Neutropenia in mesothelioma patients

Chemotherapy drug treatments reduce the number of neutrophils, also known as white bloods cells that protect the body against infection. This causes a condition known as neutropenia. Cancer patients that suffer from neutropenia have an increased risk of bacterial infections and could be fatal if left untreated. Some symptoms of neutropenia include body aches, fever and fatigue. Doctors normally find neutropenia when conducting a complete blood count (CBC) to determine the number of red and white blood cell counts.

Physicians determine the risk of neutropenia by calculating the neutrophil count, called the absolute
neutrophil count (ANC). The absolute neutrophil count is calculated by
multiplying the total white blood count by the percent of neutrophils.

The following scale shows the risk of infection based on the ANC:

Risk of Infection based on Absolute Neutrophil Count (ANC)

ANC greater than 1500: No increased risk of infection

ANC 1000-1500: Slight increase in risk of infection

ANC 500-1000: Moderate increase in risk of infection

ANC 100-500: High risk of infection  

ANC less than 100: Extremely high risk of infection 

Drugs That Cause Neutropenia 
 
Overall, most chemotherapy drugs can cause neutropenia because they tend to lower the number of neutrophils. They grow quickly but only survive three days.  
 
Drug Treatments for Neutropenia 
 
Physicians treat cancer patients that suffer from neutropenia with a drug called Neupogen (filgrastim). This substance recreates blood growth factors that boost the number of white blood cells. It is given by injection every five to seven days, but due to the inconvenience of this frequency, another type of drug called Neulasta (pedfilgrastim) was developed. It lasts longer and needs to be administered every 21 days. These drugs have side effects of their own that causes bone and joint pain.

Other Precautions to Reduce Risks of Infection

The following precautions should be taken by patients with neutropenia to reduce risk of infection:

  • Avoid people that might be sick with a cold, flu or infection
  • Keep skin moist to prevent dry, cracking skin
  • Don’t scratch sores and keep them clean with antiseptic and a bandage
  • Don’t eat raw foods
  • Keep mouth clean, brush regularly and use alcohol-free mouthwash

Fatigue as a side effect

Chemotherapy drug treatments can be effective, but they also seem to be linked to intense fatigue. Drugs that often cause cancer-related fatigue are vinblastine, cisplatin and vincristine.

The severity of fatigue may vary by individual, but almost 90 percent of cancer patients experience some level of fatigue related to cancer treatment at some time during therapy. It is also known that the symptoms from fatigue can last for months or years after cancer treatment.

Specifically, fatigue can be caused by cancer-related anemia or low thyroid function and can intensify with emotional distress or depression related to the cancer treatment. A patient with fatigue may feel weak, forgetful, have decreased energy level and an inability to concentrate.

Drug Treatments to Reduce Fatigue

Physicians treat cancer patients that suffer from fatigue in a similar way to patients with anemia. Doctors use drugs that produce hormone and stimulants such as Ritalin (methylphenidate) and Provigil (modafinil).

Other Treatments to Reduce Fatigue

None-drug treatments such as exercise, diet and conserving energy have been shown to reduce fatigue.

Exercise

Doctors put their patients on a low-intensity exercise regimen to avoid the loss of too much muscle mass that can lead to fatigue more easily than someone that does some sort of physical activity. Too much high-intensity exercise is not good for cancer patients since it can put the immune system at risk.

Diet

Cancer patients can monitor their diet to help reduce fatigue. If a patient doesn’t maintain the proper nutrition by eating the right foods, this will contribute to fatigue. It is recommended that a cancer patient gets at least 15 calories per pound of his or her body weight. Proper amounts of protein are also important to help rebuild and repair body tissue. The recommended amounts of protein are 0.5 to 0.6 grams for every pound of body weight. Patients should have a minimum of 64 ounces of fluids per day and limit their intake of alcoholic and caffeine beverages. It is recommended to supplement their diet with a multivitamin that gives them 100% of the recommended daily nutrients.

