Chemotherapy Side Effects: A Complete Guide

We all probably know someone who has had cancer at some point in their lives or another. The majority having had to go through a difficult treatment process that involves chemotherapy. While chemotherapy’s job is to eliminate the bad cancer cells from the body, it does the job so well it that actually eliminates the good, healthy, helpful cells from the body, too. This cell elimination process can be hard on the patient in many ways and it involves many side effects. What are the chemotherapy side effects? What is chemotherapy? What are the short-term chemotherapy side effects, long-term chemotherapy side effects, major chemotherapy side effects, and minor chemotherapy side effects? What is the timeline for these chemotherapy side effects to taking place? What are the chemotherapy side effects after the first session? What are remedies and ways to fight chemotherapy side effects? What are tips for managing chemotherapy side effects?

Chemotherapy side effects: What is chemotherapy

Chemotherapy, also shortened to just chemo, is a treatment for cancer by using drugs to kill the cancerous cells in the body.

Chemotherapy was discovered in World War II when U.S. Naval personnel who had been exposed to mustard gas (a deadly gas) showed changes in their bone marrow cells. After researching, a compound known as nitrogen mustard was found and it worked in killing the lymphoma. Shortly thereafter, a Bostons scientist found a compound related to folic acid, known as aminopterin, that put children with leukemia in remission. Since then, researchers have discovered a multitude of drugs that are associated with cell growth and replication.

While chemotherapy can help cure some people, it might only help slow down the cancerous cells, but not kill them, in other people. For some, chemotherapy simply eases the symptoms. For example, chemotherapy can shrink some types of tumors that cause pressure or pain. Nevertheless, chemotherapy has been proven to save lives.

Chemotherapy side effects

When someone has cancer, they have good (non-cancer) cells and bad (cancerous) cells in their bodies. The good, healthy cells include cells such as hair follicles, cells within the mouth, reproductive system, digestive tract, and the blood-forming cells within the bone marrow. The cancerous cells have a tendency to grow faster than the good cells which makes them harder to fight off. However, the use of chemotherapy has been used to kill the rapidly-growing cancerous cells. Chemotherapy uses drugs and radiation that travel throughout the body in order to kill off the bad cells. While the bad cells die, though, so do the good, healthy ones, too. These healthy cells dying cause side effects on someone who is undergoing chemotherapy, as well as the use of the chemo drugs and radiation from the treatment. It’s important to keep in mind that not everyone will receive the same chemo drugs and each person’s body will react differently depending on their age, the shape they’re in, and their diet.

Most common chemotherapy side effects

        The most common side effects include but are not limited to:

• Bruising easily
• Changes in appetite
• Intense headaches
• Hair loss, anywhere between mild and extreme. Sometimes it comes out with the brush, other times it comes out in clumps… it depends on the person and type of chemo.
• Being more prone to infections
• Feeling nauseous
• Feelings of the chills
• Constipation
• Diarrhea, sometimes long-lasting. Some types of chemotherapy cause watery bowel movements.
• Changes in nails and skin. For example, changes in skin color and dry skin
• Vomiting
• Feeling tired and fatigue is the most common side effect of chemo
• Chemo brain- a condition in which the person’s brain is affected in areas such as focus and concentration

• Muscular and nerve issues like tingling, pain, and numbness
• Experiencing problems with sores and pain swallowing in the throat, mouth, and tongue. Mouth sores happen due to the damage from chemo to the mouth and throat cells. This cell damage causes sores that are known as mucositis.
• Problems with fertility
• Libido changes and sexual function problems
• Having a low blood cell count, a condition known as anemia
• Bleeding easily
• Blood disorders. Our bone marrow is spongy and is a tissue that is inside our bones. Our bone marrow makes new blood cells. However, chemo affects the process bone marrow goes through to make new blood cells. Which, in turn, means that there could be too few blood cells. The good news is that often after chemo stops, so do the blood disorders.
• Mood swings
• Issues and changes with bladder, kidney, and urine control
• Changes in weight

Short-term chemotherapy side effects

Chemotherapy physical side effects

One of the most well-known side effects of chemotherapy is hair loss, also known as alopecia. Hair loss can occur all over the body, but it’s most common on the scalp. The hair loss is due to the chemotherapy drugs. With drugs such as docetaxel, doxorubicin, and raclitaxel, people always lose their hair.

