October 14, 2022
If chemotherapy is part of your treatment plan, you may be wondering about the potential side effects of chemotherapy and how you can prepare for them.
Short-term side effects of chemotherapy are those that you may experience shortly after having treatment. These may include fatigue, hair thinning or loss, changes to skin and nails, nausea, vomiting, appetite changes, weight gain or sometimes loss, and changes in how foods taste. Working with your medical team to find a combination of approaches that work for you and making a few small lifestyle changes can help you manage these short-term side effects.
In this article, you’ll learn more about what chemotherapy is, the effects chemotherapy can have on your body, and how you can minimize the impact these side effects have on your everyday quality of life.
What is chemotherapy?
In early-stage cancer, the goal of chemotherapy is to cure the cancer by eliminating the cancer and reducing the risk of it coming back. This is known as curative treatment.
After surgery: Some people receive chemotherapy after mastectomy or lumpectomy (breast-conserving surgery). This is called adjuvant chemotherapy. Chemotherapy can help eliminate any cancer cells that were not removed during surgery. These cells may have spread to other parts of the body and were too small to see on scans. Treating the whole body with chemotherapy decreases the chance that cancer cells will come back. 3
Before surgery: You may hear chemotherapy given before surgery referred to as neoadjuvant, preoperative, or primary systemic chemotherapy. Some tumors are more easily operated on after being treated with chemotherapy. Chemotherapy can shrink a tumor so that it becomes operable, or it can make surgery a less extensive procedure. 3
If the cancer has spread to other parts of the body or returns in other parts of the body, we can treat it with chemotherapy. 4 Sometimes, cancer may never completely disappear, but we can use chemotherapy to control it. Chemotherapy can help control the spread of the cancer, treat symptoms, and extend life expectancy. 1
Chemotherapy can also help people feel more comfortable and improve their quality of life. For example, chemotherapy can shrink a tumor that causes pain. When chemotherapy is used to treat symptoms rather than cure or treat the cancer, it’s called palliative treatment. Palliative therapy can also include other forms of treatment that ease symptoms. 1
Who gets chemotherapy?
People with ductal carcinoma in situ (DCIS), also known as Stage 0 cancer, do not receive chemotherapy. DCIS is not invasive cancer—it stays in one place in the body. Therefore, DCIS is treated with surgery and, in some people, radiation therapy. Chemotherapy, which treats the whole body, is not involved with DCIS. 5
Stage I cancer
Whether people with Stage I breast cancer receive chemotherapy depends on the risk factors of their tumor. Because the cancer has not spread beyond the sentinel lymph node (or spread to the lymph nodes at all), surgery and sometimes radiation are generally used to treat Stage I breast cancer. However, depending on certain factors like the tumor’s size, cancer characteristics, and patient’s age, some people with Stage I breast cancer receive adjuvant or (less often) neoadjuvant chemotherapy. 6
Stage II cancer
Because Stage II cancers may have spread to the lymph nodes, adjuvant or neoadjuvant chemotherapy is almost always recommended.6 In some situations, however, chemotherapy may be omitted. This depends on the specific characteristics of the cancer.
Stage III cancer
Because Stage III cancers are large tumors and/or have spread to many lymph nodes, the skin, or the chest wall, neoadjuvant chemotherapy is almost always recommended; otherwise, adjuvant chemotherapy is given. 6,7
Inflammatory breast cancer
People with inflammatory breast cancer should receive neoadjuvant chemotherapy to shrink a tumor and decrease the infiltration of the skin by cancer cells before surgery. 8
What happens during chemotherapy?
In most cases, chemotherapy is given intravenously (by IV). It can be given through a vein in your arm or a port in your chest. A port is a semi-permanent IV under the skin. This allows access to the vein throughout your treatment sessions.4
A chemotherapy nurse or pharmacist starts the IV. Chemotherapy is given from a syringe, a small IV bag, or a large bag (if you’re receiving an infusion). Before you receive the chemotherapy drugs through the IV, you will first get medicine that helps treat side effects like allergic reactions, nausea, or vomiting. IV fluid may also be given to increase the volume in the bloodstream. This helps your body excrete the chemotherapy drugs more quickly.
