10 Facts About NSCLC Treatment Side Effects
Finding out you have advanced non-small cell lung cancer (NSCLC) is scary—no doubt about it. Thankfully, though, treatments for advanced NSCLC have improved over time, meaning that more and more people are living for many years after their diagnosis with better quality of life, according to the American Society of Clinical Oncology (ASCO). That said, it’s important to understand that all treatments come with potential side effects. To prepare you for what to expect—and find ways to manage them—we spoke to the experts to learn more.
There Are Several Treatment Options for Advanced NSCLC
Depending on your specific cancer—taking into account factors such as stage and more—different treatments may be used to treat it, says Jeffrey Crawford, M.D., lung oncologist at Duke Cancer Center in Durham, NC. In general, though, locally advanced cancers—meaning those that have spread to lymph nodes between the lungs—may be treated with a combination of chemotherapy, radiation, and surgery. For those that have spread, treatments may include combinations of chemo, radiation, surgery, targeted therapy, and immunotherapy drugs.
Side Effects Vary by Treatment Type
Potential side effects depend on the treatment, says David Carbone, M.D., lung oncologist at The Ohio State University Comprehensive Cancer Center in Columbus. Chemotherapy, a mainstay of treatment for advanced NSCLC, can cause side effects throughout the body. “These are generally intravenous medications that disrupt how cells divide and grow, and they affect not only the cancer cells but normal cells too,” Dr. Crawford explains. Other types of treatments, such as targeted therapy drugs that target a specific mutation in your cancer, may have different side effects.
Surgery Comes With Potential Risks and Complications
Surgery is mainly used for early-stage lung cancers. That said, surgery may be used in combination with other therapies to treat later-stage cancers—for example, if cancer has spread to the brain and there is only one tumor, it may be removed surgically, Dr. Carbone says. Surgery complications can include blood clots, excess bleeding, pneumonia, anesthesia reactions, and wound infections, according to the American Cancer Society. It’s also important to understand that lung cancer surgery comes with a weeks- to months-long recovery period, depending on the type of surgery.
Fatigue Comes With Most Treatments
If you’re undergoing treatment for advanced NSCLC, it’s a safe bet that you’ll have fatigue along the way. Fatigue affects 80% to 100% of people with cancer, according to the American Cancer Society, and it can be a side effect of chemotherapy, radiation, certain targeted therapies, and immunotherapies. Sometimes, fatigue improves after a treatment ends, in other cases, it can continue long after. There are several ways to help manage fatigue, one of the best being exercise. Yep, physical activity (at a safe level) can improve your energy levels with cancer, according to the National Cancer Society.
Hair Loss Can Be Unavoidable
You likely know that one common side effect of chemotherapy is hair loss. Unfortunately, it’s hard to prevent, Dr. Crawford says. “There are some ice caps and cooling systems some people have used to try to reduce blood flow to the scalp [to prevent hair loss], but they are not widely used.” Losing hair can be an upsetting part of cancer treatment, but it helps to prepare, not only mentally but with practical steps—that might mean cutting your hair short or shaving it before it falls out or investing in a wig (and a couple of super-cute hats), says the American Cancer Society.
Nausea, Vomiting, and Diarrhea Are Common But Treatable
Nausea and vomiting can happen because meds may trigger different parts of the brain and stomach. Thankfully, doctors have a handle on how to help. “We have very good medications to block nausea and vomiting for most patients, even those getting the strongest of chemotherapy,” says Dr. Crawford. “Adjusting diet may also be helpful, such as avoiding spicy or very aromatic foods.” Diarrhea is also a common side effect, which the drug Imodium can help with, he says. It’s important to get these GI symptoms under control because they can contribute to other problems, like fatigue and weight loss.
Skin Changes Can Happen
Certain treatments may affect your skin, including chemo, radiation, and certain targeted and immunotherapy drugs. “Radiation is generally well tolerated, but can cause skin irritation like a sunburn,” says Dr. Carbone. Immunotherapy can also cause some people to develop a skin rash or itching, says Dr. Crawford. Such skin irritation can be managed with mild soaps and moisturizers and in some cases prescription medications from your doctor, according to the American Cancer Society. It’s also important to stay out of the sun if you’re having skin issues as the rays can make things worse.
Your Infection Risk May Rise
“Chemotherapy can cause lowering of the blood counts, which causes tiredness and increases the risk of infection,” explains Dr. Carbone. Also, certain targeted therapies for advanced NSCLC, such as drugs called angiogenesis inhibitors that block the growth of blood vessels that feed tumors, may also reduce your white blood cell counts and up your infection risk, says the American Cancer Society. Your healthcare team will monitor your blood cell counts while you’re being treated. “[Low counts] can be managed by reducing the amount of chemotherapy or using medications that stimulate bone marrow to recover white blood cells,” says Dr. Crawford.
Radiation Side Effects May Be Location Specific
If you are having radiation therapy as part of your advanced NSCLC treatment, side effects may vary depending on the area the radiation is targeting in the body. For example, radiation to the chest can result in a cough or problems with breathing due to damage to the lungs—though this usually improves once treatment is done, per the American Cancer Society. Radiation to the brain for cancer that has spread there may also result in headaches or difficulty with memory or thinking. Some side effects are short-term and end with treatment, while others may last longer.
Communication Is Key in Managing Side Effects
Many NSCLC treatment side effects are temporary during active treatment, per the American Cancer Society, while some can persist for longer. The most important way to manage advanced NSCLC treatment side effects is to communicate well with your doctor. Before a new treatment begins, make sure to discuss potential side effects and management strategies with your healthcare team. “We have really good medications today to control virtually all of the side effects of these therapies, so it is important for patients to let their doctors know about any side effects they have,” Dr. Carbone says.
Non-Small Cell Lung Cancer Treatments: American Cancer Society. (2021.) “Treating Non-Small Cell Lung Cancer.” http://www.cancer.org/cancer/lung-cancer/treating-non-small-cell.html
Cancer and Fatigue: National Cancer Institute. (2021.) “Fatigue (PDQ)-Patient Version.” https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue/fatigue-pdq
Cancer Treatment and Hair Loss: American Cancer Society. (2020.) “Coping With Hair Loss.” https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/hair-loss/coping-with-hair-loss.html
Cancer Treatment and Nausea and Vomiting: American Cancer Society. (2020.) “Understanding Nausea and Vomiting.” https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/nausea-and-vomiting/what-is-it.html
Skin Side Effects: American Cancer Society. (2020.) “Skin Rash.” https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/skin-problems/skin-rash.html