Skip to main content

Palliative Care in Lung Cancer

  • Chapter
  • First Online:
Book cover Lung Cancer

Part of the book series: Cancer Treatment and Research ((CTAR,volume 170))

Abstract

Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network’s (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. SEER stat fact sheets: lung and bronchus cancer. Available from: http://seer.cancer.gov/statfacts/html/lungb.html

  2. Walling AM et al (2015) Symptom prevalence in lung and colorectal cancer patients. J Pain Symptom Manage 49(2):192–202

    Article  PubMed  Google Scholar 

  3. WHO definition of palliative care. Available from: http://www.who.int/cancer/palliative/definition/en/

  4. Temel JS et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742

    Article  CAS  PubMed  Google Scholar 

  5. Hennessy JE et al (2013) Practical issues in palliative and quality-of-life care. J Oncol Pract 9(2):78–80

    Article  PubMed  PubMed Central  Google Scholar 

  6. Palliative Care (Version 1.2014) (2015) NCCN clinical practice guidelines in oncology. Available from: http://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. 5 Jan 2015

  7. Smith TJ et al (2012) American society of clinical oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30(8):880–887

    Article  PubMed  Google Scholar 

  8. Clinical practice guidelines for quality palliative care 3rd edition 2013. Available from: http://www.nationalconsensusproject.org. 5 Jan 2015

  9. Merskey H, Bogduk N (1994) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms, 2nd edn. IASP Press, Seattle

    Google Scholar 

  10. van den Beuken-van Everdingen MH et al (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449

    Google Scholar 

  11. Stjernsward J (1988) WHO cancer pain relief programme. Cancer Surv 7(1):195–208

    CAS  PubMed  Google Scholar 

  12. Adult Cancer Pain (Version 2.2014) (2015) NCCN clinical practice guidelines in oncology. Available from: http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf. 5 Jan 2015

  13. Fisch MJ et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30(16):1980–1988

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deandrea S et al (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19(12):1985–1991

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kvale PA et al (2007) Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edn). Chest 132(3 Suppl):368S–403S

    Article  PubMed  Google Scholar 

  16. Portenoy RK (2011) Treatment of cancer pain. Lancet 377(9784):2236–2247

    Article  CAS  PubMed  Google Scholar 

  17. Total Cancer Pain (2015) Global year against cancer pain. Available from: https://www.iasp-pain.org/files/Content/ContentFolders/GlobalYearAgainstPain2/CancerPainFactSheets/TotalCancerPain_Final.pdf. 5 Jan 2015

  18. Bruera E et al (2006) Textbook of palliative medicine. Oxford University Press, New York

    Google Scholar 

  19. Cervero F, Laird JM (1999) Visceral pain. Lancet 353(9170):2145–2148

    Article  CAS  PubMed  Google Scholar 

  20. Vargas-Schaffer G, Cogan J (2014) Patient therapeutic education: placing the patient at the centre of the WHO analgesic ladder. Can Fam Physician 60(3):235–241

    PubMed  PubMed Central  Google Scholar 

  21. Tegeder I, Lotsch J, Geisslinger G (1999) Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet 37(1):17–40

    Article  CAS  PubMed  Google Scholar 

  22. Davies G, Kingswood C, Street M (1996) Pharmacokinetics of opioids in renal dysfunction. Clin Pharmacokinet 31(6):410–422

    Article  CAS  Google Scholar 

  23. McPherson ML (2010) Demystifying opioid conversion calculations: a guide for effective dosing. American Society of Health-System Pharmacists, Bethesda

    Google Scholar 

  24. Bruera E et al (1995) Clinical efficacy and safety of a novel controlled-release morphine suppository and subcutaneous morphine in cancer pain: a randomized evaluation. J Clin Oncol 13(6):1520–1527

    CAS  PubMed  Google Scholar 

  25. Cooley ME (2000) Symptoms in adults with lung cancer. A systematic research review. J Pain Symptom Manage 19(2):137–153

    Article  CAS  PubMed  Google Scholar 

  26. Tishelman C et al (2007) Symptom prevalence, intensity, and distress in patients with inoperable lung cancer in relation to time of death. J Clin Oncol 25(34):5381–5389

    Article  PubMed  Google Scholar 

  27. Iyer S et al (2014) The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study. Support Care Cancer 22(1):181–187

    Article  PubMed  Google Scholar 

  28. Cooley ME, Short TH, Moriarty HJ (2003) Symptom prevalence, distress, and change over time in adults receiving treatment for lung cancer. Psychooncology 12(7):694–708

