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Palliative Care for Patients with Lung Cancer

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Book cover Lung Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Lung cancer is associated with significant mortality and morbidity. Palliative care plays an important role along the disease continuum for patients with advanced lung cancer. Mastery of core palliative care clinical skills, such as symptom management, prognostication, communication, decision making, and transition of care, would allow oncologists to better serve patients and families. Common symptoms in lung cancer patients, such as dyspnea, pain, fatigue, cough, hemoptysis, anorexia, cachexia, depression, and anxiety, can usually be managed effectively. For patients with severe symptoms or psychosocial distress, early involvement of the palliative care team is essential.

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References

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71-96

    Article  PubMed  Google Scholar 

  2. Hopwood P, Stephens RJ (1995) 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 71:633-636

    Article  PubMed  CAS  Google Scholar 

  3. Tishelman C, Petersson LM, Degner LF, Sprangers MA (2007) Symptom prevalence, intensity, and distress in patients with inoperable lung cancer in relation to time of death. J Clin Oncol 25:5381-5389

    Article  PubMed  Google Scholar 

  4. Pain Relief and Palliative Care (2002) In: National cancer control programmes: policies and managerial guidelines, 2nd ed. World Health Organization, Geneva, pp 83-91

    Google Scholar 

  5. Palliative Care (1995) In: National cancer control programmes: policies and managerial guidelines. World Health Organization, Geneva, pp 82-86

    Google Scholar 

  6. Coluzzi PH, Grant M, Doroshow JH, Rhiner M, Ferrell B, Rivera L (1995) Survey of the provision of supportive care services at National Cancer Institute-designated cancer centers. J Clin Oncol 13:756-764

    PubMed  CAS  Google Scholar 

  7. Goldsmith B, Dietrich J, Du Q, Morrison RS (2008) Variability in access to hospital palliative care in the United States. J Palliat Med 11:1-9

    Article  Google Scholar 

  8. IOM National Cancer Policy Board (2001) Improving palliative care for cancer. Institute of Medicine, Washington, DC

    Google Scholar 

  9. Fadul N, Elsayem A, Palmer JL et al (2009) Supportive vs. palliative care: what’s in a name? A survey of medical oncologists and mid-level providers at a comprehensive cancer center. Cancer 115(9):2013-2021

    Article  PubMed  Google Scholar 

  10. Miyashita M, Sanjo M, Morita T et al (2007) Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan: a nationwide expert opinion survey. J Palliat Med 10:390-399

    Article  PubMed  Google Scholar 

  11. Levy MH, Back A, Benedetti C et al (2009) NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw 7(4):436-473

    PubMed  Google Scholar 

  12. Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ (2004) The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Arch Intern Med 164:83-91

    Article  PubMed  Google Scholar 

  13. Meyers FJ, Linder J, Beckett L, Christensen S, Blais J, Gandara DR (2004) Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care. J Pain Symptom Manage 28:548-556

    Article  PubMed  Google Scholar 

  14. Meyers FJ, Linder J (2003) Simultaneous care: disease treatment and palliative care throughout illness. J Clin Oncol 21:1412-1415

    Article  PubMed  Google Scholar 

  15. Lamont EB, Christakis NA (2003) Complexities in prognostication in advanced cancer: “to help them live their lives the way they want to”. JAMA 290:98-104

    Article  PubMed  Google Scholar 

  16. Christakis NA, Lamont EB (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 320:469-472

    Article  PubMed  CAS  Google Scholar 

  17. Paesmans M, Sculier JP, Lecomte J et al (2000) Prognostic factors for patients with small cell lung carcinoma: analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years. Cancer 89:523-533

    Article  PubMed  CAS  Google Scholar 

  18. Paesmans M, Sculier JP, Libert P et al (1995) Prognostic factors for survival in advanced non-small-cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation algorithms in 1, 052 patients. The European Lung Cancer Working Party. J Clin Oncol 13:1221-1230

    PubMed  CAS  Google Scholar 

  19. Thorogood J, Bulman AS, Collins T, Ash D (1992) The use of discriminant analysis to guide palliative treatment for lung cancer patients. Clin Oncol (R Coll Radiol) 4:22-26

    Article  CAS  Google Scholar 

  20. Maione P, Perrone F, Gallo C et al (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23:6865-6872

    Article  PubMed  Google Scholar 

  21. Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations - a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240-6248

