Chemotherapy Side Effects

To kill cancerous growths, chemotherapy drugs target rapidly dividing cells. Certain healthy cells such as bone marrow and hair also divide rapidly, so they are often attacked by chemotherapy medications. This can result in side effects like fatigue, hair loss, lack of appetite and diarrhea.

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The severity of these effects depends on the type of drug being used, the patient’s overall physical condition and overall response to the medication.

Patients may notice mild side effects after their first session, while the more severe ones may not develop until after a full cycle has been completed. Most mild issues can be managed with dietary changes, exercise, rest and low-grade or over-the-counter medications. If side effects become too intense or pose serious health risks, the patient’s oncologist may reduce the dose of the drug or change the treatment schedule.


Fatigue is the most frequently reported side effect of chemotherapy and affects up to 96 percent of cancer patients. Patients undergoing chemo may feel consistently exhausted or "drained."

Although it is natural to feel fatigued during therapy, there are degrees of fatigue. You should call your doctor if you feel faint, dizzy or short of breath. If your fatigue results in insomnia or depression, your doctor may need to adjust your treatment.

Quick Tips for Managing Mild Fatigue:

  • Get at least eight hours of sleep each night - Adequate rest can help reduce feelings of exhaustion while also having a positive effect on your physical and emotional well-being.

  • Take short naps - Resting for 10 to 15 minutes can help restore your energy throughout the day.

  • Participate in light exercise - Physical activity eases fatigue and helps you sleep better. This is particularly beneficial for patients who are experiencing chemotherapy-induced insomnia.

  • Ask for help - If fatigue is making it hard for you to complete chores or errands, allow your friends and relatives to help with easy tasks such as grocery shopping and meal preparation.

Nausea and Vomiting

Nausea and vomiting occur in 70 to 80 percent of chemo patients. These symptoms can occur immediately after the drugs are administered or develop over several days, and they may disappear within hours or last up to a week.

Why Does Chemotherapy Cause Nausea and Vomiting?

Some drugs may be less likely to cause nausea and vomiting than others. About 90 percent of patients who use cisplatin experience nausea and vomiting, while between 10 and 30 percent of patients taking pemetrexed experience the same issues. Additionally, 1 in 3 patients experience anticipatory nausea before treatment, triggered by sensory associations such as the smells or sounds of their treatment center.

Mesothelioma patients often struggle to maintain a healthy weight while fighting nausea or bouts of vomiting. Prolonged periods of nausea can cause an electrolyte imbalance or dehydration and can make it difficult for patients to retain necessary nutrients. After vomiting, patients should immediately rehydrate with clear liquids, followed by small portions of easy-to-digest foods like bread or eggs.

Tip: Multiply your weight (in pounds) by 15 to estimate your daily calorie need while undergoing treatment. If you've lost weight, add 500 calories to this number.

Nausea is typically managed with prescription medicines taken before and after chemotherapy sessions. It is sometimes reduced by distraction techniques, dietary changes or hypnosis. For more alternative strategies for managing nausea and vomiting, visit the National Center for Complementary and Alternative Medicine (CAM) of the National Institutes of Health.

Common Anti-Nausea Medications

  • Aloxi (palonesetron)
  • Anzemet (dolasetron)
  • Emend (aprepitant)
  • Kytril (granisetron)
  • Zofran (ondanestron)

Mouth Sores

Chemotherapy drugs can damage cells inside the mouth, causing problems with a patient's teeth and gums. Patients may find it hard to eat, drink or swallow during treatment. They also may experience painful sores inside of the mouth if dental hygiene is poor before beginning treatment. Seeing a dentist a month before beginning treatment can help prevent these sores. A teeth cleaning is a start, but the dentist can take X-rays to spot any potential problems and give you tips on how to self-treat sore gums and mouth sores.

Tip: During treatment, use an extra-soft toothbrush, fluoride toothpaste, floss and an alcohol-free mouthwash to maintain dental hygiene.

Diarrhea and Constipation

Diarrhea and constipation may occur if drugs irritate the gastrointestinal tract lining. Prolonged diarrhea can cause bodily imbalances. Diarrhea and constipation can be well managed with anti-diarrheal medications or laxatives, which are available at most drugstores. Simple changes such as an increased fluid intake and dietary adjustments may also help combat these effects.

