Do What You Can to Ease Side Effects of Treatment and Symptoms of Lung Cancer

Anemia (low red blood cell levels)

Throughout your treatment, your doctor will test your blood. One thing he or she is checking is your red blood cell count. Red blood cells carry oxygen throughout the body. Any of these things can reduce your red blood cell count: the cancer itself, a small amount of blood loss, or treatment with chemotherapy or radiation. If your body does not have this oxygen, you may feel tired.

If your doctor tells you that you have anemia, take these actions to feel better:

• Take short rests when you're tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of fluids because they help your blood flow and dehydration can lead to fatigue.

• Talk with your doctor about medications or treatments that may help you manage your anemia.

Anxiety and depression

Many people feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress:

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

• Ask your doctor about medications for depression and anxiety.

• Ask your doctor for a referral to a social worker, psychologist, or psychiatrist. 

Appetite loss

People who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their chance of infection. When you're being treated for cancer, a diet high in calories and protein is best. The problem is that side effects of treatment can change or reduce your appetite. Chemotherapy can make you nauseated, change the way food tastes, or make you too tired to want to eat. Radiation can change the way food tastes to you, make it hard for you to swallow, or reduce your appetite.

Ask your doctor for a referral to a registered dietitian if you are having trouble maintaining your desire to eat. Also, try these tips to stimulate your desire to eat:

• If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual.

• If you can, eat high-calorie foods to help you maintain your weight, such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve bowel function. In addition to water, fruit juices, and other liquids, try these foods to increase fluids: gelatin, pudding, soups, Popsicles, and ice cream.

• Eat small meals throughout the day instead of three large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse.

It's important to remember that your body needs energy to heal itself, so maintaining your weight is one way to know if you are giving your body the energy it needs.

Bloating and swelling

Some chemotherapy drugs cause your body to retain water. This water retention will go away when your treatment ends.

Here's what you can do for relief:

• If your bloating is severe, your doctor may prescribe a diuretic or water pill.

• Walking as often as you can may help reduce the bloating.

• Elevating your legs may help reduce swelling.

Keep in mind that bloating and swelling may make it look as if you are maintaining a healthy weight even if you are malnourished. If you're bloated, assess your eating habits and, if necessary, see your doctor or follow the tips under Appetite loss.

Breathing problems--shortness of breath (dyspnea) and coughing

These things may cause shortness of breath: a tumor in your lung or treatment for lung cancer, including surgery, radiation, or chemotherapy. Feeling short of breath may make you feel anxious, which can make breathing problems worse. When you are anxious, you take fewer deep breaths.

Talk with your doctor or nurse about what can help. Also try these tips:

• Sit upright because it will give your lungs room to expand.

• Sleep with the head of your bed raised or sleep in a recliner.

• Use pursed-lip and abdominal breathing. Ask your doctor for instructions on how to do this.

• Avoid climbing stairs since that can tax your breathing.

• Avoid bending over because it compresses your lungs and makes it harder to get the air you need. Wear slip-on shoes so you can get them on without bending over.

• Ask family or friends for help with activities that make you short of breath.

• Avoid things that make your breathing worse, such as high humidity, cold air, pollen, and tobacco smoke.

• Ask your doctor or nurse to show you how to use relaxation exercises.

Constipation

Constipation is difficult or infrequent bowel movements. It can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it's wise to take these preventive actions. These same steps will give you relief if you are already constipated:

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative as prescribed.

Coughing

A tumor in the lung or anything that irritates the lung may cause coughing. If you have a persistent cough, it may increase pain, prevent adequate rest, and promote fatigue. Talk with your doctor about these options for relief:

• Taking prescription cough suppressants

• Learning deep breathing and effective coughing techniques

• Using an inhaler

• Quitting smoking

Diarrhea

Many drugs can cause bowel changes. Diarrhea is loose or frequent bowel movements, or both. It may lead to dehydration if you don't take these precautions:

• Avoid milk and milk products.

• Eat low-residue, low-fiber foods, such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Increase your intake of fluids (such as water and broth) to prevent dehydration.

• Ask your doctor about medications that may help.

Hair loss (alopecia)

Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will probably grow back after treatment. Try these coping tips:

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Insomnia (trouble sleeping)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Taking steroids, in particular, may cause insomnia. Use these tips to improve your rest:

• Keep a regular bedtime schedule.

• Use your bed only for sleeping, not for watching TV. Then your mind associates your bed only with sleep.

• If you don't fall asleep in 15 minutes, get up, do something else, and try again later.

• Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

• Don't eat, drink fluids, or exercise close to your bedtime. These may stimulate you and keep you awake.

• Avoid taking long naps during the day.

Mouth sores (mucositis)

Mouth sores may develop after some chemotherapies or after radiation to the head or neck area. Mouth sores may hurt and make eating an unpleasant experience.

To help prevent mouth sores, take these actions:

• Brush your teeth after meals and before bedtime. If you already floss every day, continue to do so. If not, talk to your doctor before you start. 

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to help keep your mouth moist.

To help ease the pain, take these actions:

• Avoid alcohol and mouthwashes containing alcohol because these may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco; doing so may help prevent sores. And using tobacco may irritate sores.

• Ask your doctor about topical mouth medications. These are medicines you put on the sores.