Conserve energy

Cancer patients should organize their tasks ahead of time and try to schedule rest periods to help save energy throughout their day. The following are some recommendations to conserve energy:

– Take time in the day to rest
– Take multiple short naps or breaks instead of one long break
– Save energy for important tasks
– Get help to delegate some tasks
– Moderate pace is better than rushing through tasks

Oral Mucositis – Sores in Mouth and Throat

Some chemotherapy drugs can cause sores in the mouth or throat because they inhibit the replacement of the healthy cells. The condition that causes sores in the mouth is known as stomatitis, and a comparable condition in the throat is known as pharyngitis.  

The lining of the mouth starts to become pale and dry. As time goes on, the mouth and throat may become red, sore and inflamed. The patient may have trouble eating, talking or swallowing. Eventually, the condition can lead to painful, bleeding ulcers and possibly infection. This condition normally develops approximately 5 to 14 days after chemotherapy treatment has taken place. These conditions eventually heal once chemotherapy treatment has ended. 
 
It has been determined that up to 75 percent of patients who receive high-does chemotherapy get oral mucositis and approximately 40 percent of patients that receive standard-dose chemotherapy experience this side effect. 

  
Drugs That Cause Oral Mucositis 
 
Some chemotherapy drugs such as methotrexate and 5-FU have shown to cause a higher incidence of oral mucositis than some others. If the patient is treated early, it can lessen the severity of the symptoms. 
 
Treatments to Reduce and Relieve Incidence of Oral Mucositis 
 
There are some common none-drug treatments to help reduce the severity of oral mucositis. 

Following are some steps that can be taken to help the healing process: 

– Keep the mouth clean and moist 
– Brush teeth with a soft toothbrush or swab 
– Stay away from mouthwashes; rinse with salt or baking soda solutions 
– Stay away from foods and juices that are acidic 

There are some medications that have been recommended and administered to cancer patients to help alleviate pain from oral mucositis. They include the following: 
 
– Tylenol liquid (acetaminophen) – helps relieve pain but doesn’t heal sores 
– Kepivance (palifermin) – this drug is used for severe cases of oral mucositis in patients with  
  blood cancers 
– Gelclair (hyaluronate)- relieves pain by creating a protective barrier and coating the oral  
  mucosa 
– Saforis (glutamine) – a new drug known to be effective in preventing and treating oral mucositis 

Anemia

Chemotherapy drug treatments can cause anemia, a condition that results in a low red blood cell count (RBCs). Symptoms such as fatigue, weakness, increased heart rate, dizziness and shortness of breath result because there aren’t enough red blood cells to carry nutrients and oxygen to the body tissues. These symptoms can also inhibit the intensity of the cancer treatment.  
 
Most patients treated with chemotherapy drugs are likely to get anemia. Patients with lymphoma, myeloma and leukemia are also susceptible to anemia because these diseases grow within the bone marrow and squeeze out more healthy red blood cells. Some patients may not get anemia because of cancer, but some may already have a tendency toward it such as premenopausal women.  
 
A doctor can determine whether or not a patient has anemia by evaluating the concentration of hemoglobin in the blood and the hematocrit levels. 
 
– Red blood cells contain a protein called hemoglobin that carries oxygen to the muscles and organs.  If the number of RBCs is low, the hemoglobin concentration is below the normal range. 

The normal range for women is 12 to 16 grams per deciliter and 14 to 18 grams per deciliter for men. 
 
– The percentage of total blood volume occupied by RBCs is known as hematocrit. The normal hematocrit levels should be between 37% and 52%. Usually, these percentages are higher in men than in women. 
 
Normal Adult Values-Male             Female 

RBC                          4.5 – 6.0 M/ul4.2 – 5.4 M/ul 

Hemoglobin (HgB)14 – 18 g/dL12 – 16 g/dL 

Hematocrit (Hct)40 – 52%37 – 47% 

  
 
Drugs That Cause Anemia 
 
Overall, most chemotherapy drugs can cause anemia because they tend to lower blood cell counts due to their toxic effects on bone marrow that is responsible for producing blood cells.  
 