Fighting constipation?

Increase your fiber intake with whole grains, nuts, fruits and vegetables.

Dealing with diarrhea?

Avoid caffeine, alcohol, spicy foods, high-fat foods (such as dairy) and high-fiber foods/drinks (such as prune juice).

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Hair Loss

Many mesothelioma patients worry about their hair falling out. Hair loss is one of the most common chemotherapy side effects, but unlike the others, it is not treatable. Since hair is one of the most rapidly dividing healthy cells in a patient's body, it is very susceptible to damage from these drugs. Some patients choose to wear wigs, which may be covered under some insurance plans.

Drug-Specific Side Effects

Because no single drug is declared most effective in treating mesothelioma, oncologists may prescribe a number of different medications.

Each medication can cause a unique set of side effects as indicated in the chart below:

Drug Unique Side Effect
Alimta (pemetrexed) Nerve damage/tingling sensation in the toes and fingertips (experienced by 10 percent of patients taking Alimta/Cisplatin); rash or blistering (experienced by 16 percent of patients taking Alimta/Cisplatin); mouth sores (experienced by 23 percent of patients)
Carboplatin Black, tarry stool; lower back or side pain; pinpoint red rash; blurred vision; ringing in the ears
Cisplatin Accelerated heartbeat; lower back or side pain; pinpoint spots or rash; swollen face, feet or lower legs; joint pain; loss of balance; loss of taste and/or reflexes (extremely rare)
Doxorubicin Flushed face; tearing of the eyes; yellowing of the skin/eyes; stiffness in the body(resulting from increased levels of uric acid in the body); darkening of the nail beds and skin folds
Gemcitabine Muscle aches; changes in ability to hear; tingling in fingers or toes; skin rash (experienced by more than 30 percent of patients)
Navelbine Jaw pain (experienced by less than 5 percent of patients); loss of deep tendon reflexes (experienced by less than 5 percent of patients); vein discoloration (experienced by one third of patients); pain at injection site

Blood Cell Side Effects

Chemotherapy drugs can trigger a drop in blood cell count several days after the first dose of treatment is administered. Platelets, white blood cells and red blood cells can all be affected by these drugs, but a drop in white blood cells is most common.

Low Blood Cell Counts as a Side Effect of Alimta + Cisplatin

Blood Cell Side Effects

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Diagnosed with a low white blood cell count? You are more susceptible to developing infections. Avoid crowds and anyone with a contagious illness/virus.

Diagnosed with a low platelet count? Your blood may not clot correctly. Be extra cautious to avoid cuts or bruises.

Diagnosed with a low red blood cell count?Your body may be struggling to transport oxygen and nutrients correctly. Rest frequently and maintain a nutrient-rich diet.

Rare but Serious Side Effects

Certain side effects of chemo are more serious and should be carefully monitored. These symptoms can indicate a negative reaction to medication or an infection.

Patient Suffering from Chemotherapy Side Effects

If you experience any of these side effects, immediately alert your doctor:

  • fever higher than 100.5 degrees
  • bloody stool or urine
  • unexplained bruising
  • shortness of breath
  • intense headaches

Patients who experience severe problems from their treatment are encouraged to report the experiences to the Food and Drug Administration. Patients can file a report on the FDA website to help researchers more effectively tailor future treatment.

Emotional Effects

Some physical side effects, such as hair loss and fluctuations in weight, can cause cancer patients to struggle with self-esteem, leading to depression and other emotional side effects. In fact, between 15 and 25 percent of cancer patients report feeling depressed during and after treatment. Counselors, support groups, antidepressant medications or meditation can help patients manage these psychological effects of chemotherapy.

Learn more about depression and mesothelioma.

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Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining in 2009.

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  4. Ettinger, David S, et al. (2009 May). Antiemesis Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 7 (5), 572-595.
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  8. Cleveland Clinic Foundation – Chemocare – Chemotherapy Drugs. (2005). Retrieved from
  9. Gralla, R., Grunberg, S., & Messner, C. (2008). Coping with nausea and vomiting from chemotherapy. Retrieved from
  10. Lilly USA, LLC – Mesothelioma Treatment, Symptoms, MPM – Alimta (pemetrexed for injection). (2011).

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