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Potential side effects of chemotherapy for mesothelioma
Side effects can occur with any type of treatment for mesothelioma, but not everyone has them or experiences them in the same way. Side effects of chemotherapy will depend mainly on:
- the type of drug(s)
- the dose
- how the drug is given
- Chemotherapy drugs to treat mesothelioma can be given through a vein (intravenous) and, in some cases, into a body cavity (intracavitary chemotherapy).
- the person’s overall health
- if other treatments, such as radiation therapy, are also given
Chemotherapy kills cancer cells, but it can also damage healthy cells. Different cells and tissues in the body tolerate chemotherapy differently.
Side effects can happen during, immediately after, or a few days or weeks after chemotherapy. Most side effects go away after chemotherapy is completed. However, some side effects may persist for a while because it takes time for healthy cells to recover from the effects of chemotherapy. Late side effects can occur months or years after chemotherapy. Some side effects may last a long time or be permanent.
It is important to report side effects to the healthcare team. Doctors may also grade (measure) how severe certain side effects are. Sometimes chemotherapy treatments need to be adjusted if side effects are severe.
The following are the most common side effects that people tend to experience with chemotherapy for mesothelioma. Some people may experience all, some or none of these side effects. Others may experience different side effects.
Chemotherapy used to treat mesothelioma commonly affects the bone marrow and can cause bone marrow suppression. This can lead to:
- infection caused by low white blood cell count (neutropenia)
- Infections are more likely to occur in people treated with intensive doses of chemotherapy.
- Bacterial infections are the most common type of infection after chemotherapy for mesothelioma, although infections associated with fungi, viruses and other organisms can also occur.
- bruising and bleeding caused by low platelet count (thrombocytopenia)
- fatigue, paleness and malaisemalaiseA general feeling of discomfort or illness. caused by low red blood cell count (anemia)
Low blood cell counts occur because of chemotherapy’s effect on the bone marrow, where blood cells are made. Blood cell counts often reach their lowest level about 7–14 days after chemotherapy. Bone marrow suppression is the most common and most serious side effect of chemotherapy. When it happens, the dose of chemotherapy drugs may need to be adjusted or chemotherapy may have to be stopped temporarily or postponed.
Fatigue is a common side effect of chemotherapy. It causes a person to feel more tired than usual and can interfere with daily activities and sleep. Fatigue may be caused by anemia, poor appetite or depression. It may also be related to toxic substances that are produced when cancer cells break down and die. Most of the drugs used to treat mesothelioma can also cause tiredness or fatigue. Fatigue can occur days after a chemotherapy treatment cycle. It may get better as time goes by. Fatigue can continue long after the person has finished their treatment for mesothelioma.
Chemotherapy drugs used to treat mesothelioma can cause nausea and vomiting. Individual drugs vary in their effects, but nausea and vomiting are more likely when combinations of chemotherapy drugs are given.
Nausea and vomiting can occur within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, delayed nausea and vomiting may last for a few days after treatment. Some people may have anticipatory nausea after having a few treatments, where they feel nauseated even before treatment is given because they expect to be sick.
Nausea and vomiting, fatigue, mouth sores or mesothelioma itself can cause loss of appetite. Some people lose interest in food completely and don’t eat, even though they know they need to. This can lead to weight loss and malnutrition. Maintaining good nutrition during and after chemotherapy is important to help a person recover from treatment.
Diarrhea is an increase in the number and looseness of stools. It occurs because chemotherapy drugs often affect the cells that line the gastrointestinalgastrointestinalReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine. tract. Many factors increase the risk of diarrhea, including the type and dose of chemotherapy drug used. Diarrhea is often worse when combinations of drugs are given. Diarrhea occurs soon after chemotherapy starts and can continue for up to 2 weeks after treatment has ended.
Drugs like pemetrexed, raltitrexed and vinorelbine can cause constipation. Constipation can also be made worse by loss of appetite and pain relieving drugs. Constipation can occur after chemotherapy starts and may continue until after treatment is completed. Drinking plenty of fluids, adding more fibre to the diet and medications can help.
A sore mouth (also called stomatitis or oral mucositis) occurs because of chemotherapy’s effect on cells inside the mouth. Many drugs can cause a sore mouth and it occurs more often when higher doses of drugs are used. A sore mouth occurs about a week (5–14 days) after chemotherapy starts. It often improves on its own a few weeks after treatment is finished.
Painful mouth sores, ulcers in the mouth and mouth infections can also develop. Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instructions about how often to clean and rinse the mouth and what to use. Pain medicines or special oral solutions may be needed to relieve pain.
