help alleviate side effects.
  • Major side effects include anemia, nausea, vomiting, hair loss, digestive and feeding problems, and infections.

Some medicines have unwanted effects on the body. These are called side effects. The side effects from chemotherapy drugs depend on the type of drugs, the dose of drug, and your child’s reaction. Some children may not have any side effects.

Some medicines have unwanted effects on the body. These are called side effects.

The side effects from chemotherapy drugs depend on the type of drugs, the dose of drug, and your child’s reaction. Some children may not have any side effects.

Within 30 minutes to a day

  • Nausea or vomiting
  • Allergic reaction

Within two or three weeks

  • fatigue
  • infection
  • low blood counts (myelosuppression): There are three main types of blood cells. All three types can be affected.
  • low number of white blood cells (neutropenia)
  • low number of platelets (thrombocytopenia)
  • low number of red blood cells (anemia)
  • loss of appetite
  • sore mouth or throat
  • diarrhea
  • constipation
  • taste changes
  • pain and damage to the ends of nerves in hands, feet, or jaw (neuropathy)
  • hearing loss
  • hair loss
  • changes to mood or behaviour

What can be done to deal with the side effects of chemotherapy?

The doctor may prescribe several drugs to improve or prevent the side effects of chemotherapy. Some of these drugs are used specially for chemotherapy. You can also make your child more comfortable by following some of the suggestions here, which are listed alphabetically.


When chemotherapy lowers the number of red blood cells in your child’s blood, it can lower the haemoglobin count. This can cause them to have anaemia.

What is a normal haemoglobin count?

Normally your child’s haemoglobin count should be between 110 and 140.

What happens if your child's haemoglobin gets too low?

If your child's haemoglobin count is less than 70 or if your child gets the signs of anaemia, they may need a transfusion of red blood cells.

How will I know if my child has anemia?

If your child has anaemia, they may have these signs:

  • pale skin
  • no energy
  • a poor appetite
  • shortness of breath

What you can do to help your child with anaemia

The following ideas may help your child:

  • Let them get plenty of rest. Taking naps during the day can help.
  • Limit their activities. they may feel too tired to take part in normal activities.
  • Offer a well-balanced diet.
  • When sitting, tell them to get up slowly. When lying down, ask them to sit first and then stand. This will help prevent dizziness.

What is a transfusion?

A transfusion is getting a part of the blood, such as red blood cells or platelets, that have been given by another person. These types of transfusions are called a red blood cell transfusion or a platelet transfusion.


Some chemotherapy medicines, pain medicines, and other medicines can cause constipation. If your child has not had a bowel movement for more than two to three days, call your doctor. they will tell you if your child needs to take medicine, such as lactulose. This drug is a stool softener which makes bowel movements easier. Do not give your child a laxative unless the doctor has told you to.

What you can do

  • serve plenty of fluids such as water, tea, diluted fruit juice, or prune juice
  • make sure your child takes part in some physical activity every day


Chemotherapy drugs may cause watery or loose stools (diarrhea). In serious cases, the doctor may prescribe a medicine to control the diarrhea. If your child’s diarrhea has been very severe, the doctor or nurse may suggest oral rehydration therapy to replace the water and important electrolytes lost. This is usually a drink that contains sodium, potassium​, chloride, and sugars. Do not give your child any medicines for diarrhea without asking their doctor.

What you can do

  • Offer plenty of drinks throughout the day. Try water, clear broth, ginger ale, or sports drinks such as Gatorade or oral rehydration therapy.
  • Serve small amounts of food throughout the day, instead of three large meals.
  • Serve fruits such as bananas.
  • Avoid sweet, fried, greasy, or spicy foods.
  • Your doctor may recommend a lactose-free diet for your child during the time they have diarrhea. Lactose is a sugar found in milk and milk products.
  • Infants should continue breastfeeding.

Feeding and appetite problems

Changes in taste

In some cases, chemotherapy or radiation therapy can cause a change in the sense of taste. Food may taste bitter or metallic. It might not have as much flavour as before. Your child might prefer unusual spicy foods during treatment but will go back to normal after treatment ends.

What you can do

  • Try new foods or recipes.
  • Improve the flavour of food. Use seasonings such as basil, mint, lemon juice, sweet sauces, pickles, ketchup, or others. Improve the flavour of meat by marinating it in sweet fruit juice or soy sauce.
  • Stop serving problem foods.

Loss of appetite

Loss of appetite or poor appetite is a common problem with cancer and its treatment. The following advice may help to make mealtimes more relaxed so that your child will feel like eating.

What you can do

  • Offer three small meals and two or three small nutritious snacks each day.
  • Keep high protein, high energy snacks available in the refrigerator.
  • Make mealtimes fun: serve foods with different colours and shapes, use garnishes, serve favourite foods more often, use colourful place settings, have a picnic, invite a friend for a meal or snack.
  • Make sure your child takes anti-nausea medications regularly if your child is feeling nauseous.
  • Make sure your child is having regular bowel movements.
  • Do not argue, nag, or punish your child. Forcing them to eat will not help if they refuse to eat.

