Editing Chemotherapy (section)

== Adverse effects ==
Chemotherapeutic techniques have a range of side effects that depend on the type of medications used. The most common medications affect mainly the [[fast-dividing cells]] of the body, such as blood cells and the cells lining the mouth, stomach, and intestines. Chemotherapy-related [[Iatrogenesis|iatrogenic toxicities]] can occur acutely after administration, within hours or days, or chronically, from weeks to years.<ref name=Airley2009/>{{rp|265}}

=== Immunosuppression and myelosuppression ===
Virtually all chemotherapeutic regimens can cause depression of the [[immune system]], often by paralysing the [[bone marrow]] and leading to a decrease of [[white blood cell]]s, [[red blood cell]]s, and [[platelet]]s.
[[Anemia]] and [[thrombocytopenia]] may require [[blood transfusion]]. [[Neutropenia]] (a decrease of the [[neutrophil granulocyte]] count below 0.5 x 10<sup>9</sup>/[[litre]]) can be improved with synthetic [[G-CSF]] ([[granulocyte]]-colony-stimulating factor, e.g., [[filgrastim]], [[lenograstim]], [[efbemalenograstim alfa]]).<ref>{{Cite journal |last1=Estcourt |first1=Lise J |last2=Stanworth |first2=Simon J |last3=Hopewell |first3=Sally |last4=Doree |first4=Carolyn |last5=Trivella |first5=Marialena |last6=Massey |first6=Edwin |date=2016-04-29 |title=Granulocyte transfusions for treating infections in people with neutropenia or neutrophil dysfunction |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=4 |pages=CD005339 |doi=10.1002/14651858.CD005339.pub2 |issn=1469-493X |pmc=4930145 |pmid=27128488}}</ref>

In very severe [[myelosuppression]], which occurs in some regimens, almost all the bone marrow [[stem cell]]s (cells that produce [[white blood cells|white]] and [[red blood cell]]s) are destroyed, meaning ''allogenic'' or ''[[autologous]]'' [[bone marrow transplant|bone marrow cell transplants]] are necessary. (In autologous BMTs, cells are removed from the person before the treatment, multiplied and then re-injected afterward; in ''allogenic'' BMTs, the source is a donor.) However, some people still develop diseases because of this interference with bone marrow.<ref>{{Cite journal |last1=Léger |first1=Chantal S. |last2=Nevill |first2=Thomas J. |date=2004-05-11 |title=Hematopoietic stem cell transplantation: a primer for the primary care physician |journal=Canadian Medical Association Journal |volume=170 |issue=10 |pages=1569–1577 |doi=10.1503/cmaj.1011625 |issn=0820-3946 |pmid=15136552|pmc=400723 }}</ref>

Although people receiving chemotherapy are encouraged to wash their hands, avoid sick people, and take other infection-reducing steps, about 85% of infections are due to naturally occurring microorganisms in the person's own [[Human gastrointestinal tract|gastrointestinal tract]] (including [[oral cavity]]) and skin.<ref name=Huang2000>{{cite book | name-list-style = vanc   | last1 = Huang | first1 = Elbert S. | title = Internal medicine: handbook for clinicians, resident survival guide | year = 2000 | publisher = Scrub Hill Press | location = Arlington, VA  | isbn = 978-0-9645467-5-2 | page = 130}}</ref>{{rp|130}} This may manifest as systemic infections, such as [[sepsis]], or as localized outbreaks, such as [[Herpes simplex]], [[shingles]], or other members of the [[human herpes virus|Herpesviridea]].<ref name="HSV">{{cite journal | vauthors = Elad S, Zadik Y, Hewson I, Hovan A, Correa ME, Logan R, Elting LS, Spijkervet FK, Brennan MT | title = A systematic review of viral infections associated with oral involvement in cancer patients: a spotlight on Herpesviridea | journal = Supportive Care in Cancer | volume = 18 | issue = 8 | pages = 993–1006 | date = August 2010 | pmid = 20544224 | doi = 10.1007/s00520-010-0900-3 | s2cid = 2969472 }}</ref> The risk of illness and death can be reduced by taking common antibiotics such as [[Quinolone antibiotic|quinolone]]s or [[trimethoprim/sulfamethoxazole]] before any fever or sign of infection appears.<ref name="Cochrane Database">{{cite journal | vauthors = Gafter-Gvili A, Fraser A, Paul M, Vidal L, Lawrie TA, van de Wetering MD, Kremer LC, Leibovici L | title = Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD004386 | date = January 2012 | issue = 1 | pmid = 22258955 | pmc = 4170789 | doi = 10.1002/14651858.CD004386.pub3 }}</ref> Quinolones show effective prophylaxis mainly with hematological cancer.<ref name="Cochrane Database"/> However, in general, for every five people who are immunosuppressed following chemotherapy who take an antibiotic, one fever can be prevented; for every 34 who take an antibiotic, one death can be prevented.<ref name="Cochrane Database" /> Sometimes, chemotherapy treatments are postponed because the immune system is suppressed to a critically low level.{{citation needed|date=March 2023}}

In [[Japan]], the government has approved the use of some [[medicinal mushrooms]] like ''[[Trametes versicolor]]'', to counteract depression of the immune system in people undergoing chemotherapy.<ref name="psk">{{cite web |url=http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Coriolous_Versicolor.asp |title=Coriolus Versicolor |publisher=Cancer.org |date=2008-06-10 |access-date=7 August 2012 |archive-date=25 June 2010 |archive-url=https://web.archive.org/web/20100625052416/http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Coriolous_Versicolor.asp |url-status=dead }}</ref>

