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Long-Term Side Effects of Chemotherapy

Common long-term side effects of chemotherapy include early menopause and weight gain. Rare side effects include heart problems and leukemia.

Learn about short-term effects of chemotherapy

Early menopause

Some chemotherapy drugs can damage the ovaries and stop regular menstrual cycles (amenorrhea).

  • In women under 40, it’s often temporary and periods start again [26]. 
  • In women over 40, it’s more often permanent (early menopause) [26]. This can be upsetting.

Some women may have periods again months or years after chemotherapy ends. However, even for women whose periods return, menopause may begin at an earlier age than for other women [26].

Early menopause and menopausal symptoms

As with natural menopause, you may have symptoms such as hot flashes (including night sweats) and vaginal dryness. Because the onset of menopause is sudden, these symptoms may be worse than with natural menopause.

Early menopause can also affect bone health. Menopause can cause a loss of bone density (osteopenia or osteoporosis).

You may also have muscle or joint aches.

Learn about ways to ease menopausal symptoms.

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Komen Perspectives

Read our perspective on managing menopausal symptoms.*

Early menopause and fertility

If you were hoping to have a child after breast cancer treatment, early menopause is upsetting.

However, there are things you can do that may allow you to have children after treatment. Talk with a fertility specialist before starting treatment to discuss your options. Some are described below.

Storing embryos

The most common procedure for preserving fertility involves storing embryos before chemotherapy begins.

In this procedure, some of your eggs are collected and fertilized by sperm from a spouse, partner or donor.

Unfertilized eggs (which don’t require a sperm donor) can also be frozen and stored. With modern techniques for freezing unfertilized eggs, pregnancy rates are similar to pregnancy rates using fertilized eggs that have been frozen and stored [27].

Insurance coverage for fertility services varies from state to state. Check with your insurance company to find out what’s covered.

Protecting the ovaries

There are no known treatments guaranteed to protect the ovaries from chemotherapy.

However, drugs that shut down the ovaries during chemotherapy may help women return to regular menstrual periods after treatment ends. This may help preserve fertility.

Learn more about fertility options for women undergoing chemotherapy.

Weight gain

Weight gain is a common side effect of chemotherapy [28].

Changes in metabolism caused by chemotherapy and a less active lifestyle add to weight gain during treatment.

Some studies have found women with breast cancer who got chemotherapy were 40-65 percent more likely to gain weight compared to those who didn’t get chemotherapy [29-30].

Women who gain weight usually put on about 5-15 pounds [28]. The more weight a woman gains, the less likely she is to return to her pre-diagnosis weight [29].

Preventing weight gain

Getting regular physical activity during treatment (if possible) may help prevent weight gain. Being active can also help reduce fatigue and improve quality of life [31].

Seeing a dietician may also help. 

Tips to manage your weight

  • Eat regularly (3 small meals per day).
  • Include protein, fiber and healthy fat (found in foods such as olive and canola oils, nuts, natural nut butters and avocados) in meals and snacks to give a feeling of fullness.
  • Avoid meals and snacks that contain mainly refined carbohydrates (such as most pastas, breads and rice as well as cookies, ice cream and other desserts).
  • Fill half of your plate with vegetables.
  • Choose fresh fruits instead of fruit juices.
  • Avoid eating while doing other activities (such as watching TV or reading).
  • Eat slowly.
  • Drink plenty of water.  

 

 

Healthy weight and survival

Maintaining a healthy weight after a breast cancer diagnosis is important for overall health. Some studies suggest maintaining a healthy weight may also improve survival [32-35].

However, there are no known specific foods to eat (or avoid) to improve breast cancer survival.

Aim for a well-balanced, healthy diet. Eating unhealthy foods every now and then is OK and doesn’t have any harmful effects on breast cancer treatment.

Learn more about body weight and survival after breast cancer.

Learn more about a healthy diet and survival after breast cancer.

