Cancer Expert MD

Side effects are what many people fear most about chemotherapy, and they are the most common reason doses are lowered or treatment is stopped early. Yet many of them can be prevented or eased, often with simple, inexpensive measures tested in randomized trials around the world. This article explains what the research shows for nerve damage, nausea, hair loss, mouth sores, fatigue, diarrhea and radiation skin damage, and which supplements can interfere with treatment.

Nerve Damage: Numbness and Tingling

Drugs such as paclitaxel, docetaxel and oxaliplatin can damage the nerves in the hands and feet, sometimes permanently. Prevention matters most, because once the damage is done it is hard to reverse.

Cooling the hands and feet. Wearing frozen gloves and socks from 15 minutes before a paclitaxel or docetaxel infusion until 15 minutes after narrows the blood vessels in the hands and feet, so less drug reaches the nerves. In a study at Kyoto University in Japan, each patient cooled one hand and foot but not the other, and the cooled side had much less nerve damage.¹ A 2025 review of the trials found that cooling cut moderate-to-severe nerve damage by more than half.² In a 2026 Chinese randomized trial, 65 percent of women who used cold therapy had no nerve damage by the fourth cycle of paclitaxel, compared with 45 percent without it, and their nerve tests were better.³

Compression. Wearing two layers of tight surgical gloves during the infusion works the same way. In the French ELEGANT study, compression with surgical gloves prevented nerve damage better than frozen gloves and was more comfortable.⁴ Cooling is not used during oxaliplatin, which makes nerves sensitive to cold.

Once damage has happened. The antidepressant duloxetine reduced nerve pain in a randomized trial.⁵ Ozone therapy, studied in Spain, and magnetic field therapy, studied in Germany, have also improved numbness and tingling. See our articles on ozone therapy and PEMF.

Nausea and Vomiting

Olanzapine. Adding this inexpensive medicine to standard anti-nausea drugs increased the number of people with no nausea at all over the five days after chemotherapy to 37 percent, from 22 percent.⁶ In the Japanese J-FORCE trial, a lower dose of 5 mg worked well with less drowsiness, protecting 79 percent of patients from vomiting in the days after treatment, compared with 66 percent.⁷

Ginger. In a randomized trial of 576 patients, taking 0.5 to 1 gram of ginger a day, starting three days before chemotherapy, reduced nausea on the day of treatment.⁸

Acupressure. Pressure on a point on the inner wrist, often with an inexpensive wristband, has reduced nausea in several trials.

Hair Loss

Scalp cooling caps, such as Paxman and DigniCap, chill the scalp during each infusion so less drug reaches the hair follicles. In the SCALP trial of women receiving chemotherapy for breast cancer, 50.5 percent of those who used scalp cooling kept most of their hair, compared with none of those who did not.⁹ Scalp cooling works best with taxane drugs and less well with anthracyclines such as doxorubicin.

Mouth Sores

Sucking on ice chips during short infusions of fluorouracil and high-dose melphalan reduces mouth sores. Photobiomodulation, gentle red and near-infrared light applied to the inside of the mouth, is recommended by international supportive-care guidelines to prevent mouth sores during stem cell transplantation and radiation for head and neck cancer.¹⁰ Gentle brushing and frequent salt-and-baking-soda rinses also help.

Fatigue

Movement. Regular walking and light strength exercise are the best-studied treatment for cancer fatigue.

American ginseng. In a randomized, placebo-controlled trial of 364 people with cancer-related fatigue, 2,000 mg a day of Wisconsin ginseng improved fatigue after eight weeks, especially in those still receiving treatment.¹¹

See also our articles on astragalus, approved in Taiwan for cancer fatigue, and melatonin, which improves sleep.

Diarrhea

Irinotecan often causes severe diarrhea. In a placebo-controlled pilot trial in Slovakia, patients who took a probiotic during irinotecan treatment had less severe diarrhea.¹²

Skin Damage From Radiation

In a French trial of 254 women receiving radiation for breast cancer, calendula cream reduced moderate-to-severe skin reactions to 41 percent, from 63 percent with a standard cream.¹³ Aloe vera and olive oil are also used to soothe the skin.

