Written by Ada’s Medical Knowledge Team
What are chemotherapy side effects?
Chemotherapy – often abbreviated to chemo or CTX – is a cancer treatment that uses anti-cancer drugs to fight the disease. Chemo is very common and is used to treat most types of cancer, both as a cure and as a method of improving the prognosis.
Chemotherapy can result in a wide range of side effects. Cancer cells are characterized by their tendency to divide rapidly; chemo therefore fights the disease by attacking fast-dividing cells. Unfortunately, healthy cells that divide quickly are also targeted, resulting in adverse side effects.
Although there is no way to prevent chemotherapy side effects altogether, there are methods of managing them that can lessen their worst symptoms.
Some of the more common side effects of chemotherapy may include:
- Vomiting and nausea
- Hair loss
- Loss of appetite and feeling full after eating only a small amount
- Sleeping issues
- Sex and fertility issues
- Emotional stress
- Bruising and bleeding
- Diarrhea and constipation
- Mouth and throat problems
- Skin and nail problems
- Memory loss.
There is a higher risk of chemotherapy side effects in the elderly. With increasing age, the total body water decreases, leading to a reduced volume of distribution for drugs that dissolve in water. The total body fat increases, changing the body’s distribution of drugs that dissolve in fat.
In addition, kidney function may decrease with age, leading to a decreased clearance of drugs that are excreted by the kidneys. Furthermore, the presence of other conditions, as well as other drugs being taken may, among other factors, all impact on the tolerability of chemotherapy. 1
Common side effects
Side effects of chemotherapy differ from person to person, ranging from mild to severe, depending on the type of cancer that is being treated, the chemotherapy drug that is being administered, the length of the course and the general health of the person. 2
It is difficult to predict what side effects will be experienced. Of those listed below, it is unlikely a person will experience them all. 3
Fatigue – lack of energy – is the most common side effect of chemotherapy. Those undergoing chemotherapy often feel a whole-body tiredness that is not relieved by sleep, and which may make them unable to carry out everyday tasks or work. Fatigue may continue once the treatment is over; intensive chemotherapy weakens the body, meaning full recovery can take a long time.
There are many possible underlying causes of fatigue, some of which have medical treatment options. Where possible, the best way to combat fatigue is to find out and treat the underlying cause. For instance, there are medications available for fatigue caused by anemia.
Vomiting and nausea
Vomiting and/or nausea is common to those undergoing chemotherapy. It can be managed with anti-sickness drugs which can be prescribed by a doctor. It should be noted, however, that these drugs can also have their own side effects.
Many people find that hair loss is one of the most distressing side effects of chemo treatment. This side effect is common but won’t affect all people. The head is the most common location for hair loss, though other regions of the body can also be affected. In almost all cases, the hair will grow back once chemotherapy has been completed.
Depending on the type of cancer and type of chemotherapy used, it is sometimes possible to reduce the chances of hair loss by wearing a cold cap during a treatment, designed to cool the scalp, reducing blood flow to the scalp and therefore reducing the amount of medicine that reaches it.
By lowering the amount of red blood cells in the body, chemotherapy can also result in anemia. Symptoms of anemia can include:
- Heart palpitations
- Shortness of breath
- Pale complexion.
Treatments for anemia differ according to its severity; a doctor will be able to explain the best options.
Loss of appetite and early satiety
People going through chemotherapy often experience a loss of appetite, i.e. the feeling of not being hungry, and/or early satiety, i.e. the feeling of being full after eating only a small amount. These changes may last the entire drug regimen or may only be experienced immediately after a treatment. Causes of loss of appetite include:
- Taste changes
- Dry mouth
- Mouth sores.
It is recommended that the affected person try to eat what they can and, if their doctor says it is ok, ensure they drink plenty of fluids. Some medications may be prescribed by a doctor for long-term lack of appetite.
Problems with sleep, or insomnia, are common during chemotherapy. It may be helpful to think about possible causes, such as certain medications, pain or anxiety. A healthcare provider will be able to offer advice on how to manage sleep issues.
Sex and fertility issues
Chemotherapy may lower a person’s libido or sex drive. Chemotherapy can also result in reduced fertility in both men and women. If there are concerns about lasting infertility, options such as IVF and egg/sperm banking can be explored with a doctor.
Chemotherapy can result in a large amount of emotional stress. This stress can take the form of anxiety and may develop into depression. Talking therapies such as counseling and psychotherapy, as well as support groups to share with others in similar circumstances may help with the emotional stress of chemotherapy.
Bruising and bleeding
Chemotherapy can often reduce the number of platelet cells in the blood. This can result in:
- Severe bleeding when cut
- Skin that bruises easily
- Bleeding gums.
Treatments to improve platelet cell count are available. These include corticosteroid drugs and, in severe cases, blood transfusions.
Diarrhea or constipation
Diarrhea and/or constipation can be a common side effect in the early stages of chemotherapy.An affected person can consult a doctor for dietary recommendations to minimize diarrhea or constipation. If the problem persists and a doctor says it is ok, over-the-counter medications may be taken to help minimize this side effect.
Mouth and throat problems
Chemotherapy can result in mouth and throat ulcers or sores, also known as mucositis. These ulcers can be painful and result in difficulty eating and drinking. They can also become easily infected. If necessary, doctors can prescribe painkillers or other appropriate treatments.