[[Trilaciclib]] is an inhibitor of [[cyclin-dependent kinase]] 4/6 approved for the prevention of myelosuppression caused by chemotherapy. The drug is given before chemotherapy to protect bone marrow function.<ref>{{Cite web|last=Commissioner|first=Office of the|date=2021-02-12|title=FDA Approves Drug to Reduce Bone Marrow Suppression Caused by Chemotherapy|url=https://www.fda.gov/news-events/press-announcements/fda-approves-drug-reduce-bone-marrow-suppression-caused-chemotherapy|access-date=2021-03-09|website=FDA|language=en}}</ref>

=== Neutropenic enterocolitis ===
Due to immune system suppression, [[neutropenic enterocolitis]] (typhlitis) is a "life-threatening gastrointestinal complication of chemotherapy."<ref>{{cite journal | vauthors = Davila ML | title = Neutropenic enterocolitis | journal = Current Opinion in Gastroenterology | volume = 22 | issue = 1 | pages = 44–7 | date = January 2006 | pmid = 16319675 | doi = 10.1097/01.mog.0000198073.14169.3b | doi-broken-date = 5 April 2025 | s2cid = 25479771 }}</ref> [[Typhlitis]] is an intestinal infection which may manifest itself through symptoms including [[nausea]], [[vomiting]], [[diarrhea]], a [[distended abdomen]], [[fever]], [[chills]], or [[abdominal pain]] and tenderness.<ref>{{Cite journal |last=Sinicrope |first=Frank A. |date=2003 |title=Typhlitis |url=https://www.ncbi.nlm.nih.gov/books/NBK12821/ |journal=Holland-Frei Cancer Medicine. 6th Edition |language=en}}</ref>

[[Typhlitis]] is a [[medical emergency]]. It has a very poor [[prognosis]] and is often fatal unless promptly recognized and aggressively treated.<ref name="Keidan 1989 206–9">{{cite journal | vauthors = Keidan RD, Fanning J, Gatenby RA, Weese JL | title = Recurrent typhlitis. A disease resulting from aggressive chemotherapy | journal = Diseases of the Colon and Rectum | volume = 32 | issue = 3 | pages = 206–9 | date = March 1989 | pmid = 2920627 | doi = 10.1007/BF02554529 | s2cid = 46090832 }}</ref> Successful treatment hinges on early diagnosis provided by a high index of suspicion and the use of CT scanning, nonoperative treatment for uncomplicated cases, and sometimes elective right [[hemicolectomy]] to prevent recurrence.<ref name="Keidan 1989 206–9" />

=== Gastrointestinal distress ===
[[Nausea]], [[vomiting]], [[Anorexia (symptom)|anorexia]], [[diarrhea]], abdominal cramps, and [[constipation]] are common side-effects of chemotherapeutic medications that kill fast-dividing cells.<ref name="pmid">{{cite journal | vauthors = Gibson RJ, Keefe DM | title = Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies | journal = Supportive Care in Cancer | volume = 14 | issue = 9 | pages = 890–900 | date = September 2006 | pmid = 16604351 | doi = 10.1007/s00520-006-0040-y | s2cid = 109778 }}</ref> [[Malnutrition]] and [[dehydration]] can result when the recipient does not eat or drink enough, or when the person vomits frequently, because of gastrointestinal damage. This can result in rapid weight loss, or occasionally in weight gain, if the person eats too much in an effort to allay nausea or heartburn. Weight gain can also be caused by some steroid medications. These side-effects can frequently be reduced or eliminated with [[antiemetic]] drugs. Low-certainty evidence also suggests that probiotics may have a preventative and treatment effect of diarrhoea related to chemotherapy alone and with radiotherapy.<ref>{{cite journal | vauthors = Wei D, Heus P, van de Wetering FT, van Tienhoven G, Verleye L, Scholten RJ | title = Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD008831 | date = August 2018 | issue = 8 | pmid = 30168576 | pmc = 6513393 | doi = 10.1002/14651858.cd008831.pub3 }}</ref> However, a high index of suspicion is appropriate, since diarrhoea and bloating are also symptoms of [[typhlitis]], a very serious and potentially life-threatening [[medical emergency]] that requires immediate treatment.<ref>{{Cite journal |last1=Rodrigues |first1=Fabio G |last2=Dasilva |first2=Giovanna |last3=Wexner |first3=Steven D |date=2017-01-07 |title=Neutropenic enterocolitis |journal=World Journal of Gastroenterology |volume=23 |issue=1 |pages=42–47 |doi=10.3748/wjg.v23.i1.42 |issn=1007-9327 |pmc=5221285 |pmid=28104979 |doi-access=free }}</ref>

