Lung Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy, also called chemo, uses strong medicines to kill cancer cells. The medicines travel all through your body in your bloodstream. They attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

When might chemotherapy be used for lung cancer? 

Not everyone with lung cancer needs chemo. Whether you need chemo, and what type of chemo you need, depends on:

• The kind of lung cancer you have. Chemo is a common part of treatment for small cell lung cancer (SCLC). Not all people with non-small cell lung cancer (NSCLC) need chemo.

• The stage (extent) of the cancer

• The goal of treatment

• Your age

• Your overall health

• Concerns you have about side effects

• What treatments you have had in the past (if any)

• Your preferences

Small cell lung cancer (SCLC)

Chemo is part of the recommended treatment for all people with SCLC if they are healthy enough to get it. It may be given along with radiation therapy (sometimes after surgery) for limited stage SCLC. It may be given by itself or along with immunotherapy, radiation for more advanced (extensive stage) SCLC, or both.

Non-small cell lung cancer (NSCLC)

Your healthcare provider may recommend chemo to treat NSCLC in these cases:

• If you have NSCLC that has not yet spread to distant parts of the body, you may get chemo before surgery. It may be given alone or with radiation. This is to try to shrink the tumor to make it easier to remove. This is called neoadjuvant chemotherapy. 

• You may get chemo after surgery to help make sure all the cancer cells are killed. Chemo can be given alone or along with radiation therapy. This is called adjuvant chemotherapy.

• Chemo may be your main treatment if you have cancer that hasn't spread but can't be removed with surgery. You may also get it as your main treatment if you're not healthy enough for surgery.

• If you have advanced NSCLC, chemo is often used to try to shrink the cancer or keep it under control for as long as possible. This can also help ease symptoms, such as coughing or bone pain.

How is chemotherapy given for lung cancer?

Before treatment starts, you'll meet with a medical oncologist. This is a healthcare provider with special training to treat cancer with medicines, such as chemotherapy. The provider will discuss your treatment choices with you and tell you what you might expect. 

Chemo for lung cancer is most often given right into your blood through an IV (intravenous) that's put into a vein. For more long-term use, a central line may be inserted. It usually drips in slowly over several hours.

You usually get chemo as an outpatient. This means you get it at a hospital, clinic, or healthcare provider's office. You can go home after treatment. Less often, you may need to stay in the hospital during treatment. You'll be watched for reactions during your treatments. Chemo may last for many hours, so you may want to take along something that's comforting to you, such as music to listen to. You may also want to bring something to keep you busy, like a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles typically last 3 to 4 weeks. Most people get 4 to 6 cycles as part of their initial treatment. Treatment usually lasts several months. Your healthcare provider will discuss your chemo schedule with you.

What medicines are used to treat lung cancer?

These are some common chemo medicines used to treat lung cancer. They're listed in alphabetical order, not based on how often they are used.

• Albumin-bound paclitaxel (nab-paclitaxel)

• Cisplatin

• Carboplatin

• Docetaxel

• Etoposide

• Gemcitabine

• Irinotecan

• Paclitaxel

• Pemetrexed

• Vinorelbine

Two of these medicines are often combined as the first treatment. For people who aren't healthy enough to get two medicines, or people who've already had chemo, one medicine might be used instead.

What are common side effects of chemotherapy?

Side effects of chemo are different for each person. They vary based on which medicines you get. Below are some of the most common side effects from chemo for lung cancer. Ask your healthcare provider or chemotherapy nurse for details about the side effects of the medicine you're getting. They may include:

• Hair loss

• Nausea and vomiting

• Mouth sores

• Diarrhea

• Loss of appetite, changes in the way things taste, or both

• Extreme tiredness (fatigue)

Other common side effects are a decrease in blood counts:

• During chemo, your white blood cell count may become low. This means your immune system won’t be working as well as it usually does. This increases your risk for infection. Be sure to let your healthcare provider or nurse know if you have any signs of possible infection, such as a fever, sore throat, a new cough, or burning during urination.

• Chemo can also lower your blood platelet counts. You need platelets to help the blood clot as it should. If your counts are low, you may bruise and bleed easily.

• A low red blood cell count is called anemia. This causes fatigue, weakness, and a lack of energy. These symptoms can be treated. Tell your healthcare provider or nurse about them.

Other side effects are linked to certain chemo medicines. For instance, cisplatin and carboplatin can cause nerve damage called peripheral neuropathy. This can lead to pain, tingling, and numbness in your hands and feet. 

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends. But some may last a longer time. Be sure to report sides effects to your healthcare team. There may be things you can do to prevent or manage side effects.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. Make sure you know what number to call with questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.