Small Cell Lung Cancer
Supportive Care
Today, more medications are available to make it easier to prevent and manage the effects of cancer and its treatment effectively and with a better quality of life. Your health care team will draw from a range of supportive care services to address these physical and emotional challenges associated with cancer. Your family members, caregivers and others close to you can also benefit from this support.
Supportive care, also referred to as palliative care, is designed to help anyone with a serious or life-threatening illness. It is available from the time you receive your diagnosis through survivorship. Palliative care is often confused with hospice care, which is reserved for end of life. Think of the purpose of palliative care as “quality-of-life preservation or restoration.”
As an approach to comfort care and symptom management, supportive care addresses the physical, emotional, practical, spiritual, financial and family-related challenges associated with cancer. Many people use it to manage physical side effects, which includes medications for pain, cough suppression and breathing assistance; opening closed airways; appetite stimulants; nutritional supplements to reduce weight loss; and reducing nausea, anxiety, depression, constipation, fatigue and sleep problems. Other resources available include assistance with fitness, mental health and physical/occupational therapy.
Physical Side Effects
Although most cancer treatments have physical side effects, some may be managed or even prevented (see Table 1). Others, however, may be severe. It is also important to receive, discuss and sign a written consent form for any treatment, and to talk with your medical team before treatment begins about the side effects to expect and what to do if they occur. Keep in mind that although it is helpful to talk with others who have had similar diagnoses and treatments, how your body reacts may be different. Stay in close contact with your medical team so they can address your needs promptly and safely. It may also be helpful to keep track of your symptoms. Download a side effect tracker at PatientResource.com/Tracker.
Potentially severe side effects can occur with certain treatments. Though they are uncommon, 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 2). Some irAEs can develop rapidly, becoming severe and even life-threatening without swift medical attention.
Some irAEs 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 medical 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.
Emotional Side Effects
Cancer affects more than just the body. It can upset your overall well-being. Be kind to yourself. Know that everything you feel is normal, and it is healthy and necessary to recognize and learn how to manage your emotions.
Support is available online and from in-person 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 SCLC. It can be very satisfying to share your feelings with people who can relate because they have been through something similar.
Following are some of the common emotions you may experience and suggestions for ways to feel better. However, it is critical to notify your health care team if you are unable to follow treatment due to extreme emotional distress; have excessive crying or continued feelings of hopelessness or despair; are unusually angry or irritable; are withdrawing and isolating yourself from family and friends; or feeling worthless. Get immediate medical attention for thoughts of death or suicide.
Anxiety can begin as soon as you receive your diagnosis and may ebb and flow. Dyspnea (shortness of breath) can worsen anxiety and even cause panic. Moderate to severe anxiety is often treated with medication, therapy or a combination of both. Share your feelings with a trusted friend or by journaling. Explore relaxation techniques, such as meditation, muscle relaxation, yoga or guided imagery.
Depression is a psychological reaction to your situation as a whole. Certain ongoing treatments, such as chemotherapy, can cause or contribute to depression. Don’t avoid talking to your doctor about it because you think depression is just part of having cancer — it isn’t. Talk with a member of your health care team if you feel hopeless, helpless or numb. If these feelings last more than a few days or if you have thoughts of death or of suicide, seek medical attention immediately.
Doubt about the meaning of life and your purpose may arise. 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.
Fear about the treatment, side effects and your prognosis is common. Relying on supplemental oxygen can also be unsettling. Make sure you and your caregiver know how to operate the equipment. Have extra oxygen tanks on hand so you never run out. Making plans may become difficult because every ache and pain triggers a concern. Surround yourself with a medical team you trust and a solid support system, and do your best to take it one day at a time.
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. You may feel the burden of the stigma that often accompanies a lung cancer diagnosis if you used tobacco. Rely on the strength and support of non-judgmental close friends and family members, and consider talking with a therapist about these feelings.
Scanxiety is a word that describes the anxiety that can happen when you are awaiting results from imaging scans, laboratory tests or examinations 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. Set expectations with your medical team so you can know when to expect results instead of being left waiting and wondering. Keep your mind occupied with things you enjoy, such as reading, exercising, social activities or meditation. Staying busy gives you less time to worry.
Other Support Services
Supportive care extends beyond physical and emotional issues. It includes the practical and family-related challenges that accompany cancer. This support also may include financial counseling, help with lifestyle decisions and spiritual guidance. If you need assistance and can’t find it, talk with a member of your health care team. They are skilled and compassionate and can refer you to resources that will help.
Table 1. Some Common Physical Side Effects
| Side Effect* | Symptoms |
| 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 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 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 | 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 sometimes may cause food to taste different (for example, giving it a metallic taste) |
*Side effects listed in alphabetical order. Talk with your doctor about what to expect.
Table 2. 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, fever, shortness of breath, unexplained cough |
| Renal/kidneys | Nephritis | Decreased urine output, blood in urine, swollen ankles, loss of appetite |
| Skin | Dermatitis | Rash, skin changes, itching, blisters, painful sores |
*Body systems listed in alphabetical order. Talk to your doctor about what to expect.
