Adjuvant Chemotherapy Side Effects: What to Expect & Manage

Adjuvant chemotherapy (post-surgery) aims to eradicate micrometastases. Side effects vary by regimen (e.g., FOLFOX, AC-T, CMF) but share commonalities:

Acute (During Cycles)

• Nausea/vomiting: 5-HT3 antagonist (ondansetron) + dexamethasone ± NK1 antagonist (aprepitant).
• Fatigue: cumulative; managed with activity pacing, treating anemia.
• Alopecia: scalp cooling may reduce (taxanes).
• Mucositis: oral cryotherapy, magic mouthwash.
• Diarrhea/constipation: loperamide, fiber, hydration.

Hematologic (Nadir Day 7–14)

• Neutropenia → G-CSF prophylaxis (pegfilgrastim) per risk.
• Anemia → transfusion / ESA if symptomatic.
• Thrombocytopenia → hold if <50k.

Late / Long-Term

• Peripheral neuropathy: taxanes, platinum — duloxetine, gabapentin; may be permanent.
• Cardiotoxicity: anthracyclines — echo monitoring, dexrazoxane.
• Fertility: ovarian/testicular failure — preservation pre-treatment.
• Secondary malignancy: t-MDS/AML (alkylators, topoisomerase II inhibitors).
• Cognitive ("chemo brain"): usually improves; cognitive rehab.

Survivorship Care

Risk-stratified surveillance, lifestyle modification, psychosocial support.