Common long-term side effects of chemotherapy include early menopause and weight gain. Rare side effects include heart problems and leukemia.
Some chemotherapy drugs can damage the ovaries and stop regular menstrual cycles (amenorrhea). In women under 40, this condition is often temporary and periods will start again. In women over 40, it is more often permanent, meaning menopause begins earlier than expected [29-30]. Some women may resume having periods months or years after chemotherapy ends. However, even for women whose periods return, menopause may still begin at an earlier age than for other women .
Going through early menopause can be very upsetting. As with natural menopause, you may have symptoms such as hot flashes (including night sweats) and vaginal dryness (also called vaginal atrophy). And, because the onset of menopause is abrupt, these symptoms may be more severe than with natural menopause.
Early menopause can also affect bone health. Menopause can cause a loss of bone density (osteopenia or osteoporosis). And, some women who go through menopause have muscle or joint aches.
Learn about ways to ease menopausal symptoms.
Early menopause and fertility
If you were hoping to have a child after breast cancer treatment, early menopause can be especially disheartening. However, there are procedures that may allow you to have children after treatment. Speak to a fertility specialist before starting treatment to understand your options.
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.
Insurance coverage for fertility services varies widely from state to state, so it is important to check with your insurance provider to find out which procedures are covered.
At this time, there are no known treatments to protect the ovaries from the damaging effects of chemotherapy. However, some drugs are under study (learn more).
Learn more about fertility options for women undergoing chemotherapy.
Unfortunately, weight gain is a common side effect of chemotherapy, especially in women who go into early menopause . Changes in metabolism caused by chemotherapy and a less active lifestyle add to weight gain during treatment. One study found women treated for breast cancer who got chemotherapy were 65 percent more likely to gain weight compared to those who did not get chemotherapy .
Women who gain weight usually put on about five to ten pounds . The more weight a woman gains, the less likely she is to return to her pre-diagnosis weight .
Maintaining a healthy weight is important for all breast cancer survivors. Heavier survivors may have lower survival compared to learner survivors [32-34]. Learn more about body weight and survival after breast cancer.
Making healthy food choices and getting regular exercise during treatment (if possible) may help prevent weight gain. Seeing a dietician may also help. Learn more about a healthy diet and exercise.
Although mainly a short-term problem, fatigue can affect some people long-term . When fatigued, people feel like they don’t have any energy and are tired all of the time. Sometimes, getting enough rest doesn’t help.
Regular exercise, even just walking for 10 to 20 minutes every day, can help reduce fatigue [27-28,36]. Getting a good night’s sleep is also important. Talk to your health care provider if you have fatigue or problems sleeping (insomnia).
Learn more about fatigue and insomnia.
Heart problems and leukemia
Heart problems and leukemia are rare but severe side effects of certain types of chemotherapy. These risks are related to the dose and type of chemotherapy drug. With the doses given today, the risk of having either heart problems or leukemia is very low (about one percent) .
Heart problems, like cardiomyopathy (enlarged, weakened heart) and congestive heart failure, have been linked to the use of doxorubicin and epirubicin, and to use of trastuzumab [37-38]. (Learn more about trastuzumab.) These conditions can sometimes be reversed if the drugs are stopped at the first sign of heart damage .
For some chemotherapy drugs extra care is taken. For example, before you begin chemotherapy with the drug doxorubicin, your heart function will be measured to make sure there are no pre-existing heart problems.
Leukemia has been linked to the use of cyclophosphamide, doxorubicin and epirubicin .
For most people with breast cancer, the benefits of chemotherapy far outweigh these risks.
Cognitive function (cancer brain, chemo-brain)
Some people have cognitive problems after chemotherapy, including mental “fogginess” and trouble with concentration, memory and multi-tasking [39-40]. This condition is often called “cancer brain” or “chemo-brain.” Most people have mild symptoms, though some have more troubling cognitive problems that impact daily life. They may last for one to two years after treatment or longer. Most people report the symptoms go away over time.
The link between cognitive problems and breast cancer diagnosis and treatment remains unclear. Medications used to treat side effects of chemotherapy, such as sleeping aids and anti-nausea medications, can also cause these symptoms. And, stress, anxiety and depression can affect cognitive function. Symptoms may first appear with the stress related to diagnosis and treatment and then become worse after chemotherapy. Age may also play a role. Some studies show older women tend to have more cognitive problems after chemotherapy than younger women . At this time, the true extent of the cognitive effects of chemotherapy is not well understood.
Cognitive problems may not be limited to women treated with chemotherapy. They have also been reported after other breast cancer treatments . More research is needed in this area.
Although there are no data to show these tips improve cognitive function, they may help some people with memory problems :
- Plan your day to do the things that need the most thinking when you feel best
- Get extra rest
- Write down or record (on a cell phone, for example) things that 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 or social worker for help to keep track of clinic visits
*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 at this time.