Chemotherapy medicines target and destroy the rapidly dividing cancer cells. Along with the rapidly dividing cancer cells, normal cells get damaged as well. Blood cells, cells lining the mouth, intestinal and genital tract, skin cells, hair and nails are some of the cells which are most affected by chemotherapy.

The good thing is these healthy and normal cells are capable of repairing themselves and they regain the normal function while the cancerous cells are permanently destroyed after chemotherapy.

There are many side effects associated with chemotherapy but most of them are temporary and disappear when the treatment is stopped. There are some permanent and long term side effects as well. Since every individual is different and every patient responds to chemotherapy in a unique way, the side effects of chemotherapy are very diverse too.

Short Term Side Effects of Chemotherapy for Breast Cancer

The short term side effects of chemotherapy are mainly due to the destruction of rapidly dividing normal cells of the body and most of them disappear when the treatment is stopped. These include:

• Loss of hair
• Reduced appetite
• A feeling of nausea and vomiting
• Loose stools and diarrhea
• Mouth ulcers
• Tiredness, lethargy and fatigue ( due to lack of blood cells)
• More susceptibility to bruising and bleeding ( due to reduced number of platelets)
• Increased risk of infection ( due to reduction in white blood cells)
• Damage to heart and nerves

The nausea and vomiting associated with chemotherapy can be controlled by administration of anti-emetics simultaneously. If these side effects are intolerable or very severe, the dose and type of chemotherapy can be adjusted to minimize the side effects.

Long Term Side Effects of Chemotherapy for Breast Cancer

1.     Infertility

Infertility is one of the most common long term side effects associated with chemotherapy. Chemotherapy for breast cancer can lead to menopause like symptoms; hot flashes, irregular periods and dryness of vagina are commonly experienced. The ovarian cells are damaged and ovulation stops resulting in infertility. If your periods are regular, there is a chance of getting pregnant during treatment but the chemotherapy drugs can damage the fetus. Talk to your doctor regarding contraception before the treatment starts.

2.     Osteoporosis

Bone density loss is one of the side effects of chemotherapy for breast cancer patients due to premature menopause like state. There is increased risk of fractures and bone density loss should be measured periodically and treated to avoid any serious damage.

3.     Neuropathy (Nerve Damage)

The nerve damage results in numbness or tingling sensation. Most of the times the nerves recover and the symptoms disappear after finishing chemotherapy but sometimes these can stay for a very long time.

4.     Damage to the Heart

Some chemotherapy medicines can damage the heart muscles and this damage can be permanent. The most common drugs causing this side effect are epirubicin (Ellence) and trastuzumab (Herceptin), especially in high doses.

5.     Effects on Cognitive Function

The exact mechanism of some short term memory loss and concentration problems known as chemo brain or chemo fog is not very well understood. This long term and less common side effect of chemotherapy gets better after a few years.

6.      Higher Risk of Infections

The most troublesome side effect of chemotherapy is increased susceptibility to infections. When the white blood cells are damaged the body is unable to fight off infections and is more likely to catch any kind of bug. The best thing is to avoid crowded places and limit contact with anyone with an infection. The white blood cells are at the lowest seven to ten days after the chemotherapy. Be careful at that time and contact your doctor immediately if you feel unwell.

Some infections require antibiotics and to increase the number of white blood cells rapidly, G-CSF (granulocyte colony stimulating factor, Neulasta or Neupogen) or GM-CSF (granulocyte macrophage colony stimulating factor, Leukine) can be prescribed.

7.     Other Side Effects

In addition to the side effects above, patients do experience depression, a feeling of isolation and sadness. It is very important to offer them emotional support and reassurance.

Ways to Manage Side Effects of Chemotherapy for Breast Cancer

1.     For Loss of Appetite

• Try to have small frequent meals and have the largest meal of the day when you feel most hungry.
• You can snack on nutrient rich shakes.
• Try to avoid drinking water or juices just before the meals.
• Keep yourself well hydrated.
• Exercise and stay active for a healthy appetite.

2.     For Nausea and Vomiting

• There are some medicines which can be prescribed to control nausea and vomiting, ask your doctor about them.
• Avoid very hot, oily or spicy food.
• Have small portions and frequent meals.
• Try bland foods which do not trigger nausea.
• Herbal teas can be helpful.

If the nausea or vomiting is severe, contact your doctor urgently.

3.     For Weakness and Fatigue

Chemotherapy can make you tired, exhausted and depressed.

• Try to have proper rest and sleep.
• Keep as active as you can and have some light exercise or walk every day.
• Involve your friends and family and learn to delegate some tasks to them.
• Do let your doctor know if you have any pain or the tiredness is too much to bear.
• Eat a nutrient rich diet.
• Certain medicines can boost blood cell production and can be prescribed to treat fatigue.

4.    For Mouth Soreness

Mouth ulcers can be very painful and these frequently occur with chemotherapy. There are some medicines which can help to reduce the pain and soreness of these ulcers. To be comfortable, avoid spicy and citrus food and keep yourself well hydrated.

5.     For Weight Gain

Due to decreased physical activity, you can gain some weight during or after chemotherapy. Do not go on a diet by yourself. Talk to your doctor or nutritionist first and follow their advice.

When Are Side Effects an Emergency?

Contact your doctor urgently if you have any of the following symptoms after chemotherapy:

• Fever or chills can be a sign of infection and need urgent attention.
• Mouth ulcers, swollen tongue, bleeding gums
• Dry throat and difficulty on swallowing
• Persistent cough
• Any change in your bowel habits
• Increased or decreased frequency of urination, or any pus or blood in urine
• Severe vomiting or diarrhea