LUNG CANCER

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Lung Cancer

Side Effects of Lung Cancer Treatment

The stress of a lung cancer diagnosis is increased by fears about the side effects of treatment. These fears grow from a belief that the discomfort of side effects cannot be relieved. However, it is now possible to prevent or manage many common side effects of lung cancer treatment. Managing side effects is important because if you feel better, you are more likely to complete your treatment as planned by your treatment team, which offers a greater chance for a good prognosis (outcome).

The side effects of cancer treatment differ in many ways. First, not all people treated for cancer will have the same side effects. A friend or relative may have had a certain side effect after treatment, but that does not mean you will experience the same side effect. Whether or not you experience a side effect depends on many factors, including your age, your overall health, and your specific treatment plan. Second, side effects vary in severity; that is, some cause minor inconvenience or discomfort, and others may cause more discomfort, pain, and/or emotional distress. Lastly, side effects differ according to the type of treatment you receive (Table 1).

Among the most common or troublesome side effects of lung cancer treatment are dyspnea (shortness of breath), nausea and vomiting, fatigue, low white blood cell count (neutropenia), hair loss (alopecia), dry mouth/mouth sores and skin rashes (see Table 2). Many other treatment side effects are possible, including low red blood cell count (anemia), low platelet count (which can cause easy bruising/bleeding), loss of appetite (anorexia) and dehydration. Talk to your doctor about how likely these side effects are with your particular treatment. You can also learn more about these side effects through several reliable online resources noted in the Additional Sources of Information list.

It is impossible to predict how each person will be affected by lung cancer treatment, but talking with your treatment team can better prepare you for what may happen. Knowing what to expect and how to help prevent or manage side effects can help you feel in control of your body, improve your quality of life, and, most important, ensure that you have the best chance for treatment to be effective.

Table 1. Some Common Side Effects According to Type of Lung Cancer Treatment

Type of Treatment	Underlying Cause of Side Effect	Possible Resulting Side Effects
Surgery	Damage to tissues; removal of breast(s), lymph nodes	Pain and weakness in the chest and arm Dyspnea
Chemotherapy	Damage to normal cells, primarily the cells lining the digestive tract and mouth; hair follicles; and blood-forming cells in the bone marrow bone	Nausea and vomiting Hair loss (alopecia) Decrease in the number of red blood cells, white blood cells, and platelets, resulting in fatigue, increased risk for infections, and bleeding, respectively
Radiation therapy	Damage to normal cells, primarily the skin cells in the area being irradiated and the cells lining the digestive tract and mouth	Dry, sore throat Mouth sores Difficulty swallowing Skin sensitivity (redness, dryness, peeling, itchiness Fatigue
Targeted therapy	Blocking of proteins on the surface of cancer cells but also on the surface of other (normal) cells	Acne-like rash Flu-like syndrome Diarrhea/constipation Loss of appetite Fatigue Dry, itchy skin Slow-growing, brittle hair Nausea and vomiting Mouth sores

Table 2. Management of the Most Common Side Effects of Lung Cancer Treatments

Side Effect

What Usually Causes It?

How Is It Prevented or Managed?
What Your Doctor May Do	What You Can Do

Dyspnea (shortness of breath)

Surgery, especially if a large part of the lung was removed

Some chemotherapy drugs

Prescribe drugs that relax lung muscles, open up (dilate) the airways (bronchi), or decrease inflammation and swelling
Refer you to a lung care specialist or a respiratory therapist
If shortness of breath is severe, prescribe small, portable oxygen tanks to use at home

Practice relaxation techniques, such as listening to music, imagining your favorite vacation spot, mediating, or saying a prayer.
Find a comfortable position; leaning forward may help.
Focus on your breathing and try breathing through pursed lips.
Lower the room temperature; a cooler room may make it feel easier to breathe.
Sit near a window, it can help you feel less confined and more relaxed
Aim a fan toward your face; the blowing air may make it feel easier to breathe.

Nausea and vomiting

Many chemotherapy drugs, and the likelihood is highest for cisplatin

As prevention, prescribe antiemetics to begin before chemotherapy begins and to continue for a specific period of time after treatment, with the dosage and drug dependent on the likelihood that the chemotherapy will cause nausea and vomiting. Because some antiemetic drugs work in different ways, a combination of drugs is often the best approach, especially if you will receive a chemotherapy drug that has a high likelihood of causing nausea and vomiting.

