Side Effects of Chemotherapy

The side effects of chemotherapy differ from person to person. Chemo drugs kill not only cancer cells but normal, healthy cells as well. Damage to healthy cells is why chemotherapy causes side effects. Not everyone will experience the same side effects or to the same degree. They depend on the type of cancer, location, drugs, and dose, and a person's general health.

Why Side Effects Happen

Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. Cells commonly affected by chemotherapy are those in the bone marrow, mouth, digestive system, reproductive system, and hair follicles.

Most chemotherapy treatments inhibit cell division, and, therefore, will affect not only cancer cells but also normal cells that undergo active division like cells of the gastro-intestinal tract, for example.

What Are the Side Effects?

Certain classes of chemotherapy drugs are more frequently associated with side effects.

Common Side Effects

Dry Skin

Chemotherapy agents may induce dryness and peeling of the skin. A study involving chemotherapy patients receiving hormonal treatments reported dry skin as the most common side-effect (60.86%). To manage this side effect, stay hydrated, avoid exposure to a harsh climate, and avoid personal soaps and detergents without artificial dyes or fragrances when possible. Wear protective gloves while doing tasks such as household dishes or gardening, and use moisturizing body oil after showering.

Dry skin is extremely common with radiation treatments. It is so common that you may hear it referred to as "radiation dermatitis" or "radiodermatitis." This is because your skin may not have enough time to regenerate healthy cells following the radiation damage. If you are having radiation on a part of the body where the skin is more delicate, such as the neck, you may be more prone to skin reactions. If your skin is already damaged, such as from sun exposure, these side effects may be worsened. It is estimated that 95% of those undergoing radiation treatment will experience some form of skin reaction.

Rashes

Rashes appear as discoloration of the skin and can be smooth or flat. Often, rashes cause irritation such as itching. Those with rashes as a result of their chemotherapy treatment should stay hydrated, avoid exposure to a harsh climate, and avoid personal soaps and detergents without artificial dyes or fragrances when possible. They may also want to opt for loose-fitting, cotton fabrics that may be more comfortable and avoid excessively hot baths. Colloidal oatmeal suspensions can be found in a variety of products, such as available in bath soaps. Studies have demonstrated that colloidal oatmeal can help with skin inflammation.

Some chemotherapies can make you extra sensitive to sunlight. This is called photosensitivity. It can mean you become red or burn from the sun more easily.

Fatigue

Fatigue is the most common side effect of cancer treatment. It can be caused by a variety of reasons, such as the death of healthy cells and psychological stress. Maintain a healthy lifestyle to the extent possible. For example, if you do not have the energy to go for a walk, discuss developing seated exercises with your provider. Stay hydrated and keep up with whole foods.

Nausea

Chemotherapy drugs can trigger the chemotherapy receptor zone (CTZ), which can cause nausea. Avoid foods with a strong smell (such as anchovies) and greasy foods. Eat small meals and rest after each meal. Consume beverages at room temperature. Your healthcare provider may be able to help prescribe a medication to help with nausea. Hydration is very important because nausea may induce vomiting, which can lead to dehydration.

Constipation

Constipation occurs when bowel movements are infrequent, dry, and hard. Constipation can occur as a result of cancer itself, or as the result of cancer therapies, or a combination. Staying hydrated can help soften stools. FIber, stimulant laxatives, or enemas are potential treatments. Auricular acupressure was found to be effective in reducing constipation in one study.

Hair Loss

Certain drugs have been deemed more likely to cause hair loss than others. Hormonal therapies are most associated with hair thinning. Some people choose to purchase a wig, and you can check to see if your insurance company will cover the cost. If you choose to forgo a wig, stock up on a nice selection of hats and/or headscarves! Some companies donate hats and headscarves for chemotherapy patients. Programs like Look Better, Feel Better help people adjust to changes in their appearance through support groups and beauty guides.

Diarrhea

Chemotherapy may damage the cells that line your intestines and cause loose stools. In certain cases, you may need to have IV therapy for remedial hydration. Diarrhea can cause complications such as renal failure and electrolyte disorders. Drinking beverages at room temperature and avoiding greasy, fatty foods can help. Remember the acronym BRAT: It stands for bananas, rice, apples, and toast. These are foods that are generally well-tolerated by an upset stomach.

Sexual or Reproductive Issues

People going through chemotherapy may experience erectile dysfunction (ED), or vaginal dryness.

