What Are Common Side Effects of Mesothelioma Treatments?

Side Effects of Mesothelioma Surgery

Surgery is often a cornerstone of pleural mesothelioma treatment, particularly for patients diagnosed at an early stage. However, it is a major procedure that can lead to significant side effects, particularly when dealing with the lungs, abdomen, or heart.

Pain and Discomfort

• Post-Surgical Pain: It’s common for patients to experience pain at the surgical site, which can persist for weeks or even months after the procedure. Pain management strategies, including medications and physical therapy, are essential for recovery.
• Nerve Pain: In some cases, surgery may lead to nerve damage, resulting in long-term or chronic pain in the affected area.

Respiratory Issues

• Difficulty Breathing: Patients who undergo surgeries like extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) may experience difficulty breathing, especially during the initial recovery period. This is due to the reduced lung capacity or the body adjusting to the loss of lung tissue.
• Pleural Effusion: Fluid buildup around the lungs (pleural effusion) can occur after surgery, leading to shortness of breath and discomfort. Procedures like thoracentesis may be necessary to drain the fluid.

Fatigue

• Post-Surgical Fatigue: Recovery from major surgery can lead to significant fatigue. This is compounded by the body’s efforts to heal and the physical toll of the surgery itself. Patients often require a prolonged period of rest and gradual return to normal activities.

Risk of Infection

• Infection at Surgical Site: The risk of infection is a concern after any surgery. Signs of infection include redness, swelling, warmth at the incision site, fever, and increased pain. Prompt treatment with antibiotics is necessary if an infection occurs.

Side Effects of Mesothelioma Chemotherapy

Chemotherapy is a common treatment for mesothelioma, either as a standalone treatment or in combination with surgery and radiation. Chemotherapy drugs target rapidly dividing cells, which can affect not only cancer cells but also healthy cells, leading to a range of side effects.

Gastrointestinal Issues

• Nausea and Vomiting: One of the most common side effects of chemotherapy, nausea and vomiting can occur shortly after treatment and may persist for several days. Anti-nausea medications (antiemetics) are often prescribed to help manage these symptoms.
• Loss of Appetite: Many patients experience a reduced appetite, which can lead to weight loss and malnutrition. Small, frequent meals and nutritional supplements can help maintain adequate nutrition.

Fatigue

• Chemotherapy-Related Fatigue: Fatigue is a pervasive side effect of chemotherapy, often described as a feeling of extreme tiredness that doesn’t improve with rest. It can last throughout the treatment period and even after treatment has ended.

Hair Loss

• Alopecia: Chemotherapy drugs target rapidly dividing cells, which include hair follicles. This can lead to hair loss, which is typically temporary. Hair usually begins to regrow a few weeks after the completion of chemotherapy.

Immune System Suppression

• Increased Risk of Infection: Chemotherapy can lower white blood cell counts, weakening the immune system and increasing the risk of infections. Patients may need to take precautions to avoid exposure to pathogens and may receive medications to boost white blood cell production.

Anemia and Bleeding

• Low Red Blood Cell Count (Anemia): Anemia can cause fatigue, weakness, and shortness of breath. Blood transfusions or medications to stimulate red blood cell production may be necessary.
• Thrombocytopenia: A low platelet count can lead to increased bruising and bleeding. Patients should avoid activities that could lead to injury and should report any unusual bleeding to their healthcare provider.

Side Effects of Radiation Therapy in Mesothelioma Patients

Radiation therapy uses high-energy rays to kill cancer cells or prevent them from growing. While it is a targeted treatment, radiation can still affect surrounding healthy tissues, leading to side effects.

Skin Irritation

• Radiation Dermatitis: The skin in the treatment area may become red, dry, itchy, and sensitive—a condition known as radiation dermatitis. In severe cases, the skin may blister or peel. Moisturizing creams and gentle skin care routines are recommended to manage these symptoms.

Fatigue

• Radiation-Induced Fatigue: Fatigue is a common side effect of radiation therapy, often described as a deep, pervasive tiredness. It typically develops gradually and may persist for weeks or months after treatment ends.

Respiratory Issues

• Radiation Pneumonitis: Radiation to the chest area, particularly for pleural mesothelioma, can lead to inflammation of the lungs (radiation pneumonitis). Symptoms include cough, shortness of breath, and chest pain. Steroid medications may be prescribed to reduce inflammation.

Esophagitis

• Difficulty Swallowing: Radiation therapy to the chest can cause esophagitis, an inflammation of the esophagus, leading to pain or difficulty swallowing. Soft, bland foods and pain-relieving medications can help manage this side effect.

Side Effects of Immunotherapy for Mesothelioma

Immunotherapy is a newer treatment approach that boosts the body’s immune system to fight cancer. While it can be effective, it also comes with its own set of side effects, often related to an overactive immune response.

Autoimmune Reactions

• Immune-Related Adverse Events (irAEs): Because immunotherapy stimulates the immune system, it can sometimes lead to autoimmune reactions, where the immune system attacks healthy tissues. This can affect various organs, including the lungs, liver, kidneys, and intestines.
• Common Symptoms: Symptoms of irAEs can include rash, diarrhea, colitis, hepatitis, pneumonitis, and endocrine disorders like thyroiditis. Management typically involves corticosteroids or other immunosuppressive medications to reduce the immune response.

Fatigue

• Immune-Related Fatigue: Fatigue is also a common side effect of immunotherapy, though it may be less predictable than fatigue associated with chemotherapy or radiation.

Flu-Like Symptoms

• General Discomfort: Some patients experience flu-like symptoms, including fever, chills, muscle aches, and headaches, especially shortly after receiving immunotherapy infusions.

Long-Term Side Effects and Survivorship

For mesothelioma patients who achieve remission or long-term survival, there are potential long-term side effects that need to be managed.

Chronic Pain

• Persistent Pain: Some patients may experience chronic pain due to nerve damage, scarring from surgery, or ongoing effects of radiation. Long-term pain management strategies are crucial for maintaining quality of life.

Psychological Effects

• Anxiety and Depression: The psychological impact of a mesothelioma diagnosis and the challenges of treatment can lead to long-term anxiety and depression. Ongoing mental health support, including therapy and support groups, is essential for emotional well-being.

Secondary Cancers

• Risk of New Cancers: Patients who have undergone radiation therapy may have an increased risk of developing secondary cancers in the treated area, often years after the original treatment.

Conclusion

Mesothelioma treatments, while essential for managing the disease, come with a range of potential side effects that can impact a patient’s quality of life. Understanding these side effects and how to manage them is crucial for patients and caregivers. By working closely with their healthcare team, patients can find strategies to minimize the impact of side effects, enabling them to maintain as much comfort and normalcy as possible during and after treatment.

Sources:

• National Cancer Institute - Side Effects of Cancer Treatment
• American Cancer Society - Managing Cancer Treatment Side Effects
• Mayo Clinic - Chemotherapy Side Effects
• Centers for Disease Control and Prevention (CDC) - Managing Cancer Treatment Side Effects