Take antiemetics exactly as your doctor has prescribed and not on an “as needed” basis. If you still have nausea, contact your doctor for different antiemetics before you become dehydrated (dehydration will make the nausea worse).
Eat several small meals throughout the day rather than 3 big meals.
Try eating a light meal a few hours before your scheduled treatment.
Drink plenty of fluids at small amounts throughout the day.
Avoid unpleasant odors.
Rest after eating, but don’t lie flat.

Dry mouth/mouth sores

Damage to the salivary glands causes them to be ineffective at producing saliva; may be associated with changes in sense of taste or with difficulty chewing and swallowing

Prescribe a drug to stimulate the production of saliva or recommend an artificial saliva substitute (available as a spray, gel, or tablet)

Keep your mouth and lips moist:

Rinse your mouth with water about every 2 hours during the day)
Apply lip moisturizer often
Suck on tart hard candies
Use cool mist room humidifier at night in the bedroom.

Keep mouth & teeth clean:

Use a soft-bristle toothbrush or mouth swab to clean teeth after each meal and at bedtime
Clean dentures and/or bridge after eating.
Leave out dentures if dry mouth causes discomfort.
Avoid mouthwashes with alcohol base.

Increase fluids:

Drink at least 8-12 glasses of fluid a day, unless advised not to by your doctor.
Carry a water bottle with you and sip frequently during the day to help alleviate dry mouth.

Follow diet recommendations:

Eat a soft, high protein moist diet.
Serve food lukewarm to avoid burning your mouth.
Avoid dry foods (bread, dry meat, pastries, toast and crackers, snack foods that are dry and salty).
Eat moistened casseroles and meats with gravies, sauces, soups, stews.
Avoid citric foods, juices such as tomato, orange, grapefruit based products and sauces.
Avoid carbonated beverages.
Limit coffee, tea and alcohol.

Fatigue

All types of treatment (body needs extra energy to repair healthy tissue damaged by treatment)

Other treatment side effects (pain, nausea and vomiting, sleep disorders)

Non-treatment-related contributors: stress, other medical conditions, altered sleep/wake cycles, and reduced activity

Do lab tests to see if you have anemia (low red blood cell count).

Conserve energy:

Set priorities for activities and do only what is most important
Schedule important activities for times of the day when you have the most energy
Ask friends and family to help
Sit down when washing or grooming
Use assistive devices if necessary (canes, walker, etc.)

Balance activity and rest:

Follow a structured daily routine
Attend to one activity at a time and space activities throughout the day
Participate in regular physical activity, if you’re able
Take frequent rest periods or naps, but limit each nap to 45 minutes
Get 8 hours of sleep each night

Engage in “distracting” or relaxing activities (perform deep breathing exercises, use imagery techniques, read, listen to music, play games, pray/meditate)

Seek relief of other symptoms that may contribute to fatigue (pain, nausea and vomiting, depression)

Maintain adequate nutrition with a well-balanced diet

Low white blood cell count (neutropenia), which increases the risk of infection

Chemotherapy, radiation therapy; the likelihood is greater when both these treatments are given

Order a complete blood count (CBC) regularly, to monitor the number of white blood cells.

If the count is very low, your doctor may delay your next treatment until the count has increased.

If the count is extremely low, prescribe treatment with growth factors, special proteins that can stimulate the bone marrow to produce more white blood cells.

To reduce the risk of infection:

Wash your hands frequently and carefully (especially before eating, after using the bathroom and after playing with pets).
Avoid crowds and people with infections.
Wash fruits and vegetables carefully and avoid raw meat, seafood and eggs.
Know the signs and symptoms of infection (fever, chills, skin that is red and warm to the touch, cough or sore throat, burning when you urinate). Call your doctor if you have any of these signs or symptoms.

Hair loss (alopecia)

Chemotherapy drugs can cause hair loss on the head; radiation therapy causes hair loss only in the area being treated

No medical treatments are available to prevent hair loss

Plan for hair loss by getting a wig and/or head coverings; your local American Cancer Society may provide these for free.

Skin reactions (redness and irritation similar to a sunburn; a rash; or dry, flaky skin)

Targeted therapy drugs; radiation therapy

Order a complete blood count (CBC) regularly, to monitor the number of white blood cells.

