cancer treatment living with mesothelioma

How to Manage Late Effects of Chemotherapy Drugs

Once a cancer patient’s treatments have ended, there is still a chance that he or she can experience side effects. Some side effects can continue after treatment or surface months or years after treatment. There is not a lot of concrete information that is known about cancer treatment side effects, but they can vary by treatment type and individual circumstances. 
Physicians aren’t sure why these effects occur late. Some doctors think the side effects may have been there during treatment, but they weren’t noticed because the body was counteracting them and after treatment the body no longer does this, thus they begin to emerge later. 
Side effects that are apparent during cancer treatment can continue to last months or years afterward. Most long-term effects reduce over time or completely disappear. An example of a long-term side effect is peripheral neuropathy. It can occur during chemotherapy treatment and continue months or years after treatment has been completed. 
What Chemotherapy Treatments Cause Late Side Effects? 
In general, chemotherapy treatments are more likely to cause late effects than other types of cancer treatments. Not all cancer patients may experience long-term or late effects and different chemotherapy drugs may cause various effects. 
Some of the following are long-term side effects from chemotherapy treatment: 

  • fatigue 
  • neuropathy 
  • chemobrain 
  • heart failure 
  • kidney failure 
  • infertility 
  • liver problems 
  • menopausal symptoms 

Some of the following are late side effects from chemotherapy treatment: 

  • cataracts 
  • osteoporosis 
  • chemobrain 
  • reduced lung capacity 
  • lung disease 
  • infertility 
  • liver problems 
  • second primary cancers 

More Information About Managing Chemotherapy Side Effects 
If cancer patients need more information, or have questions on how to manage chemotherapy side effects, they can contact The American Cancer Society at 1-800-ACS-2345, or read an online booklet, Understanding Chemotherapy: A Guide for Patients and their Families, at the following web address: 

cancer treatment living with mesothelioma

Rash as a Chemo Side Effect

Chemotherapy drug treatment can cause a patient to experience rashes on the back, chest, arms, neck or face that may look like a rosacea or acne type condition. A patient usually experiences rash side effects that are mild to moderate. Rash side effects do come with an infection risk factor. In some cases if the rash is serious, the treatment drugs may be reduced, delayed or terminated.

Drugs That Cause Rash

Some of the medications that increase the likelihood of a rash are Tarceva (erlotinib) and Erbitux (cetuximab). They may cause an acne-like condition that arises in the second week of the cancer treatment, but may start to diminish by the fourth week of treatment. The rash goes away once the treatment has been completed.

These medications are directed toward the epidermal growth factor receptor (EGFR) and inflammation occurs that often causes an acne-like skin reaction.

Drug Treatments to Reduce Rash Side Effects

There are no real firm standards on what can be used to treat rashes for chemotherapy patients; however, following are some medications used to help reduce rash side effects during chemotherapy drug treatment:

– antihistamines such as Benadryl and Atarax to lessen itching
– topical corticosteroids
– antibiotics (oral or topical)
– Elidel being researched to control EGFR-related rash side effect

Why do the side effects occur in specific parts of the body?

Healthy cells in certain parts of the body are especially sensitive to chemotherapy drugs. The parts of the body that seem to be prone to side effects are the parts that have rapidly dividing cells. Chemotherapy drugs attack these cells and can result in various side effects based on the drug type, dose and route in which the patient receives the drugs.

The following cells are prone to side effects:

  • the bone marrow cells (which makes blood cells)
  • hair follicles cells
  • cells that line the mouth and throat
  • cells that line digestive system

Chemotherapy treatments are normally given in a group of sessions. The sessions are followed by a period of rest. The chemotherapy sessions kill the cancer cells and the rest periods allow the healthy cells to recover.

cancer treatment living with mesothelioma


drug treatment can cause a patient to experience constipation, or the
uncomfortable passage of hard, dry stools that are infrequent. Some
symptoms include bloating, cramping, increased gas and pain. About 50
percent of cancer patients experience constipation. Other side effects
can occur from this condition such as decreased appetite and nausea.

