Lung Cancer

Supportive Care

One of your biggest concerns may be how the side effects of lung cancer treatment will make you feel. You may have friends who have had cancer treatment and heard about their side effects, so you may have certain expectations. However, keep in mind that every person’s reaction is unique, even when the diagnosis and the treatment are similar. And though cancer treatments are typically accompanied by some side effects, it may reassure you to know that the ways to prevent and manage them continue to improve.

Your health care team members are skilled in side effect management. They will draw on a group of wide-ranging services known as supportive care to relieve your symptoms from the cancer while preventing, minimizing and effectively managing treatment-related side effects.

Some common physical side effects from cancer treatment are shown in Table 2. Symptoms may be more intense when treatments are given in combination. As you look them over, remember that you likely will not have them all.

To be most effective, your health care team will rely on you to communicate openly about how you feel. As you and your doctor discuss the potential side effects that may occur with each treatment option, ask about the symptoms to watch for and what you should do if they happen. Some may require alerting the health care team as soon as symptoms begin, because prompt treatment may help prevent more serious complications.

Potentially Severe Side Effects

Severe side effects aren’t common but can occur with certain types of cancer treatment. Ask your doctor if any therapies in your treatment plan could cause severe side effects. Find out how to identify the symptoms and report them immediately if they occur.

Immune-related adverse events (irAEs) are potentially serious side effects of 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. Before beginning immunotherapy, talk with your doctor about your risk for irAEs and learn the symptoms.

Making and keeping all medical appointments on schedule is very important because routine laboratory tests and imaging may detect an irAE in early stages before you can feel symptoms. Contact your health care team if symptoms arise between appointments, and remain alert to the possibility of irAEs for up to two years after completing immunotherapy. If you have transportation problems, tell your navigator so that transportation services can be arranged for you.

Infection can occur as a result of a low white blood cell count (neutropenia) 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 treatments that are given intravenously (IV) through a vein in your arm, 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

Some Common Physical Side Effects

Most cancer treatments have physical side effects, but you likely won’t experience all of them. People respond differently, even if they have the same diagnosis and type of treatment. Knowing the symptoms will help you recognize physical side effects more easily.

Side Effects Symptoms
Anemia Low energy, weakness, dizziness, light-headedness, shortness of breath, rapid heartbeat
Bone loss and pain Weakened bone caused by the cancer or treatment
Breathing problems Shortness of breath (dyspnea) with or without cough, upper respiratory infections
Chemo brain (cognitive dysfunction) Brain fog, confusion and/or memory problems
Constipation Difficulty passing stools or 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
Fever Raised body temperature that could signal an infection
Hair loss (alopecia) Hair loss on the head, face and body
Nausea and vomiting Stomach upset, and the urge to throw up
Neuropathy Numbness, pain, burning sensations, and tingling, usually in the hands or feet at first
Neutropenia 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
Thrombocytopenia Low number of platelets in the blood, which can lead to bruising and bleeding

Explore Other Areas of Support

Supportive care offers much more than physical relief. It is also designed to ensure your whole person is cared for, and that includes help with the emotional, practical, spiritual, financial and family-related challenges you may have. If you need help in an area not listed here, talk with a member of the team.

Emotional support is available in many forms, both in person and online. Many organizations offer one-on-one buddy programs that pair you with another person who has the same type of cancer as you. Sharing your feelings with people who can relate because they have been through something similar can be very satisfying.

Dietary support may be needed if you have challenges eating or with your appetite. If a dietitian or nutritionist is not on your health care team, ask for a referral.

Sexual health is an important part of life – physically and emotionally – and it should not be ignored because of a cancer diagnosis. Talk with your doctor about ways to maintain your sexuality, or ask for a referral to a therapist who has experience working with people who have cancer.

Spiritual or religious guidance may be available from a chaplain or spiritual care advisor at the hospital or in your religious community. Spiritual support is available to you even if you do not consider yourself a religious person.

Financial counseling is accessible from a social worker, nurse navigator or financial counselor. The stress and anxiety of paying for treatment and other related expenses can negatively affect your well-being. Understanding the costs early and learning about the resources that may help financially may make you feel more in control. 

Try to maintain a healthy state of mind

Emotional side effects are expected with a cancer diagnosis, but it is crucial that you acknowledge and address them. Having a positive sense of well-being can help you cope and manage physical side effects better.

The following are some emotions you may have and suggestions for ways to feel better. Contact your health care team about excessive crying or continued feelings of hopelessness or despair. Get immediate medical attention for thoughts of suicide or death.

Remember, you’ll have ups and downs that may be unpredictable, but you don’t have to go through them alone.

Anxiety can begin as soon as you receive your diagnosis. Moderate to severe anxiety is often treated with medication, therapy or a combination of both. Explore relaxation techniques, such as meditation, muscle relaxation, yoga or guided imagery. Peer-to-peer cancer support volunteers can offer insight into what to expect, and they’re often available by phone or online.

Depression is a psychological reaction to your situation as a whole. Certain ongoing treatments, such as chemotherapy or hormone therapy, can also cause or contribute to depression. Don’t avoid talking to your doctor about it because you think depression is just part of having cancer. Talk with your doctor if you feel hopeless, helpless or numb. And if these feelings last more than a few days or if you have thoughts of death or of attempting suicide, seek medical attention immediately.

Doubt can lead to confusion and questions about the meaning of life and its purpose. Some people find strength in support from family, friends, the community or spirituality. It may also help to open up to a counselor or support group.

Embarrassment is possible after receiving your diagnosis. A great deal of stigma surrounds a lung cancer diagnosis, but it shouldn’t. Lung cancer occurs in people who both have and have not used tobacco.

Fear is common. Making plans may become difficult because every ache and pain triggers a concern. Do your best to stay focused on the present.

Guilt may occur if you feel you’ve been a burden to loved ones or if you wonder why you survived when others with similar conditions didn’t. Talk with a therapist about these feelings. You might find that you can lessen your guilt by giving back to the cancer community. Helping others can provide a sense of purpose and well-being that can help take away blame you may be placing on yourself.

Scanxiety is the anxiety that can happen when you are awaiting results from imaging scans, laboratory tests or exams you have as part of your treatment or follow-up plan. Scanxiety can be extremely stressful, and it may help to find ways to manage it. First, remind yourself that it is normal to feel this way. Set expectations with your doctor or nurse about when and how you will receive the results so you are not left waiting and wondering. Keep your mind occupied with things you enjoy, such as reading, playing games or gardening. Staying busy gives you less time to worry. Consider discussing your fears with your friends, a support group or a therapist.