Lung Cancer Palliative Care

Stage 4 lung cancer has few treatment options. Once the cancer has metastasized to other organs, palliative care is really the only remaining option. Palliative care offers symptom relief, emotional support, and pain management to people with stage 4 cancer.

Emotional Support

Diagnosis of stage 4 cancer is a devastating shock to both the individual and family members. Depression, anxiety and anger are common emotional responses. Palliative care is concerned with the emotional quality of life as much as the physical.

Counseling for both patient and family is available. If needed, antidepressant medication may be prescribed. The emotional support system also helps the patient and the family through the grieving process.

Pain Management

Pain management is a key component of palliative care and of vital importance to quality of life: Seventy to ninety percent of stage 4 cancer patients require pain relief, and cancer pain often worsens in the last stages of the disease.

Pain management can take many forms. In addition to conventional pain medications, radiotherapy and chemotherapy can relieve pain by shrinking tumors. Some people benefit from relaxation techniques and other non-traditional approaches.

Pain management is also one of the last forms of control that patients have over a life that has been debilitated by cancer.

Superior Vena Cava Syndrome

When cancer growth reduces the flow of blood through the superior vena cava and into the heart’s right atrium, a condition called superior vena cava syndrome results. Symptoms may include dyspnea (difficulty breathing), coughing, chest pain, and facial swelling. Radiotherapy and chemotherapy lessen superior vena cava syndrome symptoms by reducing tumor size.

The surgical use of a stent to expand the vena cava is also possible. A stent is a plastic or metal tube, often covered with a fine mesh, that is placed in the blood vessel and prompts normal blood flow by holding the vein open.

Dyspnea

Tumor growth in the respiratory airways can lead to shortness of breath and difficulty breathing. At least sixty percent of stage 4 cancer victims report dyspnea. Radiotherapy and chemotherapy are often employed to relieve symptoms. In addition, surgery may be used to remove lung obstructions. Photodynamic therapy uses a laser to clear away small tumor obstructions. Oxygen is also used for palliative care. Delivering supplemental oxygen can decrease the energy it takes to breath.

Vocal Cord Paralysis

Lung cancer can lead to vocal cord paralysis, which causes hoarseness and changes in voice. The inability to control the vocal cords can also lead to choking. A Teflon injection into the paralyzed vocal cord provides the vocal cord with extra bulk, lowering the chance of choking. Surgery may also be used to move the vocal cords forward, providing relief from symptoms.

Pleural Effusion

The membrane surrounding the lungs is divided into two layers called pleura. If these layers become inflamed or obstructed, excess fluid can build up between them, causing pleural effusion. The pressure from the liquid causes dyspnea, coughing, and chest pain.

Insertion of a needle into the pleural space to drain off the excess fluid is often used to relieve pleural effusion. In some cases a procedure called pleurodesis is performed. A drug is injected into the pleural space sealing the two layers together and preventing further fluid accumulation.

Hypercalcemia

Approximately twelve percent of advanced lung cancer patients suffer from hypercalcemia, an excessive build up of calcium in the body. Hypercalcemia symptoms include dehydration, nausea, kidney stones, mental confusion and, if left untreated, coma and death. Intravenous hydration and diuretic administration is often necessary.

Hemoptysis

Hemoptysis is the coughing up of blood from the lungs. Radiotherapy can be used to lessen hemoptysis, and photodynamic therapy has also been proven to prevent bleeding.

Resources

Aventis Pharmaceuticals. (nd). Lung cancer management.

CancerBACUP. (updated 2001). Management of a pleural effusion.

CancerLinksUSA. (1999). Superior vena cave syndrome.

Lungcancer.org. (updated 2001). Focus on lung cancer: Palliative care.

National Cancer Institute. (updated 2002). What you need to know about lung cancer [NIH Publication No. 99-1553].

National Institute on Deafness and Other Communication Disorders. (updated 2002). Vocal cord paralysis.

Tirgan, M. H. (nd). Hypercalcemia. HealthLinkUSA.com.