Managing the Side Effects of Metastatic Bladder Cancer Treatments
CancerBladder Cancer

Tips for Managing Metastatic Bladder Cancer Treatment Side Effects

Tips for Managing Metastatic Bladder Cancer Treatment Side Effects
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Published on April 17, 2026
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Treatment for metastatic bladder cancer can come with uncomfortable side effects, but with help from your cancer care team, they’re often manageable.

The medications used for metastatic bladder cancer — including immunotherapy, targeted therapy, and chemotherapy medications, sometimes combined with surgery or radiation — activate your body’s immune system to mobilize against the cancer cells. But this also means that your immune cells can attack organs in the body, says Kirk Tamaddon, MD, a urologic surgeon at Kaiser Permanente in Southern California.

You can manage side effects best if you report them to your doctor as soon as possible. “Working closely with your oncology team helps ensure that you navigate the potential side effects safely and in a way that is tolerable for you and aligned with your treatment goals,” says Marjorie Zauderer, MD, a professor of medicine in oncology at New York Medical College in Valhalla, New York. 

Fatigue

Every treatment for metastatic bladder cancer has the potential to cause fatigue.

 Experts think treatments cause this side effect for several possible reasons:

  • Your body uses extra energy as it heals the areas damaged by the treatment.
  • Toxic substances can build up after treatments destroy cancer cells.
  • Many treatments change how your immune system works.
  • Your sleep-wake cycle can get disrupted, leading to poor sleep and feeling tired.
Fatigue can also stem from treatment side effects like anemia, poor appetite, stress, pain, and vomiting.

 To fight fatigue, your care team may recommend these practices:

  • Taking short naps (15 to 20 minutes)
  • Sticking to a regular sleep schedule and keeping your bedroom cool and dark
  • Doing light exercise, like walking, on most days
  • Drinking 8 to 10 glasses of fluids every day
  • Eating several small meals throughout the day to avoid dips in energy
  • Using mindfulness techniques like yoga, meditation, and guided relaxation
  • Budgeting your energy for the most important tasks
Keep a record of how fatigued you feel each day, which can help your provider develop the best treatment plan.

Rash

Immunotherapy and targeted therapy can cause skin rashes. With immunotherapy, these itchy, painful rashes happen most often at the injection site,

 but because immunotherapy can cause inflammation in healthy tissue, too, rashes can appear in other places, says Dr. Zauderer.

Targeted therapy rashes are typically mild; the redness, dryness, and acne can appear anywhere from the scalp to the upper back and chest. These rashes can cause itching, burning, or stinging, but they should disappear a month or so after your last treatment.

“Treatment-related rashes are common and usually manageable without stopping treatment, but timing matters,” says Zauderer. “The sooner we know about skin changes, the easier they are to treat.” Here are some ways to prevent infection:

  • Use heavy creams or ointments with no perfumes, dyes, or alcohol.
  • Ask your doctor about topical steroids or antibiotics.
  • Use sensitive-skin soaps without fragrance.
  • Bathe in warm (not hot) water.
  • Protect your skin from the sun with clothing and sunscreen.
  • Wear soft and loose clothes.

Diarrhea

You may have diarrhea while taking immunotherapy, targeted therapy, or chemotherapy, though the symptom can be triggered in different ways.

Immunotherapy, for example, causes inflammation in the bowels, prompting diarrhea,

 whereas targeted therapy and chemotherapy can damage the lining of your colon, which prevents your intestine from absorbing enough water.

 All the water left in your colon thins out your bowel movements.

If you have diarrhea during bladder cancer treatment, try to stay hydrated and keep a stable balance of electrolytes like magnesium and sodium. You can also soothe irritation and pain in these ways:

  • Avoiding foods that are spicy or high in fiber or fat
  • Finding out from your provider how much fluid to consume in a day, then drinking room-temperature clear liquids like water, broth, and sports drinks
  • Eating frequent small meals instead of few large meals
  • Sitting in a warm bath to soothe anal pain

Mouth Sores

Any medication for cancer may damage the lining of your mouth and throat, which can cause sores to appear there. Mouth sores typically develop about one or two weeks after your first treatment, and they can take up to four weeks to heal.

