Today, let’s talk about a problem you may encounter after lung cancer treatment is complete, or even cured: delayed side effects.
Lung cancer treatment side effects can be divided into two categories: acute side effects and delayed side effects.
Acute side effects are more familiar, such as diarrhea from chemotherapy, hair loss, and rash from EGFR-targeted drugs, and they usually come on quickly with the drug but go away when you stop taking it.
There is another category of side effects, delayed side effects. They can last a long time after cancer treatment, or they don’t appear immediately after treatment, but instead show up over years and years.
I have repeatedly stressed the importance of follow-up after cancer treatment. One of the key reasons is to monitor for delayed side effects. Many delayed side effects can be managed, and if you can communicate with your doctor and intervene in a timely manner during the follow-up process, it can be a great benefit to everyone’s recovery.
(Image from Station Cool Helo)
So what are the common delayed side effects of lung cancer?
Lung problems
- There is a higher risk of lung damage from receiving chemotherapy and radiation to the chest, which may cause symptoms such as shortness of breath, wheezing, fever, dry cough, congestion, and fatigue.
Control methods
- Oxygen therapy: If there is severe respiratory distress, your doctor may recommend oxygen therapy. It is most commonly inhaled through a nasal cannula or through a face mask. In some cases, a ventilator may be used.
- Exercise: Proper exercise can help restore lung function. Be sure to check with your doctor about which exercises are safe and appropriate.
- Smoking cessation: Smoking can significantly worsen lung problems, so it is important to quit; also try to avoid secondhand smoke.
- Take medications: Your doctor can prescribe medications to help patients relax during breathing difficulties, relieve discomfort and stop pain. For example, some patients take steroid medications.
Bone loss (osteoporosis)
- Chemotherapy, steroid drugs, hormone therapy, or radiation therapy can all cause bones to become thin and brittle.
Control methods
- No smoking.
- Drink less alcohol.
- Eat foods rich in calcium and vitamin D.
- Eat foods that are rich in calcium and vitamin D.
- Participate in walking, jogging, or other weight-bearing exercise.
- Possible symptoms of delayed brain side effects that may result from some chemotherapy drugs and brain radiation include memory loss, decreased ability to calculate, difficulty concentrating, slower reactions, changes in temperament, and mobility problems.
- Help with medication or surgery to help relieve symptoms.
- Chemotherapy, hormone therapy, immunotherapy, and steroid medication use may all increase the risk of cataracts. A cataract is a condition in which the lens in the eye becomes cloudy. It may cause symptoms such as blurred, hazy or double vision, sensitivity to light, and difficulty seeing at night. Some other chemotherapy drugs may cause dry eye.
- If cataracts become severe, they can be treated with surgery. The doctor replaces the cloudy lens with an artificial lens. Patients can usually be discharged within a day.
- If you have dry eye, your doctor will prescribe eye drops or eye ointment regularly.
- Some specific chemotherapy drugs (especially cisplatin and high-dose carboplatin), as well as high-dose radiation therapy to the brain, may cause hearing damage.
- Pay strict attention to the signs of hearing damage. You should talk to your doctor as soon as you notice a change in your hearing.
- Radiotherapy to the head and neck and some chemotherapy drugs may cause side effects in the mouth area, including dry mouth, tooth decay, or osteoporosis in the mouth area.
- Perform oral exercises: 20 sets of 20 mouth opening and shutting exercises are recommended for 3 sets per day, when possible without pain.
- Stimulate saliva production: Patients are advised to carry a water bottle with them and drink water at all times. Saliva production can also be helped by chewing gum (sugar-free gum is recommended).
- Care for teeth and gums: Consistently brush daily after meals and before bed, floss and use a fluoride (alcohol-free) mouthwash.
- Some drugs used to treat lung cancer and chest radiation may cause heart problems, including weakened heart muscle (congestive heart failure), coronary artery disease, and more.
- Watch your fluid intake: Consuming too much fluid can make heart problems worse. For people with heart failure, it is important to choose the right type of fluid and the right amount.
- Lose weight safely: If a patient is overweight, it can increase the burden on the heart.
- Exercise: The right type of exercise and the right amount of exercise can help keep a patient’s heart healthy.
- Stop smoking and drinking. Smoking and drinking can worsen heart failure.
- Get enough sleep.
- Follow your doctor’s instructions and take the relevant medications.
- Radiotherapy, some chemotherapy and steroid drugs can cause loss of joint flexibility, such as in the jaw, shoulders, hips or knees.
- Difficulty opening the mouth.
- Pain when performing certain movements, such as putting your hand behind your head or putting your hand in your back pocket.
Brain changes
Control methods
If you are experiencing any of these symptoms, you first need to be tested to determine if it is from the cancer itself or a delayed side effect. If it is determined to be a delayed side effect, possible responses are:
- Seek help from a physical therapist, functional rehabilitation therapist, or speech therapist.
Eye problems
Control methods
- If you are at risk for cataracts, you will need to see your eye doctor regularly after your cancer treatment ends.
(Image from Good Site Cool Helo)
Hearing impairment
Control methods
- If you have experienced a cancer treatment that may have caused hearing damage, you should see an audiologist at least once after you finish treatment. The frequency and number of visits to the audiologist varies depending on the treatment plan and the amount of treatment.
Oral changes
Control methods
- Visit your dentist: Have your teeth checked every 1 to 2 months for 6 months after your radiation therapy ends.
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Heart problems
Control methods
- Eat a heart-healthy diet: include a variety of fruits, vegetables, and whole grains. Your doctor may recommend a low-salt diet, as salt can cause extra fluid to build up in the body, making heart problems worse.
(Image from Station Cool Helo)
Joint changes
Means of control
It is important to be aware of early signs of worsening joint problems and to intervene early. These signs include:
If these conditions occur, the physician may recommend a physical therapist to evaluate and recommend some exercise exercises for the patient. Exercises in physical therapy can reduce pain, increase strength and improve movement. In some cases, the physician may recommend a knee or hip replacement.
In addition to the above, lung cancer treatment may cause other delayed side effects, such as endocrine system changes, including effects on the thyroid gland, effects on menopause, effects on sexuality and fertility, and so on, some of which vary markedly depending on the gender and age of the patient and are too complex to expand on here. For more information on what drugs affect the endocrine system and how they are already managed, please refer to the National Cancer Institute (NCI) website.
Female sexuality and fertility issues:
https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-fertility-women
Male Sexuality and Fertility Issues:
https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-fertility-men
In conclusion, beating cancer is definitely something to celebrate, but be aware of delayed side effects. Follow up on time, keep it under active control, and try to get back to a healthy life soon!