Your kidneys, liver, heart and lungs and cancer drugs

Some cancer drugs can change the way your kidneys, liver, heart or lungs work. But your doctor or specialist nurse will do regular tests to check how well they work.

About the kidneys, liver, heart and lungs, and cancer drugs

Doctors use many different types of drugs to treat cancer. Some drugs can cause changes in the way that your kidneys, liver, heart or lungs work.

The changes are usually temporary and stop when your treatment ends. But some drugs might cause permanent changes.

Some chemotherapy drugs, targeted cancer drugs and immunotherapies are most likely to cause these changes. Some hormonal therapies and bisphosphonates cause mild changes. They usually clear up once you have finished treatment.

Even if a drug can cause these effects, it may not affect you that way. Drugs affect people in different ways. It is not possible to tell in advance who will have side effects. It depends on:

• the drug or combination of drugs you are having
• the dose
• how you react to the drug
• how you reacted to drug treatment in the past

You can't have some cancer drugs with certain drugs for heart, kidney and lung problems. Before you start cancer treatment, your doctor or specialist nurse will check if you have any other illnesses. They will also want to know if you are taking any other medicines or herbal remedies.

Your kidneys

Some cancer drugs can change the way your kidneys work. The drugs most likely to cause these changes are some:

• some chemotherapy drugs, such as cisplatin and ifosfamide
• targeted cancer drugs
• immunotherapies
• bisphosphonates

The effect is usually mild but can vary between types of treatments. Other factors may also play a role. For example, how much ifosfamide will affect your kidneys can depend on:

• the total amount of the drug you have had over time (cumulative dose)
• whether you had kidney problems before you started treatment
• whether you have it with a drug called cisplatin

If you are having drugs that might affect your kidneys, you will have a blood test before each treatment. The test checks how well your kidneys are working.

Your doctor may prescribe medicines to protect your kidneys from the treatment. Sometimes they adjust the dose of the drug you are having.

You might have extra fluid through a drip for several hours before and after you have the treatment. Your nurse may also ask you to drink plenty of fluids and to keep a record of how much you drink.

You might have to measure the amount of urine you pass and keep a record. Your nurse might also ask that you weigh yourself before and after treatment. This is to ensure you are not holding fluid.

Let your nurse or doctor know if you cannot drink as much as you have been asked to, for example, if you feel sick. Also, tell them if you’re passing less urine.

Your liver

Some cancer drugs can change the way your liver works. These changes are most likely to happen with some:

• chemotherapy drugs
• targeted cancer drugs
• immunotherapies
• hormone therapies

The effect is usually mild and your liver usually recovers when the treatment ends. Having a combination of drugs can have more of an effect on your liver.

When you are having drugs that could affect the liver, you will have a blood test before each treatment. The test checks how well your liver is working. Your doctor or specialist nurse might change the dose of your treatment if it is affecting your liver. Or they might give you a different treatment.

Your heart

There are cancer drugs that can change the way your heart works. The drugs most likely to cause these changes are some:

• chemotherapy drugs
• targeted cancer drugs
• immunotherapies
• hormone therapies

The effect of these drugs may be temporary but can sometimes be permanent.

A group of chemotherapy drugs called anthracyclines are more likely to affect the heart. These are, for example, the drug doxorubicin. Anthracycline drugs might affect you more if you:

• had treatment with anthracycline drugs before (cumulative dose)
• are obese
• are older than 65
• have existing heart problems
• have high blood pressure
• smoke
• have high cholesterol
• are diabetic

Some cancer treatments might be combined, such as chemotherapy with targeted cancer drugs. The combination of drugs may also affect your heart more.

Your doctor or specialist nurse will check your heart regularly. They will make sure that all treatments are as safe as possible. They will adjust your treatment if necessary. You might have tests to see how well your heart is working. These can be an:

• electrocardiogram (ECG)
• echocardiogram
• multi-gated acquisition (MUGA) scan

Your lungs

Some cancer drugs can change the way your lungs work. The cancer drugs most likely to cause these changes are some:

• chemotherapy drugs
• targeted cancer drugs
• immunotherapies

It is not always clear how exactly some cancer drugs affect the lungs. Some cause inflammation of the lung tissue. This is also called pneumonitis.

Sometimes the lung tissue can get thicker and less flexible and make it harder for you to breathe. This is called pulmonary fibrosis. It might happen gradually over months or years. You might have a cough or feel short of breath or tired.

Some cancer drugs might cause you to become breathless when exercising or walking uphill or upstairs.

Your doctor or specialist nurse will check your lungs to see if the drugs you are having might cause lung problems. They will do so during your treatment and afterwards.

In some situations, your doctor or specialist nurse might have to stop your treatment if the cancer drug causes you to have severe lung problems. To relieve symptoms, they might treat you with a combination of:

• oxygen
• inhalers
• steroids

Let your doctor or nurse know if you feel breathless.