Drugs That Cause Constipation

Some of the medications that increase the incidence of constipation are
opioid pain medications and chemotherapy drugs such as vincristine and

Other Causes of Constipation

Other than medications there are other factor that can lead to an increase in the likelihood that a patient experiences constipation such as depression, decreased fluid or food intake, dehydration, low fiber diet and lack of physical activity.   

Drug Treatments to Reduce Constipation 

Following are some medications that may help reduce constipation during chemotherapy treatments:

  • Psyllium (Metamucil) 
    – Docusate sodium (Colace)   
    Bisacodyl (Dulcolax)  
    – Sorbitol and sodium phosphate (Fleet’s enema) 
    – Glycerin suppository 
    – Magnesium hydroxide (Milk of Magnesia)  
    Senna (Senokot)  
    – Lactulose (Chronulac)  
    – Magnesium citrate 

Non-Drug Treatments to Reduce Constipation 

Following are some non-drug methods to help reduce the incidence of constipation during chemotherapy drug treatment: 

  • stay physically active
  • try to drink at least 3 quarts of fluids per day
  • try to eat high-fiber foods
  • patients to tell their doctor if they don’t have bowel movement for more than three days


Chemotherapy drug treatment can cause a patient to experience diarrhea, or the passing of an increased amount of a watery or loose stool multiple times throughout the day. Some symptoms include bloating, cramping, increased gas and pain. About 3 out 4 cancer patients experience diarrhea during chemotherapy treatment due to the attack on the cells in the digestive tract.

Drugs That Cause Diarrhea 

Some of the medications that increase the incidence of diarrhea are
dactinomycin, doxorubicin, docetaxel, methotrexate, irinotecan,
5-fluorouracil, antibiotics or antacids.

Also the dose of the chemotherapy drug can play a role in whether or not a patient experiences diarrhea.

can lead to dehydration and is a common side effect of irinotecan
(CPT-11). Patient’s should tell a physician when diarrhea occurs and
follow his or her instructions to stop the condition.

Other Causes of Diarrhea

Other than medications there are other factors that can lead to an increase in the likelihood that a cancer patient experiences diarrhea such as
stress, anxiety, food allergies, when a patient receives radiation and
chemotherapy simultaneously, stomach tumor, nutritional supplements and
the length of treatment.

Non-Drug Treatments to Reduce Diarrhea

Following are some non-drug methods to help reduce the incidence of diarrhea during chemotherapy drug treatment

    – stay physically active 
    – try to drink at least 8-10 glasses of fluids per day (i.e. water, Gatorade, broth) 
    – try to eat small portions of low-fiber foods frequently (i.e. banana, rice, bread, chicken) 
    – avoid greasy, fatty, fried foods 
    – avoid vegetables and fruits 
    – limit caffeine beverages and extremely hot or cold beverages 
    – avoid whole grain bread, cereal, nuts, popcorn 
    – avoid gas-forming foods and beverages 
    – avoid alcohol, lactose-containing products and supplements

Over-the-Counter Medications to Reduce Diarrhea

Following are some over-the-counter medications to help reduce the incidence of diarrhea during chemotherapy drug treatment: 

  • Kaopectate®II caplets 
    Maalox®anti-Diarrheal caplets  
    Loperamide (Imodium®)  
    Pepto® Diarrhea control (follow instructions on container)
cancer treatment


It has been shown that almost 90 percent of cancer patients suffer some type of pain during or after cancer treatments. Fifty percent of patients suffer some sort of chronic pain.

Cause of Pain

Chemotherapy drug treatments can cause different types of pain such as, acute pain that comes on and lasts a short period of time, or chronic pain, which is continuous and lasts more than six months. The pain that patients experience can occur when tumors press on nerves.

There are various pain management treatments that can help with short or long-term pain.