You can prevent and manage mouth sores with these tips:

  • Moisturize your lips with an oil-based ointment or lip balm.
  • Drink as much water as your provider approves.
  • Ask about mouthwashes or medicines that can heal sores and ease pain.
  • Snack on cold foods like popsicles, frozen yogurt, and ice chips.
  • Avoid dry foods that are hard to swallow.
  • Limit alcohol, tobacco, and acidic fruit juices.
  • See a dentist for personalized treatment.
  • Clean your mouth frequently with a soft toothbrush or swab.
  • Ask about cryotherapy (sucking on ice cubes while receiving chemotherapy treatment).
Some mouthwashes can make sores worse, so always ask your care team before you try any home remedies.

Joint or Muscle Pain

The inflammation, immune system changes, and tissue damage that come with chemotherapy, immunotherapy, and targeted therapy can affect your joints and muscles,

 causing joint swelling and redness, muscle cramps, and stiffness.

 “This is why maintaining movement and managing inflammation are key goals of care,” says Zauderer
You can improve joint and muscle pain and stay more mobile with these tips: 

  • Ask about medications and physical therapy to improve your symptoms.
  • Apply heat with a heating pad for 10 to 30 minutes at a time.

  • Stretch gently and exercise every day.
  • Try mindfulness exercises to cope with discomfort.
Chemotherapy can also cause numbness and tingling in your hands and feet (peripheral neuropathy).

 You can improve these symptoms by exercising, avoiding smoking and alcohol, and eating nutritious foods like fruits, vegetables, lean proteins, and whole grains.

Infections

Cancer medications and radiation can increase your risk of getting an infection by lowering the amount of protective immune cells in your bloodstream (neutropenia).

Inflammation in your colon and lungs can also increase infection risk by making it easier for bacteria to get through the lining of these organs.

 And immunotherapy can disrupt important hormones that help your body respond to infection.

You can help prevent an infection with these tips:

  • Clean your hands often with soap and water or hand sanitizer.
  • Bathe every day.
  • Keep your hands moisturized.
  • Wear protective equipment to prevent cuts and injuries.
  • If you have a wound, keep it clean and dry.
  • Brush your teeth twice daily (or more).
  • Avoid large crowds and wear a face mask in public.
  • Don’t let your pets lick your skin.
  • Wash and cook food well.

Hair Thinning

Chemotherapy causes hair loss because it targets fast-growing cells, including the kind that grow hair. But the type of chemotherapy typically used for metastatic bladder cancer (cisplatin) may cause less hair loss than other types.

Immunotherapy and targeted therapy can also cause hair thinning and loss, but less than chemo.

 Targeted therapy can sometimes add a yellow tint to hair color, but this usually fades after treatment finishes.

You can ask your cancer care team about preventing hair loss with cold cap therapy, which involves wearing a cooling cap to stop chemotherapy from reaching your scalp. And in some cases, your provider may recommend a medication to help restore your hair after treatment has ended.

Care for your hair during metastatic bladder cancer treatment with these tips:

  • Be gentle when you wash, brush, or style your hair.
  • Apply sunscreen to any exposed scalp.
  • Wear a bamboo, silk, or cotton sleep cap.
  • Avoid using dyes or harsh chemicals on your hair.
  • Let your hair air-dry.

The Takeaway

  • Treatment for metastatic bladder cancer can cause side effects like fatigue, skin rashes, diarrhea, mouth sores, joint pain, infections, and hair changes.
  • You can manage each side effect with doctor-prescribed treatments and other approved lifestyle changes and home remedies like getting regular exercise, good sleep, and healthy nutrition.
  • If you have side effects from metastatic bladder cancer treatment, tell your healthcare team. They know you best and can help you treat your symptoms.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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