Lung Cancer
Supportive Care
Treating cancer requires powerful strategies. As a result, most of the medications, surgeries, radiation therapies and other treatment methods have side effects. However, the progress being made in cancer care also includes advances in managing and preventing some of those side effects. Be prepared by asking your health care provider about the side effects to expect, and what to do if they occur.
Many people are as worried about the side effects of lung cancer treatment as they are of the cancer itself. Ease your fears by being aware of the following common side effects and asking your health care provider if these or any others may affect you. Keep in mind that not everyone reacts to treatment in the same way. Whether you have side effects, and how severe they are if you do, will be unique to you.
You are encouraged to keep track of your side effects using the Patient Resource Side Effects Tracker (PatientResource.com/Tracker). Alert your health care team at the first sign. Sharing details, such as when they occur and if anything provides relief, helps them understand how best to help you relieve your discomfort.
The following are some common side effects in alphabetical order:
- Bone loss and pain: Weakened bone caused by the cancer or treatment
- Breathing problems: Shortness of breath (dyspnea) with or without cough (may be caused by anemia, a lower-than-normal red blood cell count), upper respiratory infections
- Bruising and bleeding: May be caused by thrombocytopenia, a lower-than-normal number of platelets in the blood
- Chemo brain (cognitive dysfunction): Brain fog, confusion and/or memory problems
- Constipation: Difficulty passing stools or having less frequent bowel movements compared to your usual bowel habits
- Decreased appetite: Eating less than usual, feeling full after minimal eating, not feeling hungry
- Diarrhea: Frequent loose or watery bowel movements that are commonly an inconvenience but can become serious if left untreated
- Edema: Swelling caused by excess fluid in body tissues
- Fatigue: Tiredness that is much stronger and harder to relieve than the fatigue a healthy person has; may also be caused by anemia, a lower-than-normal red blood cell count
- Fever: Raised body temperature that could signal an infection
- Hair loss (alopecia): Hair loss on the head, face and/or body
- Kidney function changes: Changes in urination such as less urine output, burning or pain when urinating, different urine or odor
- Mouth sores (oral mucositis): Tiny sores begin in the mouth lining and become red, burn-like or ulcer-like sores; can make it difficult to eat, drink or swallow
- Myelosuppression: Decrease of red blood cells, white blood cells and platelets that may cause fatigue, dizziness and shortness of breath
- Nausea and vomiting: The feeling of needing to throw up and/or throwing up
- Neuropathy: Numbness, pain, burning sensations and tingling, usually in the hands or feet at first
- Neutropenia/leukopenia: Low white blood cell count that increases the risk of infection
- Pain: Musculoskeletal pain and aches that occur in the muscles, bones, tendons, ligaments or nerves
- Skin and nail reactions: Rash, redness and irritation or dry, flaky or peeling skin that may itch, grooves in nails, thickening or thinning of the nail, pale or dark streaks
- Taste changes: Cells in the mouth that are damaged by treatments may sometimes cause food to taste different (for example, a metallic taste)
- Weight loss: When this happens unintentionally, it may be from decreased appetite, mouth sores or sore throat from radiation therapy that make it challenging to eat, or because your body isn’t absorbing the nutrients needed to maintain weight
Potentially Severe Side Effects
Before beginning treatment, ask your health care provider if your care plan includes drug therapy that may result in serious and potentially life-threatening side effects. Because some of the symptoms are hard to notice yourself, bring your caregiver or loved one with you to hear what to watch for and what action to take if the symptoms occur. Additionally, not all potentially severe side effects are ones you can recognize. Some can only be seen on lab work and imaging results, making it crucial to stay on schedule with your follow-up appointments for monitoring.
Cytokine release syndrome (CRS) can occur if the immune cells affected by treatment release too many cytokines into the bloodstream that can result in a cytokine storm, which can send the immune system into overdrive. A cytokine is a type of protein that is made by certain immune and nonimmune cells. CRS can lead to high fever, inflammation, fatigue and nausea that can be severe and can damage multiple organs. Without swift medical treatment, CRS can be fatal.
Immune effector cell-associated neuro-toxicity syndrome (ICANS) affects a person’s nervous system and can occur in the days to weeks following treatment with certain types of immunotherapy. Symptoms include confusion; behavioral changes; inability to speak or understand speech; attention, thinking and memory problems; muscle weakness, muscle jerks and twitching; headaches; and seizures.