Learn more about exercise and survival after breast cancer.

Fatigue

Fatigue is mainly a short-term problem, but for some, it can persist [24,36].

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

Regular exercise, even just walking for 20 minutes every day, may help reduce fatigue [22-24,37]. Getting a good night’s sleep is also important.

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

Learn more about fatigue and insomnia.

Cognitive function (cancer brain, chemo-brain)

Some people have cognitive problems after chemotherapy, including mental “fogginess” and trouble with concentration, memory and multi-tasking [38-42]. This condition is often called “chemo-brain.”

Most people have mild symptoms, but some have more troubling cognitive problems that can impact daily life.

Symptoms may last for 1-2 years after treatment or longer. Most people report they go away over time.

Cognitive function and breast cancer treatment

The link between cognitive problems and chemotherapy remains unclear.

Problems with cognitive function may be related to the breast cancer treatment, regardless of the type of treatment [43]. For example, women treated with hormone therapy (and not chemotherapy) have also reported cognitive problems [39,42,44-45].

Stress, anxiety and depression can affect cognitive function [43]. Symptoms may first appear with the stress related to diagnosis and treatment and then become worse after chemotherapy or other treatment begins [43].

Medications used to treat the side effects of chemotherapy (such as sleeping aids and anti-nausea medications) can also cause these problems.

Age and genetic factors may also play a role. Some studies show older women with breast cancer tend to have more cognitive problems after chemotherapy than younger women [39]. Genetic factors may also decrease cognitive function in older women with breast cancer [46].

The true extent of the cognitive effects of chemotherapy is not well understood. More research in this area is needed.

Tips to improve cognitive function

Although no studies show the tips below improve cognitive function, they may help some people with memory problems [47].  

Tips to improve cognitive function

  • Plan your day to do the things that need the most thinking when you feel your best.
  • Get extra rest at night, but limit naps during the day to less than one hour.
  • Exercise (ask your health care provider what light exercise may be helpful for you).
  • Write down or record things you want to remember.
  • Use a calendar and write down important dates and information.
  • Use a pill box to keep track of medications.
  • Ask a friend or family member for help when you need it.
  • Ask your nurse, social worker or patient navigator for help keeping track of clinic visits.
  • Ask your provider about complementary therapies, such as meditation, that may help.
  • Do puzzles or play games for mental exercise.

 

Adapted from National Cancer Institute materials [47].

 

Long-term health risks

Heart problems and leukemia are rare but severe side effects of some types of chemotherapy. 

These risks are related to the dose and type of chemotherapy drug. With the doses given today, the risks of heart problems and leukemia are low [48-49].

For most people with breast cancer, the benefits of chemotherapy outweigh these risks.

Heart problems

Heart problems, like cardiomyopathy (enlarged, weakened heart) and heart failure, have been linked to the use of certain chemotherapy drugs (such as doxorubicin and epirubicin) and the HER2-targeted therapy drug trastuzumab (Herceptin) [48-51].

When these drugs are used, extra care is taken to avoid heart problems.

For example, before you begin chemotherapy with the drug doxorubicin or trastuzumab, your heart function will be measured to make sure there are no pre-existing heart conditions.

If a heart problem occurs, it can sometimes be reversed if the drugs are stopped at the first sign of heart damage [48].

Leukemia

In rare cases, the use of some chemotherapy drugs (including cyclophosphamide, doxorubicin and epirubicin) has been linked to leukemia [48,52-53].

Nerve damage

Chemotherapy drugs (including vinorelbine, cisplatin and taxanes such as paclitaxel and docetaxel) can cause nerve damage.

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

These side effects almost always go away after chemotherapy ends, though it may take weeks or months. However, in some cases, the pain or numbness can persist.

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Komen Affiliates offer breast health education and some fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate.
  • Our Family and Friends section has detailed information and resources for loved ones.
  • Our fact sheets, booklets and other education materials .

 

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.