Hair thinning or hair loss (alopecia) is a common side effect of many, but not all, chemotherapy drugs. Hair follicles are sensitive to chemotherapy drugs because they grow fast. The extent and duration of hair thinning or hair loss is unpredictable and depends on the type and dose of drugs used as well as personal factors. Hair loss can occur on all parts of the body, including the face and scalp. Hair loss can begin within a few days or 2–3 weeks after chemotherapy starts. Hair usually grows back once chemotherapy treatments are over.
Hair should not be permed, straightened, dyed or coloured during treatment. These products contain chemicals that can damage hair. It is best to wait until new hair growth becomes established and hair returns to its original state. This may take as long as 6 months or more after treatment. Talk to the healthcare team about when it is okay to use these products again.
Folic acid and vitamin B12 supplements are given to reduce certain side effects from pemetrexed (Alimta). These vitamins help protect the body's normal cells from the side effects of the chemotherapy drug. They are started before the first chemotherapy treatment, continued during chemotherapy and given for a few weeks after the last treatment.
Symptoms of nerve damage, or peripheral neuropathyperipheral neuropathyA disorder of the peripheral nerves (nerves outside the brain and spinal cord) that causes pain, numbness, tingling, burning, swelling, muscle weakness and loss of reflexes in different parts of the body., include numbness or tingling in the toes or fingers, ringing in the ears or changes in hearing. Nerve damage is a possible side effect of some chemotherapy drugs used to treat mesothelioma, such as cisplatin (Platinol AQ), carboplatin (Paraplatin, Paraplatin AQ), pemetrexed and vinorelbine (Navelbine).
Nerve damage is often related to the dose of the chemotherapy drug given. Most people experience temporary nervous system problems. In a few people, nervous system damage can become a long-term problem. Nervous system damage can develop months or years after treatment and may take months to go away.
Some chemotherapy drugs can affect the kidneys. The potential for kidney damage varies with the type of chemotherapy drug used. Cisplatin, carboplatin and gemcitabine (Gemzar) can cause kidney problems. Kidney problems rarely occur with pemetrexed. Blood tests that check kidney function are done to assess the kidneys before and during chemotherapy treatment.
Certain chemotherapy drugs can damage cells in the liver. Some chemotherapy drugs are more likely to cause liver damage than others. With some drugs, liver damage is greater when higher doses are used. Pemetrexed, vinorelbine and gemcitabine may cause liver problems, but it is not a very common side effect for these drugs. Blood tests that check liver function are done to assess the liver before and during chemotherapy treatment.
Certain chemotherapy drugs can affect the lungs. Some chemotherapy drugs are more likely to cause lung damage than others. Lung damage is often related to the dose of the drugs used and increases when higher doses are given. Gemcitabine may cause lung problems. Drugs such as pemetrexed and vinorelbine rarely cause lung problems.
Tell the doctor or healthcare team about increased coughing, breathing problems, chest pain or coughing up blood.
Certain chemotherapy drugs can affect the heart. Some chemotherapy drugs are more likely to cause heart damage than others. Heart damage is often related to the dose of the drugs used and increases if radiation therapy is given to the chest or if people already have heart problems. Cisplatin, pemetrexed, raltitrexed and gemcitabine may occasionally cause heart problems such as an irregular heartbeat (arrhythmia).
Tell the doctor or healthcare team about an irregular heartbeat, chest pain, fainting, swelling, or shortness of breath.
Pemetrexed, raltitrexed and gemcitabine can sometimes cause a rash or dry, itchy skin. In rare cases they can also cause skin blisters or peeling. Use a moisturizer daily to soften the skin and help prevent it from becoming dry or cracked. The skin may be more sensitive to the sun than normal, so it is also important to cover exposed skin and wear a hat and sunscreen if you go outside. A corticosteroidcorticosteroidAny steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances). such as dexamethasone (Decadron, Dexasone), is given before treatment with pemetrexed to reduce the chances of severe skin rash.
Flu-like symptoms can occur when gemcitabine is given for mesothelioma. Symptoms include:
- muscle and joint aches or pain
- loss of appetite (anorexia)
These symptoms often occur hours to days after gemcitabine is given. Medications, such as acetaminophen (Tylenol), can help reduce these side effects. People should check with their doctor or healthcare team if these symptoms do not go away or are bothersome. Flu-like symptoms usually go away once the body gets used to the drug.
An allergic reaction is not a common side effect of chemotherapy, but it can happen. It can occur with any of the drugs used to treat mesothelioma. An allergic reaction is most likely to occur during or shortly after the chemotherapy drug is given. Symptoms of an allergic reaction may include:
- difficulty breathing
- skin rash or hives
- severe allergic reaction (anaphylaxis)
Certain medications may be given before chemotherapy drugs to prevent an allergic reaction.
Note: Other side effects may occur. For more detailed information on specific drugs, go to sources of drug information.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.