=== Anemia ===
[[Anemia]] can be a combined outcome caused by myelosuppressive chemotherapy, and possible cancer-related causes such as [[bleeding]], [[blood cell]] destruction ([[hemolysis]]), hereditary disease, kidney dysfunction, nutritional deficiencies or [[anemia of chronic disease]]. Treatments to mitigate anemia include hormones to boost blood production ([[erythropoietin]]), [[iron supplement]]s, and [[blood transfusion]]s.<ref name="pmid10511589">{{cite journal | vauthors = Groopman JE, Itri LM | title = Chemotherapy-induced anemia in adults: incidence and treatment | journal = Journal of the National Cancer Institute | volume = 91 | issue = 19 | pages = 1616–34 | date = October 1999 | pmid = 10511589 | doi = 10.1093/jnci/91.19.1616 | doi-access = free }}</ref><ref name="pmid16925107">{{cite journal | vauthors = Henry DH | title = The role of intravenous iron in cancer-related anemia | journal = Oncology | volume = 20 | issue = 8 Suppl 6 | pages = 21–4 | date = July 2006 | pmid = 16925107 }}</ref><ref name="pmid18597709">{{cite journal | vauthors = Rodgers GM, Becker PS, Bennett CL, Cella D, Chanan-Khan A, Chesney C, Cleeland C, Coccia PF, Djulbegovic B, Garst JL, Gilreath JA, Kraut EH, Lin WC, Matulonis U, Millenson M, Reinke D, Rosenthal J, Sabbatini P, Schwartz RN, Stein RS, Vij R | title = Cancer- and chemotherapy-induced anemia | journal = Journal of the National Comprehensive Cancer Network | volume = 6 | issue = 6 | pages = 536–64 | date = July 2008 | pmid = 18597709 | doi =  10.6004/jnccn.2008.0042}}</ref> Myelosuppressive therapy can cause a tendency to bleed easily, leading to anemia. Medications that kill rapidly dividing cells or blood cells can reduce the number of [[platelet]]s in the blood, which can result in [[Hematoma|bruises]] and [[Hemorrhage|bleeding]]. Extremely low platelet counts may be temporarily boosted through [[platelet transfusion]]s and new drugs to increase platelet counts during chemotherapy are being developed.<ref name="pmid19245931">{{cite journal | vauthors = Vadhan-Raj S | title = Management of chemotherapy-induced thrombocytopenia: current status of thrombopoietic agents | journal = Seminars in Hematology | volume = 46 | issue = 1 Suppl 2 | pages = S26-32 | date = January 2009 | pmid = 19245931 | doi = 10.1053/j.seminhematol.2008.12.007 }}</ref><ref name="pmid16711312">{{cite journal | vauthors = Sekhon SS, Roy V | s2cid = 16527763 | title = Thrombocytopenia in adults: A practical approach to evaluation and management | journal = Southern Medical Journal | volume = 99 | issue = 5 | pages = 491–8; quiz 499–500, 533 | date = May 2006 | pmid = 16711312 | doi = 10.1097/01.smj.0000209275.75045.d4 }}</ref><ref>{{cite journal | vauthors = Estcourt L, Stanworth S, Doree C, Hopewell S, Murphy MF, Tinmouth A, Heddle N | title = Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD004269 | date = May 2012 | pmid = 22592695 | doi = 10.1002/14651858.CD004269.pub3 | pmc = 11972837 | collaboration = Cochrane Haematological Malignancies Group | url = https://ora.ox.ac.uk/objects/uuid:552b24c8-5ce8-4f0c-8d08-2516e6c355b5/download_file?safe_filename=Estcourt%2Bet%2Bal%2C%2B%2BProphylactic%2Bplatelet%2Btransfusion%2Bfor%2Bprevention%2Bof%2Bbleeding%2Bin%2Bpatients%2Bwith%2Bhaematological%2Bdisorders.pdf&file_format=application%2Fpdf&type_of_work=Journal+article }}</ref><ref>{{cite journal | vauthors = Estcourt LJ, Stanworth SJ, Doree C, Hopewell S, Trivella M, Murphy MF | title = Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD010983 | date = November 2015 | volume = 2015 | pmid = 26576687 | doi = 10.1002/14651858.CD010983.pub2 | pmc = 4717525 | collaboration = Cochrane Haematological Malignancies Group }}</ref> Sometimes, chemotherapy treatments are postponed to allow platelet counts to recover.

[[Cancer-related fatigue|Fatigue]] may be a consequence of the cancer or its treatment, and can last for months to years after treatment. One physiological cause of fatigue is anemia, which can be caused by chemotherapy, [[surgery]], [[radiotherapy]], primary and metastatic disease or nutritional depletion.<ref name="pmid20870636">{{cite journal | vauthors = Berger AM, Abernethy AP, Atkinson A, Barsevick AM, Breitbart WS, Cella D, Cimprich B, Cleeland C, Eisenberger MA, Escalante CP, Jacobsen PB, Kaldor P, Ligibel JA, Murphy BA, O'Connor T, Pirl WF, Rodler E, Rugo HS, Thomas J, Wagner LI | s2cid = 70400559 | title = NCCN Clinical Practice Guidelines Cancer-related fatigue | journal = Journal of the National Comprehensive Cancer Network | volume = 8 | issue = 8 | pages = 904–31 | date = August 2010 | pmid = 20870636 | doi =  10.6004/jnccn.2010.0067| doi-access = free }}</ref><ref name="pmid16500197">{{cite journal | vauthors = Franklin DJ, Packel L | title = Cancer-related fatigue | journal = Archives of Physical Medicine and Rehabilitation | volume = 87 | issue = 3 Suppl 1 | pages = S91–3; quiz S94–5 | date = March 2006 | pmid = 16500197 | doi = 10.1016/j.apmr.2005.12.015 }}</ref> [[Aerobic exercise]] has been found to be beneficial in reducing fatigue in people with [[solid tumour]]s.<ref name="pmid23152233">{{cite journal | vauthors = Cramp F, Byron-Daniel J | title = Exercise for the management of cancer-related fatigue in adults | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD006145 | date = November 2012 | issue = 9 | pmid = 23152233 | doi = 10.1002/14651858.CD006145.pub3 | pmc = 8480137 | editor1-last = Cramp | editor1-first = Fiona }}</ref>

