A medical oncologist explains the benefits and risks of chemotherapy

What are the benefits and risks of chemotherapy? A medical oncologist provides a balanced, in-depth look at what you need to know.

If you're like many cancer patients, the thought of chemotherapy may provoke anxiety over potentially facing weeks of intense nausea and vomiting, diarrhea, fatigue and transient hair loss.

But these preconceived ideas about chemotherapy aren’t entirely accurate. Many cancer patients do experience some side effects of chemotherapy—both short-term and long-term—but others experience very few. Cancer treatment is improving and changing rapidly. Many more chemotherapy drug options are available than ever before. These drugs may be used in combination with one another or with other innovative treatments, so they may be just one piece of your cancer care.

Chemotherapy drugs don’t all come with the risk of the same side effects. More (and better) medications and supportive therapies are available to help patients prevent and manage potential side effects. Many patients are surprised to find that not everyone experiences hair loss, and some patients actually feel better after starting chemotherapy when it causes the disease to regress.

Can you refuse chemotherapy?

Yes, you can refuse chemotherapy. Your doctor presents what he or she feels are the most appropriate treatment options for your specific cancer type and stage while also considering your overall health, but you have the right to make final decisions regarding your care.

To help you make an informed decision about the benefits and risks of chemotherapy, this article addresses:

If you have questions about chemotherapy or other types of cancer treatment options, or if you’d just like to talk with someone at City of Hope® about your cancer care, call us or chat online with a member of our team.

How is chemotherapy used in cancer treatment today?

How chemotherapy is used in treatment depends on the type and stage of the cancer and how aggressive it is. Some cancers, such as an indolent lymphoma or prostate cancer, may not need immediate treatment, but chemotherapy may eventually be recommended if the cancer progresses. Other cancers require immediate treatment.

Chemotherapy may be used alone as the primary treatment for a cancer, or it may be used in combination with other treatments, such as surgery, radiation therapy, targeted therapy or immunotherapy.

An oncologist may recommend chemotherapy before and/or after another treatment. For example, in a patient with breast cancer, chemotherapy may be used before surgery, to try to shrink the tumor. The same patient may benefit from chemotherapy after surgery to try to destroy remaining cancer cells left behind after the operation.

Chemotherapy may also be used to relieve symptoms caused by advanced cancer, which improves a patient’s quality of life. Some patients may be able to take occasional breaks from treatment.

The types of cancers where chemotherapy is very commonly used as primary treatment include:

Chemotherapy drugs are often delivered by infusion—a process that may take several hours. Oral drugs, however, are now an option for many patients, which allows some patients the convenience of chemotherapy treatment at home. Other delivery options may include injections, topical creams and drugs that are injected directly in the abdominal cavity or the central nervous system.

The benefits of chemotherapy


The main benefit of chemotherapy is its potential to destroy cancer cells. It remains one of the most potent tools we have to fight cancer. The potential benefit to each patient depends on treatment goals, the type of cancer, how advanced it is and what the patient hopes to get out of treatment.

For example, the goal might be to reduce the size of a tumor so that it’s easier to remove surgically. Or the goal might be to control disease progression as much as possible.

Some patients have cancer that has what we call “curative potential”—meaning the cancer responds to chemotherapy so well that there may be no evidence of the disease after treatment. In these cases, the benefit is obvious. If there’s a high likelihood that chemotherapy may get rid of your cancer, that benefit may outweigh possible side effects.

Some patients say they actually feel better and have more energy soon after starting chemotherapy because the symptoms of their cancer regress. When this happens, the improvement allows patients to enjoy some activities they hadn’t felt up to doing.

Is chemotherapy worth it? In my years of experience as a medical oncologist, my answer is, “Yes, usually.” If it’s an option for you, it’s a decision you’ll have to make given your specific diagnosis and treatment goals.

The first discussion with your doctor needs to be: What are we trying to accomplish with treatment? Your oncologist should explain what’s involved with the treatment, including risks and benefits. You can then decide whether to proceed or consider other options.

The risks of chemotherapy

While chemotherapy may kill rapidly growing cancer cells, the downside is that it may also damage healthy cells in the process. This is often the cause of some common side effects of chemotherapy. For example, chemotherapy may temporarily decrease the production of red and white blood cells in the bone marrow, which may lead to anemia, fatigue and a suppressed immune system. Certain drugs—not all— damage cells that help hair grow, which may lead to temporary hair loss. Damage to cells in the digestive system may cause vomiting, diarrhea or constipation.

Not everyone experiences the same side effects to the same degree. The side effects you may experience depend on the type of chemotherapy you receive, the combination of drugs you’re treated with, whether you have any other chronic illnesses, the medications you may be taking for other conditions and how active or fit you are going into treatment. Your oncologist considers these issues when determining which treatment options may benefit you and whether you can tolerate treatment.

Common short-term side effects include:

Long-term side effects are less common, but they include those listed below.

Peripheral neuropathy: You may experience numbness or tingling in your fingers and/or toes. It often improves after treatment ends, but sometimes, it doesn’t entirely resolve.

Heart problems: Some drugs have a higher risk of causing cardiac problems. Patients receiving these drugs should be monitored with electrocardiograms (EKG or ECG) and echocardiograms (echo) regularly.

Lung problems: Lung damage from chemotherapy is more common in patients who also receive radiation, who are smokers or who have a history of lung disease. These patients may be monitored with pulmonary function studies if their physician deems it appropriate.