Some medications are constantly administered for long-term, chronic pain and are usually long-acting so that they are always in the body to help counteract the pain. Other medications, called short-acting medications, are used for acute pain or something called “breakthrough” pain, which is a short, brief, yet severe attack of pain.

Physicians may have to try different pain relief medications before finding a balance between managing the pain and the reducing the related medication side effects.

Drug Treatments for Pain

Physicians use morphine for chronic pain relief. Patients may experience side effects from morphine such as constipation, drowsiness, nausea and sleepiness. These side effects can be managed with other medications.

Opioids are medications that are also used to help relieve pain. They are drugs that contain natural opiates and synthetic narcotics. These medications are some of the most effective and are often used for cancer-related pain management. These drugs attach to opioid receptors, or specific proteins, that are in the brain and spinal cord. In the spinal cord, they block pain messages from reaching the brain. In the brain, they change how the body interprets or experiences the pain.

Another type of high-dose medication that is applied as a patch is called Duragesic. It continuously administers opioids in high-doses so that it can relieve pain up to 72 hours. A more recent form of this patch has been released and contains a potent semisynthetic opioid called buprenorphine.

Another recent pain management drug treatment is Prialt (ziconotide). It is a potent drug and stops pain by binding to calcium ions. It has different side effects than opioids such as headaches and dizziness. In some rare cases other side effects may be hallucinations, delirium and coma. The patient receives the drug through a pump that is surgically implanted and goes directly into the spinal fluid.

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Chemotherapy drug treatments can cause neuropathy, or injury to the peripheral nerves. These consist of motor nerves that help with movement and muscle tone and sensory nerves that help with temperature, pain and touch. The symptoms of neuropathy depend on the nerve type that is affected.  

Symptoms of motor nerve damage include muscle weakness, spasms, cramps, and possibly loss of balance and coordination. Sensory nerve damage can result in pain, numbness, tingling (burning, freezing sensation), and extreme sensitivity to touch. 

If peripheral neuropathy goes untreated, it can develop into permanent damage to nerves, tissues and muscles. Proper treatment can help reduce the risk of irreparable damage and other serious consequences. 

Drugs That Cause Neuropathy

Patients that receive vinca alkaloids (anticancer drugs that stop cancer cell growth by inhibiting cell division) are susceptible to develop neuropathy during their treatment. The condition may develop weeks, month or years even after treatments end. The symptoms may wane as the nerves heal.

Some chemotherapy drugs that are known to cause neuropathy are cisplatin, paclitaxel, oxaliplatin, vincristine, thalidomide and bortezomib. Patients that are already experience nerve damage by other conditions such as diabetes or excessive alcohol use are more prone to develop chemotherapy drug related neuropathy. 

Drug Treatments for Neuropathy

Physicians are investigating some drugs such as anticonvulsants (used in the treatment of epileptic seizures) and antidepressants to help treat the symptoms of neuropathy.

Doctors have found these drugs helpful in managing the condition even though the Food and Drug Administration has not given approval of these drugs for neuropathy treatment. 

Anticonvulsants such as Neurontin have been administered to patients with the condition. Doctors prescribe a low dose to begin and increase as time goes on to help manage pain.  

Some antidepressants used to manage neuropathy symptoms are nortriptyline and amitriptyline.  

Other Non-Drug Treatments for Neuropathy

Some of the following methods can be used in combination with drug treatment or alone to help manage symptoms of neuropathy: 

– massage 
– herbs 
– acupuncture 
– physical therapy to help strengthen muscles 
– occupational therapy to help with assistance of daily tasks 

Another technique is to use transcutaneous electrical nerve stimulation (TENS) to help stop pain signals from going to the brain by using painless electrical impulses by placing electrodes on the skin. TENS seems to be more effective with acute pain and less effective with chronic pain. 

cancer treatment mesothelioma

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
cancer treatment living with mesothelioma

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.


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.


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

cancer treatment living with mesothelioma

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  
– Saforis (glutamine) – a new drug known to be effective in preventing and treating oral mucositis 

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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. 

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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.