Lung cancer: Understanding late effects of radiotherapy
Radiotherapy for lung cancer can cause late side effects. They might happen once, carry on over the long term or come and go. They can even begin many years later. Sometimes they cannot be cured, but it might be possible to manage them.
Joining a support group can be a positive way to share your experiences, feel less alone, and come to terms with the physical and emotional impact of treatment. Ask your medical team if you need more support or have any side effects that could be related to radiotherapy treatment.
How likely am I to get late side effects?
Before treatment you will discuss and sign a consent form with your clinical oncologist or therapeutic radiographer. They should tell you what to expect, and you can ask questions and discuss any concerns you have about late effects. It’s important to know what you are consenting to and can help to take someone with you.
You can read different radiotherapy consent forms (HERE) based on the specific area being treated. These consent forms are packed with useful information about early and late side effects.(1)
When you consent to treatment, you are saying you understand that you have a chance of getting late side effects. Your team will use words like Expected, Common, Less Common and Rare.
This table shows what these words mean.
| Wording on the consent form | % chance of side or late effect | How many patients will get this? |
|---|---|---|
| Expected | 50 to 100% | Between half and all patients |
| Common | 10 to 50% | Up to half of all patients |
| Less common | Less than 10% | Fewer than one in ten patients |
| Rare | Less than 1% | Fewer than one in 100 patients |
Possible late side effects
- Breathing difficulty: Some people might find it hard to breathe, have a cough, or get a fever 1 to 6 months after treatment. Medicines from your doctor can help with these symptoms. It is less common but in some cases this can become a long term issue requiring the need for oxygen so please speak to you medical team if this is an issue.
- Lung fibrosis: This is when the lungs become scarred. It usually doesn’t cause major problems and its effect on breathing is often small. The scarring can be seen on an X-ray picture or CT scan.
- Irritation of food pipe: The tube your food passes down may become sore and you may feel food is getting stuck. It is less common but you can get scarring here that causes a narrowing of the tube.
- Heart: There is a risk of damage to your heart but this depends on where the treatment is directed. Ask your clinical team if this applies to you.
- Bone fractures: Bones in the treatment area can be more likely to break.
- Cancer-related fatigue: You might find you still have fatigue after your treatment has finished. For some people this can go on for months or years.
Rare late effects
- Second Cancer: There is a very small chance that you could develop another type of cancer. This is rare, and depends on lots of different factors like age, area treated and radiation dose.
- Hypothyroidism: This is where the treatment can affect the thyroid gland causing a hormone deficiency, this may require you to take medications.
- Reduced spleen function: This can lead to an increased risk of infection. This is where the spleen is affected by the radiation. When this happens it can lower your immunity (ability to fight infection) and may require additional vaccinations and long-term antibiotics to help.
- Spinal cord myelitis: Radiotherapy may cause inflammation of the nerves in the spinal cord. This can lead to muscle weakness or changes in sensation.
- Lung infections: You can become more prone to lung infections long term.
- Arm weakness or numbness: You might feel weakness or numbness in your arm if the treatment is near the top of your lung. This happens because the nerves that control your arm can be affected.
- Risk of organ damage: This is rare but the treatment can cause damage to the lungs, heart, food pipe, windpipe including a hole (perforation) or an abnormal connection between two body parts (fistula).
What can help with these late effects?
If you have late side effects, doctors can help with different treatments:
- Keeping active: Gentle movement can help you feel better, both during and after treatment. Your medical team can tell you what is safe for you to do.
- For breathing difficulty: Medicines prescribed by your treatment team can help you breathe easier.
- For lung fibrosis: Your doctor might give you treatments or exercises to help with breathing.
- For arm weakness or numbness: Physical therapy or exercises can help strengthen your arm. There are treatments that may help if the nerves are affected speak to your medical team.
- For spinal cord damage: If you experience numbness, a loss of sensation and/or strength in your arms or legs and any incontinence (losing control over when you wee and/or poo) then tell your medical team; or go to your local accident and emergency department straight away.
- Monitoring rare side effects: Talk to your medical team if you notice any changes, catching symptoms early can make treatment easier.
- Managing cancer-related fatigue: Food and drink, keeping active, keeping a fatigue diary, medicines like steroids and physiotherapy may all be options for managing fatigue. Speak to your doctor or medical team for advice; and learn more about managing cancer-related fatigue.
- Drinking fluids: Drinking plenty of fluids such as water and squash can help with fatigue and tiredness caused by your treatment. You can try diluted juice if you don’t like water.
- Skin care: The skin in the treatment area will always be more sensitive to the sun. Always protect it by covering up and use a high factor sunblock.
- Alcohol use: Please follow the NHS guidelines on safe drinking levels and any instructions you get from your team on what is right for you, your diagnosis and your treatment. If in doubt, please ask your team.
- Stop smoking: If you are looking to stop or reduce smoking, there are services available to help you.
Always talk to your doctor or medical team about any late effects you have. Even if they are not mentioned here. Everyone is different and experiences treatment differently. There may be ways they can help you reduce or manage symptoms. The earlier these can be identified the better.
Further information
Learn more about radiotherapy consent forms (HERE).
