Palliative care for lung cancer

For patients with lung cancer, palliative care should be integrated into the care provided during active cancer treatment and continue up until hospice care. Research has shown that this improves the patient’s quality of life.

There are about 2,500 new cases of lung cancer in Finland per year. If the cancer is localised, it may be possible to cure it with surgery, but in about three out of four cases, the cancer has spread.

Metastatic lung cancer cannot be cured, but if the patient’s general condition is good, it may be possible to slow down its spread using medication or radiation therapy. Treatment of lung cancer always includes good palliative care.

It’s important to let your attending physician and other members of your care team know about any symptoms you’re experiencing, because symptoms caused by metastases can be managed effectively. Palliative care, aimed at symptom management, is provided alongside cancer medication, and continues after other treatments are stopped, in other words when moving to palliative care intent.

Important

You don’t have to cope with your symptoms alone

Be sure to tell your attending physician and members of the nursing staff about your symptoms. Although effective cancer treatment also relieves the symptoms, other treatment methods are often needed as well. Good symptom management does not affect other aspects of cancer treatment, but rather, these different approaches enhance one another and help you live a life that is as good and active as possible.

Most common symptoms

Symptoms depend on where the tumour and metastases are located. Lung cancer typically spreads to other parts of the lungs, and to the bones, liver, and brain. Read on for more information about the most common symptoms caused by metastases. Physical symptoms most commonly experienced by those with lung cancer include shortness of breath, coughing, and pain.

Shortness of breath and other respiratory symptoms

Shortness of breath and coughing are often caused by tumours in the lungs, concurrent chronic obstructive pulmonary disease (COPD), or a build-up of fluid around the lungs. Fluid from around the lungs (the pleura) can sometimes be removed either with a one-time procedure using a small catheter, or repeatedly, with a more permanent drainage catheter (a thin tube). Sometimes radiation therapy can be used to shrink tumours, while endoscopic procedures may relieve obstruction of the airways.

The most effective medicines include morphine or other opioids; some patients also find inhaled bronchodilators (medicines that widen the airways) beneficial. Other things that may be helpful include correct breathing technique and position, physical therapy exercises, and producing a stream of air (for example, by using a fan). Coughing up blood (haemoptysis) can often be relieved either with medication or with radiation therapy.

Pain

The patient may experience pain as lung cancer progresses into the chest wall, the bones, or other organs.

Bone metastases tend to cause pain, especially when moving, whereas those in the chest wall often cause pain when the patient is breathing deeply. Opioids, as well as many other kinds of pain medication, provide effective pain relief. Radiation therapy is helpful especially in the case of pain caused by bone metastases, as well as some other situations. In addition, non-medication pain management methods should be applied as well.

Symptoms caused by metastases in the liver

In many cases, individual metastases in the liver don’t cause any major symptoms. Symptoms usually appear once there is a large number of metastases and liver function starts to suffer. A common symptom experienced at this point is increasing fatigue. Corticosteroid medicines may be helpful.

Brain symptoms

Brain metastases cause symptoms such as headaches, nausea, and various neurological symptoms including vision problems, loss of balance, and paralysis. These symptoms can be relieved with corticosteroid medicines and radiation therapy. If the cancer is in the early stages, surgery might also be an option.

Psychological strain

Feelings such as anxiety and depression are understandable and fairly common symptoms in those with lung cancer. Time, talk support, and presence offered by both the care staff and the patient’s loved ones can support the patient, even during a bad day. Psychological symptoms can also be managed with medication. Treating these symptoms is especially important because they can make shortness of breath as well as other physical symptoms worse. Peer support may also be helpful.

Symptoms caused by metastases in palliative care for cancer

Palliative care: When and where?

While cancer treatment is still ongoing, it’s advisable to contact the unit responsible for your care if your general condition worsens, you develop symptoms that interfere with your life, or your symptoms get worse. Units specialised in cancer treatment have expertise in palliative care, including symptom relief and pain management. All cancer units in university hospitals, and most central hospitals, have palliative care units that can help with symptom management. Psychosocial support and talk support is also available. It’s a good idea to get acquainted with the local palliative unit while undergoing active cancer treatment, so that palliative care can be offered and planned early on.

When it’s time to end active cancer treatment, palliative care continues – at this point, the patient should be assigned a care provider in charge of their palliative care, and provided with a palliative care plan. No one should be left to cope with their illness alone.

At the end of life, the care provider in charge of the patient’s care preferably attends to the patient either at or close to the patient’s home. This can be a palliative outpatient clinic, inpatient ward at a regional hospital (formerly health centre hospital), home hospital, palliative ward, or a hospice. For assistance with essential care needs, home care services are employed. The important thing is to have a plan ready for where to get help at any time of the day or week.

At the end of life, going to the emergency department is a taxing experience. That’s why it’s preferably avoided by cooperating with the care team ahead of time to prepare a plan for what to do if the patient’s condition gets worse or if their symptoms change. Unless it’s an acute medical emergency, it’s advisable to contact the unit responsible for the patient’s care before visiting the emergency department. If the patient has pre-existing access to home hospital services, a nurse or doctor can visit the patient at home and assess the situation, if necessary, or make arrangements for transfer to inpatient care (support ward) without the need to visit the emergency department.