Mild reactions do not need to be treated

For moderate and severe reactions, prescribe a medicated cream to control itching and ease discomfort

If infection is likely, prescribe an antibiotic

Refer you to a dermatologist, if the reaction is severe

Taking special care of the skin can help minimize discomfort and promote healing; follow these Do’s and Don’t’s

Wash skin with lukewarm (not hot) water
Take baths rather than showers
Use mild soap that does not contain alcohol, perfume, or dye
Use oatmeal products designed to soothe the skin
Dry skin by patting gently with a soft towel
Moisturize your skin 2 times a day with a thick cream that contains no alcohol, perfume, or dye (apply moisturizer while your skin is still damp after bathing)
Use an electric shaver if shaving is necessary (but check first with your doctor or nurse)
Use paper (not adhesive) tape if bandaging is necessary
Wear loose-fitting clothes
Use gentle laundry detergents (free of perfumes or dyes)
Protect your skin from the sun during treatment and for at least 1 year after the end of treatment

DO NOT

Rub skin with a washcloth or towel
Rub or scratch sensitive areas
Use a pre-shave or aftershave lotion or hair removal products
Use anti-acne skin products containing alcohol, benzoyl peroxide, or retinoids
Put anything hot or cold on the affected area (such as heating pads or ice packs)
Starch your clothes
Be in the sun without protective clothing, wide-brimmed hat, and sunscreen
Use tanning beds

Peripheral neuropathy (hands and feet affected by numbness, tingling, decreased sensation, weakness, and sensitivity to hot and cold)

Chemotherapy drugs, especially cisplatin and carboplatin, as well as vinblastine, vinorelbine, etoposide, paclitaxel, docetaxel, gemcitabine

Adjust the dose and/or schedule of the chemotherapy drug

Prescribe medication to ease pain, if it is severe

Suggest that you see a physical or occupational therapist to help with strengthening exercises and finding ways to carry out everyday tasks with less discomfort

Do stretching exercises, especially before getting out of bed in the morning

Do strengthening muscles with isometric exercises (exercises in which you hold a muscle in a flexed position for a period of time).

Try massage or acupuncture.

Simple strategies to help alleviate discomfort:

Avoid snug shoes or socks
Avoid extreme (hot and cold) temperatures.
Take part in regular exercise, such as walking.

Take safety precautions to avoid injury related to the decreased sensation in your hands and feet:

Keep your house well lighted.
Watch the floor in front of you as you walk.
If you drive, make sure you can feel the pedals with your feet.

Additional Sources of Information

American Cancer Society: www.cancer.org
  Fatigue in People with Cancer
  Seven Ways to Manage Cancer-Related Fatigue
  Managing Side Effects of Chemotherapy: How Do I Deal with Losing My Hair?
  Radiation Therapy Effects: What Can I Do About Hair Loss?
  Nausea and Vomiting
  Peripheral Neuropathy Caused By Chemotherapy
  Anemia in People with Cancer
  Understanding Chemotherapy: Increased Chance of Bruising, Bleeding, and Infection
  Targeted Therapy: Side Effects of Targeted Therapy Drugs
American Society of Clinical Oncology’s patient website: www.cancer.net
  Coping with Cancer-Related Fatigue
  Hair Loss or Alopecia
  What to Know: ASCO’s Guideline on Preventing Nausea and Vomiting Caused by Cancer Treatment
  Skin Reactions to Targeted Therapy
  The Importance of Hydration
CancerCare: www.cancercare.org
Dry Mouth
Cancer Symptoms.org (by Oncology Nursing Society): www.cancersymptoms.org
  About Cancer Fatigue
  Cancer and Chemotherapy-Induced Anemia and Fatigue
  Anorexia
Lung Cancer Online Foundation: www.lungcanceronline.org
Symptoms, Side Effects & Complications
National Cancer Institute: www.cancer.gov
  Coping with Cancer: Managing Physical Effects
  Managing Chemotherapy Side Effects: Alopecia (Hair Loss)
  Managing Radiation Therapy Side Effects: What to Do about Hair Loss
  Nausea and Vomiting (PDQ®)
  Managing Chemotherapy Side Effects: Anemia
  Nutrition in Cancer Care (PDQ®)
  Eating Hints for Cancer Patients: Before, During and After Treatment