In some cases, chemotherapy is in pill form (orally) that you take at home.4
Throughout your chemotherapy session, report any symptoms you may be feeling to the nurse or pharmacist. They may be able to make adjustments to make you more comfortable.
At the end of your treatment, the IV will usually be removed, and you can return home. If you are on a treatment that requires you to come back the next day, you may go home with the needle still in your port or your arm, but this is uncommon. You’ll be informed about potential side effects and what medicines you can take to help manage them.4
How often is chemotherapy given?
Depending on your situation and the particular medication, chemotherapy may be given once a week or every two, three, or four weeks.9
If you have early-stage breast cancer, you may receive chemotherapy for three to six months. If you have advanced-stage breast cancer, you may receive it for longer.4
What are the short-term side effects of chemotherapy?
Because chemotherapy affects the whole body, chemotherapy drugs may affect more than just the cancer cells. Healthy cells, such as those in the hair follicles or digestive system, may also be impacted. When chemotherapy drugs affect these healthy cells, some people may experience side effects like hair loss or nausea. 4
You may begin to notice side effects later on after you’ve returned home from your chemotherapy session. Every medicine has different side effects, so be sure to take printed information home with you from the hospital or clinic. Ask for a translation if the information is not written in your primary language. While chemotherapy drugs are given in combination with other drugs to limit side effects, people may still experience:
Hair thinning or loss
You may begin to see hair loss about two weeks after receiving treatment. For some, hair loss is gradual, while others notice that it falls out more quickly. You might also notice hair loss in other parts of your body, like your eyelashes, eyebrows, arms, or legs. The normal timeframe for your hair to grow in is three months (your first haircut), but it will take a full six months to a year after finishing chemotherapy. 10
Changes to skin and nails
The chemicals in chemotherapy can leave skin feeling dry and itchy. You might also notice increased sensitivity to the sun or changes in your skin coloration.11
Your nails may also feel dry and may become brittle or discolored.10
Chemotherapy-related fatigue may be different from other kinds of fatigue you may have experienced. It may leave you feeling exhausted both mentally and physically.12
Fatigue may be caused by the damage done to your healthy cells or the effort your body is undergoing to repair these cells.13
When chemotherapy damages healthy cells, the immune system responds, and healthy cells release chemicals that can cause inflammation (swelling).14 Scientists have observed a link between inflammation and fatigue in people who received chemotherapy for breast cancer.15
Changes in food taste
Because chemotherapy affects the whole body, the cells in the mouth (including the taste buds) can be affected.16 This might make foods taste different to you. Some people report that food tastes bland or that it all tastes the same. You might also notice a metallic taste.17
Nausea and vomiting
Some chemotherapy drugs have nausea and vomiting as side effects. Be sure to let your doctor know if you are experiencing nausea or vomiting because vomiting can lead to dehydration or other health problems. Nausea is an important side effect that we can manage as long as we know you are having it. Your doctor can prescribe you medicine to help with nausea and vomiting.18
Weight gain or loss
A combination of fatigue, changes in the way food tastes, or nausea and vomiting can cause weight changes. You might see weight loss as nausea or taste changes decrease your appetite or the amount of food you consume. You might also see weight gain because fatigue may cause you to be less active than usual, and corticosteroids that prevent nausea and vomiting can increase your appetite. If maintaining weight is important to you, you can
set returning to your previous weight as a goal for after treatment.
What can I do to manage these side effects?
Making a few small lifestyle changes and working with your medical team can help make the side effects of chemotherapy more manageable. If you’re worried about any side effects, it’s important to call your doctor (or another doctor on call) sooner rather than later. Your doctor may be able to make some adjustments to your medications or provide some recommendations to help you feel better.
Coping with hair thinning or loss
It can be quite distressing to find that your hair is thinning or falling out. Talking with a partner, close friend, or family member can help you process any difficult feelings you may be experiencing. The best way to care for yourself during this time is to do what makes you comfortable.