    Article  PubMed  Google Scholar 

  29. Gupta D, Lis CG, Grutsch JF (2007) The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer. Support Care Cancer 15(5):533–538

    Article  PubMed  Google Scholar 

  30. Parshall MB et al (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185(4):435–452

    Article  PubMed  Google Scholar 

  31. Ernst A et al (2004) Central airway obstruction. Am J Respir Crit Care Med 169(12):1278–1297

    Article  PubMed  Google Scholar 

  32. Prakash UB (2005) Bronchoscopy. In: Murray and Nadel’s textbook of respiratory medicine. Philadelphia, Saunders, pp 1617–1650

    Google Scholar 

  33. Antony VB et al (2001) Management of malignant pleural effusions. Eur Respir J 18(2):402–419

    Article  CAS  PubMed  Google Scholar 

  34. Shaw P, Agarwal R (2004) Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev (1):CD002916

    Google Scholar 

  35. Fysh ET et al (2014) Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion. Chest

    Google Scholar 

  36. Fysh ET et al (2012) Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. Chest 142(2):394–400

    Article  PubMed  Google Scholar 

  37. Kwok Y et al (2006) Radiation oncology emergencies. Hematol Oncol Clin North Am 20(2):505–522

    Article  PubMed  Google Scholar 

  38. Abernethy AP et al (2010) Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 376(9743):784–793

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jennings AL et al (2002) A systematic review of the use of opioids in the management of dyspnoea. Thorax 57(11):939–944

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zeppetella G (1997) Nebulized morphine in the palliation of dyspnoea. Palliat Med 11(4):267–275

    Article  CAS  PubMed  Google Scholar 

  41. Abernethy AP et al (2003) Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 327(7414):523–528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Mahler DA, O’Donnell DE (2015) Recent advances in dyspnea. Chest 147(1):232–241

    Article  PubMed  Google Scholar 

  43. Mahler DA et al (2010) American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest 137(3):674–691

    Article  PubMed  Google Scholar 

  44. Booth S et al (2011) Nonpharmacological interventions for breathlessness. Curr Opin Support Palliat Care 5(2):77–86

    Article  PubMed  Google Scholar 

  45. Galbraith S et al (2010) Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage 39(5):831–838

    Article  PubMed  Google Scholar 

  46. Selim AJ et al (1997) A symptom-based measure of the severity of chronic lung disease: results from the Veterans Health Study. Chest 111(6):1607–1614

    Article  CAS  PubMed  Google Scholar 

  47. Harle AS et al (2012) Understanding cough and its management in lung cancer. Curr Opin Support Palliat Care 6(2):153–162

    Article  PubMed  Google Scholar 

  48. Molassiotis A et al (2010) Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough. Cough 6:9

    Article  PubMed  PubMed Central  Google Scholar 

  49. Simoff MJ et al (2013) Symptom management in patients with lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e455S–e497S

    Article  CAS  PubMed  Google Scholar 

  50. Kvale PA (2006) Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):147S–153S

    Article  PubMed  Google Scholar 

  51. Doona M, Walsh D (1998) Benzonatate for opioid-resistant cough in advanced cancer. Palliat Med 12(1):55–58

    Article  CAS  PubMed  Google Scholar 

  52. Sawabata N et al (2005) Persistent cough following pulmonary resection: observational and empiric study of possible causes. Ann Thorac Surg 79(1):289–293

    Article  PubMed  Google Scholar 

  53. Medical A (1992) Research Council (MRC) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non-small-cell lung cancer (NSCLC) and poor performance status. Medical Research Council Lung Cancer Working Party. Br J Cancer 65(6):934–941

    Article  Google Scholar 

  54. Glare P et al (2011) Treating nausea and vomiting in palliative care: a review. Clin Interv Aging 6:243–259

    Article  PubMed  PubMed Central  Google Scholar 

  55. von Gunten CF, Gafford E (2013) Treatment of non-pain-related symptoms. Cancer J 19(5):397–404

