Short-Term Side Effects of Chemotherapy

Although chemotherapy kills or disables cancer cells, it may harm some normal cells in the body and cause side effects.

Some of the most common and well-known short-term side effects of chemotherapy are hair loss, nausea and vomiting. 

The side effects you’ll likely have depend on the chemotherapy drugs you’ll be given.

It’s normal to worry about the short-term side effects from chemotherapy.

In addition to thinking about side effects, you may be processing your diagnosis and adjusting to ways your life has changed. Thinking about all of this can be difficult. It may help to seek support from family members, friends, your health care team and others living with breast cancer while you’re getting chemotherapy.

Before you begin chemotherapy, talk with your health care provider about possible side effects and how to manage them.

Learn about long-term side effects of chemotherapy.

Hair loss (alopecia)

Hair loss is a well-known side effect of chemotherapy.

Though it’s most visible on your head, hair loss may occur all over your body, including your eyebrows and pubic hair.

With some chemotherapy drugs, including doxorubicin (Adriamycin), paclitaxel (Taxol) and docetaxel (Taxotere), you almost always lose your hair.

Your scalp may be sensitive during this time.

Coping with hair loss

Losing your hair is hard. As with breast surgery, it affects a part of your body often tied to your identity. This can be an emotional time. It’s normal to be angry or self-conscious. Give yourself time to adjust and know that your hair will grow back.

Using a gentle shampoo and washing your hair less often may help reduce hair loss.

Some people shave their head or cut their hair short once they start chemotherapy to help prepare for the loss of their hair. This may help you feel in control.

Read our blog, Losing My Hair.

Scalp cooling

Scalp cooling may slightly reduce hair loss [25-28]. With scalp cooling, you wear a special cap filled with a very cold substance before, during and after each chemotherapy session. The extreme cold temperature of scalp cooling is uncomfortable.

Some studies have found scalp cooling may reduce hair loss by 50% or more for some women getting only taxane-based chemotherapy (with no anthracycline-based chemotherapy) [25,28]. Scalp cooling appears to be less effective at preventing hair loss for women getting an anthracycline-based chemotherapy [10,28].

For some women, enough hair is preserved that they don’t mind going out without a wig or other head covering. However, even with scalp cooling, you may still lose enough hair that you prefer to wear a wig or other head covering.

Talk with your health care provider about whether scalp cooling is right for you (and if so, how to use it).

Scalp cooling may not be covered by your insurance, so you’ll likely have to pay at least some of the cost. Talk with your insurance company to find out if they will cover any of the cost.

Wigs, hats and scarves

Wigs, hats and scarves may help you cope with hair loss.

If you’re thinking about wearing a wig, you may want to pick one out before you start chemotherapy to find a good match for your natural color and cut. Or you could try something new.

Many insurance plans cover all or part of the cost of a wig if the claim includes a health care provider’s prescription or letter.

When will your hair grow back?

Your hair will begin to grow back about 1 to 2 months after treatment ends. Your head may be itchy as your hair grows back.

Your hair may grow back a different color and texture than it was before. It often comes in curlier. Your hair texture will return to normal over many months.

You may color, highlight or treat your hair whenever you like.

A note if you are traveling by air

Susan G. Komen® wants to make sure people who have breast cancer are treated with respect and dignity. When you travel by air, these steps may be helpful: Arrive at the airport earlier than usual, so you have time to go through secondary screening if needed. If you’re concerned about going through the body scanner for any reason, request a private pat-down screening. If you choose, or are selected for, a pat-down screening, you may request a private screening away from public areas. If you feel comfortable, tell the Transportation Security Administration (TSA) agent you are undergoing breast cancer treatment. If you prefer to give this information discreetly, the TSA has a notification card you can give to the agent. Find this card on the TSA website. If you wear a scarf or other head covering, you don’t have to remove the covering to pass through security. However, you may have to undergo a pat-down search of your head. In some cases, the TSA agent may then ask you to remove the scarf or head covering, but you may request a private screening away from public areas. It’s OK for a companion or other person you choose to go with you to the screening area. If you feel uncomfortable for any reason, it’s always OK to ask to talk with a TSA supervisor. Pack your medications in carry-ons, rather than in checked luggage. Learn about TSA screening if you wear a breast prosthesis.  Learn about TSA screening if you wear a compression sleeve. If you have concerns about airline security screening, visit the TSA website.

Nausea and vomiting

Some (but not all) chemotherapy drugs cause nausea and vomiting. This is one reason some people may be scared of chemotherapy. However, there are effective anti-nausea medications.

Your health care provider will prescribe anti-nausea medications to help prevent and control nausea and vomiting. They will give you instructions on how to use them.

The anti-nausea medications you get depend on the chemotherapy drugs you’re given.