=== Nausea and vomiting ===
{{Further|Chemotherapy-induced nausea and vomiting}}
[[Nausea]] and [[vomiting]] are two of the most feared cancer treatment-related side-effects for people with cancer and their families. In 1983, Coates et al. found that people receiving chemotherapy ranked nausea and vomiting as the first and second most severe side-effects, respectively.<ref>{{Citation |last=PDQ Supportive and Palliative Care Editorial Board |title=Nausea and Vomiting Related to Cancer Treatment (PDQ®): Health Professional Version |date=2002 |url=http://www.ncbi.nlm.nih.gov/books/NBK66056/ |work=PDQ Cancer Information Summaries |place=Bethesda (MD) |publisher=National Cancer Institute (US) |pmid=26389491 |access-date=2022-11-08}}</ref> Up to 20% of people receiving highly emetogenic agents in this era postponed, or even refused potentially curative treatments.<ref>{{cite journal | title = Nausea and Vomiting in the Cancer Patient | year = 2006 | journal = Oncology | pages = 1482–1496 | doi = 10.1007/0-387-31056-8_83 | quote = Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. | last1 = Gill | first1 = Paula | last2 = Grothey | first2 = Axel | last3 = Loprinzi | first3 = Charles | name-list-style = vanc | isbn = 978-0-387-24291-0 }}</ref> Chemotherapy-induced nausea and vomiting (CINV) are common with many treatments and some forms of cancer. Since the 1990s, several novel classes of [[antiemetics]] have been developed and commercialized, becoming a nearly universal standard in chemotherapy regimens, and helping to successfully manage these symptoms in many people. Effective mediation of these unpleasant and sometimes debilitating symptoms results in increased quality of life for the recipient and more efficient treatment cycles, as patients are less likely to avoid or refuse treatment.<ref>{{Cite journal |last1=Sanger |first1=Gareth J. |last2=Andrews |first2=Paul L. R. |date=2018-09-04 |title=A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research |journal=Frontiers in Pharmacology |volume=9 |pages=913 |doi=10.3389/fphar.2018.00913 |issn=1663-9812 |pmc=6131675 |pmid=30233361|doi-access=free }}</ref>

=== Hair loss ===
[[File:Hair matting after few sessions of chemotherapy.jpg|alt=Chemotherapy adverse effects on hair|thumb|Hair matting after few sessions of chemotherapy]]
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 | caption1 = [[Hank Green]] just before the start of his chemotherapy treatment, with naturally straight hair.
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[[Hair loss]] (alopecia) can be caused by chemotherapy that kills rapidly dividing cells; other medications may cause hair to thin.  These are most often temporary effects: hair usually starts to regrow a few weeks after the last treatment, but sometimes with a change in color, texture, thickness or style. Sometimes hair has a tendency to curl after regrowth, resulting in "chemo curls." Severe hair loss occurs most often with drugs such as [[doxorubicin]], [[daunorubicin]], [[paclitaxel]], [[docetaxel]], [[cyclophosphamide]], [[ifosfamide]] and [[etoposide]]. Permanent thinning or hair loss can result from some standard chemotherapy regimens.<ref>{{Cite web |title=Chemotherapy-Related Hair Loss (Alopecia) in Children - Health Encyclopedia - University of Rochester Medical Center |url=https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02732 |access-date=2022-11-08 |website=www.urmc.rochester.edu}}</ref>

Chemotherapy induced hair loss occurs by a non-androgenic mechanism, and can manifest as [[alopecia totalis]], [[telogen effluvium]], or less often [[alopecia areata]].<ref name="pmid17642856">{{cite journal | vauthors = Chadha V, Shenoi SD | title = Hair loss in cancer chemotherapeutic patients | journal = Indian Journal of Dermatology, Venereology and Leprology | volume = 69 | issue = 2 | pages = 131–2 | year = 2003 | pmid = 17642856 }}</ref> It is usually associated with systemic treatment due to the high mitotic rate of hair follicles, and more reversible than androgenic hair loss,<ref name="pmid23187775">{{cite journal | vauthors = Lemieux J | title = Reducing chemotherapy-induced alopecia with scalp cooling | journal = Clinical Advances in Hematology & Oncology | volume = 10 | issue = 10 | pages = 681–2 | date = October 2012 | pmid = 23187775 }}</ref><ref>{{cite journal | vauthors = Shapiro J, Price VH | title = Hair regrowth. Therapeutic agents | journal = Dermatologic Clinics | volume = 16 | issue = 2 | pages = 341–56 | date = April 1998 | pmid = 9589208 | doi = 10.1016/S0733-8635(05)70017-6 }}</ref> although permanent cases can occur.<ref>{{cite journal | vauthors = Al-Mohanna H, Al-Khenaizan S | title = Permanent alopecia following cranial irradiation in a child | journal = [[Journal of Cutaneous Medicine and Surgery]] | volume = 14 | issue = 3 | pages = 141–3 | year = 2010 | pmid = 20487675 | doi = 10.2310/7750.2010.09014 | s2cid = 43583651 }}</ref> Chemotherapy induces hair loss in women more often than men.<ref>{{cite journal | vauthors = Can G, Demir M, Erol O, Aydiner A | title = A comparison of men and women's experiences of chemotherapy-induced alopecia | journal = [[European Journal of Oncology Nursing]] | volume = 17 | issue = 3 | pages = 255–60 | date = June 2013 | pmid = 22901547 | doi = 10.1016/j.ejon.2012.06.003 }}</ref>