Nausea and vomiting are another well-known chemotherapy side effects. The healthcare professionals who are in charge of the treatment plan also often prescribe anti-nausea medication to try and prevent and/or alleviate nausea and vomiting.

Chemotherapy is painful. It can cause nerve damage and muscle pain (myalgia). Drugs like cisplatin, taxanes, and vinorelbine are known to cause nerve damage. The damage feels like a shooting pain, numbness or burning in the fingers or toes known as neuropathy.

Mucositis and stomatitis (mouth and throat sores) are both a common side effect, as well. Drugs such as docetaxel and doxorubicin harm the tissues that line the throat and mouth areas and cause sores. Luckily, the sores go away when the chemo ends.

The absolute most common of the chemotherapy side effects is fatigue. Even if you get enough rest, it doesn’t feel like enough. That’s completely normal. Studies have shown that walking 20-30 minutes a day can help reduce fatigue (and it helps ward off other side effects such as osteoporosis!). Other studies have shown that mindfulness meditation, yoga, and cognitive behavioral therapy can help ward off the fatigue, too.

Chemotherapy cognitive side effects

Chemo brain, also known as chemo fog, cognitive dysfunction, and chemotherapy-related cognitive impairment is a misleading term because it might not actually have everything to do with the chemotherapy treatment. Misleading as it might be, the term chemo brain is used by patients and doctors to describe the memory, concentration, and attention issues. Essentially, it’s a form of mental fatigue.

Felt by about 30% of chemo patients, the exact causes of chemo brain are unknown. Scientists hypothesize that the drugs could have a neurotoxic effect on the brain or that they could indirectly start an immunological response that causes an inflammatory reaction within the brain. Others believe that chemo brain has little to do with chemotherapy and more to do with cancer itself. Cancer may change parts of the brain. Or, the explanation could be that chemo brain is just a heightened version of the natural cognitive decline that happens in the aging process- especially taking into account the fact that a good majority of cancer patients are over the age of 50.

Chemo brain can occur pre-chemo, during treatment (common), and after treatment (rare) to men and women of all ages. However, it’s largely reported with breast cancer survivors with an estimated 17-50% of women with the condition. One study showed that women who went to cognitive behavioral therapy after their chemo sessions had significant improvements in their executive and verbal functions as well as an improved quality of life compared to those who didn’t try the therapy. Another study on mice found that mice who underwent chemotherapy had 14% fewer hippocampal neurons (the neurons living in the hippocampus which is the part of the brain responsible for memory) three months after chemotherapy, and 26% fewer surviving neurons during chemotherapy. Considering that three months to a mouse is equal to 10 human years, the effect of chemo brain is real and, although not as common, might not go away after the therapy is done.

Chemotherapy emotional and behavioral side effects

Struggling with mental health is common for people who are suffering from a long-term illness such as cancer. Add in the harsh treatments such as chemotherapy and it becomes difficult to deal with.  Because there is no right way to deal with cancer, many people are seen dealing with it badly. However, their lack of coping well with the news and chemotherapy is normal- no one is okay with having cancer at first. People are often seen as suffering from depression, becoming irritable, having mood swings, anxiety, and sometimes apathy. Some people have panic attacks and become suicidal.

Long-term chemotherapy side effects

It’s incredibly important to bear in mind not just the short-term chemotherapy side effects, but also the long-term effects considering that they’ll be with you for a while. One study found that most often, the short-term effects are considered and the long-term effects aren’t mentioned initially.

Depending on the type of cancer, different surgeries have different chemotherapy side effects. People who suffered from soft-tissue and bone cancers and have their limbs removed can experience phantom limb pain which leaves them physically and emotionally upset. People who have cancerous surgeries in the abdomen and pelvis that experience infertility may have a lot of emotional upset. People who had their lymph nodes surgically removed or had radiation therapy done to their lymph nodes can develop what is known as lymphedema. It happens when the lymph fluids build up can pain and swell. People who had Hodgkin lymphoma before 1988 had their spleens removed- an organ which plays a vital role in the immune system balance. They are held at higher risk of infections for the rest of their lives.

