Survivorship: Lung Health After Cancer
The job of your lungs is to supply oxygen to your body. Not getting enough oxygen may make you feel short of breath, tired or lightheaded. Certain cancer treatments can affect the lungs. This can happen while you are receiving treatment or months to years later. It is important to do what you can to keep your lungs healthy and learn about possible symptoms of lung issues to report to your healthcare providers.
Who is at risk of lung problems?
If you received any of the following treatments, you may be at risk for problems with your lung health.
- Certain chemotherapies, particularly in high doses, including bleomycin, busulfan, carmustine (BCNU) and lomustine (CCNU).
- High doses of cyclophosphamide or when used long-term (most often in immune disorders).
- Radiation to an area that includes the lung. This can include axillary radiation (often used in breast cancer treatment) or total body irradiation.
- Surgery that removes part or all of a lung.
- Chronic graft versus host disease (GVHD) after bone marrow transplant.
- If you received more than one of these treatments, your risk of lung problems may be higher.
What type of lung damage can occur?
There are a few types of damage that can occur, including scarring, inflammation, and irritation. The most common effects on the lungs are:
- Thickening and scarring of the lung tissue (pulmonary fibrosis), which makes the lung tissue stiff and harder to breathe.
- Inflammation in the lungs (interstitial pneumonitis, bronchiolitis obliterans), which can be worsened by lung infections or smoking.
- Blockage of the passages in the lungs, which is called a restrictive 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.
- Difficulty 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 therapies 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 for support in quitting. OncoLink has resources to get you started.
- Avoid exposure to second-hand smoke, as this can also cause damage to your lungs.
- You should have a physical exam by a healthcare provider every year. They should evaluate your lung health during this exam.
- If you develop any concerning symptoms, your provider may order pulmonary function tests (PFTs) to evaluate your lung function.
- You should receive an annual flu vaccine and the pneumococcal vaccine (a pneumonia vaccine).
- Of note, the Children's Oncology Group recommends that pediatric cancer survivors should have a complete check-up by a pulmonary specialist if they wish to SCUBA dive, as this can damage the lungs.
It can be scary to learn about the late effects of cancer treatment. Understand that these complications are not common, but knowing about them helps you stay healthy. You can learn more about caring for your health after cancer treatment by creating 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.
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.