Oncological and Palliative Care for Patients with Lung Cancer and Patients with Breast Cancer: Two Opposite Ends of a Spectrum

Abstract

Lung cancer and breast cancer are diseases with fundamentally different clinical presentation, symptom burden, treatment options, life expectancy, and palliative needs. Most patients with lung cancer present with advanced, symptomatic disease. The great majority of these patients cannot be cured, and they have limited treatment options. Except for a few patients with molecular targets for drugs, they have to rely on chemotherapy and radiotherapy, which only marginally improve survival and are primarily used to ameliorate symptoms and delay disease progression. Patients should be offered palliative care as soon as the cancer is considered incurable. If comprehensive palliative care is put into effect this early, it not only improves the patients’ well-being but may prolong survival. In contrast, most women with breast cancer present with a localized, curable disease. If they develop metastatic disease, they cannot be cured, just like patients with lung cancer, but they face many more treatment options. Median life expectancy is about twice as long as for lung cancer. The cancer itself and cancer-associated symptoms can be controlled in many women for a prolonged period of time. Patients thus face a long-standing, chronic course with a series of relapses and re-treatments. This may result in a feeling of unlimited treatment options and necessarily leads to disappointment when treatment options dwindle. Palliative caregivers should know the differences between patients’ characteristics, treatment options, and the effect of treatment on patients’ expectations to provide optimal support.