Side Effects of Chemotherapy

Chemotherapy is an important and effective approach to treating cancer. But like many other cancer treatment options, it has side effects, which develop due to its ability to disrupt cells that divide quickly. Cancer cells divide rapidly, but so do healthy cells such as hair cells. The side effects of chemotherapy are experienced differently from person to person, and though they can appear overwhelming, they can be managed with the right support and care (1).

Chemotherapy causes side effects because it targets and disrupts the function of rapidly dividing cells (2). Cancer cells divide rapidly, but some healthy cells, (such as cells in your hair follicles, digestive tract, and bone marrow) divide rapidly too. Most chemotherapy side effects involve your rapidly dividing cells. The type of side effect experienced, and its severity, depend on the specific kind of drug used, its dosage, and your individual makeup. Side effects will be different case by case, as will the severity of symptoms. Many people experience mild symptoms and a few side effects, especially when doses are low. 

Side effects can occur shortly after a chemotherapy session or later. While some symptoms may show up within the first few hours or days after treatment, others take longer, sometimes even weeks or months. 

Common chemotherapy side effects include:

• Fatigue: This feels like overwhelming tiredness. Some people may feel more tired than others. Fatigue during chemotherapy may be due to anaemia, which is caused by suppression of bone marrow cells that produce red cells (3). Red blood cells carry oxygen around the body. A drop in the number of red blood cells means you're not getting enough oxygen, which leads to fatigue. It may also be due to loss of appetite, vomiting, or other feeding difficulties.
• Nausea and vomiting: Nausea and vomiting may occur during or after chemotherapy because certain chemotherapy medicines can affect both the digestive system and areas of the brain involved in controlling nausea and vomiting (4).
• Loss of appetite and taste changes: Chemotherapy affects taste and can make eating less pleasant, making you eat less (5).
• Hair loss: This happens because hair follicle cells divide rapidly and can be destroyed by the drugs. This can show up as hair loss, facial hair loss, eyebrow loss, and sometimes body hair loss too (6).
• Liver damage: Some chemotherapy medicines can affect liver function. In many cases these changes are temporary and improve after treatment ends, but your healthcare team may monitor your liver function during treatment.
• Increased risk of infection: This is usually due to a reduction in white blood cells, which protect you from infections (3).
• Mouth sores: a common side effect of chemotherapy, which makes eating painful (4).
• Digestive issues: Chemotherapy often causes diarrhoea and constipation. In rare cases, it may even cause lactose intolerance (4). This is because chemo drugs damage the cells lining the digestive system.
• Skin changes: You may experience changes, such as rashes or increased sensitivity to the sun. Your nails may grow slower, become fragile, or fall out. This usually stops soon after your chemotherapy (7).
• Peripheral neuropathy: Chemotherapy can damage your nerves and cause symptoms like tingling sensations, numbness, or pain in your limbs. The nerve damage can also affect balance and coordination, and disrupt your daily activities(8).
• Cognitive changes and chemo brain: You may experience problems with your normal cognitive functions, such as your memory or concentration. It may also become harder to think clearly (9). This is a temporary side effect called “brain fog” and usually clears up on its own.
• Fertility and sex: Chemotherapy can also affect fertility in both men and women, in the short- and long-term. It can reduce your desire to have sex, your sexual function, and cause changes in your hormones (10).
• Kidney changes: The kidney filters unwanted substances from the body, passing them out in urine. Since chemotherapy drugs can be toxic, they can affect your kidneys, which is why you receive a lot of kidney monitoring during chemotherapy. It helps to drink a lot of water and stay hydrated, which helps your kidneys clear out the medication effectively (11).
• Bruising and bleeding: Because chemotherapy can reduce the level of platelets (cells that help blood clot), your risk of bruising and bleeding during chemo increases. It can show up as nosebleeds, bleeding gums, or clotting difficulties (4).
• Hearing issues: Chemotherapy drugs may cause hearing issues like ringing in your ears or difficulty hearing, especially when platinum-based drugs like Cisplatin and Carboplatin are used (12).

Some chemotherapy side effects are short-term while others may linger. Short-term side effects show up during treatment and often improve shortly after your treatment ends. These include:  

• Nausea
• Vomiting
• Fatigue
• Hair loss
• Loss of appetite
• Mouth sores

Long-term side effects, also called late side effects, can develop during/after treatment but linger after treatment has ended. They include: 

• Nerve damage
• Fertility changes
• Heart, lung, or kidney problems
• Cognitive changes
• Fatigue that doesn't go away.

Your recovery from chemotherapy depends on your body makeup and the type of treatment you received or are receiving. A lot of chemotherapy side effects improve after treatment ends, while some take weeks or months to improve. You may even experience symptoms on an ongoing basis.

Follow-up care provided by your healthcare team is important to monitor how well you are recovering and manage any side effects. Your healthcare team may help you make necessary adjustments that make chemotherapy side effects easier to handle. Your doctor has access to more specialised information and can share it with you. 

• Fatigue: If you're fatigued, you should prioritise rest and spread out your daily activities. Don't do everything all at once. Engage in some light physical activity, such as taking walks, as this might improve your energy levels. Also, get enough sleep and build a healthy sleep routine.
• Nausea and vomiting: Some medications can keep you from feeling nauseous or vomiting, but they have to be prescribed by your health care team. What you can also do is refrain from eating large meals all at once if you are vomiting. Instead, eat small frequent meals and avoid strong smells. To manage morning nausea, a light breakfast right after waking up can help, like toast or biscuits. Naturally, it’s a good idea to maintain adequate hydration.
• Loss of appetite and taste changes: If you feel a reduced desire to eat, you can try smaller meals, eating more frequently, rather than larger portions. Consider high-calorie meals that have high protein and experiment with different flavours to find what you like best.
• Hair loss: If you are experiencing hair loss, you can try out hair care products that are gentle on your skin. Don’t use harsh treatments. You may choose to wear head coverings, scarves, or wigs.
• Peripheral neuropathy: Talk to your doctor about symptoms of tingling or numbness. Make sure your hands are protected from injury and don’t participate in activities with a high risk of injury. Avoid extreme heat or cold. Exercise can help prevent and improve it.
• Cognitive changes: If you're struggling with focus, it may help if you set reminders, use notes, or plan your day. Do one task at a time rather than try to merge everything into one. Some mental exercises and routines can help manage your symptoms.
• Fertility and sexual health: You should talk to your doctor about fertility preservation options and go to them with questions about any changes in your sexual function or hormone symptoms.

Depending on the side effect, your healthcare team may recommend medicines or other supportive care measures to help manage symptoms. In some cases, your chemotherapy dosage and schedule can be changed or adjusted. 

Although you can manage some chemotherapy side effects by yourself, you may need to consult a doctor when it gets serious or confusing. 

You should contact the health care team if you experience:

• Persistent or severe nausea and vomiting
• Signs of infection, like fevers and chills
• Unusual bleeding or bruising
• Severe fatigue that affects your day-to-day activities
• Pain that keeps getting worse

Speak to your health care team early on, as this can prevent complications and ensure that your side effects are managed well. Don't hesitate to seek out advice about your symptoms whenever you feel unsure.

Like other cancer treatment options, chemotherapy has its own side effects, which are experienced differently from person to person. In some people, the side effects of chemotherapy are mild. In others, they are more severe. Chemotherapy side effects can show up immediately after chemo or later on, and can be short-term or long-term. Follow up with your care team about your symptoms and concerns, and they will provide the care you need.