Long Term Side Effects of Chemotherapy for Cancer

What are Possible Late Effects of Chemotherapy?

IV dripping with patient in background
What are the long term side effects of chemotherapy?. istockphoto.com

The long-term side effects of chemotherapy aren’t usually your first concern when you find out chemotherapy is recommended for your cancer. And that’s how it should be. In most cases, the benefits of treatment far outweigh any possible complications down the line. But with improved survival from many types of cancers, it's important to understand the long-term side effects of chemotherapy that may occur months or years after treatment is completed.

Before addressing possible long term side effects, keep in mind that everyone is different. Some people may have several of these side effects, while many will have none. Side effects also vary considerably depending on the particular chemotherapy medications that are used.

Cardiac Concerns

Chemotherapy can cause cardiac effects early in treatment, but in some cases, the effects may not show up until much later. One notable example is heart damage following treatment with the medication Adriamycin (doxorubicin). With this drug, a possible long term side effect is weakening of the heart muscle, resulting in a decreased ability to pump blood through the body (heart failure). Symptoms may include increasing shortness of breath, fatigue, and swelling of the feet and ankles. If you have been treated with Adriamycin, your doctor may recommend a MUGA scan to monitor how your heart is pumping.

Other cancer treatments, such as radiation therapy to the chest area, may cause damage to the heart muscle as well.

Since left-sided radiation for breast cancer may also affect the heart and damage coronary arteries, it's even more important to talk with your oncologist if you receive these chemotherapy drugs.  Learn more about heart problems associated with Adriamycin (doxorubicin).


During chemotherapy, most people deal with fatigue -- yet a third of people continue to experience fatigue for months to years after chemotherapy is completed.

It is important to share this symptom with your doctor because many causes of fatigue are reversible.  Learn about how cancer fatigue is different from being tired, and check out these tips on coping with annoying symptom of cancer fatigue


"Chemobrain" -- a constellation of symptoms that includes problems with memory and concentration -- has only recently been recognized as a long-term side effect of chemotherapy. Chemobrain symptoms can be very frustrating, but an awareness of things you can do to cope with the symptoms can be very helpful. In most cases, chemobrain symptoms improve over time.  Learn more about the symptoms and treatments for chemobrain.


Primarily a concern for younger people with cancer, loss of fertility after chemotherapy can be heartbreaking. Infertility following treatment varies with the dose and type of chemotherapy medications used, and doesn’t affect everyone. If you believe you may want to have children after treatment (for both men and women), talk to your physician about the options available to you before you start treatment.

Peripheral Neuropathy

Peripheral neuropathy, experienced most often as a sensation of numbness and burning in your feet and hands, along with constipation, is another long-term side effect of chemotherapy. This side effect occurs more commonly in people with a history of diabetes, alcoholism, or malnutrition.

Some drugs that can cause this side effect in up to a third of people include Taxotere (docetaxel) and Taxol (paclitaxel), Other medications, such as Platinol (cisplatin), Oncovin (vincristine), and Novelbine (vinorelbine),can also result in peripheral neuropathy.

Hearing Loss

One of the most common long-term side effects of Platinol (cisplatin), a medication used for many cancers including lung cancer, is hearing loss. Other medications may also cause hearing loss and tinnitus (ringing in the ears).

Skeletal Effects

Osteoporosis (thinning of the bones) is the most common late effect of chemotherapy. Most chemotherapy drugs cause bone loss to accelerate and changes in diet that accompany cancer and its treatment can amplify the problem. The greatest concern over the long run are fractures that can result from this bone loss.

Chemotherapy has also been associated with osteomalacia, bone loss related to a deficiency of vitamin D.

Respiratory Effects

Chemotherapy can cause scarring of the lung (pulmonary fibrosis) and decreased lung capacity in some people. This may be more pronounced when chemotherapy is combined with radiation therapy to the chest area.

Liver Effects

Many chemotherapy medications can cause toxic damage to the liver (hepatotoxicity). Thankfully, the liver has a remarkable potential to regenerate most of the time, as long as other damaging effects (such as excess alcohol intake) are avoided.

Kidney and Bladder Effects

Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood. Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine.

Effect on the Eyes

Steroids are often given along with chemotherapy or for symptoms and side effects related to cancer. This can hasten the development of cataracts in some people.

Secondary Cancer

Due to the mechanism by which chemotherapy medications work, they can cause DNA damage in normal cells, which may result in secondary cancers down the line. Some chemotherapy medications are more likely to cause this damage, with a category called alkylating agents being most likely (an example of these is Cytoxan (cyclophosphamide)).

Medications used to treat lung cancer that may cause a secondary cancer (though less likely) include Vepeid (etoposide) and Platinol (cisplatin).

What Can You Do to Lower Your Risk of Long Term Side Effects?

Until we know more about long-term survivorship issues following chemotherapy for adults, there are a few things you can do:

  • Ask your oncologist about any late effects that you may expect from the particular chemotherapy drugs you were given. Are there any screening tests (for example, tests for heart problems, hearing loss, or osteoporosis) that she would recommend?
  • Keep a record of your chemotherapy regimen with you in case you see a physician who is unfamiliar with your medical history.
  • If you smoke, quit.
  • Make regular appointments with your dentist and eye doctor.
  • Engage in regular physical activity.
  • Limit your intake of alcohol.
  • Let your doctor know if you experience any new symptoms or worsening of current symptoms you have.

For childhood cancer survivors, survivorship issues have been addressed in an excellent review:


American Society of Clinical Oncology. Cancer.Net. Late Effects. Accessed 05/07/16. http://www.cancer.net/patient/Survivorship/Late+Effects

Hu, M. et al. Cancer therapies and bone health. Current Rheumatology Reports. 2010. 12(3):177-85.

Institute of Medicine. Cancer Survivorship Care Planning. Fact Sheet. Accessed 05/07/16. http://www.iom.edu/~/media/Files/Report%20Files/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition/factsheetcareplanning.pdf

National Cancer Institute. Chemotherapy and You: Support for People With Cancer. Chemotherapy Side Effects. Accessed 05/07/16.  http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you/page5

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