Lung Cancer

Plan Ahead For Managing Potential Side Effects

When you’re diagnosed with lung cancer, it’s normal to be concerned about how you’ll be affected by your treatments and by the disease itself. A group of wide-ranging services known as supportive care is designed to help you address the physical, emotional, practical, spiritual, financial and family-related challenges you may experience as a result of your cancer diagnosis and treatment. These valuable resources are available from diagnosis through survivorship. Ask your nurse navigator about the services offered at your cancer facility and in your area.

Primary goals of supportive care are to relieve cancer symptoms, prevent, minimize and effectively manage treatment-related side effects and keep you as comfortable as possible throughout treatment. Discuss potential side effects with your health care team and ask for a list of symptoms to watch for before you begin treatment. Alert your team as soon as any symptoms they have identified as needing immediate attention start. Prompt treatment may help prevent more serious complications.

Be your own best advocate by communicating frequently and openly with your health care team about how you’re feeling.

Potentially Severe Side Effects

Severe side effects aren’t common but can occur with certain types of treatments. Ask your doctor if you are at risk and how to identify the symptoms. Report symptoms 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. 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.

The systems affected by irAEs and common symptoms are as follows. Ask your doctor for a list of symptoms and side effects that may apply. Some may include:

  • Cardiovascular (cardiomyositis): chest pain, shortness of breath, swelling in the legs, palpitations (rapid heartbeat), changes in EKG reading
  • Endocrine (endocrinopathies): hyperthyroidism, hypothyroidism, extreme fatigue, persistent or unusual headaches
  • Gastrointestinal (colitis): diarrhea with or without bleeding, abdominal pain, bowel perforation
  • Liver (hepatitis): yellow skin or eyes (jaundice), nausea, abdominal pain, fatigue, fever
  • Nervous system (neuropathies): numbness or tingling, pain, burning, 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 (pneumonitis): chest pain, shortness of breath
  • Renal/kidneys (nephritis): decreased urine output, blood in urine, swollen ankles, loss of appetite
  • Skin (dermatitis): rash, skin changes

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 100.5°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 treatment 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.

Common Side Effects

The following side effects may result from various cancer treatments, so only some may apply to you. Symptoms may be more intense when treatments are given in combination.

Anemia results from an abnormally low red blood cell count. Red blood cells carry oxygen to the body’s tissues. Anemia can cause fatigue, weakness, shortness of breath, dizziness and other symptoms. It can be temporary or long lasting.

Bone loss can result from certain cancer treatments or the cancer itself. Once bone is lost, it cannot be replaced, and as a result, bones become thin, porous and brittle. Your doctor can monitor your bone health through scans taken before, during and after treatment and may prescribe bone-modifying drugs.

Cognitive dysfunction (chemo brain) can occur when people undergoing treatment have trouble thinking clearly, finding the right word or remembering details, such as names and dates. Often associated with chemotherapy, it can also result from other treatments and may occur to some degree for weeks, months or even years after treatment.

Coughing may occur because your lungs may be vulnerable to an upper respiratory infection due to a lowered immune system or from complications with treatment. Your doctor may prescribe medications or recommend over-the-counter medications. Talk to your doctor about any breathing difficulties right away.

Diarrhea is characterized by having loose stools and/or more frequent bowel movements than is normal for you. If diarrhea is a potential side effect of your therapy, ask about preventive medication beforehand. It can significantly affect your quality of life. Severe cases can lead to dehydration and loss of essential nutrients. Diarrhea can also signal an immune system near overload. Contact your health care team if you have more than six episodes in 24 hours. Make your treatment team aware of your normal bowel habits so these patterns can be factored in to mana-ging your bowel regimen going forward.

Difficulty breathing (dyspnea) , with or without coughing, can be a side effect but may also signal a serious condition, such as pneumonitis or a respiratory tract infection. Contact your doctor immediately if you are short of breath or have difficulty breathing.

