Side Effects from Treatment with Chemotherapy

Side Effects of Chemotherapy

This section covers the following topics:

managing side effects	long-term side effects
short-term side effects	resources

What are the short-term effects of chemotherapy?

Some more common short-term side effects of chemotherapy may include:

• allergic reactions
• anemia and low blood counts
• fatigue
• hair loss
• nausea, vomiting, appetite changes and weight loss
• mouth and tongue sores 
• nerve damage, tingling and pain in hands and feet

Most of the symptoms above are temporary and resolve after chemotherapy ends. 

Allergic reactions

Some people may experience an allergic reaction from chemotherapy. These reactions can range from mild to severe and are rarely fatal. Your oncologist may prescribe medication to decrease your risk for severe allergic reactions to chemotherapy. 

Anemia, bleeding and low white blood cell counts

Some chemotherapy damages bone marrow, where blood cells are made. This can result in too few red blood cells (anemia), too few platelets (thrombocytopenia) and a low white blood cell count (neutropenia). These bone marrow effects can cause fatigue, rapid heart rate, bleeding and increased risk for infection. Your oncologist may frequently test your blood to ensure that your blood counts do not drop too low, which could delay treatment. Some people may need a blood transfusion to quickly raise their blood counts. Doctors may prescribe medications that stimulate the bone marrow to make more blood cells. Diet changes or supplements may also improve anemia.

Fatigue

Fatigue is a common affect of cancer and treatment. It can be short-term but may persist months or years after treatment. 

Expert guidelines recommend that doctors ask cancer patients about their level of fatigue during their regular visits. You should report fatigue to your doctor so you can be checked and treated for underlying causes, including depression, sleep disturbances and medication side effects. Although no medications can counteract the fatigue caused by chemotherapy, some options may improve your energy level, including: 

• making sure that your diet is balanced and provides you with adequate nutrition. Ask your doctor for a referral to a nutritionist if you need help figuring out your dietary needs.
• ensuring that you get adequate sleep. 
• staying physically active even when you are tired. This can help improve your energy level. 

Hair loss

Many chemotherapy agents cause hair loss. Scalp cooling devices—including Paxman and Polar Cold Cap—protect hair follicles from the damaging effects of chemotherapy. These devices are not effective for everyone; people who use them may still experience some hair loss.  

Nausea, vomiting and appetite changes

Digestive issues are common during chemotherapy. Despite these effects, it's important to try to maintain proper nutrition while on treatment. Your body needs calories and nutrients to fight cancer and repair the damage caused by chemotherapy. Several different medications may help reduce nausea, vomiting and diarrhea during chemotherapy. Reducing nausea can improve appetite, reduce weight loss and support a balanced diet. If you need help, ask for a referral to a nutritionist. It can be helpful to eat small meals and identify the foods that are less likely to trigger nausea, vomiting or upset stomach. Ginger candies or gingerale may help settle upset stomach from chemotherapy. 

Mouth and tongue sores

Chemotherapy can cause painful sores of the mouth and lips (stomatitis), which can make eating painful. Certain medications can help to repair mouth cells, coat the sores or block the pain caused by the sores. Rinsing your mouth with salt or baking soda can also improve mouth sores. Sucking ice chips during chemotherapy may protect your mouth and tongue from the damaging effects of chemotherapy.

What are the long-term effects of chemotherapy?

Some of the longer-term effects may include:

• fatigue
• loss of fertility
• nerve damage, tingling and pain in extremities
• difficulty focusing or thinking (also called chemobrain)
• heart damage
• hearing loss

Some of these effects may improve with medication or other medical interventions. It's important that you report any symptoms or changes in your health to your doctor. You may also report any suspected side effects directly to the FDA online or by calling 1-800-FDA-1088.

Loss of fertility

Some chemotherapy can cause early menopause in women and low sperm counts in men. These changes may be temporary or permanent. Options are available for men and women who are diagnosed with cancer and wish to preserve their fertility. It's important to discuss fertility preservation before starting treatment for cancer. 

Nerve damage, tingling and pain

Some chemotherapy drugs can damage nerves, leading to pain, numbness, tingling or weakness in the arms, legs, hands and feet. This condition is often referred to as chemo-induced peripheral neuropathy (CIPN). It may go away on its own or improve over time. In some cases, it may be permanent. Certain chemotherapy agents—such as taxanes and platinums—are more likely to cause CIPN than other drugs. Medications may help to reduce the symptoms of peripheral neuropathy. Physical therapy, acupuncture and certain types of exercise may also help to reduce symptoms and improve strength and balance. 

Chemobrain

Chemotherapy may affect memory and cognitive function; patients sometimes refer to this as "chemobrain." This change can persist years after treatment ends. You should report cognitive changes to your doctor. You should also be checked and treated for underlying causes, including depression, sleep disturbance, fatigue and medication side effects. Limiting alcohol and drugs that can affect memory may improve chemobrain. Some research shows that people with chemobrain may benefit from yoga, exercise, mindfulness, meditation, cognitive training and Modafinil, a drug used to treat sleep disorders.

Heart damage

Certain chemotherapy—especially adriamycin—can cause heart damage. Your oncologist may run tests to ensure that your heart function is normal before, during and after chemotherapy. Some drugs may help protect the heart from damage caused by chemotherapy. Heart damage can also be minimized by lowering the dose of chemotherapy, changing how it is given or switching to a different drug.  

Hearing loss

Most patients who receive platinum chemotherapy do not experience problems with hearing. Some patients, however, experience platinum chemotherapy-related hearing loss and ringing in the ears. Although no treatments are available for hearing loss caused by chemotherapy, clinical trials are testing medications that may protect cells in the ear from chemotherapy-related damage. This type of damage tends to happen over time, so it's important to notify your oncologist of any changes to your hearing while you receive chemotherapy.