People undergoing chemo and radiation therapy (specifically to the chest, but other areas of the body apply as well) to the chest can experience heart problems. The common conditions are congestive heart failure, coronary artery disease, and irregular heartbeats (arrhythmias). Those, especially at risk, are:

• Anyone over age 65.
• Anyone who had high doses of chemo or radiation therapy.
• Anyone who had treatment for hodgkin lymphoma in their childhood.
• Anyone who received medications such as doxorubicin (Doxil, Adriamycin), or trastuzumab (Ogivri, Herceptin).

Lung issues can occur due to chest damage from the radiation and chemo. Survivors that received both chemo and radiation are at higher risk for lung problems. Some of the issues include inflammation of the lungs, a change in how well the lungs are working, and a thickening in the lung lining. The drugs that have had the most reported lung issue side effects are Beckenham, BiCNU, Carmubris (Carmustine), Blexame (Bleomycin), and Methotrexate.

Issues in learning, attention, and memory happen when the chemo and high-dose radiation reach the brain. They’re a common ordeal known as chemo brain and should go away once the treatment is done. However, that doesn’t always happen and some patients may still have trouble processing information and remembering things after the treatment is done.

High blood pressure is another possibility due to some drugs that help with chemo but at the same time that target the vascular endothelial growth factor (VEGF). Common drugs that do this are sorafenib (Nexavar), Bevacizumab (Avastin, Mvasi), and Sunitinib (Sutent). The risk for hypertension decreases after the person is done taking the drugs. However, the long-term effects of these types of medications aren’t known yet.

Long-term damage to the brain, nerves, and spinal cord is possible, too. This damage can include things such as an increased risk of stroke due to the high dose of radiation in the brain, hearing loss from high doses of chemo, and damage to the nerves outside the spinal cord and brain (peripheral neuropathy).

Problems with the bones, joints, and soft tissue are common for those who underwent chemo, hormonal therapy, or took steroid medications because these therapies can cause osteoporosis– a condition that thins the bones and causes joint pain. It helps to lower one’s risk for long-term osteoporosis by remaining physically active, eating vitamin D and calcium, and avoiding tobacco and alcohol products.

Experiencing hormonal problems due to the endocrine system is common in some cancer treatment plans. The endocrine system includes the organs and glands that produce eggs, sperm, and hormones. Common hormonal issues include menopause, early menopause, and infertility. Women over 40 who undergo chemo shouldn’t expect their periods to return- at least with regularity if at all. People who had head and neck radiation therapy will have lower hormone levels overall and possibly have changes in the thyroid (the hormone regulator).

Overall, the most common long-term risks are surgical issues, heart problems, lung issues, attention and memory problems, hypertension, brain and spinal cord issues, bone and joint problems, hormonal problems

Chemotherapy side effects: Late effects

There are effects that pop up months or even years after the chemo treatment has ended. These effects are known as late effects. Children who had chemotherapy and all cancer survivors are at a higher risk to develop late effects and second cancers later in life. Common late effects include muscle weakness, early menopause, chemo brain, numbness, tingling, bone problems, and heart problems as well as chronic fatigue.

Timeline of chemotherapy side effects

Most chemotherapy side effects begin when the treatment dies and go away once the treatment stops. However, some take a few months or more to stop completely. Other chemotherapy side effects may never go away. It depends on the person, cancer, the medication, and the chemo/radiation treatment. Studies have shown that chemotherapy side effects are common while the patient is in routine care (hospitalized, being taken care of nurses, watched hourly by the doctor, etc.), and common while undergoing chemotherapy.

1st chemo treatment side effects

After the first chemo treatment, the patient is often given a medication or two to help control and prevent nausea and vomiting due to the chemotherapy. Rashes may appear on the skin as well as swelling and unusual pain. The day after the first chemo session, people are always tired and need to rest. It’s important to do so. They may also feel somewhat fuzzy brained from the medications. Think about the fact that radiation is going into their body and actually poisoning them to help get rid of the cancerous cells. It’s best to rest, drink lots of water, and relax after the first chemo session to help lessen the chemotherapy side effects that can occur.

