The reality is that most cancer treatments have side effects, so planning for them is important. Your supportive care team members are aware of the many advances that help minimize and even prevent some side effects. Work closely with your team to understand the symptoms and signs to watch for and what to do when you experience one.
Supportive care is available from the time you receive your diagnosis through survivorship. It is also referred to as palliative care, and people often confuse it with hospice care, which is reserved for end of life. Think of palliative care as “quality-of-life preservation or restoration,” and use it for comfort care and symptom management of the physical, emotional, practical, spiritual, financial and family-related challenges associated with cancer.
The following are some common side effects in alphabetical order. Whether you experience them and how you respond to them will depend on many factors, including your diagnosis, treatment plan, health history, age and other characteristics:
- 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
- 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 reactions: Rash, redness and irritation or dry, flaky or peeling skin that may itch
- 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
Though they are not common, potentially severe side effects can occur with certain treatments. Ask your doctor whether you are at risk from the therapies in your treatment plan, how to identify the symptoms and when to seek emergency care. Report symptoms immediately so they can be treated right away. Some potentially severe side effects include the following.
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 (see Table 1).
Some irAEs can develop rapidly, becoming severe and even life-threatening without swift 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.
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|
The emotional effects of cancer
Managing cancer can be so unsettling that it affects your mental health. You may go from being scared or angry to anxious to depressed, sometimes all in a day. Don’t be surprised at the frequency of your mood changes or by how intense your feelings are. Everything you feel is normal, and it is important to approach these emotional side effects as you would physical side effects. Before you become overwhelmed, find out how to get relief and remember that you’re not alone.
Take advantage of the resources around you, starting with your family, friends and community. Your supportive care team can connect you with support groups, advocacy organizations, counselors, psychologists, psychiatrists and other specialists. Some organizations offer one-on-one buddy programs that pair you with another person who has your type of lung cancer. It can be comforting to share your feelings with people who can relate, especially if you experience the stigma associated with having lung cancer. That can be debilitating emotionally, regardless of whether you smoked.
Focusing on relaxing activities, such as meditation, reading or journaling, can help. Yoga, walking and other exercises offer stress relief. Many people believe that having a positive attitude makes a difference. Today, studies are even underway to explore whether a hopeful outlook during cancer treatment may be directly related to a better outcome. Other studies suggest that people who are educated about their illness heal more quickly because they understand and follow their treatment plans more efficiently.
Even with the best intentions, be aware that some days will be more difficult than others. Be kind to yourself, and accept that it is okay to have the occasional down day. Contact your health care team right away if you are unable to follow treatment due to extreme emotional distress. Get immediate medical attention for thoughts of suicide or death.