Elsevier

Clinical Lung Cancer

Volume 7, Issue 4, January 2006, Pages 241-249
Clinical Lung Cancer

Comprehensive Review
Comprehensive Symptom Management in Patients with Advanced-Stage Non–Small-Cell Lung Cancer

https://doi.org/10.3816/CLC.2006.n.001Get rights and content

Abstract

Although we have made steady improvements in the survival rates of patients with advanced-stage lung cancer, the majority of patients still experience distress and suffering. Although the symptom burden is greatest in patients in the end stages of life, many patients living with lung cancer suffer from troubling symptoms and side effects of therapy. Even long-term survivors with early-stage non–small-cell lung cancer (NSCLC) often experience respiratory symptoms, such as dyspnea and cough. Because of the high prevalence of NSCLC and the frequency with which it presents in an incurable stage, symptom management is a large component of the care of these patients. Dyspnea, cough, fatigue, anorexia/cachexia, and pain are the most common symptoms in patients with advanced-stage NSCLC. Cancer-directed therapy can improve some of these symptoms but often incompletely and temporarily. Therefore, comprehensive care of patients with advanced-stage NSCLC must include therapies targeted at these difficult and distressing symptoms.

References (116)

  • PA Foral et al.

    Nebulized opioids use in COPD

    Chest

    (2004)
  • GC Man et al.

    Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease

    Chest

    (1986)
  • SH Ahmedzai

    Cough in cancer patients

    Pulm Pharmacol Ther

    (2004)
  • F Dimeo et al.

    Correlation between physical performance and fatigue in cancer patients

    Ann Oncol

    (1997)
  • K Tanaka et al.

    Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer

    J Pain Symptom Manage

    (2002)
  • T Okuyama et al.

    Fatigue in ambulatory patients with advanced lung cancer: prevalence, correlated factors, and screening

    J Pain Symptom Manage

    (2001)
  • K Ahlberg et al.

    Assessment and management of cancer- related fatigue in adults

    Lancet

    (2003)
  • JD Yee et al.

    Dextroamphetamine or methylphenidate as adjuvants to opioid analgesia for adolescents with cancer

    J Pain Symptom Manage

    (1994)
  • WD Dewys et al.

    Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group

    Am J Med

    (1980)
  • JH Von Roenn et al.

    Control of common, non-pain cancer symptoms

    Semin Oncol

    (2005)
  • JE Beal et al.

    Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS

    J Pain Symptom Manage

    (1995)
  • R Arriagada et al.

    Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer

    N Engl J Med

    (2004)
  • A Sandler et al.

    Randomized phase II/III trial of paclitaxel (P) plus carboplatin (C) with or without bevacizumab (NSC # 704865) in patients with advanced non-squamous non-small cell lung cancer (NSCLC): an Eastern Cooperative Group (ECOG) trial - E4599

    J Clin Oncol

    (2005)
  • FA Shepherd et al.

    Erlotinib in previously treated non-small-cell lung cancer

    N Engl J Med

    (2005)
  • T Winton et al.

    Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer

    N Engl J Med

    (2005)
  • P Hopwood et al.

    Symptoms at presentation for treatment in patients with lung cancer: implications for the evaluation of palliative treatment. The Medical Research Council (MRC) Lung Cancer Working Party

    Br J Cancer

    (1995)
  • S Lutz

    Symptom frequency and severity in patients with metastatic or locally recurrent lung cancer: a prospective study using the Lung Cancer Symptom Scale in a community hospital

    J Palliat Med

    (2001)
  • P Hopwood et al.

    Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data

    J Clin Oncol

    (2000)
  • M O'Driscoll et al.

    The experience of breathlessness in lung cancer

    Eur J Cancer Care (Engl)

    (1999)
  • L Adams et al.

    The measurement of breathlessness induced in normal subjects: validity of two scaling techniques

    Clin Sci (Lond)

    (1985)
  • JR Thomas et al.

    Management of dyspnea

    J Support Oncol

    (2003)
  • SB LeGrand et al.

    Opioids, respiratory function, and dyspnea

    Am J Hosp Palliat Care

    (2003)
  • E Bruera et al.

    Subcutaneous morphine for dyspnea in cancer patients

    Ann Intern Med

    (1993)
  • AP Abernethy et al.

    Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea

    BMJ

    (2003)
  • RD Stark et al.

    Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide

    Clin Sci (Lond)

    (1981)
  • AA Woodcock et al.

    Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers

    Br Med J (Clin Res Ed)

    (1981)
  • S Booth et al.

    Oxygen or air for palliation of breathlessness in advanced cancer

    J R Soc Med

    (2003)
  • E Bruera et al.

    A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea

    Palliat Med

    (2003)
  • HP Liss et al.

    The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease

    Am Rev Respir Dis

    (1988)
  • RM Schwartzstein et al.

    Cold facial stimulation reduces breathlessness induced in normal subjects

    Am Rev Respir Dis

    (1987)
  • J Hately et al.

    Breathlessness clinics within specialist palliative care settings can improve the quality of life and functional capacity of patients with lung cancer

    Palliat Med

    (2003)
  • M Bredin et al.

    Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer

    BMJ

    (1999)
  • J Corner et al.

    Non-pharmacological intervention for breathlessness in lung cancer

    Palliat Med

    (1996)
  • TC Braun et al.

    Development of a clinical practice guideline for palliative sedation

    J Palliat Med

    (2003)
  • J Homsi et al.

    Hydrocodone for cough in advanced cancer

    Am J Hosp Palliat Care

    (2000)
  • M Doona et al.

    Benzonatate for opioid-resistant cough in advanced cancer

    Palliat Med

    (1998)
  • M Moroni et al.

    Inhaled sodium cromoglycate to treat cough in advanced lung cancer patients

    Br J Cancer

    (1996)
  • M Bennett et al.

    Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care

    Palliat Med

    (2002)
  • D Irvine et al.

    The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals

    Cancer Nursing

    (1994)
  • NJ Vogelzang et al.

    Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition

    Semin Hematol

    (1997)
  • Cited by (61)

    • Health-related quality-of-life results for pembrolizumab versus chemotherapy in advanced, PD-L1-positive NSCLC (KEYNOTE-024): a multicentre, international, randomised, open-label phase 3 trial

      2017, The Lancet Oncology
      Citation Excerpt :

      Taken together, the superior survival, manageable safety profile, and favourable patient-reported outcome data obtained in the KEYNOTE-024 study suggest that pembrolizumab could be considered as a new standard of care for the first-line treatment of strongly PD-L1-expressing (tumour proportion score of 50% or more), advanced NSCLC. Patients with advanced NSCLC have a high burden of symptoms, such as fatigue, cough, dyspnoea, anorexia, weight loss, and pain that can have a substantial negative effect on health-related quality of life (HRQOL) and functioning.2–5 Therefore, the effect of novel treatments on symptom control and HRQOL needs to be considered alongside survival.

    • The role of advanced nursing in lung cancer: A framework based development

      2015, European Journal of Oncology Nursing
      Citation Excerpt :

      The systemic therapy is nearly always proposed to lung cancer patients. Further, as lung cancer is often detected in advanced stages, these patients often need high levels of supportive care (Joyce et al., 2008; Temel et al., 2006). Therefore, we focused on developing an APLCN clinical pathway for lung cancer patients receiving systemic therapy combined (or not) with radiotherapy.

    View all citing articles on Scopus

    Electronic forwarding or copying is a violation of US and International Copyright Laws.

    Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1525-7304, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400.

    View full text