Some cancers cause anemia due to blood loss. Cancers that have an impact on the genitourinary or gastrointestinal tracts may cause bleeding. Tumors are another cause of bleeding, they can bleed from within.  

 
Treatments to Reduce Anemia 
 
If a cancer patient shows signs of severe anemia, a blood transfusion can be given to return the RBC levels to a proper level. This option is normally only used in very severe cases because blood transfusions may present some risks. 
 
A more common approach taken to maintain the proper RBC levels is to use a drug called Procrit or Epogen (epoetin alfa). This substance acts like the body’s naturally-occurring substance, erythropoietin, by stimulating red blood cell production. Epogen is usually administered once a week by an injection to boost the hemoglobin levels.  
 
A more recent drug used to treat chemotherapy-induced anemia is Aranesp (darbepoetin alpha), approved for use in 2002, it has the same characteristics as the naturally-occurring erythropoietin. 

Nausea and vomiting and hair loss

Nausea and vomiting

Chemotherapy drugs can cause nausea and vomiting because they irritate the stomach lining and the duodenum. This results in activating the part of the brain that triggers vomiting. It can also be triggered through intestinal blockage and inflammation that are likely chemotherapy effects.

Drugs That Cause Nausea and Vomiting

The severity of nausea and vomiting side effects vary by patient. Some of the chemotherapy drugs that are most likely to cause nausea and vomiting are cisplatin, dacarbazine, mechlorethamine, melphalan, daunorubicin, carmustine, procarbazine, lomustine and others.

Treatments to Reduce Nausea and Vomiting

It is a common practice to control nausea and vomiting by administering some drugs before chemotherapy treatment begins. Some drugs are administered alone or in combination with others to prevent or reduce nausea and vomiting side effects. These drugs are known as anti-emetics and include the following: Ativan (lorazepam), Compazine (prochlorperazine), Reglan (metoclopramide), Zofran (ondansetron), Phenergan (promethazine), and Aloxi (palonosetron).

There are some non-drug treatments to help control nausea and vomiting such as:

– ginger ale or ginger tablets
– soothing music
– relaxation exercises

Hair Loss

Cells formed in hair follicles divide rapidly. It is this characteristic that makes hair loss, also known as alopecia, a common side effect during chemotherapy. The amount of hair loss varies among patients. The patient’s drug treatment schedule and drug dose can also determine the severity of hair loss. This side effect may start with a tingling sensation when the patient’s first strands of hair start to fall out. Hair loss can also occur on the patient’s legs, arm, face (eyebrows and eyelashes), and in the nose.

Drugs That Cause Hair Loss

The chemotherapy drugs that have shown to cause significant hair loss have been drugs such as Adriamycin (doxorubicin), Taxotere (docetaxel) and Taxol (paclitaxel). Other chemotherapy treatments that have shown to cause significantly less hair loss are drugs such as Oncovin (vincristine) and Gemzar (gemcitabine).

Treatments to Reduce Hair Loss

Recently, other treatments have been used that are referred to as “targeted agents” that do not cause hair loss since they are directed only at the existing cancer cells. These agents are Herceptin (trastuzumab) and Gleevec (imatinib).

In other cases where traditional chemotherapy drugs are used, the hair may start to grow back at its normal pace after the chemotherapy treatment has ended. Hair loss from chemotherapy is difficult to prevent with alternative methods; however, it is suggested to use mild hair products, soft brushes, and try to avoid harsh chemicals such as dying and perming products.

Patients can choose to use head coverings such as caps, scarves, hairpieces or wigs. The National Cancer Institute suggests that if a patient does choose to get a wig, it is advised to get it before the hair loss side effects so that it can be colored to match your natural hair color.  

Patients should check with their health insurance company to make sure whether or not the cost of the wig or hairpiece is covered. Some policies do cover them as part of cancer treatment.

Side Effects of Chemotherapy Drugs For Cancer Treatment

When a person is cancer-free and in good health, their cells grow, die and then divide and regenerate in a natural, controlled manner.  Cancer cells on the other hand, tend to divide at an uncontrolled rate and reproduce rapidly. Chemotherapy drugs are used to attack cancer cells and keep them from multiplying uncontrollably.  
 