    Article  Google Scholar 

  56. Harris DG (2010) Nausea and vomiting in advanced cancer. Br Med Bull 96:175–185

    Article  PubMed  Google Scholar 

  57. Navari RM, Nagy CK, Gray SE (2013) The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 21(6):1655–1663

    Article  PubMed  Google Scholar 

  58. Prommer E (2013) Olanzapine: palliative medicine update. Am J Hosp Palliat Care 30(1):75–82

    Article  PubMed  Google Scholar 

  59. Mancini I, Bruera E (1998) Constipation in advanced cancer patients. Support Care Cancer 6(4):356–364

    Article  CAS  PubMed  Google Scholar 

  60. Rangwala F, Zafar SY, Abernethy AP (2012) Gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, insights, and a proposed approach. Curr Opin Support Palliat Care 6(1):69–76

    Article  PubMed  Google Scholar 

  61. Fallon M, O’Neill B (1997) ABC of palliative care. Constipation and diarrhoea. BMJ 315(7118):1293–1296

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Cancer-Related Fatigue (Version 2.2015). NCCN Clinical Practice Guidelines in Oncology; Available from: http://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf. 25 Jan 2015

  63. Hinds PS et al (2000) An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. Eur J Oncol Nurs 4(1): 6–17; discussion 18–19

    Google Scholar 

  64. de Raaf PJ et al (2013) Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. J Clin Oncol 31(6):716–723

    Article  PubMed  Google Scholar 

  65. Bower JE et al (2014) Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol 32(17):1840–1850

    Article  PubMed  PubMed Central  Google Scholar 

  66. Mock V et al (2000) NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park) 14(11A):151–161

    CAS  Google Scholar 

  67. Palesh OG et al (2010) Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 28(2):292–298

    Article  PubMed  Google Scholar 

  68. Roscoe JA et al (2007) Cancer-related fatigue and sleep disorders. Oncologist 12(Suppl 1):35–42

    Article  PubMed  Google Scholar 

  69. Lo C et al (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28(18):3084–3089

    Article  PubMed  Google Scholar 

  70. Kroenke K et al (2010) The association of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manage 40(3):327–341

    Article  PubMed  PubMed Central  Google Scholar 

  71. Pirl WF et al (2012) Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care. J Clin Oncol 30(12):1310–1315

    Article  PubMed  PubMed Central  Google Scholar 

  72. Walker J et al (2014) Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol 15(10):1168–1176

    Article  PubMed  Google Scholar 

  73. Sharpe M et al (2014) Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 384(9948):1099–1108

    Article  PubMed  Google Scholar 

  74. Li M, Fitzgerald P, Rodin G (2012) Evidence-based treatment of depression in patients with cancer. J Clin Oncol 30(11):1187–1196

    Article  PubMed  Google Scholar 

  75. Chochinov HM (2001) Depression in cancer patients. Lancet Oncol 2(8):499–505

    Article  CAS  Google Scholar 

  76. Ng CG et al (2011) The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord 131(1–3):1–7

    Article  CAS  PubMed  Google Scholar 

  77. Patient-Centered Care and Communication. Available from: http://appliedresearch.cancer.gov/areas/pcc/. 5 Jan 2015

  78. Baile WF et al (2000) SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5(4):302–311

    Article  CAS  PubMed  Google Scholar 

  79. Back AL et al (2008) Communication about cancer near the end of life. Cancer 113(7 Suppl):1897–1910

    Article  PubMed  PubMed Central  Google Scholar 

  80. Back AL et al (2014) Reframing the goals of care conversation: “we’re in a different place”. J Palliat Med 17(9):1019–1024

    Article  PubMed  PubMed Central  Google Scholar 

  81. Sanders J (2015) Finding the right words at the right time-high-value advance care planning. N Engl J Med 372(7):598–599

    Article  CAS  PubMed  Google Scholar 

  82. ACP Definition. Available from: http://acpelsociety.com/acpdefinition.php. 5 Jan 2015

  83. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (2014). Available from: http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx. 5 Feb 2015

  84. Advanced Care Planning. Available from: http://www.cancer.net/navigating-cancer-care/advanced-cancer/advanced-cancer-care-planning. 5 Jan 2015

  85. The debate in hospice care. J Oncol Pract 4(3):153–157 (2008)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arvind M. Shinde .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Shinde, A.M., Dashti, A. (2016). Palliative Care in Lung Cancer. In: Reckamp, K. (eds) Lung Cancer. Cancer Treatment and Research, vol 170. Springer, Cham. https://doi.org/10.1007/978-3-319-40389-2_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40389-2_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40387-8

  • Online ISBN: 978-3-319-40389-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics