Late side effects of chemotherapy

Most chemotherapy side effects are temporary. They get better once your treatment is over. For some people chemotherapy can cause long term changes in the body months or years after treatment.

Tiredness (fatigue)

Many people feel more tired than usual for a long time after chemotherapy treatment. This can last more than a year after treatment finishes. It is most likely to happen after a lot of treatment, or very intensive treatment. For example, if you are having a bone marrow or stem cell transplant. 

Problems with different organs

Some chemotherapy drugs can cause long term problems with specific body organs. This includes problems with your:

• heart
• lungs
• liver
• kidneys
• bladder

You will have tests before and during your treatment so your doctor can keep an eye on your side effects. Your doctors may continue to check you for some years after certain treatment.

There may be some chemotherapy drugs your doctor won't use if you have a heart condition. 

Second cancers

Developing another cancer in the future is a long term side effect of some chemotherapy drugs. This is called a second cancer.

It is important to remember that this is a very small risk, and only occurs with some chemotherapy drugs. You would be at a higher risk from your existing cancer if you didn't have the treatment your doctor recommends.

Your doctor will talk to you if this is a specific risk with the drugs you are having.

Cognitive changes (chemo brain)

During and after cancer treatment, some people notice changes in their memory, concentration and the way they think. These changes are called mild cognitive impairment (MCI) or cognitive dysfunction. Some people call them 'chemo brain' or 'chemo fog'.

But the term chemo brain is misleading. Doctors now think these problems could be due to various reasons. This includes the different cancer treatments and the cancer itself.

Researchers are trying to find out:

• what causes chemo brain
• how health professionals and people with cancer can best manage the symptoms of cognitive impairment

Fertility

Some chemotherapy drugs can affect fertility . Whether your infertility is temporary or permanent depends partly on your drugs and doses.

Some chemotherapy drugs can cause damage to the eggs or sperm. Some treatment can cause an early menopause. 

You can ask your healthcare team if the drugs you’re having are likely to make you infertile.

Bone thinning

Chemotherapy treatment can sometimes cause your bones to become thinner (osteoporosis). This increases the risk of broken bones. 

Low hormone levels can also increase your risk of osteoporosis. So if your treatment affects your fertility, you might have a higher risk.

Your doctor may suggest you have a scan to check your bones. Or you may have treatment to stop your bones from thinning.

Nerves

Some chemotherapy drugs can damage nerves, especially in your hands and feet. It can make them feel numb or cause feelings like pins and needles. The medical name for this is peripheral neuropathy (pronounced peh-rih-feh-rul noor-ah-puh-thee).

This usually improves once treatment has ended, but it can take many months. It might be a permanent side effect in a small number of people.

Tell your healthcare team if you have any numbness or tingling.

Mental health

Some people start struggling with their mental health after chemotherapy. This might be because you have less support from the hospital or friends and family. You might also have more time and space now to reflect on your experience as you are no longer in ‘survival’ mode.

Some people worry that their cancer will come back after treatment. Seeing a healthcare professional can be reassuring and help with these feelings. But once treatment has finished, you might see them less often. This might increase your worries about your cancer.

If you are struggling with your mental health, tell your healthcare team. You may be able to get mental health support through them, your GP. support groups or charities. 

What to do if you are worried

There are many different chemotherapy drugs and they all have different side effects. It’s important to remember that you probably won't get every side effect listed. 

Ask your healthcare team if you are worried about the long term side effects of your treatment.