1. Side effects of chemotherapy for breast cancer
2. Effects on the blood
3. Hair loss and chemotherapy
4. Hand-foot (Palmar-plantar) syndrome
5. Effects on the nerves (peripheral neuropathy)
6. Sickness, nausea and vomiting
7. Other effects on your digestive system
8. Mouth and dental problems
9. Skin and nail changes
10. Longer-term side effects
11. Effects on memory and concentration (‘chemo brain’)
12. Menopausal symptoms
13. Fatigue and chemotherapy
14. Chemotherapy effects on fertility
15. Risk of blood clots
Side effects of chemotherapy are usually temporary and most can be controlled.
Chemotherapy affects people in different ways, and two people having the same drugs may feel completely different to each other during the course of their treatment.
Before starting chemotherapy you should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.
Between each cycle of chemotherapy, you’ll have an assessment to see how you’re feeling and whether you’ve had any side effects.
Chemotherapy drugs can temporarily affect the number of healthy blood cells in the body. Blood cells – white blood cells, red blood cells and platelets – are released by the bone marrow (spongy material in the hollow part of bones) to replace those naturally used up in the body. Chemotherapy reduces the ability of the bone marrow to make these cells.
You’ll have regular blood tests throughout your treatment to check your blood count. If the number of blood cells is too low your next course of treatment may be delayed or the dose of chemotherapy reduced.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection. When the white blood cells fall below a certain level, it’s known as neutropenia.
Your resistance to infection is usually at its lowest point around 7–14 days after chemotherapy has been given. The number of white blood cells usually returns to normal before your next course of chemotherapy is due.
Contact your hospital immediately if:
- you have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- you suddenly feel unwell, even with a normal temperature
- you have any symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
You may need antibiotics. Sometimes your doctor may recommend injections of drugs called growth factors to stimulate the production of white blood cells to reduce your risk of infection.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your specialist team know. A blood transfusion may be necessary during your treatment if the number of red blood cells falls significantly.
Bruising and bleeding
Chemotherapy can reduce the number of platelets, which help the blood to clot. You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth.
Tell your specialist team if you have any of these symptoms. A platelet transfusion can be given, although this is rarely needed as platelet levels usually correct themselves over time.
Reducing the risk of infection and bleeding
You can help reduce the risk of infection and bleeding by:
- regularly washing and drying your hands thoroughly
- cleaning any cuts and grazes and cover with a dressing or plaster
- avoiding people who are unwell or may be infectious
- eating as healthily as possible, and following any advice about food and drink given to you by your hospital
- drinking plenty of fluids
- storing and cooking food correctly
3. Hair loss and chemotherapy
For some people, hair loss can be one of the most distressing side effects of chemotherapy. The likelihood of losing your hair depends on the type and amount of chemotherapy drugs given.
Read our information about hair loss.
4. Hand-foot syndrome (Palmar-plantar syndrome)
This is a common side effect of some chemotherapy drugs that usually affects the palms of the hands and soles of the feet.
Find out more about hand-foot syndrome.
5. Peripheral neuropathy
Read our information on peripheral neuropathy, which happens when nerves, most commonly in the fingers and toes, are damaged.
The likelihood of having nausea (feeling sick) and vomiting (being sick) after chemotherapy depends on the type and dose of drugs you’re having. But nausea and vomiting can usually be controlled.
You’ll be given anti-sickness medication, by mouth or intravenously, before each cycle of chemotherapy, as well as some anti-sickness tablets to take home.
Several types of anti-sickness drugs are available. You may need to take a combination of drugs to relieve your nausea. This may include taking a low dose of steroids for a short time. If nausea and vomiting are affecting you, let someone in your specialist team know.
Contact your hospital if you have severe vomiting and can’t drink any fluids without vomiting, even if it happens at the weekend or during the night.
Nausea can start straight after chemotherapy, a few hours after or up to several days later. For some people it can last for a few hours and for others it can continue for several days.
