OBJECTIVE: To assess the frequency and troublesomeness of side-effects of chemotherapy for ovarian cancer as they affect patients' physical and social health and treatment compliance. METHOD: A questionnaire was developed based on a literature review of reactions to chemotherapy and published product information on side-effects The questionnaire was pilot tested for time, ease of understanding and surface validity. Trained clinical interviewers administered in-depth face-to-face interviews to 29 women with ovarian cancer. Participants rated 28 potential side effects on a 5 point Likert Scale ranging from 0 (Not at all troublesome) to 4 (Extremely troublesome), For side-effects rated at least "slightly troublesome", a series of open ended follow-up questions were asked to more fully understand the response. Chart reviews were conducted to verify diagnosis and treatment regimens. RESULTS: Ages ranged from 25 to 78 years (x=53). The most frequently reported side-effects (hair loss [n=25], general weakness [n=23], numbness [n=20], nausea [n=19] and infusion reaction [n=18]) were not perceived as most troublesome. Means for most troublesome side-effects were: infections (x=3.2), pain in hands and feet (x=3.0), constipation (x=3.0), vomiting (x=3.0) and sores in the mouth and throat (x=2.8). Results indicated side-effects are an extremely common and often under-treated component of chemotherapy. Many respondents were bothered that health-care providers neither gave sufficient warning about the troublesomeness of specific side-effects nor provided practical advice on how symptoms could be ameliorated. CONCLUSION: The effectiveness of chemotherapy regimens as measured through impact on survival as well as more subjective measures such as quality of life traditionally do not take into account the significant impact of side-effects on physical and social functioning and treatment compliance. The nature of side-effects continues to change as new chemotherapy agents are developed. These results suggest that therapies that avoid or ameliorate the most troublesome side-effects would be preferred agents.