Some people choose to wear a scarf, a wig, or a hat. The National Cancer Institute recommends being as gentle with your hair as you can by using a soft hairbrush and gentle shampoo, avoiding using heat products on your hair, or washing your hair less often.19 Because your scalp may be more exposed to the sun, be sure to apply sunscreen or wear a hat to protect your scalp from sun damage.
As your hair grows back after finishing chemotherapy, you’ll want to continue to be gentle with your hair during this time and avoid coloring it right away.10 You may notice that your hair comes back with a different color, texture, or thickness, but it may return to normal with time.19
Caring for skin and nails
Drinking plenty of water can help restore some of your skin’s hydration. When bathing or washing your hands, try to use warm water rather than hot—hot water can dry out your skin faster. Applying moisturizer after bathing and throughout the day can help treat dry skin and nails.10 Be sure to choose products that are gentle on the skin. Your doctor may be
able to provide some recommendations.11 As always, wear sunscreen when going outside.
The fatigue that arrives with chemotherapy treatment may require you to take a step back from your usual routines and activities—and that’s okay. Now is the time to lean on friends or family for help with childcare, household chores, cooking, or anything else that may overwhelm you during this time. Your loved ones will want to support you in any way they
Especially if you’re someone who likes to keep busy, it can be hard to dial things back. Be gentle with yourself during this time. It’s okay to say no to social engagements, volunteering, or other non-essential tasks and take some time to rest.
You might also be worried about going to work while experiencing this fatigue. Many people are still able to work while getting chemotherapy. To help make this easier on you, consider asking your supervisor for adjustments to your schedule, like shortened workdays or the option to work remotely. Under the federal Family and Medical Leave Act (FMLA),
you may be entitled to 12 weeks of unpaid medical leave. Visit
https://www.dol.gov/agencies/whd/fmla to learn more.
Although exercising is probably one of the last things you want to do when feeling fatigued, light exercise can actually help you find some relief from fatigue. Exercise can help decrease the inflammation in our bodies that makes us tired. Researchers studying the effects of exercise on women going through chemotherapy for breast cancer treatment found that endurance (cardio) exercises improved participants’ energy levels and reduced nausea, while resistance exercises (weights) increased energy and reduced nausea and stress.20 Before starting an exercise regimen, check with your doctor to discuss how much you should be exercising and what type of exercises may be right for you.
Adapting to changes in food taste
If foods taste different during chemotherapy, you may not enjoy your favorite foods as much as you used to, but you may be interested in something new. Listen to your body and try things that sound good to you.
If food tastes metallic or you have a metallic taste in your mouth, you can try using alternatives to metal silverware such as bamboo, plastic, or compostable silverware. Some people find that chewing gum or sucking on citrus- or mint-flavored hard candies can help with the metallic taste. 17
If food tastes bland, you might like to try squeezing citrus fruits like lemon on your food. Marinades, salt, spices, herbs, or other seasonings can help add flavor to your food as well. 17
If you’re having a hard time adapting to these changes or others that impact your appetite and food consumption during chemotherapy treatment, a nutrition specialist can help you develop a diet plan that works for you. A nutrition specialist may be part of your medical team for cancer treatment, and services are often covered by insurance.
Finding relief from nausea and vomiting
Your doctor may prescribe medication to help with chemotherapy-related nausea and/or vomiting. Before experiencing full-on nausea, many people get what is known as “stomach awareness.” This means that you’re aware of a general feeling of discomfort in you stomach. When you’re experiencing stomach awareness is a good time to take any anti-nausea medication that your doctor may have prescribed. Anti-nausea drugs may make you tired, so you may want to take them before bedtime, especially if your nausea keeps you awake or interrupts your sleep.
If you feel that your anti-nausea medications aren’t working, reach out to your doctor. Your doctor may be able to add to or change your medicines to help with your nausea.
Aside from medication, some lifestyle changes can help with nausea, such as eating smaller, more frequent meals or changing what kinds of food you eat. You might like to consult a nutrition specialist for guidance. Finding other things to focus on or trying techniques such as meditation can help distract you from feelings of nausea. 18
Plain, dry foods such as saltine crackers can help when your nausea keeps you from eating. Food and drink containing ginger can also soothe feelings of nausea. You might like to try ginger snaps, ale, tea, or lozenges.