People who are very anxious or prone to travel sickness or morning sickness in pregnancy may be more likely to experience vomiting.
Chemotherapy can affect your digestive system in different ways. Some people get constipated, other people have diarrhoea.
Some chemotherapy drugs can make indigestion more likely. Some may also cause heartburn, which is a burning feeling in the lower chest.
Let your chemotherapy team know if you have any of these side effects. They can prescribe medications to help and can give you information about diet. You can also be referred to a dietitian if necessary.
Your hospital will have its own guidelines, but if you have four or more episodes of diarrhoea within 24 hours contact you GP or specialist team. Drink plenty of fluids to avoid dehydration.
Chemotherapy may affect your mouth in a number of ways. It can cause:
- sore mouth and ulcers
- dry mouth, which can also increase the risk of tooth decay
- oral thrush
- bleeding gums
See your dentist for a check-up before chemotherapy begins. If you need any dental work speak to your oncologist about the best time to have this.
Your taste may change during chemotherapy, making foods taste bland or different. Your taste should return to normal once your treatment has finished, although for some people taste changes can last after treatment.
You can read tips for if you experience a sore mouth or taste changes on our diet during breast cancer treatment page.
Some chemotherapy drugs can make your skin dry, more sensitive or prone to reactions. Some chemotherapy drugs can also cause rashes. If you develop a rash tell your specialist team as soon as possible.
Chemotherapy may cause changes to the appearance of your nails. This can be a change in the nail colour or texture, such as ridges forming. Nails can become more brittle and cracked. Occasionally the nail may lift off the nail bed and fall out.
As you’re more at risk of infection while having chemotherapy, it’s important to report any signs of infection such as redness, heat, swelling or pain in or under your fingernails and toenails.
To help protect your skin and nails:
- moisturise your skin to help with dryness, but choose creams with the least amount of perfume and colour to minimise the risk of a reaction; test on small area of skin first
- take care in the sun: cover your skin and wear a hat, use a high-factor sunscreen, and avoid the sun during the hottest part of the day (11am–3pm)
- hand cream will help moisturise your hands, feet and nails
- use gloves for household chores to protect your nails
- if your toenails are affected, avoid tight-fitting shoes
- don’t wear false nails during chemotherapy as these can lead to infection or mask the signs of it
- avoid nail varnish as it tends to dry the nails out more, or you could try a water-based version as this is less harsh
Most chemotherapy side effects are temporary and disappear once your treatment is over.
For some people side effects can last longer or may develop months or years after chemotherapy has finished.
Some chemotherapy drugs can cause heart or lung problems, and some drugs increase the risk of getting another cancer in the future. However, these late effects are rare. Your specialist can talk to you about the benefits of treating your breast cancer with chemotherapy compared to the risk of these rare effects occurring.
11. Effects on concentration or memory (‘chemo brain’)
Some people find treatment affects their ability to concentrate and makes them more forgetful. This is called cognitive impairment, but is sometimes referred to as ‘chemo brain’ or ‘chemo fog’.
Find out more about chemo brain, including what might help.
Some women have menopausal symptoms. This is because chemotherapy affects the ovaries, which produce oestrogen.
If you have not yet reached the menopause, your periods may stop or become irregular during chemotherapy. Whether your periods return will depend on the type of drugs used, the dose given and your age.
Other common menopausal symptoms include:
- hot flushes
- night sweats
- mood changes
- joint aches and pains
- vaginal dryness
You can talk to your breast care nurse or specialist team about ways of coping with any of these symptoms.
13. Fatigue and chemotherapy
Fatigue is extreme tiredness and exhaustion that doesn’t go away with rest or sleep.
Find out about fatigue, including tips for coping.
14. Chemotherapy effects of fertility
Chemotherapy causes changes in the ovaries, which can affect your ability to become pregnant.
Find out about fertility and breast cancer treatment.
15. Risk of blood clots
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. Having chemotherapy increases the risk of blood clots such as deep vein thrombosis (DVT).
Find out about blood clots.