• Take over-the-counter pain-relief medication, such as acetaminophen, if necessary.

Be sure to continue getting proper nutrition. If you cannot eat, talk with your doctor or nurse about liquid food supplements that may give you the nutrition you need. Also, call your doctor or nurse if your temperature reaches 100.5 degrees or higher because this is a sign of infection.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe.

It may help you to understand the different types of nausea:

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting means vomiting occurs despite treatment to prevent it. It requires other types of treatment.

• Refractory vomiting occurs after one or more treatments--essentially, you're no longer responding to antinausea treatments.

To prevent nausea, take these actions:

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then, make sure you take it as directed. If you are vomiting and cannot take your medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed.

To help ease nausea or vomiting if you have it, try these tips:

• Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu, morning sickness, or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help decrease your nausea.

Neutropenia (low white blood cell levels)

Throughout your treatment, your doctor will test your blood. One thing he or she is checking is your white blood cell count. Many chemotherapies can cause low white blood cell counts, or they can be caused by the cancer itself. Without enough white blood cells, your body may not be able to fight infection. If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

• Avoid crowds or people with colds.

• Wash your hands often throughout the day to kill germs. Keep your body clean to keep the number of bacteria down.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees or higher; severe chills; a cough; pain or a burning sensation during urination; or any sores or redness.

• Talk with your doctor about medications that may help prevent your white blood cell count from dropping when you take your chemotherapy.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some chemotherapies are known to cause this, for instance Taxol (paclitaxel). Other signs of this problem are ringing in your ears or feeling hot or cold. If you have symptoms such as these, take these precautions to protect yourself:

• Take extra care walking and moving so that you don't fall.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing so you're less likely to slip.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. He or she can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving because you may have trouble feeling the gas and brake pedals. Ask friends and family to drive you places.

Pain

You may have pain from the tumor pressing on organs. Or you may have pain as a result of treatment, such as from cuts made during surgery. Try these tips to ease pain:

• Take your pain medications regularly. Don't wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

• Change your activity level. See if you feel better if you rest more or move around more--either may help.

• Distract yourself with music, funny videos, or computer games.

• Use heat, cold, relaxation techniques (such as yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexuality/reproductive issues

Sexuality issues may include reduced libido (interest in and ability to have sex) and infertility. Treatments can contribute to this, as well as the general psychological problems associated with cancer.

Taking these actions may help you cope with these changes:

• Talk with your partner about changes in your desire or ability to have sex.

• Explore new ways to share affection and intimacy.

• See a counselor who specializes in sexual problems.

• If childbearing is an issue, talk with your doctor about this before your treatment. There may be ways to store sperm in a bank or protect your ovaries.

• Talk with your doctor about birth control options if you are on active treatment for your cancer.

Skin changes

Radiation treatment can cause dry or red skin in the area being treated. You may also have nail changes, such as splitting or slower growth. Some targeted therapy drugs may also cause skin changes such as rashes. If you have skin changes, take these steps to protect yourself: 

• Protect your skin from sun exposure, especially between 10 a.m. and 3 p.m., by wearing sunscreen with an SPF of at least 30.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sunblock, perfume, cosmetics, or powder on your skin within two hours after radiation.

• Wear loose, soft clothing over the area treated with radiation.

• Don't scratch, rub, or scrub skin treated with radiation.

• Don't bandage skin with tape. If you must bandage it, use paper tape and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don't apply heat or cold to the area treated with radiation. Bathe only with lukewarm water.

• If you must shave the treated area, use only an electric shaver. Don't use lotion before shaving. And don't use hair-removal products.

• Keep your nails well trimmed and clean so you don't scratch the sensitive skin.

Thrombocytopenia (low platelet count)

When your doctor tests your blood throughout your treatment, one thing he or she will check is your level of platelets. Reduced platelets can be a side effect of chemotherapy. Without enough platelets, your blood may have difficulty clotting. If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to uncontrolled bleeding:

• Protect your skin from cuts, scrapes, and sharp objects.

• Shave with an electric razor.

• Use a soft toothbrush to prevent bleeding gums.

• Take steps to prevent constipation, which can lead to hemorrhoids.

• Call your doctor if you develop a rash, bleeding, or bruising.

• Talk with your doctor about medications that may help prevent your platelets from dropping when you take your chemotherapy.

Tiredness (fatigue)

Tiredness is a very common symptom and side effect from chemotherapy and radiation treatments. You may feel only slightly tired, or you may suffer from extreme fatigue. Fatigue can last four to six weeks after treatment ends.

Taking these actions may help increase your energy level:

• Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine because it stimulates better sleeping.

• Save your energy for important tasks.

• Drink plenty of fluids because it improves blood flow and keeps the cardiovascular system functioning.

• Take action to treat a poor appetite because eating improperly can make you tired.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

Trouble thinking and remembering (chemo brain)

You may have mild problems with concentration and memory during and after chemotherapy. Fatigue can aggravate the problem. Taking these actions may help:

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks. 

For More Information

For more information on how to quit smoking or schedule lung cancer screenings, contact Nancy Sayegh-Rooney, R.N., Pulmonary Nurse Navigator at Richmond University Medical Center, 718-818-2391.

Free screenings are available for at-risk individuals, please call for additional information.