For some patients, facing chemotherapy can be even more frightening than the cancer diagnosis itself. Cancer is bad enough, but there is a separate kind fear around chemotherapy, and women especially worry about losing their ability to work, care for their families, and keep their hair.

One of the most important things to remember about chemotherapy is that it's different for every person. When you multiply types of cancer by types of treatment by types of people, you get an almost limitless number of ways a person might respond to chemotherapy. Gone are the days when every person facing chemo will be incapacitated by fatigue and nausea. Because of advances in chemotherapy and the drugs treating its side effects, today's chemo patients face a variety of outcomes.

Here are 5 things you need to know when facing chemotherapy:

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1. Chemo affects fast-producing cells

Most chemotherapy drugs are designed to kill cells that divide rapidly. This makes the drugs effective at killing rapidly dividing cancer cells, but it also means that they can deal serious damage to other fast-growing cells like those in the mouth, throat, and stomach as well as to hair follicles. This causes a lot of the more well known side effects like mouth sores, gastrointestinal troubles, and hair loss. But not every chemo patient will experience these side effects. Almost all chemo patients will experience fatigue, but other side effects vary greatly.

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2. It's better than it used to be

Part of the reason chemotherapy causes such a strong reaction is that people have often heard about a loved one going through intense side effects. And chemotherapy drugs are potent, but in recent years chemo drugs have become more targeted and are less associated with nausea and fatigue. Many patients are still able to handle their normal daily activities while going through chemotherapy.

It's important to note that some forms of chemotherapy can still be intense and come with intense side effects, but overall chemotherapy has become much more tolerable, and researchers are still discovering new ways to make side effects even less severe.

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3. There are short-term, long-term, and latent side effects

Each patient should talk to their care team about the side-effects associated with their particular course of treatment. It's important to prepare for both short- and long-term side effects. Short-term side-effects might include nausea, hair loss, fatigue, anemia, appetite changes, gastrointestinal issues, mouth and throat issues, and skin and nail changes.

Long-term side effects might include weight changes, "chemo brain", changes in sexual function, fertility problems, and possible damage to the heart, kidneys, bladder, lunches, and nervous system.

Again—side effects should be discussed with your care team, including some that may not show up until after cancer treatment is completed. These include risk for a second bout of cancer, mental and emotional health challenges including fear of recurrence, and lymphedema.

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4. How to talk to your doctor

Cancer patients will hopefully feel encouraged to talk to their care team about all their side effects, and in turn the care team should encourage patients to share about side effects so they can make adjustments and recommendations as needed. But sometimes it's hard to know what's important or how to quantify side effects.

Cancercare.org recommends keeping a journal noting the side effects you experience and their frequency and severity. This can help you share specifics with your doctor. Try making concrete notes such as what the side effect kept you from doing, how often it happened, and how severe the pain was on a scale of 1 to 10. A journal can help you remember to report all your symptoms and help your care team to understand them.

It's also important to know when to reach out to your team right away. Reach out if you experience:

• A fever that is 100.5°F or higher
• Unexplained bruising or bleeding
• An allergic reaction, including swelling of the mouth or throat, trouble swallowing, or intense itching
• Severe chills
• Pain at chemo injection site or catheter site
• Intense pain or headache with no explanation
• Trouble breathing and shortness of breath (call 911 immediately if you are having trouble breathing)
• Diarrhea or vomiting that won't stop
• Blood in stool or urine

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5. Vitamins Could Complicate Chemo

Cancer patients are usually motivated to adopt as healthy a lifestyle as possible, and for many Americans, being healthy means taking supplements. Cancer patients should check with their care team about supplements they are taking or thinking about taking as some can interact negatively with chemo and make side effects worse.

Even over-the-counter drugs, like aspirin, can weaken blood platelets that may already be low from chemo. It's better to share too much information than too little when it comes to medications and supplements.

Specifically, antioxidant vitamins, like A, E, and C, may make chemo and radiation less effective. Antioxidants can prevent the formation of free radicals, which is normally a good thing. But some chemo drugs and radiation treatments produce these free radicals in order to damage cancer cells, and it's possible that taking vitamins in high doses could damage this effect.

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Cancer treatment is scary, painful, and life-changing. But it is getting better, and fear and misunderstanding can make it worse than it really is. When faced with a cancer diagnosis, be quick to ask questions. It may be a good idea to bring a friend or loved one along to appointments so they can ask questions you forget about or are too tired to ask. Make sure you prepare for your cancer treatment, not the treatment a friend had 10 years ago.

Take a deep breath, and let facts, not fear, inform your strategy. Stay strong, friends!