Before therapy, patients have to sign consent forms that list every potential side effect—many of which are very rare but still quite scary. Your doctor can tell you which ones you may be more likely to experience.

Advances in cancer care that have improved the chemotherapy experience

Cancer clinical trials, such as those we offer here at City of Hope®, have resulted in an increasing number of treatment options and chemotherapy drugs. More options means your oncologist may have more choices if a treatment isn’t working for you or if you’re experiencing difficult treatment-related side effects. A quick look at the National Cancer Institute’s list of drugs approved to treat breast cancer (over 80 at the time of this writing!) provides a good example of how treatment options have increased.

Researchers have also worked hard to reduce the toxicity of some drugs. Modifications include changing the dosage amounts, the intervals of administration and even how they’re administered. For example, researchers found that giving Velcade® (bortezomib) to patients newly diagnosed with multiple myeloma may decrease the incidence of peripheral neuropathy in most patients when it’s given by subcutaneous injection (into the tissue underneath the skin) instead of by infusion.

Medications to prevent nausea and vomiting in those patients who experience it have also improved over the years. Some anti-nausea medications may be given at the same time as a patient’s chemotherapy infusion.

Chemotherapy drugs are sometimes used in combination with other innovative treatment options, such as targeted therapy or immunotherapy. In patients whose cancer is linked to certain genomic mutations, immunotherapy (sometimes with and sometimes without chemotherapy) may keep their cancer in check on a long-term basis—almost as if it were a chronic illness like type 2 diabetes or heart disease.

Supportive care therapies to prevent and manage side effects

Supportive care

Evidence-informed supportive care therapies are designed to prevent and manage side effects a patient may experience during conventional cancer treatment. Early access to these types of therapies may help prevent, manage or reduce the severity of common side effects, which may also prevent treatment disruptions and improve patients’ quality of life during and after treatment.

Most cancer patients have access to these types of therapies, which we at City of Hope call integrative care, as part of our whole-person approach to cancer care. Examples of care we provide include those listed below.

Behavioral health, which includes individual and group counseling, stress reduction techniques and other therapeutic practices to help patients and their caregivers cope with the emotional, mental and social challenges of cancer and its treatment

Oncology rehabilitation, which includes services such as physical therapy, occupational therapy, speech therapy and lymphedema prevention

Nutritional support, which helps patients navigate nutrition during cancer treatment, with the goal of helping patients maintain a healthy weight, muscle mass and energy levels to improve treatment tolerance, support the immune system and reduce the impact of potential side effects

Pain management, which includes prescription medications, implanted pain pumps and nerve block therapies to control pain for those experiencing it

Spiritual support, which is available to patients and family members in the form of counseling, prayer services and ceremonies, prayer groups and access to the Health, Hope and Inspiration podcast

Naturopathic support, which includes consultations with our naturopathic providers to explore whether dietary supplements, herbal and botanical preparations and other naturopathic approaches may help manage side effects

Having access to a supportive care team to create a plan, answer questions and be on call to provide help as needed may significantly improve your treatment experience.

Questions to ask your doctor about chemotherapy

Patients are sometimes reluctant to ask questions, but I tell my patients that any question is important when it comes to their cancer care. Oncologists deal with cancer every day, but it's all new to the patient. Getting your questions answered will help you make informed decisions about your care.

Think about your questions before your appointment. Write them down and bring them with you. I also recommend bringing a family member or friend to take notes during the appointment because it’s easy to get overwhelmed by information.

Here are some questions to consider asking your doctor about chemotherapy:

  • What drug or drugs are you recommending?
  • What’s the goal of this treatment?
  • How long will I be on it?
  • How do I receive it? (IV? Oral? Injections? Topical?)
  • How often do I have to come in? Can someone come in with me?
  • If I’m taking this drug at home, where do I store it? How often do I take it? What if I forget to take it?
  • What are the potential side effects? Are you going to give me anything ahead of time to deal with them?
  • Am I likely to have long-term side effects from this drug?
  • Who do I call if I’m at home and I have a question?
  • What kind of support is available to help me through this treatment?
  • Is there any support for my caregivers?

If you think of more questions after your appointment, call back and ask them.

Consider talking to other patients who’ve been through the same treatment. Some cancer treatments sound scary. It’s comforting to hear from someone who's been through it. Cancer Fighters is a support community for City of Hope patients that connects potential and current patients, their family members and/or caregivers with cancer survivors who’ve been through similar experiences. If you don’t have access to a similar community, ask your doctor if any previous patients may be willing to talk to you. Other nonprofit cancer organizations may also be able to assist you in making these types of connections.

If you start chemotherapy and your experience is different from what you expected, talk to your care team. They may be able to make changes that help you.

Remember that chemotherapy isn’t something you’ll have to do forever without a break. You can always stop if the side effects aren’t what you expected.

Chemotherapy can be challenging, but there are strategies and tools your care team can offer to help you through your journey. Some patients come in saying, “I’m not going to do chemotherapy.” Often, the ones who do it are surprised and say, “It really wasn’t that bad.” I've seen it help so many people and hope that everyone who needs it will give it a chance.

If you’re interested in learning more about chemotherapy and other treatment options at City of Hope, or if you’d like to get a second opinion at one of our cancer centers, call us or chat online with a member of our team.