Chemotherapy Side Effects During Lung Cancer Treatment

Common adverse effects and management

bald woman on chemotherapy leaning against door
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Chemotherapy side effects are relatively common, and may include concerns such as hair loss, bone marrow suppression, peripheral neuropathy, nausea, and more. Fortunately, treatments are now available that have made chemotherapy much more tolerable than in the past. We will look at why these side effects occur, some of the specific problems you may face, and how they are addressed.

Side Effects (Adverse Effects) From Chemotherapy

Understanding adverse effects is easier to understand when you consider how these medications work. Chemotherapy drugs attack cancer cells by interfering with the different steps involved in cell division. Cancer cells are continuously dividing and are therefore most susceptible to these medications, but some normal cells that divide frequently (such as those lining the stomach and mouth, hair follicles, and bone marrow) are also affected.

Everyone experiences chemotherapy differently depending on the medications used and other factors, such as age, sex, and general health. You may have several of the symptoms below, or you may not experience any symptoms at all. Thankfully, the management of these symptoms has improved dramatically in recent years

Be sure to let your cancer team know about any symptoms you are experiencing during chemotherapy, so they can work with you to make the journey as comfortable as possible. Management of side effects has come a long way over the last few decades, and many of these can be controlled with medications and other therapies.

Bone Marrow Suppression

Red blood cells, white blood cells, and platelets are continuously produced in the bone marrow and often affected by chemotherapy. The phrase which describes the reduction of all of these cells due to chemotherapy is chemotherapy-induced bone marrow suppression. Our bone marrow contains the precursor cells (hematopoietic stem cells) which eventually develop into white blood cells, red blood cells, and platelets. When these stem cells are affected by treatment, all of the different cell types are diminished. Your oncologist will monitor these cells with blood counts during your therapy.  

Neutropenia

Chemotherapy can lower the different types of white blood cells, but one type called neutrophils is often of most concern. Neutrophils are very important in preventing infections, and a low neutrophil count can raise the risk of both minor and serious infections. Fortunately, medications that stimulate the product of white blood cells such as Neulasta and Neupogen are available, and are sometimes given routinely with high dose chemotherapy to reduce the risk of infections.

Anemia

Anemia, or a low red blood cell count, is also common during chemotherapy, though often the level is not low enough to require treatment. When severe, a blood transfusion or medications may be required.

Thrombocytopenia

A low platelet count, thrombocytopenia, can increase the risk of bleeding. The platelet count usually needs to be quite low, however, to seriously raise the risk.

Nausea and Vomiting

Nausea is one of the most dreaded side effects of chemotherapy, but ways of managing this symptom have come a long way in recent years. Your doctor may prescribe anti-nausea medications at the time of your treatment in an effort to prevent nausea from occurring altogether.

Diarrhea

Diarrhea can be a dangerous symptom, often prompting a change in the dose of chemotherapy or discontinuing treatment. Dehydration is also a concern if diarrhea is present.

Loss of Appetite

Loss of appetite may occur as a side effect of chemo, but may also be due to the cancer itself. Both nausea and a loss of appetite can result in weight loss. While many people welcome a little weight loss, this can be dangerous in the setting of cancer. Take a moment to learn about how you can manage your symptoms as well as how to recognize cancer cachexia, a syndrome of weight loss with cancer that is responsible for a significant number of cancer deaths.

Hair Loss

Hair loss is usually more of a nuisance than a symptom, but it can be distressing nonetheless. According to research, hair loss is one the most feared side effects of chemotherapy. Some chemotherapy drugs more or less likely to cause hair loss than others, and hair loss can range from a little thinning to total baldness. It helps to be aware (and frequently comes as a surprise) that all hair can be affected, and it is not uncommon to lose eyebrow hair, facial hair, and even pubic hair.

Hair loss usually begins a week or so after the start of chemotherapy and begins to grow back 6 to 8 weeks after completing therapy. Talking about options such as wigs and other head coverings before you lose your hair can ease some of the anxiety at this time. There are some methods to prevent hair loss such as scalp cooling, however, these can be uncomfortable and are not always effective.

