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Supportive care for lung cancer

Coughing

Difficulty breathing and shortness of breath

Fatigue

Loss of appetite

Pain

Pleural effusion

Superior vena cava syndrome

Coping with advanced cancer

 

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of lung cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

 

Recovering from lung cancer and adjusting to life after treatment is different for each person, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects.

 

A person who has been treated for lung cancer may have the following concerns. Some symptoms, such as cough, difficulty breathing, pain and fatigue, are often seen together in people with lung cancer, especially in advanced disease.

Coughing

Coughing is one of the most common concerns for people with lung cancer. Coughing may be one of the first symptoms of lung cancer, but it may also be a concern during all stages of the disease. The cough may be dry and hacking or wet and productive (coughing up sputum). Sometimes the sputum may contain blood from the lungs (hemoptysis).

 

Coughing may be caused by:

  • a lung tumour in the large airway (bronchus) of the lung
    • Squamous cell carcinoma is most likely to cause coughing, but any tumour that blocks the respiratory tract will cause a cough.
  • chemotherapy or radiation therapy
  • radiation pneumonitis
  • pleural effusion
  • lung infection (pneumonia)
  • other existing lung or heart problems
    • asthma
    • chronic obstructive pulmonary disease (COPD)
    • congestive heart failure
    • chronic bronchitis
  • gastroesophageal reflux disease (GERD)
  • certain medications used to control high blood pressure

 

Treatment for cough will depend on the underlying cause. Treatment options may include:

  • endobronchial therapies to treat a tumour that is blocking the airway
  • antibiotics to treat infections
  • opioid medications
    • Opioid medications may be the best option for a cough that cannot be relieved by other methods.
  • supportive care
    • using a humidifier in dry rooms
    • deep breathing exercises
    • suction of mucus from the airway
    • clearing the airways with techniques based on gravity (postural drainage)

 

Report a new cough or any changes to an existing cough to the healthcare team.

 

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Difficulty breathing and shortness of breath

Many people with lung cancer have difficulty breathing (dyspnea) and shortness of breath. This can be a very distressing symptom, which can significantly affect a person’s quality of life. It can affect work, walking and physical activity, sleeping and general activities.

 

Breathing difficulties in people with lung cancer can be caused by:

  • a lung tumour blocking the airway
  • pleural effusion
  • pericardial effusion
  • rapidly growing tumours
  • lung infection (pneumonia)
  • anemia
    • Anemia may be caused by chemotherapy or poor diet.
  • other underlying medical conditions
    • chronic obstructive pulmonary disease (COPD)
    • asthma
    • heart failure
  • anxiety

 

Treatment for difficulty breathing and shortness of breath will depend on the cause(s) and may include:

  • endobronchial therapies to shrink a tumour blocking the airway(s)
  • removing fluid from around the lungs or heart
  • treating anemia
  •  drug therapy
    • antibiotics to treat lung infection
    • medications to open breathing passages (bronchodilators)
    • corticosteroids
    • pain medications
      • Pain medications may be used to help relieve the feeling of breathlessness.
  • supportive care measures
    • oxygen therapy
    • using a fan across the face to help air movement
    • relaxation exercises
    • breathing exercises

 

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Fatigue

Many people with lung cancer experience fatigue. Fatigue may be caused by the cancer and can be made worse by coughing, difficulty breathing or poor appetite. It can be hard to cope when you feel very tired and don’t have a lot of energy, especially for a while after treatment or if the cancer is advanced.

 

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Loss of appetite

Many people with lung cancer have advanced disease when they are diagnosed. As the cancer progresses, people can lose their appetite. If people don’t eat properly, their nutritional intake can be poor and they may lose weight.

 

Trying small amounts of high-calorie foods or fluids, having smaller, more frequent meals and nutritional supplements can be helpful. Anti-nausea drugs can be used to control nausea and vomiting. Eating cold foods and using plastic cutlery can help if the person experiences smell or taste changes with food. When appropriate, the doctor may order medicines to help increase appetite.

 

Cachexia (severe loss of body weight and muscle mass) can occur in people whose lung cancer is very advanced.

 

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Pain

Pain is very common in people with lung cancer. It may become worse as the cancer advances.

 

Pain may be treated by:

 

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Pleural effusion

Pleural effusion is a build up of fluid in the space between the outside covering of the lung and the inside lining of the chest wall (pleura). Lung cancer often causes pleural effusion. Treatment options for pleural effusion may include:

  • removing fluid from the chest cavity through a hollow needle (thoracentesis)
  • sealing the 2 layers of the pleura together by placing a chemical powder (talc) or a drug into the pleural space through a chest tube (pleurodesis)
  • inserting a chest tube or pleural catheter to drain the fluid that has collected in the pleural space
    • The chest tube may be attached to a plastic drainage container or a catheter with a special valve (pleural catheter) may be attached to a bag so that the tube can be drained.
  • radiation therapy may be given after thoracentesis to try to prevent fluid from building up again

 

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Superior vena cava syndrome

Superior vena cava syndrome is a group of symptoms caused when the superior vena cava becomes partially blocked. The superior vena cava is the main vein that carries blood from the upper body (head, neck, chest and arms) to the heart. Advanced lung cancer can cause superior vena cava syndrome. Treatment for superior vena cava syndrome may include:

  • radiation therapy
  • chemotherapy
  • placing a tube (stent) in the blocked artery
  • supportive care
    • raising the head of the bed
    • oxygen therapy
    • corticosteroids to decrease swelling (edema)
    • fluid pills (diuretics) to get rid of extra fluid

 

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Coping with advanced cancer

Lung cancer is often diagnosed at quite an advanced stage. People with advanced lung cancer are offered palliative care. This is a special type of care that focuses on making the person as comfortable as possible, relieving symptoms, providing support and improving or maintaining the person’s quality of life.

 

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See a list of questions to ask your doctor about supportive care after treatment.

References

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We can give information about cancer care and support services in Canada only. To find a cancer organization in your country, visit Union for International Cancer Control or International Cancer Information Service Group.