Tips to manage nausea

Eat 4-6 small meals or snacks (instead of larger meals) each day. Nausea becomes worse on an empty stomach. Try to include a fat, a carbohydrate, and a protein together to help you stay fuller longer to prevent or reduce nausea. Try ginger tea, ginger ale or crystallized ginger. Add fresh ginger when you’re cooking. Drink lemonade or lemon water. Eat bland, easy-to-digest foods that don’t have an odor, such as toast, rice or baked potatoes. Eat cool or frozen foods. These may have fewer odors than warmer foods. Avoid foods that are spicy, fried, very greasy or very sweet. Cook and freeze meals to reheat during times when you feel nauseous. Reheating causes fewer odors than cooking. Open the windows to keep fresh air flowing. Use an overhead fan to decrease cooking odors. Take walks or step outside to get fresh air. Talk with your health care provider about complementary and integrative therapies that may help (such as acupressure, acupuncture, relaxation techniques, hypnosis, guided imagery and music therapy).

Komen has a fact sheet on diet and nutrition during breast cancer treatment.

The National Comprehensive Cancer Network (NCCN) has a booklet with more information on preventing and coping with nausea and vomiting.

The National Cancer Institute (NCI) has a booklet with eating hints before and during cancer treatment.

You may also ask your health care provider for a referral to a registered dietitian to help you with nutrition during chemotherapy treatment. You may want to check with your insurance company to see if your plan covers visits to a registered dietitian.

Marijuana

Some people report marijuana (cannabis) may be helpful for nausea and vomiting [29-30]. However, there are no studies proving marijuana products, including cannabidiol (CBD), are useful for cancer-related health conditions. (CBD is made from the cannabis plant but does not contain the chemical in the plant that causes the “high” feeling.)

Marijuana isn’t legal in every state. Some states allow the use of medical marijuana and some further allow the use of recreational marijuana. If you’re considering using medical marijuana, check the laws in your state and talk with your health care provider.

The NCI has more information on marijuana products, including CBD, and nausea related to chemotherapy.

Learn more about marijuana products, including CBD.

Diarrhea

Some chemotherapy drugs (and some HER2-targeted therapy drugs) can cause diarrhea. Bowel movements may become more frequent and/or looser. You may also have cramping and gas.

Some ways to manage diarrhea are listed below. Talk with your health care provider about which over-the-counter diarrhea medication to take and take it as prescribed. If that doesn’t work, you may need prescription medicine.

Keep track of the number of bowel movements you have. If you’re having more than 4 loose bowel movements a day or the diarrhea doesn’t improve after 2 days, or if you become dehydrated or light-headed, let your health care provider know right away. These are signs the diarrhea is serious and needs medical care.

If the diarrhea improves after 1-2 days, you can eat small, regular meals again [31].

Ways to manage diarrhea

Eat small, bland meals (such as bananas, rice, toast, applesauce or plain pasta). Include foods and drinks that have potassium such as bananas, potatoes, apricots and some sports drinks in your diet (you may lose potassium when you have diarrhea). Drink 8-10 large glasses of clear liquids a day (broth and sports drinks with electrolytes are good choices). Avoid milk and other dairy products. Avoid acidic drinks such as orange juice and tomato juice. Let carbonated soft drinks go flat before drinking them (pour the drink into a glass and let it sit for at least 10 minutes). Avoid alcohol and caffeine. Avoid foods that are spicy, fried, very greasy or very sweet. Sit in a tub of warm water or a sitz bath to ease discomfort in the anal area. Keep the anal area clean and apply a water-repellent ointment or petroleum jelly to the area.

Adapted from select sources [31-32].

Komen has a fact sheet with tips on managing diarrhea.

The National Cancer Institute (NCI) has a booklet with eating hints before and during cancer treatment.

Fingernail and toenail changes

Some chemotherapy drugs (such as paclitaxel and docetaxel) can damage your fingernails and toenails. The nails may:

• Become brittle and sore
• Develop ridges
• Get darker
• Fall off

Like hair loss, nail problems are worrisome, but they are short-term.

Keeping your nails short during treatment may make nail care easier. Your nails will return to normal once chemotherapy ends.

You can use nail polish whenever you wish.

Pain

Nerve damage

Some chemotherapy drugs, including carboplatin and taxanes (such as paclitaxel and docetaxel), may cause nerve damage.

If this happens, you may have neuropathy (feel a burning or shooting pain or numbness), usually in your fingers or toes.

These side effects usually go away after chemotherapy ends, but it may take weeks or months. In some cases, the symptoms can persist.

Learn more about managing neuropathy related to treatment.

Muscle pain (myalgia)

Chemotherapy may cause muscle pain (myalgia).

If you have pain, tell your health care provider right away. You should never feel you have to endure pain. Your provider may want to adjust your chemotherapy plan to ease these symptoms.

