Lung Cancer
Supportive Care
Most cancer treatments cause some type of side effect. Fortunately, the advances in treatment strategies also include ways to prevent and minimize the effects of treatment. Supportive care services can help you with the physical and emotional side effects that accompany your lung cancer diagnosis and treatment. These valuable resources are available from diagnosis through survivorship. Ask your health care team about the services offered at your cancer facility and in your area.
Also referred to as comfort care and symptom management, supportive care can also address the practical, spiritual, financial and family-related challenges associated with cancer. Many people use it to manage physical side effects, but other resources available include assistance with nutrition, fitness,
mental health and physical/occupational therapy. Your family members, caregivers and others close to you can also benefit from this support.
As you discuss treatment options with your doctor, ask about the potential side effects of each. Keep in mind that how you respond to those side effects will depend on many factors, including your specific diagnosis, health history, age and other characteristics. Ask whether telehealth appointments or an online portal are available for reporting symptoms or complications between follow-up visits.
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
- 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
The drug therapies used for treating cancer are powerful. Some can even be accompanied by side effects that may become serious and potentially life-threatening. If any of your therapies have the potential to cause a severe effect, it is critical to discuss with your doctor what to watch for before treatment begins. Not all potentially severe side effects are ones you can recognize. Some are only identifiable on lab work and imaging results, so it is 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 neurotoxicity syndrome (ICANS) is a clinical and neuropsychiatric syndrome that can occur in the days to weeks following treatment with certain types of immunotherapy, especially immune effector cell and T-cell engaging therapies. ICANS affects a person’s nervous
system. 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 |
Managing the emotional effects of cancer
Receiving a cancer diagnosis can bring up a range of emotions. This is completely normal. Feelings may include fear, anxiety, anger depression, loneliness, guilt, etc. Just as you will need to treat physical side effects, it is important to manage emotional concerns and side effects that you may experience as well.
No one should go through cancer alone, and lung cancer can feel especially isolating. Regardless of whether you have smoked in the past or not, facing a lung cancer diagnosis can be complicated by the stigma surrounding it. Draw on the support of your family, friends, and community. Do not hesitate to ask for a referral to a patient counselor or mental health professional to help you work through your feelings. Many mental health professionals are especially trained to help people with a cancer diagnosis.
Maintaining your mental health and staying positive will be crucial during treatment. Studies have found that adopting a positive outlook during treatment can lead to a better quality of life. Even with adopting the suggestions on this page, it is important to realize that some days will be more emotionally difficult than others. Allow yourself to have bad days. When they happen, try to be gentle with yourself and try any of the suggestions listed here to help bring some comfort. Be sure to contact your health care team immediately if you are unable to follow your treatment regimen due to extreme emotional distress, and seek immediate medical attention if you are experiencing suicidal thoughts.
Suggestions to boost your emotional health
- Talk with other people who have experienced lung cancer.
- Educate yourself on your diagnosis.
- Try gentle exercise, such as walking or yoga.
- Avoid limiting yourself from things you enjoy.
- Create a schedule for your days to offer structure.
- Spend time in nature.
- Read survivor stories.
- Call a friend or family member.
- Take time to journal or read.
- Practice breathing deeply to calm your anxiety.
- Sleep at least 8 hours per night and avoid screen time before bed.
- Find activities that bring you happiness (e.g. knitting, cooking, coloring, etc.).