[[Hypothermia cap|Scalp cooling]] offers a means of preventing both permanent and temporary hair loss; however, concerns about this method have been raised.<ref name="pmid19341937">{{cite journal | vauthors = Trüeb RM | title = Chemotherapy-induced alopecia | journal = Seminars in Cutaneous Medicine and Surgery | volume = 28 | issue = 1 | pages = 11–4 | date = March 2009 | pmid = 19341937 | doi = 10.1016/j.sder.2008.12.001 | doi-broken-date = 28 January 2025 }}</ref><ref name="pmid22178150">{{cite journal | vauthors = Chon SY, Champion RW, Geddes ER, Rashid RM | title = Chemotherapy-induced alopecia | journal = Journal of the American Academy of Dermatology | volume = 67 | issue = 1 | pages = e37-47 | date = July 2012 | pmid = 22178150 | doi = 10.1016/j.jaad.2011.02.026 }}</ref>

=== Secondary neoplasm ===
Development of secondary neoplasia after successful chemotherapy or radiotherapy treatment can occur. The most common [[secondary neoplasm]] is secondary acute myeloid leukemia, which develops primarily after treatment with alkylating agents or topoisomerase inhibitors.<ref>{{Cite book |title=Secondary neoplasias following chemotherapy, radiotherapy and immunosuppression |date=2000 |publisher=Karger |isbn=9783318006155 |volume=55 |location=Basel |oclc=606559421}}</ref> Survivors of [[childhood cancer]] are more than 13 times as likely to get a [[secondary neoplasm]] during the 30 years after treatment than the general population.<ref>{{cite journal | vauthors = Hijiya N, Hudson MM, Lensing S, Zacher M, Onciu M, Behm FG, Razzouk BI, Ribeiro RC, Rubnitz JE, Sandlund JT, Rivera GK, Evans WE, Relling MV, Pui CH | title = Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia | journal = JAMA | volume = 297 | issue = 11 | pages = 1207–15 | date = March 2007 | pmid = 17374815 | doi = 10.1001/jama.297.11.1207 | doi-access = free }}</ref> Not all of this increase can be attributed to chemotherapy.

=== Infertility ===
Some types of chemotherapy are gonadotoxic and may cause [[infertility]].<ref name=Brydoy>{{cite journal | vauthors = Brydøy M, Fosså SD, Dahl O, Bjøro T | title = Gonadal dysfunction and fertility problems in cancer survivors | journal = Acta Oncologica | volume = 46 | issue = 4 | pages = 480–9 | year = 2007 | pmid = 17497315 | doi = 10.1080/02841860601166958 | s2cid = 20672988 }}</ref> Chemotherapies with high risk include procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil, and chlormethine.<ref name=Brydoy /> Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin.<ref name=Brydoy /> On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, [[antibiotic]]s such as bleomycin and dactinomycin, and antimetabolites such as methotrexate, mercaptopurine, and 5-fluorouracil.<ref name=Brydoy />

[[Female infertility]] by chemotherapy appears to be secondary to [[premature ovarian failure]] by loss of [[primordial follicles]].<ref name=Morgan2012>{{cite journal | vauthors = Morgan S, Anderson RA, Gourley C, Wallace WH, Spears N | title = How do chemotherapeutic agents damage the ovary? | journal = Human Reproduction Update | volume = 18 | issue = 5 | pages = 525–35 | year = 2012 | pmid = 22647504 | doi = 10.1093/humupd/dms022 | doi-access = free | hdl = 1842/9543 | hdl-access = free }}</ref> This loss is not necessarily a direct effect of the chemotherapeutic agents, but could be due to an increased rate of growth initiation to replace damaged developing follicles.<ref name=Morgan2012 />

People may choose between several methods of [[fertility preservation]] prior to chemotherapy, including [[cryopreservation]] of semen, ovarian tissue, oocytes, or embryos.<ref>{{cite journal | vauthors = Gurgan T, Salman C, Demirol A | title = Pregnancy and assisted reproduction techniques in men and women after cancer treatment | journal = Placenta | volume = 29 Suppl B | pages = 152–9 | date = October 2008 | pmid = 18790328 | doi = 10.1016/j.placenta.2008.07.007 }}</ref> As more than half of cancer patients are elderly, this adverse effect is only relevant for a minority of patients. A study in France between 1999 and 2011 came to the result that embryo freezing before administration of gonadotoxic agents to females caused a delay of treatment in 34% of cases, and a live birth in 27% of surviving cases who wanted to become pregnant, with the follow-up time varying between 1 and 13 years.<ref>{{cite journal | vauthors = Courbiere B, Decanter C, Bringer-Deutsch S, Rives N, Mirallié S, Pech JC, De Ziegler D, Carré-Pigeon F, May-Panloup P, Sifer C, Amice V, Schweitzer T, Porcu-Buisson G, Poirot C | title = Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study | journal = Human Reproduction | volume = 28 | issue = 9 | pages = 2381–8 | date = September 2013 | pmid = 23832792 | doi = 10.1093/humrep/det268 | doi-access = free }}</ref>