Your health care provider may also prescribe mild pain relievers or suggest other treatments to ease your symptoms.

Learn more about managing pain related to treatment.

Mouth and throat sores (mucositis, stomatitis)

Some chemotherapy drugs (such as doxorubicin and docetaxel), can harm the tissues that line your mouth and throat, causing sores. This is called mucositis or stomatitis. Low white blood cell counts can also cause mouth sores.

Mouth and throat sores can make it painful to eat and drink. These sores go away once chemotherapy ends.

Chemotherapy can also cause thrush, a fungal infection in the mouth and throat.

If you have any pain or see any changes in your mouth or throat, tell your health care provider. Your provider can prescribe a special mouthwash or other medication to relieve the pain, treat mouth and throat sores, and treat thrush. 

Fatigue

Chemotherapy can cause fatigue (extreme tiredness). Fatigue is mainly a short-term problem, but for some, it can persist [13].

You may feel like you don’t have any energy and may feel tired all the time. Resting may not help.

Regular exercise, even just walking for 20 minutes every day, can help reduce fatigue [13-16]. Getting a good night’s sleep is also important.

Talk with your health care provider if you’re fatigued or have insomnia (problems sleeping).

Learn more about fatigue and insomnia.

Anemia

Chemotherapy can cause a drop in your red blood cell count. This is called anemia.

Anemia can cause fatigue and shortness of breath. It can also make you look pale.

Sometimes, anemia can be treated by increasing iron or folate in your diet. Severe anemia can be treated with a blood transfusion.

Growth factors, such as erythropoietin (Procrit, Epogen and Aranesp) and similar drugs can increase red blood cell count. However, safety studies have raised questions about whether people with breast cancer should get erythropoietin. For more on these safety studies, visit the FDA website.

Leukopenia/neutropenia

Chemotherapy can cause a drop in your white blood cell count. This is called leukopenia or neutropenia.

Some chemotherapy plans include white blood cell growth factors such as filgrastim (Neupogen), tbo-filgrastim (Granix), pegfilgrastim (Neulasta) and pegfilgrastim-jmdb (Fulphila).

These growth factors help you maintain white blood cell counts and reduce your risk of infection while undergoing chemotherapy.

Growth factors are given by injection. A nurse can inject these medications, or you can learn to do it yourself at home.

Your health care provider may suggest you wear a face mask and stay out of large crowds to reduce your risk of infection while undergoing chemotherapy.

Learn about long-term side effects of chemotherapy.

Other short-term side effects

Chemotherapy drugs can cause other short-term side effects, including:

• Changes to sense of taste and smell
• Infection
• Insomnia (sleep disorders)
• Menopausal symptoms (such as hot flashes)
• Temporary loss of menstrual periods (amenorrhea)
• Weight gain    

Unfortunately, some of these side effects, such as loss of menstrual periods and weight gain, may last after treatment ends.

Constipation

Some medications used in breast cancer care, such as those used to ease nausea, may cause constipation.

If you become constipated, you may need to make some changes in your diet or take medications to promote regularity. To manage constipation, your health care provider may recommend you:

• Eat high-fiber foods, such as fruits and vegetables
• Drink plenty of liquids (warm or hot liquids may be helpful)
• Take a soluble fiber supplement (for example, Benefiber rather than Metamucil)
• Use a mild laxative, such as Senna, or a stronger laxative, such as polyethylene glycol (Miralax)
• Take a stool softener, such as docusate (Colace)

If you don’t have a bowel movement within 4 days of taking the recommended laxatives, tell your health care provider.

Komen has a fact sheet with tips on managing constipation.

The National Cancer Institute (NCI) has a booklet with eating hints before and during cancer treatment.

Susan G. Komen^® educational resources

If you’ve been recently diagnosed with breast cancer or feel too overwhelmed to know where to begin to gather information, Komen has a Questions to Ask Your Doctor About Chemotherapy and Side Effects resource that might help.

You can download and print it to take with you to your next doctor’s appointment or you can save it on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write or type the answers to the questions.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.

Susan G. Komen® Support Resources

Do you need help? We’re here for you. The Komen Patient Care Center is your trusted, go-to source for timely, accurate breast health and breast cancer information, services and resources. Our navigators offer free, personalized support to patients, caregivers and family members, including education, emotional support, financial assistance, help accessing care and more. Get connected to a Komen navigator by contacting the Breast Care Helpline at 1-877-465-6636 or email helpline@komen.org to get started. All calls are answered Monday through Thursday, 9 a.m. to 7 p.m. ET and Friday, 9 a.m. to 6 p.m. ET. Se habla español. The Komen Breast Cancer and Komen Metastatic (Stage IV) Breast Cancer Facebook groups are places where those with breast cancer and their family and friends can talk with others for friendship and support. Our fact sheets, booklets and other education materials offer additional information.