Fasting and Mistletoe

In a German trial at the Charité in Berlin, women who fasted around chemotherapy reported better quality of life and less fatigue. In Germany, mistletoe extracts are widely used alongside chemotherapy to improve quality of life. See our articles on fasting during chemotherapy and mistletoe therapy.

Supplements That Can Interfere

St. John’s wort. In a Dutch study at Erasmus University in Rotterdam, St. John’s wort lowered blood levels of the active form of irinotecan by 42 percent, and it speeds the breakdown of many other cancer drugs.¹⁴

Green tea extract and high-dose vitamin C can block the myeloma drug bortezomib. Grapefruit and berberine can raise blood levels of many targeted drugs. See our articles on multiple myeloma and berberine.

For the side effects of immunotherapy, see our article on how immunotherapy works.

How Cancer Expert MD Helps

Cancer Expert MD provides education and consultation for people with every type and stage of cancer, and specializes in Stage IV and metastatic cancer. Our book, The New Reality of Cancer, has a full chapter on preventing and treating the side effects of chemotherapy, radiation and immunotherapy, and covers every agent’s drug interactions.

Frequently Asked Questions

Can nerve damage from chemotherapy be prevented?

Often, yes. Cooling the hands and feet with frozen gloves and socks, or wearing tight surgical gloves, during paclitaxel or docetaxel infusions cut moderate-to-severe nerve damage by more than half in trials.

Can I keep my hair during chemotherapy?

Many people can. In the SCALP trial, half of the women who used a scalp cooling cap kept most of their hair.

Does ginger help chemotherapy nausea?

In a trial of 576 patients, 0.5 to 1 gram of ginger a day, started three days before chemotherapy, reduced nausea on the day of treatment.

Which supplements interfere with chemotherapy?

St. John’s wort lowers the levels of many cancer drugs. Green tea extract and high-dose vitamin C can block bortezomib, and grapefruit and berberine can raise the levels of many targeted drugs.

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References

1. Hanai A, Ishiguro H, Sozu T, et al. Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: prospective self-controlled trial. Journal of the National Cancer Institute. 2018;110(2):141–148.
2. Cryotherapy for preventing chemotherapy-induced neuropathy in breast cancer patients treated with paclitaxel: a systematic review and meta-analysis. 2025.
3. Limb cold therapy for preventing paclitaxel-induced peripheral neuropathy in breast cancer patients: a randomized controlled study. World Journal of Surgical Oncology. 2026;24(1):343.
4. Compression therapy with surgical gloves compared to cold therapy with frozen gloves in preventing paclitaxel-induced peripheral neuropathy: results from the prospective ELEGANT trial in patients with breast cancer. European Journal of Cancer. 2025.
5. Smith EML, Pang H, Cirrincione C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013;309(13):1359–1367.
6. Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. New England Journal of Medicine. 2016;375(2):134–142.
7. Hashimoto H, Abe M, Tokuyama O, et al. Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Oncology. 2020;21(2):242–249.
8. Ryan JL, Heckler CE, Roscoe JA, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Supportive Care in Cancer. 2012;20(7):1479–1489.
9. Nangia J, Wang T, Osborne C, et al. Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial. JAMA. 2017;317(6):596–605.
10. Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423–4431.
11. Barton DL, Liu H, Dakhil SR, et al. Wisconsin ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. Journal of the National Cancer Institute. 2013;105(16):1230–1238.
12. Mego M, Chovanec J, Vochyanova-Andrezalova I, et al. Prevention of irinotecan induced diarrhea by probiotics: a randomized double blind, placebo controlled pilot study. Complementary Therapies in Medicine. 2015;23(3):356–362.
13. Pommier P, Gomez F, Sunyach MP, et al. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. Journal of Clinical Oncology. 2004;22(8):1447–1453.
14. Mathijssen RHJ, Verweij J, de Bruijn P, Loos WJ, Sparreboom A. Effects of St. John’s wort on irinotecan metabolism. Journal of the National Cancer Institute. 2002;94(16):1247–1249.

This article is for education only. It is not medical advice and does not diagnose or treat any condition. Cancer Expert MD has no financial relationship with any laboratory, drug maker, supplement company, clinic or hospital.