Potential protective or attenuating agents include [[GnRH analog]]s, where several studies have shown a protective effect ''[[in vivo]]'' in humans, but some studies show no such effect. [[Sphingosine-1-phosphate]] (S1P) has shown similar effect, but its mechanism of inhibiting the [[Sphingomyelin#Apoptosis|sphingomyelin apoptotic pathway]] may also interfere with the [[apoptosis]] action of chemotherapy drugs.<ref name="RonessKalich-Philosoph2014">{{cite journal | vauthors = Roness H, Kalich-Philosoph L, Meirow D | title = Prevention of chemotherapy-induced ovarian damage: possible roles for hormonal and non-hormonal attenuating agents | journal = Human Reproduction Update | volume = 20 | issue = 5 | pages = 759–74 | year = 2014 | pmid = 24833728 | doi = 10.1093/humupd/dmu019 | doi-access = free }}</ref>

In chemotherapy as a [[conditioning regimen]] in hematopoietic stem cell transplantation, a study of people conditioned with cyclophosphamide alone for severe aplastic anemia came to the result that ovarian recovery occurred in all women younger than 26 years at time of transplantation, but only in five of 16 women older than 26 years.<ref>{{cite journal | vauthors = Tichelli A, Rovó A | title = Fertility issues following hematopoietic stem cell transplantation | journal = Expert Review of Hematology | volume = 6 | issue = 4 | pages = 375–88 | date = August 2013 | pmid = 23991924 | doi = 10.1586/17474086.2013.816507 | s2cid = 25139582 }}
<br />In turn citing: {{cite journal | vauthors = Sanders JE, Hawley J, Levy W, Gooley T, Buckner CD, Deeg HJ, Doney K, Storb R, Sullivan K, Witherspoon R, Appelbaum FR | title = Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation | journal = Blood | volume = 87 | issue = 7 | pages = 3045–52 | date = April 1996 | pmid = 8639928 | doi = 10.1182/blood.V87.7.3045.bloodjournal8773045 | doi-access = free }}</ref>

=== Teratogenicity ===
Chemotherapy is [[teratogenic]] during [[pregnancy]], especially during the [[first trimester]], to the extent that [[abortion]] usually is recommended if pregnancy in this period is found during chemotherapy.<ref name=arnon2011>{{cite journal | vauthors = Arnon J, Meirow D, Lewis-Roness H, Ornoy A | title = Genetic and teratogenic effects of cancer treatments on gametes and embryos | journal = Human Reproduction Update | volume = 7 | issue = 4 | pages = 394–403 | year = 2001 | pmid = 11476352 | doi = 10.1093/humupd/7.4.394 | doi-access = free }}</ref> Second- and third-trimester exposure does not usually increase the teratogenic risk and adverse effects on cognitive development, but it may increase the risk of various [[complications of pregnancy]] and fetal myelosuppression.<ref name=arnon2011 />

Female patients of reproductive potential should use effective [[contraception]] during chemotherapy and for a few months after the last dose (e.g. 6 month for [[doxorubicin]]<ref name="dailymed">{{DailyMed|00634b2b-4e48-4178-8877-28582af894ad|DOXORUBICIN HYDROCHLORIDE injection, solution}}</ref>).

In males previously having undergone chemotherapy or radiotherapy, there appears to be no increase in genetic defects or congenital malformations in their children conceived after therapy.<ref name=arnon2011 /> The use of [[assisted reproductive technologies]] and [[micromanipulation technique]]s might increase this risk.<ref name=arnon2011 /> In females previously having undergone chemotherapy, miscarriage and congenital malformations are not increased in subsequent conceptions.<ref name=arnon2011 /> However, when [[in vitro fertilization]] and [[embryo cryopreservation]] is practised between or shortly after treatment, possible genetic risks to the growing oocytes exist, and hence it has been recommended that the babies be screened.<ref name=arnon2011 />

=== Peripheral neuropathy ===
{{further|Chemotherapy-induced peripheral neuropathy}}
Between 30 and 40 percent of people undergoing chemotherapy experience [[chemotherapy-induced peripheral neuropathy]] (CIPN), a progressive, enduring, and often irreversible condition, causing pain, tingling, numbness and sensitivity to cold, beginning in the hands and feet and sometimes progressing to the arms and legs.<ref name = NCI>{{cite journal | vauthors = del Pino BM | date = 23 February 2010 | journal = NCI Cancer Bulletin | volume = 7 | issue = 4 | page = 6 | title = Chemotherapy-induced Peripheral Neuropathy | url = http://www.cancer.gov/cancertopics/research/chemotherapy-induced-peripheral-neuropathy}}</ref> Chemotherapy drugs associated with CIPN include [[thalidomide]], [[epothilone]]s, ''vinca'' alkaloids, taxanes, [[proteasome inhibitor]]s, and the platinum-based drugs.<ref name = NCI /><ref>{{cite journal|url=http://www.kup.at/kup/pdf/10376.pdf |archive-url=https://web.archive.org/web/20120812155252/http://www.kup.at/kup/pdf/10376.pdf |archive-date=2012-08-12 |url-status=live| vauthors =Grisold W, Oberndorfer S, Windebank AJ|journal=European Association of Neurooncology Magazine|title=Chemotherapy and polyneuropathies|year=2012|volume=12|issue=1}}</ref> Whether CIPN arises, and to what degree, is determined by the choice of drug, duration of use, the total amount consumed and whether the person already has [[peripheral neuropathy]]. Though the symptoms are mainly sensory, in some cases [[motor nerve]]s and the [[autonomic nervous system]] are affected.<ref name=Beijers>{{cite journal | vauthors = Beijers AJ, Jongen JL, Vreugdenhil G | title = Chemotherapy-induced neurotoxicity: the value of neuroprotective strategies | journal = The Netherlands Journal of Medicine | volume = 70 | issue = 1 | pages = 18–25 | date = January 2012 | pmid = 22271810 | url = http://www.njmonline.nl/njm/getarticle.php?v=70&i=1&p=18 }}</ref> CIPN often follows the first chemotherapy dose and increases in severity as treatment continues, but this progression usually levels off at completion of treatment. The platinum-based drugs are the exception; with these drugs, sensation may continue to deteriorate for several months after the end of treatment.<ref name= Windebank>{{cite journal | vauthors = Windebank AJ, Grisold W | title = Chemotherapy-induced neuropathy | journal = Journal of the Peripheral Nervous System | volume = 13 | issue = 1 | pages = 27–46 | date = March 2008 | pmid = 18346229 | doi = 10.1111/j.1529-8027.2008.00156.x | s2cid = 20411101 }}</ref> Some CIPN appears to be irreversible.<ref name= Windebank /> Pain can often be managed with drug or other treatment but the numbness is usually resistant to treatment.<ref name=Savage>{{cite journal | vauthors = Savage L | title = Chemotherapy-induced pain puzzles scientists | journal = Journal of the National Cancer Institute | volume = 99 | issue = 14 | pages = 1070–1 | date = July 2007 | pmid = 17623791 | doi = 10.1093/jnci/djm072 | doi-access = free }}</ref>

