Apart from the traditional form of treatment of cancer like the chemotherapy and medications, palliative care is also an important part of treatment. Palliative care is mainly used to manage symptoms and improve quality of life of patients suffering from lung cancer. It is important to know about palliative care for lung cancer for patients as well as care takers.
What is Palliative Care For Lung Cancer?
Living with lung cancer is quite daunting. It is not only the cancer that creates trouble for an individual but also the treatment. Both of these may spoil the quality of life. A lung cancer is the formation of a mass of cell that grows uncontrollably to result out into a tumor, nodule or a lesion. The tumor can be either in the inactive state (benign) or the cancerous state.
Palliative care for lung cancer is an important element of cancer treatment that mainly aims at reducing the symptoms.
Symptoms of Lung Cancer
The symptoms of lung cancer differ at various stages in the disease trajectory, however, following are the symptoms that can be witnessed right from the initial stages.
Palliative care is aimed at different symptoms and often has to be planned based on the severity of the symptoms and the condition of the patient.
The commonest symptoms of lung cancer include
- Shortness of breath
- Harsh sound on breathing also known as stridor
- Persistent coughing
- Coughing up blood
- Change in the volume as well as color of sputum
- Recurrent experiences of problems like pneumonia and bronchitis
- Pain in the shoulder, chest and back irrespective of the pain due to cough
- Coughing out mucus phlegm, tangled with blood
If lung cancer spreads to other parts of the body through the lymph nodes, following are the symptoms that may develop in the human body:-
- Cachexia, also termed as muscle wasting.
- Blood clots
- Unexplained weight loss or loss of appetite
- Increase in the chances of bone fractures
- Unexplained swelling in the facial or neck region
- Loss of memory, unsteady gait and related neurological disorders
- Unusual weakness in the body
- Increased risk of development of infections
How Palliative Care Can Help In Dealing With Lung Cancer?
Palliative care helps in providing relief from the symptoms, stress as well as pain caused due to lung cancer. The objective of using palliative care for lung cancer is to improve the quality of life of the patient as well as the family taking caring of their beloved sick family member.
It has been found that the lung cancer patients experience great distress as compared to the other types of cancer. The burden of the symptoms and associated effects on the human body can lead to the impairment of the patient’s ability to carry out day to day activities necessary for daily living.
Some of the symptoms that can be managed under palliative care for lung cancer include dyspnea, cough, pain, hemoptysis caused due to the primary tumor. Further, the loco-regional metastases can lead to symptoms like symptomatic pleural effusion or superior vena cava obstruction that may also need palliative care for lung cancer. Along with these, distant metastases may also contribute to the impairment of life, which, however can be tackled with the help of palliative care for lung cancer.
Palliative Care For Lung Cancer
Following are the measures taken under palliative care for lung cancer to deal with the related symptoms.
Pain is the most common symptom of lung cancer. Nearly 75-80% of the patients suffering lung cancer experience frequent episodes of varying degrees of pain, which are related to nerve damage, chemotherapy, radiotherapy, surgery etc.
Palliative care for lung cancer follow, WHO’s guidelines in curtailing pain:-
Palliative care helps in managing the pain by following the WHO’s (World Health Organization) analgesic ladder to control pain. This approach works on the principle that as and when the pain increase due to the progression of the disease, there should be a stepwise increase in the dose of analgesics and vice-versa.
Following are the guiding principles for administering the analgesics to take over pain in the human body during lung cancer:-
- Clock – Analgesics should be administered round the clock, in the form of a treatment regime instead of taking it as and when required.
- Mouth as a Route of Administration – Ideally, it is the oral route that should be preferred for administering the analgesics, unless there is any reported contraindication like vomiting or nausea through this route of administration.
- Individualized Approach – Under this approach, a titration of dose for each patient is decided with the aim to relieve pain with minimal analgesic side effects.
- Ladder Approach – In the ladder approach, the intensity of the pain at which the palliative care for lung cancer starts is noted and a simple, rational stepwise approach is adopted to deal with the pain.
- Continuous attention to detail – Under the palliative care for lung cancer methodology, a continuous monitoring of prescription, review as well as titration is done to avoid any side effects in the body.
- Alternate form of treatment – Apart from the prescription analgesics, use of opioids is made to curb the moderate to severe pain. Since these do not have a ceiling effect, therefore there is no upper limit to its use however it is administered in titrated dose to avoid any adverse effects in the body.
