If you have never experienced cancer treatment firsthand because of your own illness or that of a close family member, then you have only heard about the scariest parts, like the debilitating side effects, including hair loss, nausea and vomiting, and immunosuppression. Research about many types of cancer, including mesothelioma, is ongoing, which is why the five-year survival rates for most types of cancer have been increasing since data on these diseases started to be recorded. Researchers are always working to develop new chemotherapy drugs and more effective ways to use existing chemotherapy drugs, in addition to developing new cancer treatments that do not involve chemotherapy. If you have recently received a mesothelioma diagnosis or are about to start treatment, ask your oncologist about current clinical trials for new mesothelioma treatment regimens. Chances are that your mesothelioma treatment plan will include chemotherapy, whether or not you also have surgery, radiation, immunotherapy, or some combination of these.
What Is Chemotherapy, and Why Is It an Important Part of Mesothelioma Treatment?
Chemotherapy drugs are medications that destroy the most rapidly dividing cells in the body, a category that includes cancer cells. Unlike most cells, cancer cells do not undergo apoptosis, which is the natural process of cell recycling; instead, they just keep dividing and spreading until cancer overtakes the entire body. Chemotherapy can shrink cancerous tumors or slow their growth and can also destroy cancerous cells that have spread to the bloodstream.
Chemotherapy side effects such as hair loss, dry mouth, ulcers in the mouth, nausea, vomiting, diarrhea, and weakened immunity occurs because the chemotherapy drugs also damage the rapidly dividing cells in healthy tissues such as the bone marrow, oral mucosa, hair follicles, and linings of the stomach and intestines. Maximizing effectiveness while minimizing side effects is an important factor in determining the dosage and timing of chemotherapy treatments, and doctors will make an individualized chemotherapy plan for you and adjust it if necessary.
Most mesothelioma patients undergo chemotherapy, usually alongside other treatments. Surgery enables doctors to remove tumors that are visible to the naked eye; they might even find, during surgery, that the tumor is bigger than it appeared on imaging scans. Even if they are able to remove the entire tumor during surgery, they cannot be sure that they did not miss any cancer cells on the margins of the tumor or cancer cells that have broken off from the tumor and have started circulating through the bloodstream or started to form tumors in other parts of the body. Therefore, the best way to ensure that the cancer is completely gone is to apply chemotherapy drugs directly to the site where the tumor was growing or to the entire body through the bloodstream. If your tumor is difficult to operate on, doctors might order a series of chemotherapy sessions before surgery, and perhaps also additional sessions afterward. Some patients choose not to have surgery and just to slow down the progress of cancer as much as possible with chemotherapy.
Where Do Chemotherapy Treatments Take Place?
Even if you had to travel to another state for your mesothelioma surgery, most hospitals have cancer centers where patients can receive chemotherapy treatments. Therefore, if you traveled to visit mesothelioma specialists to confirm your diagnosis and arrive at a treatment plan, the mesothelioma specialists will communicate your plan to oncologists at your local hospital center. Therefore, you will most likely be able to live at home while undergoing chemotherapy. Most treatments take place at outpatient clinics, some of which are affiliated with hospitals and some of which are not.
If your doctors are worried that you will experience severe side effects, they will admit you to the hospital for one or more chemotherapy sessions, so that they can observe you and help you manage side effects. They will discharge you from the hospital and let you go home when your health is stable enough for this.
What Determines the Timing of Chemotherapy Treatments?
Most chemotherapy sessions last for several hours, during which one or more drugs are administered. The sessions might occur at whatever interval your medical team decides is the most appropriate. For example, they could take place once per day, once per week, or once every few weeks. In some courses of treatment, the sessions could be closely spaced at the beginning but become less frequent as the treatment continues. These are some factors that determine the timetable for your chemotherapy treatments:
- Staging – How far cancer has progressed is a factor in determining the timing of chemotherapy sessions.
- Your general health – Your doctors will give lower doses or less frequent treatments if they are reasonably concerned that giving the doses that would destroy cancer most quickly would make you sicker because of pre-existing health conditions.
- Side effects – If you suffer severe side effects from chemotherapy, your medical team will adjust your treatment plan.
- Your overall treatment plan – The timing and dosage of your chemotherapy sessions depends on whether you are also having surgery or immunotherapy.
- The goal of treatment – Some courses of chemotherapy aim to eradicate every cancer cell in the body, while other courses simply aim to slow the spread of cancer and reduce discomfort.
It is almost impossible to predict with certainty, when you begin chemotherapy, how many sessions you will need or how they will be timed. Your response to the treatment, which your doctors will continuously monitor, plays a role in determining the next steps. If the goal of the chemotherapy is to shrink a tumor before or instead of surgery, then CT scans are the best way to see how quickly the tumor is shrinking.
How Are Chemotherapy Drugs Administered?
The most common route of administration for chemotherapy drugs is by intravenous injection, also known as IV. This means that a small catheter is inserted into a vein. The catheter is then connected to tubes attached to a bag filled with a solution containing the chemotherapy drugs. The solution slowly drips through the tube and into the catheter until the bag of medication is empty. The usual place to insert the IV tube is in a vein in the forearm, especially in patients who are in relatively good health. If the patient’s veins are not readily accessible for IV administration, nurses may need to insert a catheter and leave it in place for several weeks, until the course of chemotherapy is complete. The usual places for inserting a semi-permanent IV catheter are veins in the forearm or wrist.
Some semi-permanent catheters extend outside the skin so that you can insert them and remove them yourself as needed. The downside of these catheters is that you must frequently and carefully clean them to make sure that an infection does not develop. Other catheters are inserted deeper inside the vein. While these are easier to maintain (all they really need is for nurses to check them every time you come in for treatment or tests), they are harder to remove, and minor outpatient surgery is required to remove the catheter when you are finished with chemotherapy.
Intravenous injection is not the only way to administer chemotherapy medications. Some chemotherapy drugs, such as methotrexate, can be administered by intramuscular injection. If you have ever taken an influenza vaccine or COVID-19 vaccine, then you have had an intramuscular injection before; it is simply a shot. Another way of administering chemotherapy drugs is by applying them directly to the site of the cancer, which is the chest cavity in the case of pleural mesothelioma or the abdominal cavity in the case of peritoneal mesothelioma. Sometimes the drug is heated before administration so that it can work more efficiently. These chemotherapy treatments take place during the surgery, while you are still under anesthesia, so they do not hurt. An advantage of applying chemotherapy drugs directly inside the abdomen or chest is that there is less damage to bone marrow, hair follicles, and gastrointestinal cells, and therefore fewer and milder side effects.
Paying for Chemotherapy Treatment
Many prescription drugs are expensive, and most chemotherapy drugs are no exception. Health insurance pays for them, but every insurance plan comes with its own restrictions. For example, your insurance might pay for your chemotherapy sessions if you do them at the university hospital in the next county but not if you do them at the cancer clinic in your own town. If your health insurance is leaving you with hefty bills for chemotherapy, you should contact the Meso Foundation. It will connect you to programs where drug companies subsidize the costs of their chemotherapy drugs.
Drug Interactions and Chemotherapy
Other medications you take can make chemotherapy drugs less effective or cause serious adverse reactions. This could apply to prescription drugs you have been taking for years (for example, blood pressure medication or thyroid medication), over-the-counter drugs (such as pain medications or sleeping pills that you can get without a prescription) or even dietary supplements, such as vitamins. Be sure to discuss all of your medications and supplements with your doctors before you begin chemotherapy.