01. Treatment Side Effect Overview
What Are the Side Effects of Mesothelioma Treatment?
Many standard mesothelioma treatment options can cause side effects. Common reactions include pain, nausea, vomiting and sleep trouble. These reactions occur when cancer treatments damage healthy cells.
Common Side Effects of Mesothelioma Treatment
- Anorexia and cachexia
- Bruising and bleeding more easily
- Cancer pain
- Chemo brain
- Fertility problems
- Gastrointestinal issues (constipation and diarrhea)
- Hair loss
- Increased risk of infection
- Intimacy issues
- Nausea and vomiting
- Nerve pain (neuropathy)
- Shortness of breath
- Skin rash
- Sleep problems
- Throat changes (difficulty swallowing)
- Trouble breathing
- Urinary or bladder changes
- Weakened immune system
Mesothelioma patients experiencing treatment side effects should discuss their difficulties with their healthcare team. Mesothelioma doctors, dietitians and others can help manage pain, discomfort and other problems. A doctor can also help weigh the potential reactions and benefits before choosing a treatment approach.
Side effects may vary depending on several factors, including:
- Individual treatment plans
- Personal characteristics, including pre-existing conditions
- Treatment type
- Type of mesothelioma cancer
Patients can discuss these factors with their oncology team. The team can help explain how these factors may affect the individual.
How Long Do Mesothelioma Treatment Side Effects Last?
Mesothelioma treatment side effects may be long- or short-term. Some short-term side effects, such as hair loss, may go away on their own after treatment. Others may require medication, counseling or other interventions. Mesothelioma survivors may experience long-term side effects. For example, long-term survivor Heather Von St. James lived with radiation-related nerve damage for years.
What Causes Mesothelioma Treatments Side Effects?
Mesothelioma treatment attempts to remove or kill as many cancer cells as possible. The goal is to improve prognosis and quality of life. But treatments that harm cancer cells can also hurt healthy cells, potentially causing side effects.
Common side effects can differ between specific treatments. Mesothelioma patients may undergo chemotherapy, radiation and/or surgery. They may also receive newer treatments such as immunotherapy. Patients can discuss the side effects tied to their individual therapy plan with an oncologist.
Patients may wonder about the potential side effects of experimental therapies. These treatments may be available through mesothelioma clinical trials. The trial staff can help patients understand how much is known about the side effects of the treatment they are investigating.
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02. Cancer Pain
Cancer Pain in Mesothelioma Patients
Pain is a common side effect of many cancer treatments, including mesothelioma treatment. It is also a common side effect of cancer itself. The amount of pain a patient experiences depends on several factors. Stage of disease, treatment type, other health problems and tolerance for pain can all affect a patient’s pain experience.
Pain caused by mesothelioma may vary based on tumor location and stage of disease. Pleural mesothelioma patients may experience lower back or chest pain or painful coughing. Patients with peritoneal mesothelioma may have abdominal pain.
Different treatments may cause different kinds of pain in mesothelioma patients. For example, pain-related chemotherapy side effects may include:
- Mouth sores and inflammation
- Nerve pain
- Pain at injection site
- Painful swallowing
- Skin rash
Surgery may cause patients to experience pain or discomfort at the surgery site. Radiation therapy may cause skin problems, including inflammation, blisters and itching. Other types of pain may depend on where on the body a patient receives radiation.
Immunotherapy, an emerging form of mesothelioma treatment, may result in pain and swelling. Checkpoint inhibitors, such as Yervoy® (ipilimumab) and Opdivo® (nivolumab), may cause joint pain or muscle aches.
Treatment-associated pain may be chronic or temporary. If left untreated, some symptoms may worsen over time. Patients should bring any new or worsening side effects to their doctors’ attention. A patient’s cancer care team can help monitor and address pain symptoms as they arise.
Cancer Pain Management Options and Techniques
Pain management is an important part of treatment. Mesothelioma patients may be able to manage pain in a number of ways. Doctors can help develop a pain-management strategy based on individual patients’ needs. Management strategies may involve palliative care or alternative forms of therapy.
Palliative care aims to improve patients’ quality of life during and after treatment. Palliative specialists may use various interventions to address pain, including:
- Nerve blocks
- Over-the-counter medication
- Prescription medication
Pain management may also involve alternative forms of therapy. Techniques may include acupuncture, meditation, yoga or physical therapy. A palliative care specialist can help patients explore alternative therapy options.