    Article  PubMed  Google Scholar 

  22. Stone PC, Lund S (2007) Predicting prognosis in patients with advanced cancer. Ann Oncol 18:971-976

    Article  PubMed  CAS  Google Scholar 

  23. Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J (1992) Estimate of survival of patients admitted to a palliative care unit: a prospective study. J Pain Symptom Manage 7:82-86

    Article  PubMed  CAS  Google Scholar 

  24. Chuang RB, Hu WY, Chiu TY, Chen CY (2004) Prediction of survival in terminal cancer patients in Taiwan: constructing a prognostic scale. J Pain Symptom Manage 28:115-122

    Article  PubMed  Google Scholar 

  25. Morita T, Tsunoda J, Inoue S, Chihara S (1999) The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 7:128-133

    Article  PubMed  CAS  Google Scholar 

  26. Yun YH, Heo DS, Heo BY, Yoo TW, Bae JM, Ahn SH (2001) Development of terminal cancer prognostic score as an index in terminally ill cancer patients. Oncol Rep 8:795-800

    PubMed  CAS  Google Scholar 

  27. Maltoni M, Nanni O, Pirovano M et al (1999) Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain Symptom Manage 17:240-247

    Article  PubMed  CAS  Google Scholar 

  28. Pirovano M, Maltoni M, Nanni O et al (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 17:231-239

    Article  PubMed  CAS  Google Scholar 

  29. Glare PA, Eychmueller S, McMahon P (2004) Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer. J Clin Oncol 22:4823-4828

    Article  PubMed  Google Scholar 

  30. Glare P, Virik K (2001) Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service. J Pain Symptom Manage 22:891-898

    Article  PubMed  CAS  Google Scholar 

  31. Loprinzi CL, Johnson ME, Steer G (2000) Doc, how much time do I have? J Clin Oncol 18:699-701

    PubMed  CAS  Google Scholar 

  32. Hancock K, Clayton JM, Parker SM et al (2007) Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage 34:190-200

    Article  PubMed  Google Scholar 

  33. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C (2001) How accurate are physicians’ clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol (R Coll Radiol) 13:209-218

    CAS  Google Scholar 

  34. Mackillop WJ, Stewart WE, Ginsburg AD, Stewart SS (1988) Cancer patients’ perceptions of their disease and its treatment. Br J Cancer 58:355-358

    Article  PubMed  CAS  Google Scholar 

  35. Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S (2001) Patient preferences versus physician perceptions of treatment decisions in cancer care. J Clin Oncol 19:2883-2885

    PubMed  CAS  Google Scholar 

  36. Bruera E, Willey JS, Palmer JL, Rosales M (2002) Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer 94:2076-2080

    Article  PubMed  Google Scholar 

  37. Grunfeld EA, Maher EJ, Browne S et al (2006) Advanced breast cancer patients’ perceptions of decision making for palliative chemotherapy. J Clin Oncol 24:1090-1098

    Article  PubMed  Google Scholar 

  38. Stinnett S, Williams L, Johnson DH (2007) Role of chemotherapy for palliation in the lung cancer patient. J Support Oncol 5:19-24

    PubMed  CAS  Google Scholar 

  39. Anderson H, Hopwood P, Stephens RJ et al (2000) Gemcitabine plus best supportive care (BSC) vs BSC in inoperable non-small cell lung cancer-a randomized trial with quality of life as the primary outcome. UK NSCLC Gemcitabine Group. Non-Small Cell Lung Cancer. Br J Cancer 83:447-453

    Article  PubMed  CAS  Google Scholar 

  40. Shepherd FA, Dancey J, Ramlau R et al (2000) Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol 18:2095-2103

    PubMed  CAS  Google Scholar 

  41. Bezjak A, Tu D, Seymour L et al (2006) Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol 24:3831-3837

    Article  PubMed  CAS  Google Scholar 

  42. Florescu M, Hasan B, Seymour L, Ding K, Shepherd FA (2008) National Cancer Institute of Canada Clinical Trials Group. A clinical prognostic index for patients treated with erlotinib in National Cancer Institute of Canada Clinical Trials Group study BR.21. J Thorac Oncol 3:590-598

    Article  PubMed  Google Scholar 

  43. Temel JS, McCannon J, Greer JA et al (2008) Aggressiveness of care in a prospective cohort of patients with advanced NSCLC. Cancer 113:826-833

    Article  PubMed  Google Scholar 

  44. Werner-Wasik M, Scott C, Cox JD et al (2000) Recursive partitioning analysis of 1999 Radiation Therapy Oncology Group (RTOG) patients with locally-advanced non-small-cell lung cancer (LA-NSCLC): identification of five groups with different survival. Int J Radiat Oncol Biol Phys 48:1475-1482