=== Cognitive impairment ===
Some people receiving chemotherapy report fatigue or non-specific neurocognitive problems, such as an inability to concentrate; this is sometimes called [[post-chemotherapy cognitive impairment]], referred to as "chemo brain" in popular and social media.<ref name="pmid15169812">{{cite journal | vauthors = Tannock IF, Ahles TA, Ganz PA, Van Dam FS | title = Cognitive impairment associated with chemotherapy for cancer: report of a workshop | journal = Journal of Clinical Oncology | volume = 22 | issue = 11 | pages = 2233–9 | date = June 2004 | pmid = 15169812 | doi = 10.1200/JCO.2004.08.094 | doi-access = free }}</ref>

=== Tumor lysis syndrome ===
In particularly large tumors and cancers with high [[white cell count]]s, such as [[lymphoma]]s, [[teratoma]]s, and some [[leukemia]]s, some people develop [[tumor lysis syndrome]]. The rapid breakdown of cancer cells causes the release of chemicals from the inside of the cells. Following this, high levels of [[hyperuricemia|uric acid]], [[hyperkalemia|potassium]] and [[hyperphosphatemia|phosphate]] are found in the blood. High levels of phosphate induce secondary hypoparathyroidism, resulting in low levels of calcium in the blood.<ref>{{Citation |last1=Adeyinka |first1=Adebayo |title=Tumor Lysis Syndrome |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK518985/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30085527 |access-date=2022-11-08 |last2=Bashir |first2=Khalid}}</ref> This causes kidney damage and the high levels of potassium can cause [[Cardiac dysrhythmia|cardiac arrhythmia]]. Although prophylaxis is available and is often initiated in people with large tumors, this is a dangerous side-effect that can lead to death if left untreated.<ref name=Wood2005/>{{rp|202}}

=== Organ damage ===
[[Cardiotoxicity]] (heart damage) is especially prominent with the use of [[anthracycline]] drugs ([[doxorubicin]], [[epirubicin]], [[idarubicin]], and [[liposomal doxorubicin]]). The cause of this is most likely due to the production of [[free radical]]s in the cell and subsequent [[DNA damage]]. Other chemotherapeutic agents that cause cardiotoxicity, but at a lower incidence, are [[cyclophosphamide]], [[docetaxel]] and [[clofarabine]].<ref name="pmid22382639">{{cite journal | vauthors = Shaikh AY, Shih JA | title = Chemotherapy-induced cardiotoxicity | journal = Current Heart Failure Reports | volume = 9 | issue = 2 | pages = 117–27 | date = June 2012 | pmid = 22382639 | doi = 10.1007/s11897-012-0083-y | s2cid = 35723897 }}</ref>

[[Hepatotoxicity]] (liver damage) can be caused by many cytotoxic drugs. The susceptibility of an individual to liver damage can be altered by other factors such as the cancer itself, [[viral hepatitis]], [[immunosuppression]] and [[nutritional deficiency]]. The liver damage can consist of damage to liver cells, [[Hepatic veno-occlusive disease|hepatic sinusoidal syndrome]] (obstruction of the veins in the liver), [[cholestasis]] (where bile does not flow from the liver to the intestine) and [[liver fibrosis]].<ref>{{cite journal | vauthors = Thatishetty AV, Agresti N, O'Brien CB | title = Chemotherapy-induced hepatotoxicity | journal = Clinics in Liver Disease | volume = 17 | issue = 4 | pages = 671–86, ix–x | date = November 2013 | pmid = 24099024 | doi = 10.1016/j.cld.2013.07.010 }}</ref><ref name="pmid11306728">{{cite journal | vauthors = King PD, Perry MC | title = Hepatotoxicity of chemotherapy | journal = The Oncologist | volume = 6 | issue = 2 | pages = 162–76 | year = 2001 | pmid = 11306728 | doi = 10.1634/theoncologist.6-2-162 | s2cid = 39518402 | url = http://theoncologist.alphamedpress.org/content/6/2/162.full.pdf }}</ref>

