When Is Chemotherapy Not Recommended?

Although chemotherapy is an effective cancer treatment, it's not recommended for everyone. In certain situations, chemotherapy may not be recommended for patients who may experience serious side effects from the treatment.

In this article, we'll discuss when chemotherapy is not recommended and what factors are taken into consideration when making that decision.

Senior asian female cancer patient wearing mask talking to doctor

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The Benefits of Chemotherapy

Chemotherapy is a group of medications that can kill cancer cells and is recommended for several types of cancer. It is very effective, and may be used on its own or combined with other treatments. For example, your oncologist may recommend a round of chemotherapy to shrink your tumor before surgery. 

Cancer cells tend to multiply quickly and replicate much faster than healthy cells. For this reason, chemotherapy targets fast-growing cells. The main drawback to chemotherapy is that it cannot differentiate cancer cells from healthy cells. Therefore, normal cells are also destroyed in the process. This is why chemotherapy has so many possible side effects. 

When developing your treatment plan, your oncologist aims to find the dose of chemotherapy that kills cancer cells while trying to spare as many healthy cells as possible. Fortunately, normal cells are able to recover from chemotherapy, but it may take time. Cancer cells, on the other hand, are not able to recover from chemotherapy. 


Chemotherapy is an effective treatment for destroying cancer cells. Unfortunately, in addition to targeting cancer cells, it also destroys healthy cells in the process.

When Is Chemo Not Recommended?

Chemotherapy is not recommended when the potential risks outweigh the benefits. Because of chemotherapy’s considerable side effects, it may not be safe for individuals who have underlying conditions. If your oncologist worries that your body is not strong enough to withstand chemotherapy, they will likely recommend other treatment options. 

Factors to consider when determining if chemotherapy is appropriate include:

  • Other diseases present (comorbidities)
  • Age
  • Overall health
  • Surgery complications
  • Disease progression 

Fortunately, cancer treatments are always evolving and improving. There are now certain types of cancer that no longer require chemotherapy because more effective treatment protocols have been developed.

For example, a 2018 study in the New England Journal of Medicine found that most women diagnosed with early-stage breast cancer do not require chemotherapy after surgery. According to the study’s authors, this means that 70% of early-stage breast cancer patients can safely avoid chemotherapy because it is not necessary. 


Because of chemotherapy’s possible risks and side effects, it is not always recommended. Your oncologist may recommend avoiding chemotherapy if your body is not healthy enough to withstand chemotherapy or if there is a more effective treatment available. 

Chemotherapy’s Risks

Because chemotherapy destroys healthy cells throughout the body, several side effects are possible. The healthy cells that are most likely to be damaged by chemotherapy are located in the bone marrow, hair follicles, mouth, digestive tract, and reproductive system.

Like cancer cells, the cells in these areas of the body also grow quickly and are thus targeted by chemotherapy. Chemotherapy may also damage cells in the heart, lungs, kidneys, bladder, and nervous system. 

The most common chemotherapy side effects include:

  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Bleeding and bruising
  • Higher risk of infection
  • Low red blood cells (anemia)
  • Mouth sores 
  • Diarrhea or constipation
  • Dry skin
  • Peripheral neuropathy, damage to the peripheral nerve system
  • Cardiac problems 
  • Bladder changes
  • Weight loss
  • Lowered ability to focus, known as chemo brain
  • Mood changes
  • Changes in sexual function or libido
  • Fertility issues 

What to Expect During Chemotherapy Treatment

Chemotherapy treatments can vary drastically based on the type of cancer and how advanced it is. A chemotherapy appointment may take place in an oncology clinic, doctor’s office, or the hospital. 

Because chemotherapy can cause significant side effects, the treatment is usually given in rounds with breaks in between. These breaks allow time for your body to recover. The chemotherapy treatment and rest period are known as a treatment cycle. 

Chemotherapy can be given in the following forms:

  • Intravenous (IV): The medication is injected directly into the vein over a few minutes to hours.
  • Oral: Chemotherapy is given in pill form and can be taken at home.
  • Injected: The medication is given as an injection into the muscle or subcutaneous, under the skin, tissue. 
  • Intra-arterial: Chemotherapy is injected directly into a large vein known as an artery.
  • Abdominal: Some cancers are treated with chemotherapy placed directly into the abdomen. 
  • Topical: Topical chemotherapy is applied to the skin in the form of a cream. This can be given at home.

Other Types of Treatment for Cancer

There are several types of cancer treatments available, and the list is always growing. Common cancer treatment options include:

  • Surgery: The surgeon removes the primary tumor and/or lymph nodes. Surgery is sometimes followed by chemotherapy or radiation therapy to kill any remaining cancer cells. 
  • Radiation therapy: This treatment uses high doses of radiation to kill cancer cells.
  • Targeted therapies: Targeted therapies target specific proteins on cancer cells. The advantage of this treatment is that it does not attack healthy cells like chemotherapy does. 
  • Hormone therapy: These drugs can slow the growth of certain types of cancers by blocking hormones in the body.
  • Immunotherapy: Immunotherapy works by boosting the immune system’s response to help it become more effective at fighting cancer cells. 


Chemotherapy is a cancer treatment that uses chemicals to destroy cancer cells. However, it also attacks healthy cells and can lead to significant side effects. Possible side effects include fatigue, hair loss, nausea and vomiting, and many others. Talk with your doctor about whether the potential benefits of chemotherapy outweigh the risks for you. 

A Word From Verywell

Dealing with a cancer diagnosis is likely one of the most stressful experiences of your life. You may be wondering if chemotherapy is worth the risks. Talk with your oncology team about the benefits of chemotherapy, as well as the potential drawbacks. Because cancer research is always evolving, there may be a more effective treatment available. 

Frequently Asked Questions

  • Is chemotherapy worth its risk?

    The short answer is, it depends. While chemotherapy comes with a significant risk of side effects, it is also an effective treatment option for fighting several types of cancer. Talk with your medical team about the possible side effects and the likelihood of chemotherapy being effective against your type of cancer. 

  • Is chemotherapy still recommended after multiple treatments?

    If you have undergone several rounds of chemotherapy without an improvement in your disease, your medical team will likely discuss other options with you. Treatment options for cancer include chemotherapy, radiation therapy, surgery, targeted therapies, hormone therapy, and immunotherapy. 

  • Is it possible to refuse chemotherapy?

    Yes, it is always possible to refuse treatment for cancer. Your medical team will talk with you about their recommendations for your treatment plan, but you are the one to decide whether or not to begin treatment.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. How chemotherapy drugs work.

  2. El Shayeb M, Scarfe A, Yasui Y, Winget M. Reasons physicians do not recommend and patients refuse adjuvant chemotherapy for stage III colon cancer: a population based chart review. BMC Res Notes. 2012 Jun 7;5:269. doi:10.1186/1756-0500-5-269

  3. Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, Olson JA Jr, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW Jr. Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med. 2018 Jul 12;379(2):111-121. doi:10.1056/NEJMoa1804710

  4. American Cancer Society. Chemotherapy side effects.

  5. Cancer.Net. Understanding chemotherapy.

By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.