03. Chemo Brain
Chemo Brain in Mesothelioma Patients
Mesothelioma treatment may cause thinking and/or memory problems, commonly called “chemo brain.” Despite its name, this term refers to cognitive issues related to many cancer treatments. Chemo brain may occur during and continue after treatment.
Chemo Brain Symptoms
- Difficulty finding the right word
- Difficulty learning new skills
- Difficulty multitasking
- Mental fog
- Short attention span
- Short-term memory problems
- Trouble recalling visual images
- Trouble remembering a specific conversation
- Unusual difficulty with concentrating
- Unusual difficulty with staying organized
Experts believe there may be different causes of chemo brain. Certain cancer treatments can cause inflammation, including brain inflammation. This could cause the types of cognitive changes associated with chemo brain. Cancer treatment may also impair brain cells’ abilities to create and use energy. Cisplatin, a common mesothelioma chemotherapy drug, can have this effect. Energy usage problems in brain cells have been linked to cognitive impairment.
Various factors may put cancer patients at risk of developing chemo brain. These factors may be demographic, medical or psychological, including:
- Brain metastasis
- Genetic mutations
Patients can discuss potential chemo brain risk factors with their healthcare team. They should also tell their doctor if they experience any chemo brain symptoms.
How Long Does Chemo Brain Last?
Individuals may experience chemo brain for different lengths of time. Some cancer patients report symptoms improving after six to twelve months. However, it is possible for chemo brain to linger for years. Patients may be able to take steps to help recover from chemo brain.
Tips for Recovery From Chemo Brain
Mesothelioma doctors may suggest different interventions to address chemo brain symptoms. Strategies that may help patients recover from chemo brain include:
- Cognitive training: This involves brain-training exercises, such as remembering lists and sequences. These exercises aim to improve organization and visualization skills.
- Good nutrition: Diet and nutrition may help manage the cognitive effects of cancer treatment. For example, eating high-antioxidant fruits and vegetables may help minimize brain cell damage. Doctors may recommend a supplement if a patient cannot get enough antioxidants from food.
- High-quality sleep: Sleep deprivation can lead to lowered cognition. It can damage brain cells and impair the brain’s ability to remove toxins. Getting enough sleep can help avoid these symptoms.
- Medication: Certain neurostimulants may help improve memory and brain function after cancer treatment.
- Mind-body interventions: Stress can lead to problems with memory, attention and cognition. Mind-body interventions may help mesothelioma patients manage stress. It may involve training in techniques such as mindfulness.
- Physical activity: Chemo brain symptoms may improve from participation in activities such as yoga. Walking, running, dancing, biking and strength training may help as well.
Healthcare teams can help patients explore ways to manage and address chemo brain. An individualized plan may help patients manage their specific symptoms.
04. Nausea, Vomiting and Anorexia
Eating-Related Side Effects of Mesothelioma Treatment
Mesothelioma treatment can lead to weight loss, loss of appetite and other eating-related side effects. But patients can take steps to combat these problems and help maintain nutrition during treatment. For instance, small dietary changes may help some patients eat more comfortably.
Nausea and Vomiting in Mesothelioma Patients
Mesothelioma patients may experience nausea and/or vomiting after chemotherapy, radiation or immunotherapy. Eating smaller meals or avoiding certain foods may help patients stay nourished in spite of nausea. A dietitian can help patients develop an individualized nutrition plan to manage these symptoms. Anti-nausea medications may also help.
Mesothelioma Treatment Drugs That Cause Nausea and Vomiting
Alimta® (Pemetrexed) and Cisplatin
More than 80% of mesothelioma patients receiving Alimta and cisplatin chemotherapy experienced nausea or vomiting.
Opdivo® (Nivolumab) and Yervoy® (Ipilimumab)
More than 20% of mesothelioma patients receiving this treatment experienced nausea or vomiting.
Anorexia and Cachexia in Mesothelioma Patients
Mesothelioma patients undergoing treatment may also experience anorexia and/or cachexia. Anorexia is a significant loss of appetite and aversion to food. Cachexia is a condition where patients lose muscle mass and fat tissue.
Cancer-caused anorexia is not the same as anorexia nervosa, the eating disorder. Anorexia in cancer patients may occur for different reasons, including:
- Cancer-caused nutritional deficiencies
- Changes in gut function
- Difficulty swallowing
- Hormonal changes
Cancer itself may cause weight loss. Patients with treatment-induced anorexia may experience additional weight loss. This can contribute to malnutrition.
