Based on PubMed | Can gallbladder cancer treatments like chemotherapy, radiation, or immunotherapy cause muscle weakness, and how is this side effect typically managed?

Cancer treatments for gallbladder cancer can be associated with muscle weakness, but the mechanisms and risk vary by treatment type and by the individual’s overall condition. ^[1] Chemotherapy and radiation are commonly used in this disease, and immunotherapy may be used in certain settings; each can contribute to fatigue and weakness in different ways. ^[2]

How each treatment can cause muscle weakness

• Chemotherapy

  • Chemotherapy drugs can cause profound fatigue and a sense of physical weakness; this is common during active treatment courses. ^[3] In addition to general tiredness, some drugs can injure nerves (peripheral neuropathy), leading to weakness, numbness, or trouble with fine motor tasks and walking. ^[4] On a biological level, chemotherapy-associated fatigue and weakness have been linked to oxidative stress and direct effects on skeletal muscle, which can impair muscle contraction and endurance. ^[5] Over time, cancer and its treatments can lead to loss of muscle size and function, reducing the capacity to perform daily tasks and exercise. ^[6]

• Radiation therapy

  • Radiation can cause stiffness and tightness in nearby muscle groups, which may feel like weakness and can limit range of motion and function in the treated area. ^[7] When head-and-neck or nearby fields are irradiated in other cancers, people can experience jaw, neck, and shoulder stiffness; similar regional effects can occur in other body areas depending on the field treated. ^[8] Targeted rehabilitation with physical therapy is commonly recommended to address radiation-related muscle stiffness and functional limitations. ^[9]

• Immunotherapy

  • Immune checkpoint inhibitors can, less commonly, trigger inflammatory conditions such as myositis (inflammation of muscle), which presents with new or rapidly worsening muscle weakness, often in the shoulders and hips, sometimes with muscle pain. ^[10] These immune-related side effects can escalate quickly and require prompt evaluation and treatment. ^[11] Management typically involves holding immunotherapy and starting corticosteroids, guided by established immune-related adverse event protocols and specialist input. ^[12]

• The role of cancer-related cachexia

  • Independent of the treatment type, gallbladder cancer and many other cancers can cause cachexia, a syndrome of weight loss and muscle wasting that leads to weakness and worsens treatment tolerance and outcomes. ^[13] Mitochondrial dysfunction and inflammatory signals contribute to muscle loss and reduced muscle power in cachexia, which can compound treatment-related weakness. ^[14]

Typical management strategies

• General measures

  • A structured, gentle exercise program (for example, walking and light resistance training) is one of the most effective non‑drug strategies to reduce treatment‑related fatigue and rebuild strength; even small, regular activities can help. ^[3] Planning demanding tasks for times of higher energy and pacing with short rest periods during the day can make symptoms more manageable. ^[15] Staying hydrated, eating regularly, and seeking help from family or caregivers for strenuous tasks can also reduce perceived weakness and fatigue burden. ^[15]

• Addressing chemotherapy‑related symptoms

  • If neuropathy (tingling, numbness, burning, or weakness in hands/feet) develops or worsens, clinicians may adjust drug doses, change schedules, or switch agents to prevent long‑term nerve injury. ^[4] Practical safety steps like wearing sturdy shoes, taking care with hot surfaces, and using handrails can reduce fall and injury risk while neuropathy improves. ^[3] Some centers also offer integrative therapies, such as acupuncture, to help with neuropathic symptoms and overall well‑being. ^[4]

• Radiation rehabilitation

  • For stiffness or localized weakness following radiation, referral to rehabilitation medicine and physical therapy is common; programs include stretching, range‑of‑motion work, posture training, and progressive strengthening tailored to the treated region. ^[7] In head and neck or nearby treatment fields, targeted therapy for jaw, neck, and shoulder mobility helps restore function and reduce pain. ^[8] Early initiation of therapy often leads to better long‑term outcomes by preventing contractures and deconditioning. ^[9]

• Managing immunotherapy‑related myositis or neurologic events

  • New proximal muscle weakness, difficulty rising from a chair, lifting arms, neck weakness, or trouble swallowing during immunotherapy should prompt urgent evaluation; clinicians typically withhold the drug and start corticosteroids if myositis is suspected. ^[11] Because immune‑related adverse events can be serious or even life‑threatening, standardized management pathways recommend rapid assessment, steroid therapy, and involvement of relevant specialists (neurology, rheumatology, cardiology if myocarditis is suspected). ^[12] Care teams weigh the risks and benefits of resuming immunotherapy after improvement on a case‑by‑case basis. ^[16]

• Countering cancer‑related muscle loss

  • A multifaceted plan nutrition optimization with adequate protein and calories, exercise training, symptom control, and, when appropriate, pharmacologic support can help mitigate cachexia‑related weakness and improve quality of life and treatment tolerance. ^[13] Exercise and anti‑inflammatory strategies may help improve mitochondrial function in muscle, which is a key driver of strength restoration in cachexia. ^[14]

When to contact your care team

• You should contact your clinician promptly if you notice rapidly worsening weakness, difficulty walking, frequent falls, trouble handling small objects, or new muscle pain especially during immunotherapy since these symptoms may need urgent evaluation and treatment adjustments. ^[4] Because side effects can often be eased by dose changes, supportive medications, or rehabilitation referrals, early reporting helps prevent long‑term problems and keeps treatment on track. ^[17]

Summary table: Treatment type, how weakness happens, and common management

Treatment	How it can cause weakness	Typical management
Chemotherapy	Fatigue, oxidative stress on muscle; neuropathy causing weakness and balance issues	Activity pacing and regular light exercise; dose adjustments; neuropathy safety measures; supportive therapies such as acupuncture
Radiation	Local muscle stiffness/tightness reducing strength and range of motion	Physiatry/physical therapy referral; stretching, ROM, progressive strengthening; early rehab to prevent deconditioning
Immunotherapy	Immune‑related myositis or neurologic events causing acute/subacute weakness	Urgent evaluation; hold drug; corticosteroids and specialist care per immune‑related toxicity protocols
Cancer/cachexia	Inflammation‑driven muscle loss and mitochondrial dysfunction	Nutrition support, adequate protein/calories; anti‑inflammatory measures; structured exercise and rehab

Chemotherapy and radiation are standard options in gallbladder cancer care and are known to cause fatigue and functional decline, which often improve with proactive rehabilitation and supportive care. ^[1] With immunotherapy, muscle weakness is less common but may signal an immune‑related condition that needs prompt treatment according to established safety pathways. ^[11]