Immune-related adverse events (irAEs) are associated with certain immunotherapy drugs. They can occur if the immune system becomes overstimulated by treatment and causes inflammation in one or more organs or systems in the body. Some irAEs can develop rapidly, becoming severe and even life-threatening without quick medical attention. Others can be detected early during routine laboratory and imaging tests even before you can feel symptoms, which makes it crucial to stay on schedule with all follow-up appointments. Contact your medical team if symptoms arise between appointments and remain alert to the possibility of irAEs for up to two years after completing immunotherapy.
Infection can occur as a result of a low white blood cell count (neutropenia/leukopenia) or other factors. Contact your doctor immediately – do not wait until the next day – if you have any of these symptoms: oral temperature over 100.4°F, chills or sweating; body aches, chills and fatigue with or without fever; coughing, shortness of breath or painful breathing; abdominal pain; sore throat; mouth sores; painful, swollen or reddened skin; pus or drainage from an open cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching.
Infusion-related reactions most frequently occur with drug therapies that are given intravenously (IV) through a vein in your arm or through a port, usually soon after exposure to the drug. Reactions are generally mild, such as itching, rash or fever. Other symptoms, such as shaking, chills, low blood pressure, dizziness, throat tightness, skin rash or flushing, breathing difficulties and irregular heartbeat, can be serious or even fatal without medical intervention.
Table 1.
Immune-Related Adverse Events (irAEs)
| Body System | irAE | Symptoms and Signs |
| Cardiovascular | Myocarditis | Chest pain, shortness of breath, leg swelling, rapid heartbeat, changes in EKG reading, impaired heart pumping function |
| Endocrine | Endocrinopathies | Hyperthyroidism, hypothyroidism, diabetes, extreme fatigue, persistent or unusual headaches, visual changes, alteration in mood, changes in menstrual cycle |
| Gastrointestinal | Colitis | Diarrhea with or without bleeding, abdominal pain or cramping, bowel perforation |
| Liver | Hepatitis | Yellow/orange-colored skin or eyes (jaundice), nausea, abdominal pain, fatigue, fever, poor appetite |
| Nervous system | Neuropathies | Numbness, tingling, pain, a burning sensation or loss of feeling in the hands or feet, sensory overload, sensory deprivation |
| Neurologic | Encephalitis | Confusion, hallucinations, seizures, changes in mood or behavior, neck stiffness, extreme sensitivity to light |
| Pulmonary/lung | Pneumonitis | Chest pain, shortness of breath, unexplained cough or fever |
| Renal/kidneys | Nephritis | Decreased urine output, blood in urine, swollen ankles, loss of appetite |
| Skin | Dermatitis | Rash, skin changes, itching, blisters, painful sores |
Facing your feelings head on
Though some days are more difficult than others, daily life must go on in spite of a cancer diagnosis. Having a healthy mindset not only helps you, it is essential for healing, both physically and emotionally. As you work with your health care team to treat the physical aspects of your lung cancer, it is essential to find ways to care for your mental health.
Cancer taps into many emotions, from fear and anger to sadness and, in some cases, hope and renewal. Your mood may change day to day, even hour to hour. No matter how emotional or unlike yourself you appear to feel, it is important to remember that it is all completely normal. Simply knowing that you may be on this roller coaster of emotions will make it much easier to accept and manage.
Following are suggestions for improving your emotional health.
- Surround yourself with support. The lung cancer community is broad and eager to help. Talk with other people whose lives have been touched by lung cancer.
- Maintain your normal routine. Set a daily schedule. Consistency is comforting.
- Stay active. Any type of physical activity, such as yoga, stretching or walking, is a mood booster.
- Get a good night's sleep. Limit your screen time before bed, and try to sleep seven to nine hours a night.
- Give yourself some grace. Everyone gets angry, stressed or anxious at some point, and you have good reason. Just make sure you don’t let it take over. Have an outlet for when you are upset. Vent to a friend, exercise or have some alone time.
- Pamper yourself. Do not let your world focus only on your illness. Do things you enjoy, such as reading, knitting, having coffee with a friend or getting a massage.
- Refuse to feel ashamed. A dangerous stigma surrounds lung cancer diagnoses, causing feelings of isolation, guilt and sadness. Even if you are or were a nicotine user, no one deserves lung cancer. Talking with people in the lung cancer community can help you work through these heavy feelings.
- Stay positive … most of the time. Allow yourself to have “down days,” but try not to stay down for too long. You may be depressed. If you find that you are suffering so much that you are not able to carry out your daily activities or have thoughts of suicide, contact your health care team immediately.