Tips for managing and fighting against the chemotherapy side effects

• Tiredness. Considering that fatigue is one of the most common side effects, and being chronically tired can lead to other side effects, it’s important to take care of it as soon as possible. It helps to get plenty of rest, avoid big tasks that you really don’t feel up to doing, and doing light exercise such as yoga or walking 30 minutes a day to help boost energy levels.
• Anemia. Be sure to watch out for anemia (low blood cell count), a serious condition and chemotherapy side effect, because fatigue is one of the most common side effects. Taking Iron supplements and eating foods high in iron (such as meats, beans, whole grains, and dark-green leafy veggies) can help prevent anemia.
• Hair loss. Although it doesn’t happen to everyone, it’s a common chemotherapy side effect of chemo. It’s most often hair loss from the scalp, although hair loss from the body such as the arms, face, and legs is also possible. Minor hair loss will start within the first few weeks of chemo. The good news is that hair loss is temporary and the hair should begin to grow back soon after the treatment is finished. That said, the hair could grow back a different color, or be straighter or curlier than before the chemo treatment. People use wigs or headscarves to help cover up the hair loss once it has begun. Some people use a cold cap to prevent hair loss. A cold cap isn’t always 100% effective and is essentially a helmet that is designed to cool the scalp during the chemo treatment. The cap is meant to reduce the blood flow to the scalp which reduces the amount of medicine that reaches it. One study found that it worked by reducing hair loss by 50% on women receiving chemo for breast cancer.

• Chemo brain. Chemo brain is pneumonia that involves having difficulty concentrating and remembering things. It helps to use lists, phone reminders, post-it notes, and calendars to remember some things. It also is useful to get enough sleep and eat well.
• Nausea and vomiting. People go through bouts and spurts of feeling nauseous and throwing up during chemo. It helps to take some anti-sickness medication to prevent or at least reduce the symptoms. Older studies have claimed that marijuana helps alleviate vomiting, but medical marijuana isn’t legal everywhere. One study claims that mirtazapine is a drug that helps alleviate the symptoms best.
• Insomnia. It’s common for people going through chemo to experience insomnia. Try sleeping with thick curtains, avoid electronics a couple hours before bed, and avoiding things such as caffeine and nicotine before falling asleep.
• Changes in skin and nails. Although temporary, changes such as dry and itchy skin, slightly discolored and flaky nails, or being extremely sensitive to the sun are conditions that are never fun. Using moisturizers (with no traces of alcohol in them) on the nails and skin can help prevent at least some of the symptoms.
• Infections. Chemotherapy reduces the body’s ability to fight infection. It’s a smart idea to wash your hands regularly, get the flu shot, and avoid people who have the flu or chickenpox. Some patients take antibiotics during chemo treatment to prevent any infections from happening.
• Emotional issues. Cancer and chemotherapy aren’t an easy thing and they can really have an impact on not just the person who has cancer, but their surrounding loved ones, too. Try joining a cancer support group or talking to other people who are in a similar situation.
• Vitamins. Chemo takes away a lot of the good things within the body and some people take vitamins to make up for it. However, some vitamins make chemo less effective so it’s important to ask your doctor before taking them. Vitamins that act as antioxidants, such as vitamin A, C, and E, can help prevent the formation of free radicals (ions) that damage DNA. These ions damage the cancerous cells so they are unable to reproduce and grow. This damage is theorized to play a large role in causing cancer. Antioxidants sound good, right? Well, not exactly. Some scientists and doctors believe that taking high doses of antioxidants while undergoing chemotherapy can make the chemo and/or radiation treatment less effective. So, it’s actually best to avoid taking vitamins that contain antioxidants and supplements during the chemotherapy period. The best thing to do is eat a well-balanced diet.

It’s important to keep in mind that not everybody will get chemotherapy side effects- it depends on the person and the type of chemo they are undergoing. Talk with your doctor and cancer team about which chemotherapy side effects are most common with your type of chemotherapy treatment plan. They should be able to tell you how long the effects last and how bad they might be. Even though the chemotherapy side effects aren’t fun, weighing them against the need to kill the cancerous cells beats out those effects.

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Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.