Where anorexia describes a loss of appetite or aversion to food, cachexia describes a loss of body mass. Patients with rapid weight loss, low body mass index (BMI) and low muscle mass may be diagnosed with cachexia. This disorder may cause fatigue, weakness and loss of appetite.
Nutritional counseling or medical intervention may help patients manage anorexia and cachexia symptoms. Certain cancer-fighting foods may help build strength and energy. A dietitian can help mesothelioma patients with nutrition during and after treatment.
A dietitian may recommend patients with anorexia or cachexia eat frequent, small meals. They may also suggest eating more in the morning and avoiding spicy foods. A doctor may recommend steroids or other drugs to help stimulate the appetite.
05. Gastrointestinal Issues
Gastrointestinal Issues Related to Mesothelioma Treatment
Patients may experience gastrointestinal issues related to mesothelioma treatment. Chemotherapy, radiation therapy and immunotherapy may cause constipation or diarrhea. Constipation may also result from certain drugs used to manage mesothelioma side effects. Opioids and anti-nausea medication may both cause infrequent or difficult bowel movements.
Staying hydrated can help manage both constipation and diarrhea. It can reduce the severity of constipation and prevent dehydration that may result from diarrhea. To manage constipation, patients may also want to exercise and eat high-fiber foods, unless a doctor advises otherwise. A doctor may prescribe medication or recommend over-the-counter laxatives.
Dietary changes may help provide relief from diarrhea. Eating more frequent, smaller meals low in fiber and high in probiotics may help. It may also help to avoid foods that can irritate the digestive tract, including:
- High-fat foods
- Spicy foods
Over-the-counter medications and supplements may help manage some cases of diarrhea. Mesothelioma patients should consult with a doctor before taking any of these. A doctor can determine if they might cause dangerous side effects in cancer patients. A doctor may also prescribe medications for diarrhea relief.
06. Hair Loss
Hair Loss in Mesothelioma Patients
Hair loss is a side effect often associated with certain types of chemotherapy drugs. Chemotherapy targets fast-growing cells. This includes cancer cells, but chemotherapy can also damage the cells that form hair follicles. Thus, chemotherapy can cause hair to weaken, break or fall out.
Mesothelioma chemotherapy patients may have a somewhat low risk of hair follicle damage. This may result from the types of drugs used and the way they are administered.
- The types of chemotherapy drugs used: The most common systemic chemotherapy for mesothelioma patients consists of cisplatin plus Alimta. This combination may carry a low risk of hair loss for mesothelioma patients. In patients with non-small cell lung cancer (NSCLC), only 12% experienced hair loss from cisplatin plus Alimta. According to one study, about 65% of cancer patients receiving chemotherapy experience hair loss.
- The way chemotherapy drugs are administered: Hair loss may be less likely with chemotherapy confined to the abdomen rather than given systemically. Mesothelioma patients may receive intracavitary chemotherapy as part of their treatment plan. For example, peritoneal mesothelioma patients commonly undergo heated intraperitoneal chemotherapy (HIPEC). This treatment concentrates chemotherapy in the abdomen, away from the head. This may help avoid damage to hair follicles.
In most cases, hair grows back after treatment ends, although it may be a different color and texture than before. Patients cannot prevent hair loss, but they may be able to manage it by being gentle to their hair. Avoiding things that can weaken the hair, such as bleaching and dying, may help minimize hair loss. Patients may also want to use a soft brush and a gentle shampoo during treatment.
Some patients may choose to wear a wig or headscarf. Head-covering options that cater specifically to cancer patients may be available.
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07. Increased Risk of Infection
Increased Risk of Infection in Mesothelioma Patients
Certain types of mesothelioma treatment may weaken the immune system. This can increase the risk of infection. Chemotherapy, radiation, surgery and immunotherapy can all leave patients susceptible to infection. Patients with weakened immune systems may choose to adjust daily habits to help avoid contracting illnesses.
Mesothelioma treatments may affect the immune system differently. For example, chemotherapy may kill healthy immune cells along with cancer cells. This can make patients more susceptible to infection. It may also mean that infections last longer than they normally would.
Immunotherapy can help body’s immune system fight cancer. However, it may also cause other changes in the immune system that can leave patients vulnerable to infection.
Surgery side effects may include infection risk at the surgery site. Catheter-associated urinary tract infections are also a risk. Doctors and nurses can watch for any signs of infection after surgery. They may prescribe antibiotics if an infection occurs.
Radiation therapy side effects may include infection risks. Patients concerned about this side effect may be able to take steps to protect themselves.
