Survivorship: Lung Health After Cancer
The job of your lungs is to bring oxygen into your body. Not getting enough oxygen may make you feel short of breath, tired or lightheaded/dizzy. Certain cancer treatments can affect the lungs. This can happen while you are getting treatment or months to years later. It is important to do what you can to keep your lungs healthy and learn about possible signs of lung issues to tell your healthcare providers about.
Who is at risk of lung problems?
If you received any of these treatments, you may be at risk for problems with your lung health.
- Certain chemotherapies, such as bleomycin, busulfan, carmustine (BCNU), and lomustine (CCNU). Getting high doses of these medicines has a higher chance of causing lung issues.
- High doses of cyclophosphamide or when it is used for a long period of time (most often in immune disorders).
- Trastuzumab medications including Herceptin, Ontruzant, Enhertu, and Kadcyla.
- Radiation to an area that involves the lung. This can include radiation to the axilla (underarm, often used in breast cancer treatment), or total body irradiation (TBI).
- Surgery that removes part or all of a lung.
- Chronic graft versus host disease (GVHD) after bone marrow transplant.
- If you got more than one of these treatments, your risk of lung problems may be higher.
What type of lung issues can happen?
The treatments above can have different late and long-term effects, such as scarring (scar tissue), inflammation (swelling), and irritation. The most common effects on the lungs are:
- Thickening and scarring of the lung tissue (called pulmonary fibrosis or interstitial lung disease), which makes the lung tissue stiff. This makes it harder to breathe.
- Inflammation (swelling) in the lungs such as interstitial pneumonitis or bronchiolitis obliterans. These can be worsened by lung infections or smoking.
- Blockage of the passages in the lungs, which is called a restrictive lung disease such as COPD.
What symptoms should I report to my provider?
You should report any new or worsening lung symptoms. These include:
- New or worsening shortness of breath.
- Trouble catching your breath or taking a deep breath.
- New or worsening cough.
What can I do to protect my lung health?
If you have had any treatments that can affect your lung health, you should do what you can to keep your lungs healthy. This includes:
- You should not smoke tobacco or use other inhaled drugs (marijuana, vaping, other elicit inhaled drugs).
- If you do smoke, talk with your provider about quitting. OncoLink has support to get you started.
- Avoid exposure to second-hand smoke, as this can also harm your lungs.
- You should see your healthcare provider every year for an exam. They should check your lung health during this exam.
- If you develop any concerning symptoms, your provider may have you get pulmonary function tests (PFTs) to check your lung function.
- You should get a yearly flu shot and the pneumococcal vaccine (a pneumonia vaccine).
- Of note, the Children's Oncology Group suggests that pediatric cancer survivors should have a complete check-up by a pulmonary specialist if they wish to SCUBA dive, as this can harm the lungs.
It can be scary to learn about the late effects of cancer treatment. These problems are not common, but knowing about them can help you stay healthy. You can learn more about caring for your health after cancer treatment by making an OncoLife survivorship care plan.
Carver, J. R., Shapiro, C. L., Ng, A., Jacobs, L., Schwartz, C., Virgo, K. S., … Vaughn, D. J. (2007). American Society of Clinical Oncology Clinical Evidence Review on the Ongoing Care of Adult Cancer Survivors: Cardiac and Pulmonary Late Effects. Journal of Clinical Oncology, 25(25), 3991–4008.
Children's Oncology Group. Long-Term Follow-Up Guidelines for survivors of Childhood, Adolescent and Young Adult Cancers, Version 5.0. Monrovia, CA: Children's Oncology Group; October 2018; Available online: http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf
Haugnes, H. S., Oldenburg, J., & Bremnes, R. M. (2015, September). Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors. In Urologic Oncology: Seminars and Original Investigations (Vol. 33, No. 9, pp. 399-406). Elsevier.
Leger, P., Limper, A. H., & Maldonado, F. (2017). Pulmonary toxicities from conventional chemotherapy. Clinics in Chest Medicine, 38(2), 209-222.
Scarlata, S., Annibali, O., Santangelo, S., Tomarchio, V., Ferraro, S., Armiento, D., … Avvisati, G. (2017). Pulmonary complications and survival after autologous stem cell transplantation: Predictive role of pulmonary function and pneumotoxic medications. European Respiratory Journal, 49(3), 1601902.
Versluys, A.B., Bresters, D. (2016). Pulmonary Complications of Childhood Cancer Treatment. (2016). Paediatric Respiratory Reviews, 17, 63–70.
Yahalom, J., & Portlock, C. S. (2011). Long-term cardiac and pulmonary complications of cancer therapy. Heart Failure Clinics, 7(3), 403-411.