Hair loss

Hair loss is a common side effect of some chemotherapy drugs. Your doctor can tell you if hair loss might occur with the medicines your child is taking. Hair loss can occur on all parts of the body. The hair may fall out gradually or in clumps, but it will grow back. Sometimes, it may be a different colour or texture.

Hair roots are also sensitive to radiation. Hair in the treatment area may fall out. In most cases the hair will regrow within two or three months. However, higher doses of radiation may cause permanent hair loss.

What you can do

  • Your child may wish to wear a wig. You may be able to buy or borrow a wig. If you get a prescription, health insurance might cover part or all of the cost.
  • If your child doesn’t want a wig, they may pick out several hats or scarves before hair loss begins. They could start wearing them before hair is lost to become comfortable with them.
  • Use a mild shampoo and soft hair brush.
  • Use a sun screen, sun block, hat, or scarf to protect their scalp from the sun if they lost hair on their head.

Hearing loss

Chemotherapy may have an impact on hearing. Some chemotherapy drugs, such as cisplatinum or, to a lesser extent, carboplatin, can damage hearing cells. A specialist called an audiologist will monitor your child’s hearing during treatment. The doses of drugs will be decreased if hearing loss occurs to preserve hearing.

Infants treated with a cisplatinum are at risk for losing their ability to hear high-pitched sounds. Examples of high-pitched sounds include the letters “s” and “f.” If children have problems hearing these sounds, then they may have problems learning to say them. Some of these sounds are important for language development. For example, the “s” sound is used to make a plural, as in dogs and cats. It is also used to show the possessive, as in daddy’s car or mommy’s dress. Speech and language therapy with a speech-language pathologist is effective in helping children overcome these problems.

Infectious disease exposure

It is important to know that your child must stay away from people with infectious diseases, such as measles, chicken pox, shingles, or mumps. If your child is around anyone who has any of these diseases, call your nurse or doctor right away. If your child breaks out with chicken pox or shingles, contact your nurse right away. Your child may need to be admitted to the hospital and receive anti-viral medicine. Please do not bring your child to the clinic without calling your clinic nurse first. Your child will need to be isolated from the other children in clinic or the emergency department.

Infections of central lines

Central lines are thin tubes inserted into a large vein leading to the heart. Central lines can be used to provide chemotherapy drugs, antibiotics, other medicines, fluids, and nutrition to your child intravenously. One common complication of central lines is bacterial infection. The main symptoms of bacterial infection are fever, with or without chills, and swelling of the skin in the area where the central line enters the vein. Bacterial infection can be diagnosed with a blood test, although sometimes it is difficult to say for sure that the infection is due to the central line.

Central line bacterial infections are treated with antibiotics. The choice of antibiotics is determined by how ill the child is, and what the bacteria is thought to be. Antibiotics are usually started intravenously until the child has stabilized. Then a switch may be made to an oral agent. Your child's doctor will determine how long they need to receive antibiotics, depending on how serious the infection is. In some rare situations, and with certain types of bacteria, the central line may need to be removed. Once the infection is cured, the central line can be reinserted.

Nausea or vomiting

If your child feels sick or is throwing up, the doctor may prescribe anti-nausea (anti-emetic) drugs. One example of an anti-nausea or anti-emetic drug is ondansetron​. Sometimes your child may need more than one kind of anti-nausea drug. You will get to know how your child responds to each type of chemotherapy. If your child has been vomiting a lot, the doctor or nurse may suggest oral rehydration therapy to replace the water and important electrolytes lost. This is a drink that contains sodium, potassium, chloride, and sugars.

What you can do

  • If your child has been vomiting, rinse their mouth with water. For smaller children wipe the inside of the mouth with a damp cloth. Give your child small sips of water frequently.
  • Give your child anti-nausea medications regularly.
  • Give your child small meals throughout the day.
  • Serve dry, bland foods like crackers, toast, yogurt, pretzels, oatmeal, and soft and bland fruits and vegetables. Popsicles or ice chips may help with the nausea.
  • Avoid sweet, fried, or fatty foods.
  • Try giving water, unsweetened fruit juice, or flat ginger ale between meals. Tell your child to drink slowly.
  • if your child is not drinking well, encourage ice chips or popsicles.
  • Some foods, such as meats or chicken, may be more acceptable if they are served cold or room temperature.
  • If nausea occurs during chemotherapy, do not serve food for a few hours before.
  • When your child can keep down clear liquids, gradually work up to a regular diet.
  • Keep the kitchen or dining room well aired so there are no bad smells.