Managing Infection Risk Due to Mesothelioma Treatments
Mesothelioma patients may adjust their behavior due to a weakened immune system. To help avoid infection, patients may want to:
- Avoid potentially risky areas and situations: Patients may want to avoid certain situations, such as events and areas with large crowds and swimming. If a patient cannot avoid a crowd, they may want to wear a mask.
- Get a flu shot: Cancer patients and survivors may have an increased risk of flu complications. The Centers for Disease Control (CDC) recommends they get a flu shot every year. For patients over 65, doctors may recommend a special vaccine designed to create a better immune response.
- Get a pneumococcal shot: Pneumococcal pneumonia is a serious flu-related complication. The CDC recommends this shot to help immunize cancer patients from this complication.
- Wash hands and clean surfaces: Patients can wash their hands with soap and warm water to help avoid infection. They can also carry alcohol-based hand sanitizer with them to clean their hands when they are out. Moist cleaning wipes can also help clean surfaces and items such as door handles, ATMs and tabletops.
Individual patients’ immune systems respond to treatment differently. A mesothelioma patient’s doctor can help assess infection risks. They can check a patient’s situation and medical history to provide recommendations.
08. Intimacy Issues
Intimacy Issues in Mesothelioma Patients
Mesothelioma cancer may affect the way patients experience emotional and physical intimacy. Patients may be able to take steps to maintain and even build intimacy with their loved ones and sexual partners. Patients can also learn healthy habits for coping with treatment-related intimacy issues.
Cancer patients may experience depression, anxiety and distress. This can negatively affect the way they relate to others. Counseling, medication and practices such as mindfulness may help patients with mood problems.
Cancer may also affect sexual intimacy in a number of ways. A trusted physician may be able to recommend treatments or therapies for cancer-related intimacy challenges. Joining a cancer support group may help patients cope with body changes and build their self-esteem.
09. Sleep Troubles
Sleep Troubles in Mesothelioma Patients
Mesothelioma patients may experience trouble falling and staying asleep, a condition called insomnia. This may occur for several reasons, including mesothelioma symptoms and treatment side effects. Not getting enough sleep can negatively affect cancer patients’ physical and emotional health. It is important for patients to take steps to address sleep troubles as they arise.
Some studies show that as many as half of all cancer patients experience sleep problems during treatment. Insomnia can stem from several sources, including:
- Cancer symptoms
- Cancer treatment side effects
- Changes to environment and routine, such as overnight stays at the hospital
- Stress, anxiety or depression
Some medications used to manage cancer side effects may also cause insomnia. Steroids, anti-nausea medication and hormone treatment may result in sleep problems.
Treatment Side Effects That May Cause Sleep Troubles
- Nerve pain
- Shortness of breath
- Skin rashes
- Urinary and bladder problems
A lack of sleep can have negative consequences for cancer patients. Sleep deprivation can damage brain cells and prevent brain regeneration. It can also impair the brain’s ability to get rid of toxic wastes. These problems caused by insomnia may contribute to chemo brain. This can affect a patient’s memory and ability to concentrate. Insomnia can also exacerbate pain, fatigue, anxiety and depression in cancer patients.
Mesothelioma patients experiencing insomnia can talk to their healthcare team. They can try to improve the quality of their sleep in several ways, including:
- Avoiding certain sleep-inhibiting activities: Patients may want to avoid spicy foods, heavy meals, sugar and caffeine close to bedtime. These can all prevent sleep. Drinking alcohol and smoking can also prevent patients from getting high-quality sleep.
- Following a set bedtime routine: A set bedtime routine can help patients develop healthy sleeping habits. They may want to go to bed at the same time every night, avoid screens before bed and only use their bed for sleep and sexual activity.
- Participating in cognitive behavioral therapy (CBT): CBT can help teach patients how to control thought processes related to sleep. This can help patients relax their minds and bodies.
- Participating in relaxation therapy: This type of therapy may include yoga, muscle relaxation, hypnosis and other techniques that may improve sleep.
- Taking sleep medicine: Medication is available if other interventions do not improve sleep. Doctors will consider the patient’s individual circumstances before making a recommendation. Patients should not take sleep medication without first consulting their oncology team.
Good sleep can have a positive effect on patients’ overall health. It is important for mesothelioma patients to address treatment side effects, such as insomnia, as they arise. Mesothelioma patients should not assume they have to live with any side effects. Doctors, dietitians and other members of the healthcare team are there to help manage treatment side effects.