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Chemotherapy Side Effects: What To Expect

Medically reviewed by Todd Gersten, M.D.
Written by Emily Wagner, M.S.
Posted on September 8, 2022

  • Chemotherapy for breast cancer can cause several side effects, including hair loss, mouth problems, and fatigue.
  • Many of these side effects begin shortly after treatment starts. They typically resolve within weeks of ending treatment.
  • Understanding what side effects to expect can help you better prepare yourself before beginning chemotherapy.

Chemotherapy is a powerful cancer treatment used to treat several types of cancer, including breast cancer. Chemotherapy drugs work by targeting rapidly dividing cells in the body, including both cancer cells and healthy cells. When healthy cells are damaged or destroyed, it can cause side effects like hair loss and fatigue.

Side effects of cancer treatment can have a big impact on your life. They may affect your energy levels, mood, self-esteem, and ability to work and perform daily activities. Understanding the possible side effects from chemotherapy can help you prepare mentally and physically before you begin treatment.

Common Side Effects of Chemotherapy

Chemotherapy affects the entire body, leading to several side effects. Common side effects include hair loss, mouth issues, weight loss, and fatigue. An important part of preparing for chemotherapy is understanding what side effects to expect, as well as when they might develop and resolve. Being prepared can help you to take steps to feel your best during treatment.

Hair Loss

Hair loss is one of the most common side effects of chemotherapy. Each person’s experience with hair loss is different. Hair loss is often seen on the scalp, but it is also possible to lose hair from your:

  • Eyebrows
  • Eyelashes
  • Pubic area
  • Armpits

Hair loss typically starts within two to four weeks of starting chemotherapy. It may fall out gradually or suddenly in large clumps. You may notice it more when washing or brushing your hair, or it may collect on your pillow while you’re sleeping. Your scalp might also feel tender from the hair loss.

After you finish chemotherapy treatment, it can take up to a few months for your hair to start growing back. Around one month after treatment, there will likely be a soft peach fuzz on your scalp. Over the next three to six months, you can expect to grow back another two to three inches of hair. After one year, four to six inches of hair will grow back.

Chemotherapy treatment damages hair follicles, where hair grows from. The follicles have to heal before new hair can begin growing. You may notice changes in your hair’s texture and color after chemotherapy. Some people who are treated with docetaxel (Taxotere) may not completely regrow hair in some places, such as the eyelashes or eyebrows.

Dry Mouth and Mouth Sores

Dry mouth and mouth sores can occur rarely during chemotherapy treatment. Dry mouth (also known as xerostomia) occurs when you don’t make enough saliva. Your saliva may also become sticky and thick, which can contribute to dryness.

Mouth and throat sores (also known as mucositis) can also form during chemotherapy treatment. These are red, swollen sores that may look like ulcers. Several kinds of chemotherapy used to treat breast cancer may cause these sores, including:

  • Doxorubicin (Adriamycin)
  • Docetaxel
  • Paclitaxel (Taxol)
  • Cyclophosphamide (Cytoxan)

These sores tend to develop around five to 10 days after beginning chemotherapy. Occasionally, oral yeast infections can develop and make the sores worse. This is because many cancer treatments, including chemotherapy, make it difficult for the immune system to fight infections. One of the most common oral infections is thrush, which looks like white patches in the mouth.

Weight Loss

Weight loss is common during cancer treatment. The stress and shock of a cancer diagnosis may also contribute to weight loss. Weight loss during chemotherapy can happen for many reasons, including taste changes, loss of appetite, and nausea.

Taste and smell are important aspects of enjoying food, and certain chemotherapy drugs can affect them. These drugs include docetaxel, ixabepilone (Ixempra), and fluorouracil (Adrucil). You may notice that foods taste more bland, bitter, or metallic within the first week of chemotherapy treatment. Taste changes tend to occur throughout treatment, and they typically resolve a few months after treatment stops.

Nausea and loss of appetite are also common with chemotherapy. More severe nausea may cause vomiting, which can further contribute to weight loss. Several chemotherapy drugs cause nausea, including:

  • Doxorubicin
  • Carboplatin (Paraplatin)
  • Fluorouracil
  • Cyclophosphamide
  • Gemcitabine (Gemzar)
  • Methotrexate (Mexate, Folex, Amethopterin)

Unlike other side effects of chemotherapy, nausea and vomiting tend to occur immediately after treatment begins. This is especially true if you’re receiving an IV infusion or taking chemotherapy drugs by mouth. Delayed nausea and vomiting may also occur 24 hours after treatment and last up to a few days. You may experience stomach pain along with nausea and vomiting, which can make you lose your appetite as your digestive system recovers.

Fatigue

Fatigue, or extreme tiredness, can occur at any stage of treatment for breast cancer. More than 80 percent of people living with cancer are thought to experience fatigue over the course of treatment. Even after completing treatment, fatigue can continue for months as the body heals.

Fatigue from chemotherapy is sometimes caused by anemia, or a low number of red blood cells. Fatigue tends to peak around one to two weeks after starting chemotherapy treatment. After you complete your chemotherapy course, you will gradually start to feel better. Most people return to their normal energy levels within six months to a year after treatment stops.

Skin and Nail Changes

Skin and nail cells are constantly dividing and being replaced in the body, making them a target of chemotherapy drugs. You may notice bruising around your nails. The nail itself may become thinner, or the nail bed may dry out. Chemotherapy drugs like doxorubicin, ixabepilone, and docetaxel cause these symptoms.

Nail changes can start shortly after treatment, or they may take months to occur. If you lose a fingernail or toenail, it can take anywhere from six months to over a year to grow them back.

The chemotherapy drug ixabepilone can also cause skin discoloration. It is also possible to have a reaction to IV-infused chemotherapy drugs, which can lead to skin rashes. After treatment stops, the skin typically returns to normal.

Chemo Brain

“Chemo brain” is a term used to describe memory loss and brain fog associated with chemotherapy. It can also affect your ability to concentrate and think, such as finding the right words to say.

Chemo brain is more common with certain types of chemotherapy, including fluorouracil, cyclophosphamide, and doxorubicin. For many people, chemo brain tends to resolve within nine months to a year after stopping chemotherapy. Around 10 percent to 20 percent of people may have long-term brain fog.

Late Side Effects of Chemotherapy

You may notice some lasting side effects after you’ve completed your course of chemotherapy. Some people may not experience any late side effects, depending on the drug they received. Some of these side effects include:

  • Early menopause
  • Nerve damage
  • Dental problems
  • Loss of taste
  • Infertility
  • Bone problems, such as osteoporosis
  • Hearing loss

If you notice any of these side effects after your treatment stops, talk to your doctor. They will come up with a treatment plan to help you manage them.

Managing Side Effects of Chemotherapy

Managing the side effects of chemotherapy while coping with treatment can feel overwhelming. However, you can manage most side effects at home with remedies to feel more comfortable. Talk to your doctor or ask fellow members on MyBCTeam for ways to find relief from your side effects. Many members have likely experienced similar side effects and can share their tips and suggestions.

Talk With Others Who Understand

On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you experienced these chemotherapy side effects? How did you manage them? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    Posted on September 8, 2022
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    Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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