Fatigue related to cancer or its treatments is more severe than general tiredness, lasts longer and may not be relieved by sleep. If fatigue regularly keeps you from your normal activities and things you enjoy, talk with your health care team about your options.

Hair loss (alopecia) can affect your entire body. Scarves, hats, turbans, caps and other head coverings are available. If you’re interested in a wig, ask your oncologist for a prescription for “a cranial prosthesis due to alopecia caused by cancer treatment.” This wording may make it eligible for full or partial coverage as a medical expense, but check first with your health insurance provider. You may also consider asking your doctor about “cooling cap” therapy to prevent hair loss and over-the-counter topicals or serums to preserve your eyebrows.

Loss of appetite (anorexia) is a common symptom of cancer and its treatments. To prevent weight loss, try to maintain a nutritious diet during and after treatment. If you cannot eat enough food to maintain your weight, talk to your doctor.

Nausea and vomiting are much easier to prevent than control, so ask your doctor about antiemetics (anti-nausea drugs) before treatment begins. Commonly, patients are given a prescription for an antiemetic in case these side effects happen. Your doctor may recommend taking it before treatment to prevent nausea and vomiting from happening at all. Severe vomiting can lead to dehydration. Contact your doctor about any of these serious symptoms: more than three episodes of vomiting an hour for at least three hours, blood in vomit, vomit resembling coffee grounds; weakness or dizziness; or being unable to keep your medications down, eat solid food for more than two days or drink more than 8 cups of fluid or ice chips in 24 hours.

Pain may be caused by a tumor pressing on organs, tissues or joints, or cancer that has metastasized to bone. This pain is often felt in the back, pelvis and hips, which are common sites of bone metastasis. External-beam radiation therapy can be used to relieve that pain, and low-level radiation can be injected into your veins if you have multiple sites of painful metastases. Talk with your treatment team about the options available to you.

Peripheral neuropathy can result from certain treatments or the disease itself. Symptoms may include tingling, numbness, pain or a burning sensation, often in the hands and/or feet at first. Normal activities, such as buttoning clothes, writing, walking and/or keeping your balance, may become difficult.

Skin reactions can include redness and irritation similar to a sunburn; rash; dry, flaky and/or itchy skin; and nails becoming discolored or forming ridges. Most reactions are mild to moderate, but some can become severe without early treatment.

Thrombocytopenia results from a low number of platelets in the blood, which can be caused by certain treatments or the disease. Symptoms include bruising, bleeding and clotting problems. If tiny speckled spots or large bruises appear on your arms or legs while you are undergoing chemotherapy, notify your doctor immediately. Avoid taking Omega 3 supplements, aspirin and other blood thinners, and inform your health care team about all other nonprescription medicines and supplements you take, as some may add further complications.

Take Care Of Your Emotional Well-Being

Cancer can affect you emotionally as well as physically. It’s common to experience anger, fear, guilt, insecurity, loneliness and other emotions. Taking care of your emotional well-being will help you better cope with cancer-related issues, including managing side effects. Supportive care services can connect you with resources to help you work through your feelings. These suggestions may also help.

  • Allow yourself to fully express your emotions when they occur to help you avoid releasing bottled-up feelings in unhealthy ways.
  • Cancer survivors can be a great source of support, friendship and insight. Ask about cancer support groups available in your community, options for online support or phone-based peer support programs.
  • Explore meditation, gentle yoga, massage therapy, deep breathing exercises or other relaxation techniques.
  • Get outside, regardless of the season. Fresh air and nature can be therapeutic.
  • Express your feelings by writing in a journal.
  • Take charge of things you can control. If decision-making feels overwhelming, ask loved ones to handle routine decisions for now.
  • Give yourself permission to grieve the loss of the life you had before cancer. Share your feelings with someone you trust.
  • Staying positive is important, but give yourself a break when you need it.
  • Find something to laugh about every day.
  • It’s extremely important to talk with your doctor about feeling depressed, hopeless or desperate, particularly if these feelings last more than a few days.
  • Seek medical attention immediately for thoughts of suicide.
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