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Healthy living after treatment of childhood, adolescent, and young adult cancer

Pulmonary Health after Cancer Treatment
The lungs are very important organs that supply oxygen to the body. Sometimes, treatments given for childhood cancer
can cause lung damage. If you received any treatments that may cause lung problems, it is important to learn about thelungs, and what you can do to keep them as healthy as possible.
How the lungs function
The lungs transfer oxygen from the air to the blood, where it is circulated to the body tissues. The lungs also remove
carbon dioxide, a waste product made by the body’s cells. For oxygen to reach the blood, it must move through tiny airsacs (alveoli) in the lungs and into tiny blood vessels (capillaries) that surround each air sac. When the air sacs become
damaged or scarred, there is less area for oxygen to enter the bloodstream, and less oxygen reaches the blood. The
person may then need to breathe faster in order to get enough oxygen. This can make the person feel short of breath.
Other lung problems can be caused by inflammation (swelling) of the air passages in the lungs or increased mucous
production as a result of irritation or infection. Symptoms can include cough, wheezing, chest pain, and shortness ofbreath.
Am I at risk for lung problems?
If you received any of the following treatments during your cancer therapy, you may be at risk for developing lungproblems:• Bleomycin (See the “Bleomycin Alert” Health Link for more information)• Carmustine (also known as BCNU)• Lomustine (also known as CCNU)• Busulfan• Radiation to the chest or axilla (underarm area)• Total body irradiation (TBI)• Surgery involving the chest or lung (this does NOT include surgery for placement of a central line, such as aHickman, Broviac, Port-a-Cath or Mediport)• Chronic graft-versus-host disease (cGVHD) following bone marrow transplant or stem cell transplant from a donor
other than yourself (allogeneic transplant)• Certain chemotherapy drugs known as anthracyclines, such as daunorubicin (Daunomycin®), doxorubicin(Adriamycin®), Mitoxantrone (Novantrone®), idarubicin (Idamycin®) and epirubicin can damage the heart andmay contribute to lung problems, especially if given in combination with bleomycin, BCNU, CCNU, and radiation
treatment.
Other factors that may increase your risk are:
• Younger age at the time of cancer treatment• A history of lung infections, asthma or other lung problems• Tobacco use or exposure to secondhand smoke•

Inhaled drugs, such as smoking marijuana, vaping, or cocaine

What problems can develop?
Problems can include scarring of the lungs (pulmonary fibrosis), repeated lung infections (such as chronic bronchitis,bronchiectasis, or recurrent pneumonia), inflammation of the lung tissues and small airways within the lungs
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Healthy living after treatment of childhood, adolescent, and young adult cancer(bronchiolitis obliterans), and rupture of the tiny air sacs in the lungs or thickening and blockage of air passages within
the lungs (restrictive/obstructive lung disease).
What are the symptoms of lung damage?
Symptoms may include shortness of breath, frequent coughing and/or wheezing, chest pain, and frequent lunginfections, such as bronchitis or pneumonia. Becoming easily fatigued or short of breath during mild exercise (exerciseintolerance) is sometimes an early symptom of lung damage. If you begin to experience these symptoms, discuss themwith your healthcare provider. A consultation with a lung specialist (pulmonologist) may be recommended.
What monitoring is recommended if I have no symptoms?
• A yearly medical check-up is recommended.
• Pulmonary function tests (including DLCO and spirometry) may show lung problems that are not apparent
during a check-up. For this reason, it is helpful to have these tests done at least once (at least two years after
completing cancer treatment) to find out if there are any problems. Your healthcare provider can decide if further
testing is needed based on these results.
Are there any special precautions I should take?
If you have had any of the treatments listed above you should:• Get the pneumococcal (pneumonia) vaccine.
• Get yearly influenza (flu) vaccines.
• Avoid SCUBA diving, unless you have had a complete check-up and have been advised by a pulmonologist (lungspecialist) that diving is safe.
What can I do to prevent lung problems?
• Avoid or quite smoking.
• Avoid second-hand smoke.
• Get regular physical exercise.
• Avoid inhaled drugs, such as marijuana, vaping, or cocaine.
• Avoid breathing toxic fumes from chemicals, solvents, and paints.
• Follow all safety rules in your workplace, such as the use of protective ventilators in some work environments.
Report any unsafe working conditions to the Occupational Safety and Health Administration (OSHA).
Where can a smoker find help in order to quit?
Your most important resources for quitting smoking are your family, friends and your healthcare provider. Listed below
are some additional sources of education and support:
Telephone Resources
If you don’t have access to the Internet, you can call the following organizations to request educational materials(usually free) about how to quit smoking:American Cancer Society: 1-800-ACS-2345
American Heart Association: 1-800-AHA-USA1
American Lung Association: 1-800-LUNG-USA
National Cancer Institute: 1-800-QUIT-NOW
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Healthy living after treatment of childhood, adolescent, and young adult cancer

On-Line Resources
If you have access to the Internet, you may find the following websites helpful:
Information from the National Institutes of Health to help you quit smoking is available at: www.smokefree.org
The Center for Disease Control’s Tobacco Information and Prevention Source (TIPS) includes guides for quitting thetobacco habit and is available online at: www.cdc.gov/tobacco/campaign/tips
The American Lung Association’s free online “Stop Smoking” program is available online: www.lung.org/stop-smoking/Where can I find more information about how to keep my lungs healthy?
More information about the lungs, and how to keep them healthy, is available at:
The National Heart, Lung and Blood Institute’s web site with general information for: www.nhlbi.nih.gov/health-topics/
The National Lung Health Education Program has information about how to keep lungs healthy: www.nlhep.org
Written by Charlene Maxen, RN, CNP, CPON®, Childrens Hospital Medical Center of Akron, Akron, OH; and Sarah E. Friebert, MD,Childrens Hospital Medical Center of Akron, Akron, OH.
Reviewed by Leeann Carmichael, DNP, APN, FNP-BC; Melissa Acquazzino, MD, MS; and Kayla L. Foster, MD, MPH.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
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