Skin and nail problems
Dry, itchy, discolored or sore skin can result from chemotherapy. The nails can also become brittle or flaky. Ointments and creams can be prescribed to help.
For reasons that aren’t completely clear, chemotherapy can also result in short-term memory loss and an inability to concentrate properly. This side effect usually dissipates once the treatment is complete. Many people manage this by setting reminders, keeping written records and asking for help where necessary.
Nerve damage can occur with chemotherapy. It often occurs during chemotherapy but can last longer or even be irreversible. It may also worsen with each dose. Symptoms of nerve damage may include some of the following sensations in the hands and feet: 4
- Discomfort or pain
- Being less sensitive to hot and cold
- Cramps in the feet.
Treatment may be given to relieve the pain of nerve damage, and occupational therapy may be recommended in cases of permanent nerve damage. Sometimes, chemotherapy treatment has to be stopped because of nerve damage.
More serious side effects
Some side effects of chemotherapy are less common but can become serious.
People undergoing chemotherapy are more at risk of developing osteoporosis, a condition that thins and weakens the bones. Women, particularly those over the age of 50, as well as people with breast cancer, are most at risk of osteoporosis. 5 Getting enough calcium and vitamin D (see vitamin D Deficiency) lessens the risk of developing the condition. If osteoporosis does develop after chemotherapy, treatment options are available.
In rare cases, heart problems can occur with chemotherapy. The symptoms of this may include: 6
- A rapid or irregular heartbeat
- Chest pain
- Breathing problems.
In extreme cases, these heart problems may lead to a heart attack. If a person experiences any of these symptoms, it is important they contact their doctor immediately.
Anti-cancer drugs used in chemotherapy can, in rare cases, lead to eye problems, including: 7
Thorough washing of the hands and the avoidance of unnecessary touching of the eyes can reduce the risk of eye problems.
Long-term side effects
The duration of chemotherapy side effects varies. A majority of chemotherapy side effects will continue in duration for the length of the chemotherapy and disappear soon after the treatment has finished. However, some can be more long lasting, and others can develop after the chemotherapy has finished.
Chemo side effects after treatment may include:
The anti-cancer drugs used in chemotherapy can lead to long-term problems in organs such as the heart, lungs, kidneys and bladder. 8 To lessen the chances of developing these problems, doctors will check the person’s medical history before administering the drugs and avoid uncomplimentary drugs accordingly.
Risk of second cancer
Some chemotherapy drugs have been linked to causing a second cancer of a different type. It is important to realize that this is very rare, and that doctors will avoid the use of these drugs if at all possible. They will also advise about the risks before going forward with the treatment. 9
Q: Are there any natural remedies for chemotherapy side effects?A: There are a variety of natural remedies that may help with the management of mild chemotherapy side effects. Always talk to a doctor before beginning to use any chemotherapy side effect remedies, as some methods could interfere with the treatment itself. Natural chemotherapy side effect remedies include: 10
- Ginger: Research suggests eating or drinking foods containing ginger can act as a natural antiemetic.
- Relaxation: Taking steps to relax can help to reduce stress, something that may contribute to chemotherapy side effects.
- Zinc: Eating foods rich in zinc, such as beef, shellfish and fortified breakfast cereals, may help prevent taste changes, a side effect of chemotherapy, radiation and some pain medicines.
- Glutamine: Taken in supplement form, glutamine may help to reduce weakness and numbness or pain in the hands and feet, and mouth sores and soreness, though evidence is not conclusive.
- Acupuncture: Many people report that this helps with pain relief, as well as other symptoms such as nausea, dry mouth and anxiety.
Q: Chemotherapy side effects: when do they start?A: Chemotherapy side effects can be acute, meaning immediate, or late, meaning they are delayed. Acute side effects may begin when the treatment is given or very soon after it is finished. However, some people may develop side effects further into the treatment or after treatment is finished, or may have no side effects at all. 11
Q: Do chemo side effects get worse with each treatment?A: Some people undergoing chemotherapy report that they feel more fatigue the further along they get in their regimen. Nerve damage can occur with chemotherapy, and this may get worse with each dose. Sometimes, treatment has to be stopped because of this. However, other side effects, including nausea, constipation and diarrhea, are not typically cumulative with repeated treatment. 12
Q: What is the timeline for chemo side effects?A: Everyone reacts differently to chemotherapy, and some people may have mild or no side effects at all or only experience one or two symptoms. However, the first symptom following treatment is often nausea, which may last for a few hours after each treatment or may linger for several days and may continue throughout the drug regimen. Symptoms that may develop slightly later, in the days, weeks and months after beginning treatment, include: 13
- Mouth soreness and changes in taste: Often occurs within five to ten days after starting; typically goes away gradually in about three to four weeks after treatment is finished.
- Fatigue: Usually begins after the first week or two of chemotherapy; normally resolves within six months after treatment.
- Loss of mental acuity: Often occurs within the first few weeks after beginning chemotherapy; may increase, depending on the dosage, type of chemotherapy and general health of the person affected; may last for up to a year or two after treatment is finished.
- Hair loss: Usually begins within two to three weeks after starting chemotherapy; tends to start growing back two to three months after treatment is finished.