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:

Fatigue
Vomiting and nausea
Hair loss
Anemia
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 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

Fatigue – lack of energy – is the most common side effect of chemotherapy. Those undergoing chemotherapy often feel 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 are 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 side effects.

Hair loss

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.

Anemia

By lowering the number of red blood cells in the body, chemotherapy can also result in anemia. Symptoms of anemia can include:

Fatigue
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 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.

Sleeping issues

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.

Emotional stress

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
Nosebleeds
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 effects 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.

Memory loss

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

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

Tingling
Burning
Warmth
Numbness
Weakness
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.

Osteoporosis

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.

Heart problems

In rare cases, heart problems can occur with chemotherapy. The symptoms of this may include:⁶

A rapid or irregular heartbeat
Fatigue
Chest pain
Coughing
Dizziness
Breathing problems

In extreme cases, these heart problems may lead to a heart attack. If a person experiences any of these symptoms, they must contact their doctor immediately.

Eye problems

Anti-cancer drugs used in chemotherapy can, in rare cases, lead to eye problems, including:⁷

Cataracts
Conjunctivitis
Dry Eye Syndrome
Glaucoma
Light sensitivity

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:

Organ problems

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

FAQs

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.

“Breast Cancer in the Elderly.” Medscape. Date Accessed: 3 August 2018. ↩
“Managing Chemotherapy Side Effects.” Breast Cancer. February 14 2017. Date Accessed: June 26 2017. ↩
“Side-effects of chemotherapy.” NHS Choices. February 22 2017. Date Accessed: June 26 2017. ↩
““What Is Peripheral Neuropathy?” American Cancer Society. 8 January 2019. Date Accessed: 27 February 2019. ↩
“Bone Health.” NCCN. Date Accessed: June 26 2017. ↩
“Can chemotherapy side-effects increase the risk of heart disease?.” Mayo Clinic. October 13 2015. Date Accessed: June 26 2017. ↩
“Eye Problems.” Chemocare. Date Accessed: June 26 2017. ↩
“Chemotherapy’s Effects on Organs/Body Systems.” URMC. Date Accessed: June 26 2017. ↩
“Late side effects of chemotherapy.” Cancer Research UK. January 15 2015. Date Accessed: June 26 2017. ↩
“Can Natural Remedies Help Ease Cancer Drug Side Effects?” WebMD. Date Accessed: 3 August 2018. ↩
“Chemotherapy: effects and side effects.” The Royal Marsden NHS. Date Accessed: 3 August 2018. ↩
“Side Effects of Chemotherapy.” Cancer.Net. Date Accessed: 5 August 2018. ↩
“What is the Timeline for Chemotherapy Side Effects?” Livestrong.com. 14 August 2017. Date Accessed: 3 August 2018. ↩

**Chemotherapy Side-Effects:**

**What is⁤ Chemotherapy?**

Chemotherapy is a cancer treatment that uses powerful drugs to kill cancer cells. These drugs work by interfering with the growth⁣ and reproduction ⁣of cancer⁣ cells.

**What are the Common‌ Side-Effects of Chemotherapy?**

Chemotherapy can cause a wide range of side-effects, ⁢including:

* Nausea and vomiting

* Fatigue

* Hair loss

* Low blood counts

* Diarrhea

* Constipation

* Mouth sores

* Skin problems

* Nerve damage

**What Causes Chemotherapy Side-Effects?**

Chemotherapy drugs are toxic⁢ to both cancer cells and healthy cells. This toxicity can lead ⁢to a variety of side-effects. The specific side-effects a person experiences will depend ⁣on the type of chemotherapy drugs ⁤used, the dosage, and the person’s individual ⁤reaction.

**How Can I Manage Chemotherapy Side-Effects?**

**Nausea and Vomiting:**

* Take anti-nausea medications prescribed by your doctor.

* Eat bland foods, such as crackers or rice.

* Avoid strong odors and spicy foods.

* Get plenty of rest.

**Fatigue:**

* Get regular exercise, even if it’s just light walking.

* Eat a healthy diet and drink plenty of fluids.

* Get enough sleep.

**Hair Loss:**

*⁢ Use a ⁢gentle‍ shampoo and⁤ conditioner.

* Cover your head with a hat or scarf.

* Protect your scalp from the sun.

**Low Blood Counts:**

* Get regular blood tests to monitor your blood counts.

* Avoid contact with people ‌who ⁢are‍ sick.

* Wash your hands frequently.

**Diarrhea:**

* Drink plenty of fluids to avoid dehydration.

* Eat bland foods, such as bananas or⁣ rice.

*‍ Avoid caffeine and alcohol.

**Constipation:**

* Eat a high-fiber diet.

* Drink plenty of fluids.

* Exercise regularly.

**Mouth Sores:**

* Rinse your mouth regularly with salt water.

*⁢ Avoid alcohol-based mouthwashes.

* Eat soft foods, such as yogurt or⁤ pudding.

**Skin Problems:**

* Use a gentle soap and moisturizer.

* Avoid harsh sun exposure.

* Wear comfortable, loose-fitting clothing.

**Nerve Damage:**

* Numbness and tingling‍ in the hands and feet are potential side-effects of some chemotherapy drugs.

* Protect your hands and feet from cold temperatures.

* Use gloves ‍and socks when handling cold items.

**Other Side-Effects:**

* Infertility

* Kidney problems

* Liver problems

* Heart problems

**When Should I Call My Doctor?**

It’s important to call your doctor if you ⁣experience any side-effects of chemotherapy that are severe or do not improve. Your doctor can adjust your treatment plan to minimize side-effects.

Chemotherapy Side-Effects