The chemotherapy drugs are transported through the blood and eventually access the cancer cells. The problem with chemotherapy drugs is that when they attack cancer cells, they can also attack the healthy cells. In most cases, the healthy cells can survive, but sometimes the attack on the healthy cells results in side effects. For the most part, the side effects are only temporary and last as long as the length of the chemotherapy drug treatment. 
 
The type of chemotherapy side effects can vary based on the type of cancer the patient is diagnosed with, the type of chemotherapy drugs that are used for treatment, and how the patient’s body reacts to the drugs.

Alternative Cancer Treatments

While many scams and get-rich-quick schemes involve “alternative cancer therapies”, many reputable hospitals and non-profit organizations are also researching non-traditional therapy methods that can offer many of the same benefits.  The study of Complimentary and Alternative Medicine (CAM), while still relatively new, has shown promise to patients who are looking for ways to gain the benefits of current modes of treatment while alleviating many of the painful side effects.  Some of these alternatives include: 

  • Acupuncture to manage pain  
  • Dietary supplements to maintain energy 
  • Yoga and other stretching exercises to keep up muscle strength and flexibility 
  • Therapeutic activities (e.g. art therapy) to combat depression and anxiety

Patients often find comfort in these methods for several reasons: 

  • The patient is taking an active approach to their treatment regimen.  This approach helps the patient to feel less like a “lab rat” or a “guinea pig” than in a clinical setting. 
  • The patient understands how these methods can add to the effectiveness clinical treatment sessions. 
  • Most CAM methods are administered in more welcoming and inviting environments.  These settings allow the patient to take a break from the cold, sterile surroundings of hospitals and doctor’s offices.

Patients should always check with their doctor or health care professional regarding CAM methods.  They should also attempt to do thorough research on the costs and benefits of different CAM treatments. 

Surgery and Hospital Care

Many cancer cases require surgery to remove portions of the tumor.  In instances of more advanced or aggressive forms of the disease, the affected organ may also need to be removed in whole or in part (e.g. mastectomy in breast cancer cases, excision of an affected testicle).  The removal of affected tissue and the potential loss of the functionality of the organ can have a severe effect on the patient’s outlook.  In their minds, they have literally lost a part of themselves.  Also, the physical scarring, the extended hospital stays and additional tests that are part of the surgical process can have a negative impact on the patient’s emotional state. 

One study published in the Journal of Surgical Oncology reveals what some experts consider an unexpected result: 

“Although often acknowledged, the impact of the surgical treatment of cancer on the spouse of the adult cancer patient is a largely unexplored area…The results (of the study) indicated that at both the presurgical and postsurgical period, spouses were exhibiting significantly greater distress than patients. Surprisingly, spouses’ levels of distress remained fairly constant across the presurgery to postsurgery period, while the patients distress decreased…Spouses of cancer patients undergoing surgical treatment appear to be an underacknowledged population at risk.” 

Before surgery, patients and their families are best served by educating themselves on the specific procedure as well as a time frame for recovery.  After the procedure, patients can learn more about what limitations they will have and how long such restrictions will be in place.  Family and friends can make the patient as comfortable as possible during both the inpatient and outpatient phases of surgical recovery.     

Internet Research and Telling the Family

Of course, many patients will begin their search for more information via the Internet.  Most hospitals, research clinics and treatment providers offer news and resources through their web sites.  Also, organizations such as the American Cancer Society and the National Cancer Institute give visitors access to a wealth of information on how to manage the various aspects of their treatment.   

One aspect of Internet research of which patients should be aware is the prevalence of misinformation, lies and outright scams that some unscrupulous people can perpetrate on someone desperate for a “miracle cure”.  Many websites that promote themselves as resources for cancer patients often contain misleading information, either as a result of incomplete or inaccurate research or as an attempt to sell their product.  These books, pills and diet plans, in the best cases, are as effective as placebos or, in the worst instances, can cause great harm to a cancer patient’s sensitive metabolism. 

