Side effects of Chemotherapy

Side effects of chemotherapy are well known and are mostly related to the effect of chemotherapy drugs on normal dividing cells. Some cells in the body divide more rapidly than others because they have to constantly replace themselves for the body to function normally. Blood cells are a good example of this. The bone marrow produces white blood cells, which fight infection. These cells are produced by stem cells, which divide frequently and white blood cells only live for a short time, they can easily fall to low levels during chemotherapy treatment. This is important because when the white blood cells are low this allows the possibility of overwhelming and sometimes fatal infection. Having a low white count is called ‘neutropenia’.

The cells, which line the bowel also rapidly divide and are sloughed off by the passage of food and liquid. When these are not replaced quickly enough there is ulceration of the mouth, throat and bowel. Ulceration lower down in the intestines can lead to bleeding, nausea, abdominal pain and diarrhoea. It is these effects on normal cells, which limit the amount of chemotherapy that can be given.

Main short term side effects during Chemotherapy

• Fatigue - is the main physical side effect of treatment with chemotherapy. In the days after treatment it is usual for the patient to feel like they are developing a flu-like illness. The acute effects will resolve but feelings of tiredness may persist throughout the treatment cycle and can be very debilitating.
• Hair loss - is common and may cause significant distress.
• Nausea and Vomiting - the majority of chemotherapeutic drugs cause nausea and vomiting of varying degrees. The treatment of this has dramatically improved in recent years and it can usually be effectively managed with anti-emetic drugs.
• Psychological effects - because the physical symptoms are better controlled, the emotional side effects of having cancer and receiving chemotherapy have become more important. It is impossible to separate out the side effects of the treatment and the side effects of having cancer. General tiredness, the strain of being diagnosed with cancer, undergoing tiring treatment and the burdens this imposes on the family are all important. Worries about the future are common.

Another common cause of anxiety about chemotherapy in the past was fear of needles and the discomfort of treatment; this has been addressed by the use of local anaesthetic creams before putting needles in and to an extent by the increased use of indwelling ports and catheters.

Other commonly reported short term side effects

• Giddiness on standing up
• Diarrhoea
• Weight gain
• Shortness of breath

Short term side effects resolve once treatment is complete.

Long term disabling effects of chemotherapy treatment

Peripheral neuropathy (neuritis, plexopathy) - is a toxic effect on nerves, which prevents nerves from working properly.

• Motor nerves – these control movement of muscles, damage may lead to clumsiness or in severe cases paralysis of muscles supplied by the affected nerves. Some recovery may occur once treatment is stopped but the changes are usually slow to improve or permanent.
• Sensory nerves – these nerves enable the sensation of touch, damage to them results in numb areas or areas of pins and needles. In some cases pain fibres are affected and this can lead to pain syndromes.

Abnormal sensations can make simple activities like making a cup of tea, fastening a button or walking difficult, impossible or painful and distressing.

• Breathlessness - has many causes including lung problems and heart failure, which may have been caused by the chemotherapy or radiotherapy. Lung damage or heart problems caused by certain drugs may be irreversible or progressive.
• Leukaemia - is more common in children who have had chemotherapy or radiotherapy treatment.
• Infertility – chemotherapy and radiotherapy can cause infertility.

These side effects are rare.