Side Effects Timeline

Rashes and dry skin

• Radiation treatments may result in skin peeling, itching, redness, irritation, and general dry skin, which can increase with the frequency of treatments. The dry skin can begin to appear within as little as one week and is likely to worsen as long as treatments continue. The good news is that your skin is very likely to repair itself once the radiation treatments have stopped. However, the effects can last as long as four weeks after the final treatment. There is a distinct condition, known as "chronic radiation dermatitis" which can last for years following radiation therapy. Speak with your healthcare provider if your skin symptoms persist in the months following treatment.
• Other chemotherapy treatments, including targeted therapy and immunotherapy, can also result in dermatologic reactions. Though many of these treatments have improved the overall lifespan of these patients, they have also increased the number of people experiencing side effects. A study of 100 patients undergoing chemotherapy treatments revealed that most people experienced a peak in skin symptoms at 2-3 weeks.

Fatigue

• The stress of impending chemotherapy can cause fatigue, or tiredness of the mind and body, even leading up to treatment. Depending upon your predisposition to stress, this could impact you in the weeks, or even months, before you initiate chemotherapy treatments. The period of time immediately following a chemotherapy treatment day is typically the worst.
• Hormonal changes in men and women undergoing treatment can cause fatigue, particularly in relationship to disrupted sleep cycles. Cancer-related fatigue sometimes referred to as "CRF", has been reported to persist for as long as 10 years post-treatment. However, there is no evidence to suggest this length of persisting fatigue is common.

Nausea and vomiting

• In a 5-day study of 827 patients, the majority experienced a gradual decline in nausea and vomiting over time.

Constipation and diarrhea

• Bowel-related problems are most common in the hours and days immediately following chemotherapy.

Hair loss

• Hair loss related to chemotherapy, sometimes called chemo-related alopecia, can begin in the days to weeks after the first treatment.

Sexual or reproductive issues

• While you are undergoing chemotherapy treatment, it is recommended to use a condom during all types of sex to avoid the transmission of toxins to your sexual partner.
• Pregnancy during chemotherapy is not recommended, as there is a significant risk for birth defects. In general, but in particular, during the first trimester, abortion is the recommended course of action in the event of a pregnancy.
• Conceiving within a year of commencing treatment carries a significantly elevated risk of preterm birth.
• Issues with sexual function vary with treatment type and dosage, but generally are most acute during, and immediately following, treatment, but in the cases of chemo-induced menopause, infertility, and prostate removal, they may persist indefinitely.

Long-Term Effects/Late Effects

Most side effects go away after treatment, but some of them continue, come back, or develop later. A number of long-term effects are associated with chemotherapy treatment.

Cardiac Concerns

Those who have treatment for left-sided breast cancer may experience damage to the heart and coronary arteries. It is important to speak with your oncologist about these concerns. A respiratory grating is a technique used for left-sided breast cancer that can help mitigate these effects.

Fatigue

Many people feel fatigued long after their chemotherapy has finished. It is important to share this with your provider. Frustrating cognitive effects, sometimes referred to as chemobrain, can be very frustrating, but the symptoms usually improve over time.

Infertility

Infertility following treatment varies by treatment type and dose. It is important to let your care team know if you want to have children or may want to. They can discuss options with you such as sperm preservation, embryo preservation, and freezing eggs.

Peripheral neuropathy

Peripheral neuropathy may present as numbness and burning in your feet and hands and constipation. Some drugs that are more likely to cause peripheral neuropathy are Taxotere (docetaxel) and Taxol (paclitaxel). The medications Platinol (cisplatin), Oncovin (vincristine), and Novelbine (vinorelbine), can also result in peripheral neuropathy.

Hearing Loss

Platinol (cisplatin) is commonly linked to hearing loss (ototoxicity).

Osteoporosis

This is the most common delayed effect of chemotherapy. Osteoporosis can make bones more vulnerable to fracture and lead to bone loss.

Pulmonary fibrosis

Chemotherapy can lead to pulmonary fibrosis in certain people, especially when chemotherapy is combined with radiation to the chest region.

Kidney and Bladder Effects

Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood. Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine. People on chemotherapy often receive steroids, which can hasten the development of cataracts in some people.

Frequently Asked Questions 

How long do the side effects of chemotherapy last?

What are the worst side effects of chemotherapy? 

Does your body get used to chemotherapy?

• In other words, do the symptoms ever improve?

A Word From Verywell

Concerns about side effects prior to beginning treatment for chemotherapy are normal. There is a wealth of information available on the specific symptoms associated with personal factors and specific chemotherapy agents. Every treatment path is unique. Maintaining an optimistic attitude and relying on your support system can help to significantly reduce anxiety. Although it is important to take time to research your care, it is also important to take time to disconnect and relax.