- Non pharmacological interventions – Like massage, aromatherapy and relaxation also play an important role in getting relief from pain.
Dyspnea is a condition in which an individual experiences difficulty in breathing which significantly impacts a patient’s social, physical as well as psychological well-being. Palliative care for lung cancer is of great use in such cases.
Palliative Approach for Treatment of Dyspnea in Lung Cancer
Under the palliative care for lung cancer, a stepwise approach is deployed to relax the body from the distress caused due to dyspnea by using corticosteroids, bronchodilators, opioids and anxiolytics.
Apart from the pharmacological interventions, the non-pharmacological interventions practiced in the alternative form of medications can also be used to relieve the body from the distress of this symptom, i.e. dyspnea.
It is a serious symptom and occurs in 20% of the patients suffering from lung cancer. In extreme cases the patient may suffer from terminal massive hemoptysis.
Palliative Approach For Treatment of Hemoptysis in Lung Cancer
Under the palliative care for lung cancer regime, bronchoscopy is used for both the therapeutic as well as diagnostic purposes to identify the source of bleeding. Once the source of bleeding is identified, it can be treated with electrocautery or laser treatment.
For the management of bleeding, apart from electrocautery or laser treatment, external beam radiotherapy also may be used.
Bone metastases is the commonest cause for cancer related pain and is very commonly seen in majority of lung cancer patients. Further, along with the pain, complications like skeletal fractures, loss of mobility, spinal cord compression as well as hypercalcemia is experienced by lung cancer patients, which leads to impairment of quality of life.
This is an important area where palliative care for lung cancer is required.
Palliative Approach For Treatment of Bone Metastases
Under the palliative care treatment regime, a multifactorial approach is implemented where in radiotherapy, radioisotopes, bisphosphonates along with analgesics are administered to curtail the excessive pain.
Spinal Cord Compression
Around 40 % of the lung cancer patients suffer from spinal cord compression. If not addressed on time, it may lead to medical emergencies too.
Palliative Approach For Treatment of Spinal Cord Compression
Under the treatment regime of palliative care for lung cancer, dexamethasone is administered in high doses, initially. This helps in improvement of the quality of life by decreasing the levels of pain by acting upon the peri-tumoral inflammation. The dose is gradually titrated as the inflammation reduces.
- Use of radiotherapy treatment in conjunction with dexamethasone further helps in the reduction of pain by decreasing the size of tumor.
- In certain extreme cases, surgical suppression of the tumor may also be considered.
Cough is the commonest symptom experienced by patients suffering from lung cancer.
Palliative Approach For Treatment of Cough in Lung Cancer
- As per the palliative approach for treatment, the patient is first evaluated for the potentially reversible causes.
- Further, incase, if the patient has chronic obstructive pulmonary disorder (COPD) as an underlying cause of cough, a standard bronchodilator therapy is used to alleviate cough or any associated episodes of wheezing.
- Cough suppressants may be used during the initial stages of cough however for chronic cases of cough, opioids along with cough suppressants may be used.
Brain metastasis occurs in 33% of the patients suffering from non-small cell lung cancer (NSCLC) however in cases of small cell lung cancer, only 10% of the patients show the clinical feature of brain metastasis. Treating it is essential, and if ignored, it can lead to neurological deterioration, hence palliative care for lung cancer also focuses on this issue.
Palliative Approach For Treatment of Brain Metastasis in Lung Cancer
Corticosteroids are used to treat patients who experience brain metastasis during lung cancer. It has a success rate of 75%. The neurological signs and symptoms improve with it and the degeneration also ceases.
In complex cases, where in multiple brain metastases occur, whole brain radiotherapy is the technique that is used to treat the patient.
Malignant Pleural Effusion
Malignant pleural effusion occurs in 15% of the lung cancer patients. It is often linked with dyspnea. Prolonged presence of the symptom may further lead to cough, orthopnea, chest discomfort as well as pain.
Palliative Approach For Treatment
- Thoracentesis, which is also called as therapeutic pleural drainage should be performed to relieve the patient
- In case of symptomatic effusion, which normally occurs after thoracentesis, talc pleurodesis or chest tube drainage is the methodology, generally deployed for the treatment.
- It is not just the efficient therapeutic care or palliative treatment for lung cancer that would help cure the patient effectively but also the support of the family or next of kin members throughout the treatment.
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