From the Guidelines
Chemotherapy is associated with a wide range of adverse effects, including pain, fatigue, nausea, vomiting, mucositis, hair loss, infection, and myelosuppression, as well as long-term effects such as cognitive impairment and fertility problems 1.
Common Adverse Effects
- Fatigue
- Nausea and vomiting
- Hair loss
- Decreased blood cell counts (leading to increased risk of infection, bleeding, and anemia)
- Mouth sores
- Digestive issues like diarrhea or constipation
- Nerve damage (neuropathy) causing tingling or numbness in extremities
- Skin changes
- Cognitive effects ("chemo brain")
- Fertility problems
Management of Adverse Effects
Medications to manage these side effects are often prescribed prophylactically, such as ondansetron or palonosetron for nausea, growth factors like filgrastim to boost white blood cells, and various pain medications for neuropathy 1.
Long-term Effects
The combination of chemotherapy and immunotherapy has been associated with an increased incidence of all grade adverse events and serious adverse events, including high grade diarrhea, dyspnea, fatigue, rash, and elevated liver enzymes 1. The most recent and highest quality study suggests that chemotherapy can cause cognitive impairment, characterized by a decline in performance in cognitive function related to learning, attention, executive functions, memory, multitasking, and processing speed, with a prevalence of clinically significant cognitive impairment varying between 17% and 78% 1.
From the FDA Drug Label
The most common adverse reactions in adults for the: prevention of chemotherapy-induced (greater than or equal to 5%) are: headache, malaise/fatigue, constipation, diarrhea. Most common adverse reactions: Chemotherapy-induced nausea and vomiting (≥3%): Headache, and constipation
The adverse effects of chemotherapy include:
- Headache
- Malaise/Fatigue
- Constipation
- Diarrhea as reported in the prevention of chemotherapy-induced nausea and vomiting 2 and 3.
From the Research
Adverse Effects of Chemotherapy
The adverse effects of chemotherapy can be categorized into short-term and long-term side effects. Some of the common side effects include:
- Fatigue
- Nausea and vomiting
- Mucositis
- Hair loss (alopecia)
- Dry skin
- Skin rash
- Bowel changes
- Anemia
- Increased risk of acquiring infection
- Chemotherapy-induced peripheral neuropathy
- Cardiotoxicity
- Diarrhea
- Infertility
- Chemo brain
Organ-Specific Side Effects
Chemotherapy can also cause inflammation of various organs, including:
- Heart
- Lungs
- Liver
- Kidney
- Neurons
- Coagulation cascade
Impact on Quality of Life
The side effects of chemotherapy can significantly impact a patient's quality of life, with symptoms such as:
- Nausea
- Dysgeusia
- Peripheral neuropathy
- Loss of appetite
- Myalgia
- Peripheral edema having a negative effect on health-related quality of life 4, 5, 6.
Management of Side Effects
While some side effects are unavoidable, others can be managed through supportive care and approved treatments. The use of 5-HT3 receptor antagonists, such as ondansetron and granisetron, can help reduce chemotherapy-induced nausea and vomiting 7. However, the severity, frequency, and duration of side effects should be assessed and taken into account when providing care to chemotherapy patients 6, 8.