Neuropathy (nerve pain)

Sometimes chemotherapy drugs can cause damage to nerves. Your child may feel tingling, numbness, weakness, or pain in the hands or feet. Sometimes these symptoms appear after treatment stops. In most cases, the symptoms will go away in time. It can take up to a year for this to happen. The dose of chemotherapy may need to be reduced if neuropathy occurs.

What are the symptoms of neuropathy?

You should tell your child’s treatment team if she has any of these signs.

  • tingling
  • burning
  • weakness or numbness in the hands and/or feet
  • walking problems
  • weak, sore, tired, or achy muscles
  • clumsiness
  • difficulty picking up objects and buttoning clothing
  • shaking or trembling


Chemotherapy lowers your child's white blood cell count. White blood cells protect your child from infection. They find and kill the germs called bacteria in your child's blood. There are many types of white blood cells. The type you will hear most about is the neutrophil. The number of neutrophils in your child's blood is called the poly count.

With some chemotherapy protocols, a drug called granulocyte colony stimulating factor (GCSF) is given to increase white blood cell production.

What are normal white blood cell counts and poly (neutrophil) counts?

Normally your child’s total white blood cell count should be between 5 and 12. The poly count should be between 1.5 and 8.5. Usually a poly count of more than 1.0 is okay if your child is having chemotherapy.

What happens if your child has neutropenia?

If your child has neutropenia, her white blood cell count will be less than 1.0 and the poly count will be 0.5 or less. This means that your child's body will not be able to fight infection as well as usual.

What are the signs of an infection?

Your child may have these signs of an infection:

  • fever and chills
  • a sore throat
  • mouth sores
  • a cough
  • pain when he urinates (pees)
  • loose or watery bowel movements (diarrhea)

Your child may have an infection if you see any of these signs. Call the treatment team.

What happens if your child has an infection?

If your child has an infection, they may have a fever. Your child will need to go to the hospital as soon as possible if:

  • your child’s fever is 37.8°C / 100.0°F, taken under the arm
  • your child’s fever is 38.5°C / 101.3°F, taken in the mouth

If your child has a fever and a poly count less than 0.5, your child will have to take antibiotics, which are medicines that fight infection. Initially the antibiotics will be given intravenously.

Your child will have to stay in hospital for at least two days, or 48 hours, until the blood culture results are back. they may have to stay in the hospital for as long as seven to 10 days to receive antibiotics.

What can you do to help prevent infections if your child has neutropenia?

Most infections are caused by an imbalance of good versus bad bacteria in your child's body. Because of this, most infections cannot be prevented from arising. But there are certain things you can do to help reduce the risk:

  • wash your child's hands well and often
  • stay away from large crowds
  • do not have certain immunizations, such as pneumonia shots, without checking with the doctor
  • avoid eating raw meat, including fish, seafood, or eggs

Mucositis (mouth sores)

When your child has a low white blood count, they may develop mouth sores. To help prevent them, try the following:

  • Have your child rinse their mouth often with water to help remove food.
  • Make sure your child brushes after each meal. Use a soft toothbrush or a damp swab or cloth.
  • Visit the dentist regularly, and whenever problems arise.

If your child has mouth sores, the treatment team will prescribe a special mouth wash. Your child may require pain medication.


Chemotherapy can lower your child’s platelet count. Thrombocytopenia is a condition that can occur when there is an abnormally low number of thrombocytes (platelets). When this count drops, she may have bruises and bleeding.

What is a normal platelet count?

Your child’s platelet count should be between 150 and 450.

If your child's platelet count is less than 20, if your child has bleeding or a lot of bruising, she may need a transfusion of platelets. Your child may have nosebleeds.

What are signs of thrombocytopenia?

  • unexpected bruising
  • small red spots under the skin
  • reddish or pinkish urine
  • black or bloody bowel movements
  • headaches or changes in vision

What do you do if your child gets a nosebleed?

Have your child sit up, lean forward, and spit out any blood. Have a basin available so he can spit out any blood that drains into his throat. Swallowed blood is irritating to the stomach. Don't be surprised if it is vomited up. Keep your child leaning forward and use a tissue if you wish to catch the blood but do not pinch the nose. If the bleeding does not stop, contact the treatment team.

How can you prevent your child bleeding if her platelet count is low?

To prevent bleeding in your child, she should:

  • Use a soft toothbrush so that her gums do not bleed.
  • Drink lots of liquids and eat foods with lots of fibre, such as fresh fruit and vegetables, and beans. This will help her have regular, soft bowel movements without bleeding.
  • Not take aspirin or any other medicine or natural product that has the word salicylate or ASA or acetylsalicylic acid​ on the label. If you are not sure, ask your pharmacist for medicines without salicylate in them.
  • Avoid activities that might make her fall and cause bleeding. For example, your child should not play rough sports such as hockey or football. She should also not ride a bicycle or a skateboard until counts have returned to normal.
Last updated: July 10th 2009