Treatments for early NSCLC

Intravenous (IV) chemotherapies:

Some chemotherapies are given with an IV drip in hospital or at a clinic. Every clinic is different, but as a general guide:

• You may have an appointment with your oncologist before each chemotherapy session. During these appointments, your oncologist will check your general health to make sure you are well enough to receive chemotherapy
• On the day of your chemotherapy session, when you arrive at the clinic you may need to fill in some paper work, and confirm your name, date of birth, and address
• Your nurse will explain what kind of chemotherapy you will be receiving and make sure that you are seated comfortably. Most chemotherapy suites have big comfy chairs that you can relax in
• You may be given some medicine that will help manage any side effects that you get while receive the chemotherapy. For example, anti-emetic medication, in case you start to feel a bit nauseated
• When your treatment is ready, a nurse will bring it over in a plastic bag with a tube coming out of it. On the end of the tube is a needle, which the nurse will carefully insert into a vein – usually either on the back of your hand or in your arm
• You can then sit back and wait while the treatment flows out of the bag and into your vein
• If at any point you feel worried, or unwell, call a nurse over and they will help you
• Once your treatment is over, the nurse will remove the needle and give you some instructions. When they think you are ready to leave the clinic, you can head home

Oral chemotherapies

Other chemotherapies are available as pills or tablets that you can take at home, although you will need to come in and see your oncologist for some health checks before beginning to take them, and at regular intervals afterwards. The number of pills you take, how often you take them, and for how long will depend on the specific medicine you have been prescribed.

Top tips

• If you are receiving IV chemotherapy, you may be at the clinic for quite a while. Bring some home comforts and things to keep you comfy and distracted. For example, a blanket, pillows, a book, a craft project, or a tablet with your favourite movie or TV series loaded onto it
• Some people receiving IV chemotherapy sometimes get a side effect where they might notice a funny, metallic taste in their mouth. Sucking on some sweets, or chewing gum might help with this
• If you are taking pills or tablets at home, you might occasionally forget to take your treatment. In these cases, make sure you know what to do. Don’t assume you can take a double dose next time – many treatments strongly advise against this

What side effects might I get?

Side effects will vary depending on exactly what chemotherapy you are receiving. Your healthcare team will be able to tell you what are the most common side effects that occur in people who are receiving the same therapy as you.

We have put together a list of common side effects that can affect people who are receiving chemotherapy.² Looking at this may feel a bit overwhelming, or cause you some worries, however it is important to remember that everyone is different, and you may only experience some of the below side effects. You may also have different side effects, or experience none of these at all.

• Feeling tired most of the time
• Feeling sick, and/or vomiting
• Hair loss
• An increased risk of picking up infections
• A sore mouth
• Dry, sore, or itchy skin
• Diarrhoea or constipation

How do I receive it?

External radiotherapy

External radiotherapy is given with a special machine,⁴ so you need to attend an appointment at a hospital or clinic.

Once there, you will lie on a bed, and have marks made on your skin in a long-lasting ink, so that the technician can always line up the radiation in the same place. If you are having radiotherapy on your head or neck, you will have a mask that holds your head in place, and the ink marks will be made on this.⁴

The radiotherapy technician will adjust the machine and the position you are lying in so that the radiation can reach where the cancer it. Once ready, the machine sends a beam of radiation at your cancer.⁴

After you have had your radiotherapy, the technician may give you some instructions to follow, and then you can head home.

Internal radiotherapy

If you are having an implanted therapy, this may require some surgery.⁴ In these cases, your healthcare team will guide you through exactly what will happen. How long implants are left in varies. Some may only be there for a few minutes, others may be a few days. Some very small implants can be left in permanently, as they only contain a small amount of radiation and this gradually decreases over time. You may need to stay in hospital for a few days while any excess radiation leaves your body, and visitors may be limited during this time to avoid exposing them to any radiation you may be emitting.^4.5

If you are receiving a therapy that you inject or swallow, you will receive this in a hospital or clinic. Again, you may need to stay in the hospital for a while until the excess radiation has left your body.⁴

Top tips

• If you are going to be in hospital for a while after internal radiotherapy, confirm any rules around visits from friends and family. Immediately after you receive your implant or swallow your radiotherapy, you may not be allowed any visitors. Later, visits might be restricted, and pregnant women and very young children may not be allowed to visit at all⁵

What side effects might I get?

Side effects with radiotherapy typically appear in the week or two after your appointment, and go away on their own. They might include:³

• Sore, red skin
• Fatigue
• Hair loss around the area where the radiation has been focused
• Nausea
• Diarrhoea
• Sore mouth
• Loss of appetite

• You will have a consultation with a surgeon (your oncologist may also be there too). They will review your medical file and any x-rays and scans you have had⁷
• On the day of your surgery:
  • You will be asked not to eat or drink anything for several hours beforehand⁷
  • You will be given a hospital gown to wear, and some tight socks, called compression stockings – these help to prevent blood clots from forming in your legs, called deep vein thromboses (DVT)⁷
  • You may also be asked to have a shower, and shave any body hair over the area that is being operated on (a surgical nurse might help with this)⁷
  • You will also be asked to review and sign some paperwork⁷
• When it is time for your surgery, a specialist doctor called an anaesthetist will come and visit you. They will have calcuated the amount of anaesthesia you need to help you go to sleep, and give this to you with either an injection or a face mask.⁸ They might ask you to count backwards from ten as the medicine takes effect. Most people fall asleep very quickly, after counting only a few numbers
• Once you are asleep, you will be wheeled into the surgical theatre where the surgeon and their team will be waiting, and they will perform your surgery. The aneasthetist will join them, and keep an eye on your anaesthesia levels, and vital signs⁸
• When the surgery is completed, you will be wheeled back to a recovery ward, where you will be looked after while the anaesthesia wears off. You may find that when you wake up you feel quite groggy and confused⁸ – this is normal, and will eventually stop on its own
• The healthcare team will give you and your loved one some advice on anything you need to do in the coming days to help you recover, and your surgeon may visit you to discuss how the surgery went
• You may need to spend some time in hospital while you recover initially. If you go home on the same day you probably won’t be able to drive, so somebody will need to pick you up, and keep an eye on you for the rest of the day

Top tips

• If you are likely to be in hospital for a few days, make sure you bring some entertainment from home – a book, craft project, or a tablet loaded with your favourite movies or TV series are good ideas
• If you are worried about anything after your surgery, get in touch with your healthcare team. They can give you advice, and support you if needs be

Side effects

As with any treatment, any side effects you experience will depend on your situation, and what your surgery has involved. Some common side effects of surgery include:⁹

• Pain
• Fatigue
• Loss of appetite
• Swelling, and/or bruising around the surgical site
• Drainage from the surgical site
• A bit of bleeding may sometimes happen around the surgical site
• Feeling groggy, confused, and/or nauseated from anaesthesia (usually immediately after waking up, but this gets better after a while)