It is common for people undergoing chemotherapy not to feel ill or have significant side effects. There are several reasons why someone may not experience sickness or other issues during their chemo treatment.
Why Don’t Some People Feel Sick During Chemo?
There are a few key factors that contribute to whether or not a person feels unwell during chemotherapy:
- The type of chemotherapy drugs used – Some chemo drugs are more likely to cause nausea and vomiting than others. Drugs like cisplatin are highly emetogenic (meaning they frequently cause nausea/vomiting) while others like 5-FU may not cause much sickness.
- Use of anti-nausea medications – Powerful anti-nausea drugs like Zofran and Compazine can be very effective at preventing chemotherapy-induced nausea and vomiting. These are routinely given with chemo.
- Individual variation – People respond differently to chemotherapy drugs. Some are more sensitive and likely to have side effects while others may experience minimal issues.
- Chemotherapy dose – Higher chemo doses are more likely to cause side effects than lower doses. If someone is on a relatively low or moderate dose, they may not feel very sick.
- Chemotherapy schedule – Some chemo regimens that space out treatments and use lower doses at each session may be less likely to cause sickness than intensive regimens given close together.
The factors above all contribute to why some chemotherapy patients do not experience significant nausea, vomiting, fatigue and other bothersome side effects.
Common Side Effects of Chemotherapy
While not everyone feels ill from chemo, some side effects are very common. According to the American Cancer Society, common side effects of chemotherapy include:
- Fatigue
- Nausea and vomiting
- Constipation or diarrhea
- Mouth sores
- Hair loss
- Loss of appetite
- Nerve and muscle issues like neuropathy and myalgia
- Easy bruising and bleeding
- Skin and nail changes
These effects can range from mild to severe depending on the chemotherapy regimen, medications given, and individual variation in response. Fatigue, nausea, appetite changes, and gastrointestinal issues tend to be most common.
What if I Feel Completely Normal During Chemotherapy?
For some people, it may seem concerning if they expect to feel sick during chemo but do not experience any noticeable side effects. However, not having significant sickness, fatigue, or other problems does not necessarily mean that chemotherapy is not working.
There are a few reasons why someone may feel completely normal during their chemotherapy treatment:
- They are on chemo drugs that are not highly likely to cause nausea and vomiting, like cyclophosphamide, methotrexate, 5-FU, etc.
- They are receiving excellent anti-nausea support with medication like Zofran, Compazine or Emend which prevents sickness.
- They are on a relatively low or moderate dose chemotherapy regimen.
- They are spacing out treatments every 2-3 weeks, allowing the body to recover between doses.
- They happen to be someone not as affected by the side effects of their particular chemotherapy drugs (individual variation).
As long as your oncology team is monitoring your labs and scans carefully during chemotherapy to assess its effectiveness, feeling well does not indicate that the chemo is not working. The drugs impact the molecular level and are treating cancer even without causing significant sickness. However, discuss any concerns with your cancer care team.
Tips for Coping Without Nausea During Chemo
For some people, not feeling sick or having nausea may seem strange and concerning if they prepared to feel very ill during chemotherapy. Here are some tips for coping emotionally if you are not experiencing the side effects you anticipated:
- Remember every person responds differently – Do not worry that just because you feel well means the chemo is not attacking your cancer. Everyone reacts differently to treatment.
- Focus on the positive – View your lack of sickness as an advantage that allows you to continue activities and spend time with loved ones during treatment.
- Discuss concerns with your care team – Talk to your oncologist, nurse or pharmacist if you have worries about not feeling unwell during your chemotherapy regimen.
- Consider journaling – Writing down your thoughts, worries and questions in a journal can help you process the emotions that come with an easier than expected chemo experience.
- Join a support group – Connecting with others going through chemotherapy may help give insight about varied treatment reactions.
While many people struggle with difficult side effects during cancer treatment, try to view feeling well as a positive if it happens during your chemo. Stay focused on the big picture of overcoming your cancer, regardless of how sick or healthy you feel during the process.
Caution About Infections During Chemotherapy
One important caution if you do not feel sick during chemo is that you may still be at higher risk for infections. Many chemotherapy drugs lower your white blood cell counts, weakening your immune system. It is very important to take precautions against germs even if you feel well:
- Wash hands frequently
- Avoid contact with obviously sick people
- Avoid raw meats, sushi, and unpasteurized items
- Stay up to date with flu and COVID vaccines
- Do not hesitate to call your oncology team if you think you are getting sick
Being aware of infection risk and preventing illness will help keep you healthy and avoid treatment delays. Be sure to monitor for fever, chills, cough or other signs of infection.
When to Call Your Care Team
Make sure to contact your oncology doctors and nurses if you notice any concerning symptoms during chemotherapy, even if you do not feel sick or have nausea. Call your care team if you experience:
- Fever of 100.4 F or higher
- Chills or sweating
- Uncontrolled nausea/vomiting lasting over 24 hours
- Bloody stool or urine
- Bleeding that will not stop
- Extreme fatigue that interferes with daily tasks
- Signs of infection like cough, pain or flu-like symptoms
- Numbness or tingling that won’t go away
- Mouth sores that prevent swallowing
Monitoring for side effects and quickly reporting concerns allows your medical team to manage issues promptly and prevent complications.
Coping With a Lack of Sickness During Treatment
Adjusting to not feeling sick during chemo when you expect to be very ill can take some mental coping. Here are some healthy ways to help process and come to terms with minimal side effects from chemotherapy:
- Talk it out – Discuss your concerns and feelings with a counselor, therapist or support group.
- Release control – Remind yourself treatment reactions are out of your control and focus on what you can manage.
- Compare experiences – Listen to others’ chemotherapy stories remembering each one is unique.
- Express gratitude – Appreciate each day you feel well enough to engage in meaningful activities.
- Empower yourself – Learn about your chemo drugs, side effects, and questions to ask your medical team.
- Consider journaling – Writing down thoughts, worries, and milestones can help process emotions.
Staying in touch with your inner experience and talking openly with supportive care providers can help you adjust to minimal sickness during chemo – and take advantage of feeling your best on the days you do.
The Takeaway
Not feeling sick or having significant side effects during chemotherapy is actually more common than you may think. Various factors like the specific drugs used, preventive medications, dosing schedule, and individual variation determine someone’s reaction to chemo agents.
While many do struggle with difficult nausea, fatigue and other issues during cancer treatment, try not to worry if you happen to feel relatively well. This does not mean the chemotherapy is ineffective. Focus on following your care team’s monitoring plan and taking precautions to stay healthy during your chemo regimen. And appreciate an easier than anticipated experience as a blessing when it occurs.