[[Nephrotoxicity]] (kidney damage) can be caused by [[tumor lysis syndrome]] and also due direct effects of drug clearance by the kidneys. Different drugs will affect different parts of the kidney and the toxicity may be [[asymptomatic]] (only seen on blood or urine tests) or may cause [[acute kidney injury]].<ref name="pmid16473645">{{cite journal | vauthors = de Jonge MJ, Verweij J | title = Renal toxicities of chemotherapy | journal = Seminars in Oncology | volume = 33 | issue = 1 | pages = 68–73 | date = February 2006 | pmid = 16473645 | doi = 10.1053/j.seminoncol.2005.11.011 }}</ref><ref name="pmid15574506">{{cite journal | vauthors = Humphreys BD, Soiffer RJ, Magee CC | title = Renal failure associated with cancer and its treatment: an update | journal = Journal of the American Society of Nephrology | volume = 16 | issue = 1 | pages = 151–61 | date = January 2005 | pmid = 15574506 | doi = 10.1681/ASN.2004100843 | doi-access = free }}</ref>

[[Ototoxicity]] (damage to the inner ear) is a common side effect of platinum based drugs that can produce symptoms such as dizziness and [[Vertigo (medical)|vertigo]].<ref name="pmid22547603">{{cite journal | vauthors = Brock PR, Knight KR, Freyer DR, Campbell KC, Steyger PS, Blakley BW, Rassekh SR, Chang KW, Fligor BJ, Rajput K, Sullivan M, Neuwelt EA | display-authors = 6 | title = Platinum-induced ototoxicity in children: a consensus review on mechanisms, predisposition, and protection, including a new International Society of Pediatric Oncology Boston ototoxicity scale | journal = Journal of Clinical Oncology | volume = 30 | issue = 19 | pages = 2408–17 | date = July 2012 | pmid = 22547603 | pmc = 3675696 | doi = 10.1200/JCO.2011.39.1110 }}</ref><ref name="pmid19851045">{{cite journal | vauthors = Rybak LP, Mukherjea D, Jajoo S, Ramkumar V | title = Cisplatin ototoxicity and protection: clinical and experimental studies | journal = The Tohoku Journal of Experimental Medicine | volume = 219 | issue = 3 | pages = 177–86 | date = November 2009 | pmid = 19851045 | pmc = 2927105 | doi = 10.1620/tjem.219.177 }}</ref> Children treated with platinum analogues have been found to be at risk for developing hearing loss.<ref>{{cite journal | vauthors = van As JW, van den Berg H, van Dalen EC | title = Different infusion durations for preventing platinum-induced hearing loss in children with cancer | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD010885 | date = January 2020 | issue = 1 | pmid = 31961948 | pmc = 6984653 | doi = 10.1002/14651858.CD010885.pub5 }}</ref><ref>{{cite journal | vauthors = van As JW, van den Berg H, van Dalen EC | title = Platinum-induced hearing loss after treatment for childhood cancer | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD010181 | date = August 2016 | volume = 2019 | pmid = 27486906 | pmc = 6466671 | doi = 10.1002/14651858.cd010181.pub2 }}</ref><ref>{{cite journal | vauthors = van As JW, van den Berg H, van Dalen EC | title = Medical interventions for the prevention of platinum-induced hearing loss in children with cancer | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD009219 | date = May 2019 | issue = 5 | pmid = 31063591 | pmc = 6504134 | doi = 10.1002/14651858.cd009219.pub5 }}</ref> 

=== Other side-effects ===
Less common side-effects include red skin ([[erythema]]), dry skin, damaged fingernails, a dry mouth ([[xerostomia]]), [[Water retention (medicine)|water retention]], and [[sexual impotence]]. Some medications can trigger [[allergic]] or [[pseudoallergic]] reactions.

Specific chemotherapeutic agents are associated with organ-specific toxicities, including [[cardiovascular disease]] (e.g., [[doxorubicin]]), [[interstitial lung disease]] (e.g., [[bleomycin]]) and occasionally [[secondary neoplasm]] (e.g., [[MOPP (medicine)|MOPP]] therapy for Hodgkin's disease).<ref>{{Cite book |last=Shannon |first=Vickie R. |title=Oncologic Critical Care |chapter=Cancer Treatment-Related Lung Injury |date=2019-07-09 |pages=531–556 |doi=10.1007/978-3-319-74588-6_52 |pmc=7123056|isbn=978-3-319-74587-9 }}</ref>

[[Chemotherapy-induced acral erythema|Hand-foot syndrome]] is another side effect to cytotoxic chemotherapy.<ref>{{Cite journal |last1=Kwakman |first1=Johannes J.M. |last2=Elshot |first2=Yannick S. |last3=Punt |first3=Cornelis J.A. |last4=Koopman |first4=Miriam |date=2020-05-13 |title=Management of cytotoxic chemotherapy-induced hand-foot syndrome |journal=Oncology Reviews |volume=14 |issue=1 |pages=442 |doi=10.4081/oncol.2020.442 |issn=1970-5565 |pmc=7232019 |pmid=32431787}}</ref>

Nutritional problems are also frequently seen in cancer patients at diagnosis and through chemotherapy treatment. Research suggests that in children and young people undergoing cancer treatment, [[parenteral nutrition]] may help with this leading to weight gain and increased calorie and protein intake, when compared to enteral nutrition.<ref>{{cite journal | vauthors = Ward EJ, Henry LM, Friend AJ, Wilkins S, Phillips RS | title = Nutritional support in children and young people with cancer undergoing chemotherapy | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD003298 | date = August 2015 | volume = 2015 | pmid = 26301790 | doi = 10.1002/14651858.cd003298.pub3 | pmc = 8752126 }}</ref>