The long-term side effects of chemotherapy range from common to very rare. Common long-term side effects of chemotherapy include early menopause and weight gain. Although mainly a short-term side effect, some people may continue to suffer from fatigue for a long time. Very rare side effects include heart problems and leukemia.
Early Menopause
Some chemotherapy drugs can damage the ovaries and stop regular menstrual cycles (amenorrhea). In women under 40, this condition may be temporary and periods will start again. In women over 40, however, it is more often permanent, meaning that menopause begins earlier than usual [17]. Women who do not have a menstrual period for one year after treatment are likely to have early menopause rather than short-term amenorrhea [17].
Going through menopause early can be frustrating and disappointing. As with natural menopause, you may have symptoms such as hot flashes and vaginal dryness. And, because the onset of menopause is abrupt, these symptoms may be more intense than those related to natural menopause. Early menopause is also related to loss of bone density (osteoporosis).
If you were hoping to have a child after treatment, early menopause can be disheartening. However, there are procedures that may allow you to have children after treatment. Speak to a fertility specialist before starting treatment to help you understand your options. Insurance coverage for fertility services varies widely from state to state, so it is important to check with your insurance provider to find out what procedures are covered.
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. At this time, there are no known treatments that protect the ovaries from the damaging effects of chemotherapy. For more on fertility options for women undergoing chemotherapy, visit Unique Issues for Young Women with Breast Cancer.
Weight Gain
Weight gain is most often seen in women who are treated with chemotherapy, especially those who go into early menopause [17,18]. One study found that women who get chemotherapy are 65 percent more likely to gain weight compared to those who do not [18]. Women who gain weight during chemotherapy usually put on about five pounds [19]. This weight gain may be short-term or long-term [18]. The more weight a woman gains after initial treatment, the less likely she is to return to her pre-diagnosis weight [18]. Changes in metabolism caused by chemotherapy and a less active lifestyle add to weight gain during chemotherapy treatment. Making healthy food choices and getting regular exercise during treatment (if possible) can help prevent weight gain. Seeing a dietician may also be helpful.
Heart Disorders and Leukemia
Heart disorders and leukemia are severe but rare side effects of chemotherapy. Leukemia has been linked with cyclophosphamide use as well as the use of doxorubicin and epirubicin. Heart disorders, like cardiomyopathy (enlarged, weakened heart) and congestive heart failure, have been linked to the use of doxorubicin and epirubicin, and to use of trastuzumab (for more, see Targeted Therapy). These conditions can sometimes be reversed if the drugs are stopped at the first sign of heart damage. Before you begin chemotherapy, your heart function will be measured to make sure that there are no pre-existing heart problems.
The risk of heart disorders and leukemia is related to the dose of chemotherapy drugs. With the lower doses being given today, the risk of having either heart disorders or leukemia is very low (less than two percent) [17].
For most people with breast cancer, the benefits of chemotherapy far outweigh these risks.
Cognitive Function/ Chemo-brain
Some people have cognitive problems, such as mental “fogginess” and trouble with concentration and memory, after chemotherapy. This condition is often called “chemo-brain”. Most people have mild symptoms, though some have more troubling cognitive problems that impact daily life. Chemo-brain may last for one to two years after treatment or longer. However, most people report that the symptoms go away over time.
The exact relationship between these symptoms and breast cancer diagnosis and treatment remains unclear. Medicines used to treat side effects of chemotherapy, such as sleeping aids and anti-nausea medicines, may also contribute to these symptoms. Stress, anxiety and depression can also affect cognitive function. Symptoms may first appear with the stress related to the initial diagnosis and treatment and then become worse after chemotherapy. At this time, the true extent of the cognitive effects of chemotherapy is not well understood. More research is needed in this area.
Updated 08/24/09