Telling the Family 

After patients receive their diagnosis and their treatment information, the next step often involves telling their spouses and families.  For many patients, this step may be as emotionally difficult as when they first heard the news themselves.  Spouses may often feel the same sense of helplessness as patients; they may feel that this disease will take away their partner and that they can do nothing to stop it.  Young children may not entirely comprehend all of the physical ramifications of what could happen to their parent, but they will pick up on the emotional distress and become depressed, sad or angry.   

Most experts agree that the best way to combat these feelings is to keep the lines of communication open throughout the treatment schedule.  The patient should answer any questions, especially from younger children, as openly and honestly as possible.  One of the best ways to combat the feelings of helplessness that family members may experience is to include them in the therapeutic process.  Simple actions, such as organizing task lists and completing simple chores, can both alleviate the mental stress and add to the family’s feelings of contribution to the patient’s well being.   

The patient’s relationship with their spouse will undergo many of the more serious changes during treatment.  The patient may experience both physical and mental exhaustion during this time, so the spouse may have to take care of their normal household duties (taking out the trash, cooking dinner, dressing the children for school).  In addition, the nature of the couple’s physical relationship will also change.  Along with the lack of energy, the patient may have either lost their desire for sex or may be physically unable to perform.  These changes could cause resentment and anger to disrupt the relationship and add more stress onto their situation.  The spouse may then feel a measure of guilt for harboring these feelings against their ill partner.

Many psychologists, counselors and mental health professionals specialize in therapy for cancer patients and their families.  Even with the technology available to modern medicine, the idea of cancer is still very traumatic for both the patient and their loved ones.  These specialists can offer outlets for all the members of the family affected by the disease, the treatment and the consequences.  With the opportunities to alleviate much of the emotional stress caused by the illness, the patient and the family can focus on the other aspects of cancer therapy and potential recovery. 

Fertility or reproductive health may be an issue with patients and their spouses during treatment, especially if the reproductive organs are the ones affected by the cancer.  Doctors can give information on potential risks and outline options for couples that still hope to have children either during or after treatment.  Some techniques include protection of the reproductive organs during radiation treatment, tissue preservation of the organs for later reimplantation, hormone therapy and sperm/egg banking. 

Coping with Cancer

“You have cancer.”

No patient is ever prepared to hear these words from their doctor. The diagnosis can lead the patient to feel overwhelmed with anxieties, worries and fear. In years past, these words were the equivalent of a death sentence. However, with numerous advances in detection, drugs and other treatment options, many patients can experience a full life while undergoing therapy for the disease. While modern technology has helped in the treatment of many forms of cancer, the road to recovery is still long, often painful and very expensive. During this process, patients will encounter many serious issues that reach beyond the oncologist’s office and into every facet of their lives.

Knowledge Is Power

One of the best ways the patient can deal with the emotional shock of the initial diagnosis is to ask as many questions as possible. Patients should understand that they are the most important participants in their own recovery process. Doctors should encourage questions from patients and allow them to take an active role during the course of the treatment schedule. According to the American Society of Clinical Oncology, some of these questions should include:

  • What is the exact type and name of the cancer I have?
  • How was it diagnosed?
  • What tests were taken and what did they show?
  • Will I need additional tests?
  • What stage is the cancer and what does that mean?
  • What are my treatment options?
  • What clinical trials are open to me?
  • What are the possible side effects of this treatment option, both in the short term and the long term?
  • What is my prognosis? What will my quality of life be?
  • What are the next steps?

Such a frank exchange of information will help patients take control of their emotions and give them a course of action to follow, rather than allow them to be carried away by feelings of helplessness and despair. Doctors also benefit from these sessions; the more feedback they receive from the patient, the better they can tailor the treatment regimen to that specific patient’s needs.

Some patients may also be well served in obtaining a second opinion on their diagnosis. In many cases, doctors may recommend that patients see other specialists in order to gather more information on the specific form of cancer as well as to learn about the latest data on other treatment options. Patients may also benefit from the perspective of another professional opinion and incorporate that into their approach during the healing process.