Not being able to eat due to nausea or changes in taste or appetite can affect you mentally and physically. Talking with others going through a similar situation can help. Check with your hospital, clinic, or treatment center to learn about support groups near you.
Chemotherapy may cause short-term side effects such as fatigue, hair thinning or loss changes to skin and nails, nausea and vomiting, appetite changes, weight loss or gain, and changes in how foods taste. Experiencing these symptoms can be challenging physically, mentally, and emotionally. Talking with a partner, friends, family members, or support group members can help you cope. It’s important to keep your doctor informed of any symptoms you’re experiencing so that adjustments can be made to limit your discomfort. Your doctor, a nutritionist, and other medical team members can help you manage side effects with medications or small lifestyle changes.
1 Goals of chemotherapy: How is chemotherapy given? American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-is-chemotherapy-used-to-treat-cancer.html. Published November 22, 2019. Accessed September 23, 2022.
2 NCI Dictionary of Cancer terms. National Cancer Institute.
chemotherapy. Accessed September 23, 2022.
3 Chemotherapy. Breastcancer.org. https://www.breastcancer.org/treatment/chemotherapy.
Published August 5, 2022. Accessed September 23, 2022.
4 Chemotherapy for breast cancer. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/chemotherapy-for-breast-cancer/about/pac-20384931. Published February 24, 2021. Accessed September 23, 2022.
5 Ductal carcinoma in situ (DCIS). Johns Hopkins Medicine.
cancer/ductal-carcinoma-in-situ. Published January 28, 2022. Accessed September 23, 2022.
6 Treatment of breast cancer stages I-III. American Cancer Society.
https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html. Published April 12, 2022. Accessed September 23, 2022.
7 NCNN Guidelines for Patients: Invasive Breast Cancer. National Comprehensive Cancer Network. https://www.nccn.org/patients/guidelines/content/PDF/breast-invasive-
patient.pdf. Published 2022. Accessed August 29, 2022.
8 Treating inflammatory breast cancer. American Cancer Society.
https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-inflammatory-breast-cancer.html. Published April 12, 2022. Accessed September 23, 2022.
9 Chemotherapy for breast cancer: Side effects & more. Cleveland Clinic.
https://my.clevelandclinic.org/health/treatments/8340-chemotherapy-for-breast-cancer. Published August 18, 2021. Accessed September 23, 2022.
10 Skin, nail, hair care during cancer treatment. Cleveland Clinic.
https://my.clevelandclinic.org/health/articles/17988-cancer-treatment-skin-hair-and-nail-care-during-and-after-treatment. Published October 9, 2018. Accessed September 26, 2022.
11 Skin and nail changes and cancer treatment – side effects. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/skin-nail-changes. Published June 14, 2019. Accessed September 26, 2022.
12 Cancer fatigue: What it is, causes, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/5230-cancer-fatigue. Published September 8, 2021. Accessed September 26, 2022.
13 Cancer fatigue: Why it occurs and how to cope. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-fatigue/art-20047709. Published July 12, 2022. Accessed September 26, 2022.
14 Immune response: Medlineplus medical encyclopedia. MedlinePlus.
https://medlineplus.gov/ency/article/000821.htm. Accessed September 26, 2022.
15 Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology. 2014;11(10):597-609. doi:10.1038/nrclinonc.2014.127
16 Appetite, taste changes and cancer drugs. https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/side-effects/appetite-taste-changes. Published January 17, 2020. Accessed September 26, 2022.
17 Taste changes. Cancer.Net. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/taste-changes. Published January 2020. Accessed September 26, 2022.
18 Nausea and vomiting. Cancer.Net. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/nausea-and-vomiting. Published July 14, 2020. Accessed September 26, 2022.
19 Hair loss (alopecia) and cancer treatment-side effects. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/hair-loss. Published January 15, 2020. Accessed September 26, 2022.
20 Johnsson A, Demmelmaier I, Sjövall K, Wagner P, Olsson H, Tornberg ÅB. A single exercise session improves side-effects of chemotherapy in women with breast cancer: An observational study. BMC Cancer. 2019;19(1). doi:10.1186/s12885-019-6310-0