Side effects of chemotherapy

Chemotherapy kills cells that are rapidly dividing. Unfortunately, some normal cells—such as skin, hair and blood cells, and the cells that line the intestinal tract—also grow rapidly, and chemotherapy can kill these cells too. This can lead to many of the side effects that are seen with chemotherapy. Each person experiences chemotherapy differently. Not all people experience chemotherapy side effects. For those who do, there may be options for minimizing or eliminating some of these side effects. It's important to talk with your doctor about possible treatment side effects and how they can be managed. Consider participating in a clinical trial looking at new ways to manage chemotherapy side effects. 

Short-term effects

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

• allergic reactions
• anemia and low blood counts
• fatigue
• hair loss
• nausea, vomiting and 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. 

Long-term effects

Some of the longer term effects may include:

• loss of fertility
• nerve damage, tingling and pain in extremities
• difficulty focusing and fogginess of 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.

Allergic reactions

Some people may experience an allergic reaction from chemotherapy. These reactions can range from mile to severe. Rarely these reactions can be 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 lead to symptoms like fatigue, rapid heart rate, bleeding and increased risk for infection. Your oncologist may test your blood frequently, to make sure 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 may be caused by cancer or treatments, including chemotherapy. Fatigue is common in cancer survivors and can persist years after treatment. 

NCCN guidelines recommend that doctors ask cancer survivors about changes in memory and ability to think clearly, and level of fatigue during their regular visits. People should report fatigue to their doctors so they can be checked and treated for underlying causes, including depression, sleep disturbances and medication side effects. 

Although no medications can counteract fatigue caused by chemotherapy, you can take steps to try to improve your energy level, including: 

• making sure that your diet is balanced and provides you with adequate nutrition. As your doctor for a referral to a nutritionist if you need help figuring out your nutritional needs.
• making sure that you get adequate sleep. 
• trying to stay physically active, which 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 using them may still experience some degree of hair loss.  

Nausea, vomiting and appetite changes

Several different medications help to reduce nausea during chemotherapy. Reducing nausea can improve appetite, reduce weight loss and support a balanced diet—referral to a nutritionist can help assure that your diet is balanced during treatment. Certain foods may be more or less likely to trigger nausea, vomiting or upset stomach. Ginger in the form of candy or gingerale may help settle upset stomach from chemotherapy. 

Mouth and tongue sores

Chemotherapy can cause painful sores of the mouth and lips (called 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 on ice chips during chemotherapy may protect your mouth and tongue from the damaging effects of chemotherapy.

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, improve over time, or 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 "chemo-brain. This change can persist even years after treatment ends. People should report cognitive changes to their doctor. They 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 chemo-brain. Some research has shown a 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 make sure 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 different drug.  

Hearing loss

Platinum chemotherapies can cause hearing loss and ringing in the ears in some patients. Most patients who receive platinum chemotherapy do not experience problems with hearing. Although no treatments are available for hearing loss caused by chemotherapy, clinical trials are looking for 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 are receiving chemotherapy.