What are the most common side effects of Non-Small Cell Lung Cancer treatment

Common Side Effects of Non-Small Cell Lung Cancer Treatment

The side effects you experience depend on which type of treatment you receive—surgery, radiation therapy, chemotherapy, immunotherapy, or targeted therapy. Let me walk you through what's most common for each approach.

Radiation Therapy Side Effects

According to the NCCN Guidelines for Patients, radiation therapy side effects are cumulative, meaning they build up slowly and tend to be worse toward the end of treatment. The good news: most side effects typically improve 2 to 4 weeks after treatment finishes.

Most common side effects include:

• Fatigue - A lack of energy that's one of the most frequent side effects. This is different from normal tiredness and doesn't improve with rest or sleep.
• Skin changes - In the treatment area, often described as similar to a sunburn. For people with darker skin, radiation can cause the skin to darken and become painful.
• Difficulty swallowing - Near the end of treatment, you may experience pain when swallowing due to irritation of your esophagus.
• Lung inflammation (less common but important) - Although uncommon, your lung may become inflamed after treatment, causing sudden shortness of breath or cough. This is called radiation pneumonitis, and you should call your radiation oncologist immediately if this happens.

Important note: The type of radiation matters. Most people have no side effects from SABR (stereotactic ablative radiation), while proton therapy may cause skin changes. IMRT (intensity-modulated radiation therapy) rarely causes skin changes.

Chemotherapy Side Effects

According to the NCCN Guidelines, chemotherapy drugs used for NSCLC (often platinum-based combinations like cisplatin or carboplatin paired with drugs like pemetrexed, gemcitabine, or paclitaxel) each have their own set of side effects. Common ones include:

• Nausea and vomiting
• Hair loss
• Low blood cell counts (increasing infection risk, anemia, or bleeding)
• Mouth sores
• Loss of appetite
• Diarrhea or constipation

Immunotherapy Side Effects

Immunotherapy works by helping your immune system attack cancer cells, but it can sometimes cause your immune cells to attack healthy cells instead. This creates immune-related side effects that differ from traditional chemotherapy. These can include:

• Fatigue
• Skin rashes
• Joint or muscle pain
• Thyroid problems
• Lung inflammation
• Digestive issues

Targeted Therapy Side Effects

If you're receiving bevacizumab (a targeted therapy called a VEGF antibody), common side effects include:

• High blood pressure
• Headache
• Changes in taste
• Dry or inflamed skin
• Watery eyes
• Back pain

Less common but serious problems can include tears in your digestive tract, wounds that don't heal, serious bleeding, and blood clots.

Chemoradiation Side Effects

When chemotherapy and radiation are given together (which is common for locally advanced NSCLC), you typically experience more side effects than either treatment alone.

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Questions to Ask Your Care Team

According to the NCCN Guidelines, here are important questions about side effects:

1. What are the possible side effects specific to MY treatment plan?
2. Which side effects are most common, and how long do they usually last?
3. Which side effects are serious or life-threatening, and what symptoms should I report right away?
4. What can I do to prevent or relieve side effects?
5. Do any medications I'm taking worsen side effects?
6. Will you stop or change treatment if I develop serious side effects?

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Managing Side Effects

Your care team can help significantly. During radiation therapy, your radiation oncologist will see you about once a week to check for side effects. Tell your team about any new or worsening symptoms—there are often ways to help you feel better and prevent some side effects from getting worse.

For more detailed information about managing specific side effects like cancer-related fatigue, the NCCN has additional patient guides available at NCCN.org/patientguidelines and on the NCCN Patient Guides for Cancer app.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.