A technique called "reframing" is surprisingly helpful in coping with hair loss if you are struggling. With reframing, you don't change a situation, but you change how you feel about the situation. For example, instead of grieving your beautiful head of hair, women can smile that they don't have to shave their legs (and men, their faces) for several months. Reframing can be helpful with many of the side effects of cancer treatment but like many things, you may have to "fake it 'till you make it."

Chemotherapy-Related Fatigue

Of all the chemotherapy side effects, fatigue is one of the most distressing, and can persist long after your infusions are done. Unlike ordinary tiredness, chemotherapy-related fatigue is frequently described as tiredness that does not resolve with rest, “whole body” tiredness, or a feeling in which even the most mundane activities require effort. Fatigue may begin shortly into treatment and can persist for up to a year, and maybe more, following completion.

The first step toward coping with cancer-related fatigue is to understand that it is normal and common. Since there are several "reversible" causes of fatigue during cancer treatment, it's important to mention this side effect to your oncologist. Some causes, such as anemia, can be treated. Most of the causes of fatigue, however, can't be treated directly, but there are still many tips you can follow to help you cope with the fatigue. Asking for and accepting help, and prioritizing your days are musts.

Oral Symptoms

Oral symptoms are common with chemotherapy and can make eating difficult for some people. Symptoms often develop a week or so after beginning chemotherapy and resolve soon after treatment is finished.

Mouth Sores

Mouth sores are very common and can be uncomfortable. Your infusion nurse may have you suck on ice cubes or a popsicle during your infusion to reduce mouth sores, but even with this, mouth sores are common. Carefully choosing foods in your diet, such as avoiding citrus juices, can ease the symptoms until the sores heal.

Taste Changes

Different types of taste changes may occur with different chemotherapy drugs, although "metal mouth" is quite common. Along with avoiding plastic silverware and choosing foods with strong flavors, there are many small changes you can make to ease these symptoms.

Peripheral Neuropathy

Some medications can cause symptoms of numbness, tingling, or burning in the hands and feet. With lung cancer, this is most commonly seen with Platinol (cisplatin), Navelbine (vinorelbine), Taxotere (docetaxel), and Taxol (paclitaxel). These symptoms may occur early on in treatment and go away, or they may occur weeks to months after treatment. In some cases, the symptoms can be permanent. Clinical trials are in progress to find ways of preventing peripheral neuropathy related to chemotherapy.

Coping

Chemotherapy, as well as other treatments for cancer, are physically and emotionally draining. Yet it's also an opportunity to see the glass as half full rather than half empty. Some people have used their chemotherapy infusions as a way to reconnect with different friends. It's not often that many people have the opportunity to spend time together without the distractions of everyday life.

Managing the side effects can also be an opportunity to not only accept a new normal but to strive for an awesome new normal. In addition to traditional treatments, integrative therapies such as acupuncture, meditation, and qigong help some people not only cope with chemotherapy, but continue to obtain the benefits of these therapies after treatment is done.

Reaching out fellow cancer survivors can be priceless. Not matter how close you are to family members or friends, there is something special about being able to talk to someone who truly understands what you are experiencing.

Unfortunately, there are some long-term effects of chemotherapy that can cause symptoms and lower quality of life long after the infusions are finished. Many cancer centers now have rehabilitation programs (such as the STAR program) that are designed to address and treat these lingering problems. Since cancer is a relatively recent addition to cancer care (unlike rehab after a knee replacement or a heart attack that have been standard for a long time), you may need to request a consult.

A Word From Verywell

Many people are frightened by the potential side effects of chemotherapy, and horror stories from the past are still rampant. Fortunately, advances in medicine have made chemotherapy much more tolerable than in the past. At the current time, many people do not experience any nausea or vomiting, and if you do, there are many good options available. Medications are also available that can increase low white blood cell counts, and in doing so, lower the risk of infections.

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