    Article  PubMed  CAS  Google Scholar 

  45. Walker-Renard PB, Vaughan LM, Sahn SA (1994) Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 120:56-64

    Article  PubMed  CAS  Google Scholar 

  46. Cranston JM, Crockett A, Currow D (2008) Oxygen therapy for dyspnoea in adults. Cochrane Database Syst Rev (3):CD004769

    Google Scholar 

  47. Bruera E, de Stoutz N, Velasco-Leiva A, Schoeller T, Hanson J (1993) Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet 342:13-14

    Article  PubMed  CAS  Google Scholar 

  48. Bruera E, Sweeney C, Willey J et al (2003) A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med 17:659-663

    PubMed  Google Scholar 

  49. Bruera E, MacEachern T, Ripamonti C, Hanson J (1993) Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med 119:906-907

    Article  PubMed  CAS  Google Scholar 

  50. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE (2002) A systematic review of the use of opioids in the management of dyspnoea. Thorax 57:939-944

    Article  PubMed  Google Scholar 

  51. Kvale PA, Selecky PA, Prakash UB, American College of Chest Physicians (2007) Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:368S-403S

    Article  PubMed  Google Scholar 

  52. Bausewein C, Booth S, Gysels M, Higginson I (2008) Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev (2):CD005623

    Google Scholar 

  53. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain 132:312-320

    Article  PubMed  Google Scholar 

  54. Fainsinger RL, Nekolaichuk CL (2008) A “TNM” classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP). Support Care Cancer 16:547-555

    Article  PubMed  Google Scholar 

  55. Wiffen PJ, McQuay HJ (2007) Oral morphine for cancer pain. Cochrane Database Syst Rev (4):CD003868

    Google Scholar 

  56. Eisenberg E, McNicol E, Carr DB (2006) Opioids for neuropathic pain. Cochrane Database Syst Rev 3:CD006146

    PubMed  Google Scholar 

  57. Wiffen PJ, McQuay HJ, Edwards JE, Moore RA (2005) Gabapentin for acute and chronic pain. Cochrane Database Syst Rev (3):CD005452

    Google Scholar 

  58. Saarto T, Wiffen PJ (2007) Antidepressants for neuropathic pain. Cochrane Database Syst Rev (4):CD005454

    Google Scholar 

  59. Forlenza MJ, Hall P, Lichtenstein P, Evengard B, Sullivan PF (2005) Epidemiology of cancer-related fatigue in the Swedish twin registry. Cancer 104:2022-2031

    Article  PubMed  Google Scholar 

  60. Mock V, Atkinson A, Barsevick A et al (2000) NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park) 14:151-161

    CAS  Google Scholar 

  61. Cramp F, Daniel J (2008) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev (2):CD006145

    Google Scholar 

  62. Bruera E, Valero V, Driver L et al (2006) Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. J Clin Oncol 24:2073-2078

    Article  PubMed  CAS  Google Scholar 

  63. Fleishman S, Lower E, Zeldis J, Faleck H, Manning D (2005) A phase II, randomized, placebo-controlled trial of the safety and efficacy of dexmethylphenidate (d-MPH) as a treatment for fatigue and “chemobrain” in adult cancer patients. Breast Cancer Res Treat 94:S214

    Google Scholar 

  64. Minton O, Stone P, Richardson A, Sharpe M, Hotopf M (2008) Drug therapy for the management of cancer related fatigue. Cochrane Database Syst Rev (1):CD006704

    Google Scholar 

  65. Morrow GR, Jean-Pierre P, Roscoe JA et al (2008) A phase III randomized, placebo-controlled, double-blind trial of a eugeroic agent in 642 cancer patients reporting fatigue during chemotherapy: a URCC CCOP Study. J Clin Oncol 26:504s

    Article  Google Scholar 

  66. Barton DL, Soori GS, Bauer B et al (2007) A pilot, multi-dose, placebo-controlled evaluation of American ginseng (panax quinquefolius) to improve cancer-related fatigue: NCCTG trial N03CA. J Clin Oncol 25:493s

    Article  Google Scholar 

  67. Bennett CL, Silver SM, Djulbegovic B et al (2008) Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 299:914-924

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  69. Moroni M, Porta C, Gualtieri G, Nastasi G, Tinelli C (1996) Inhaled sodium cromoglycate to treat cough in advanced lung cancer patients. Br J Cancer 74:309-311

    Article  PubMed  CAS  Google Scholar 

  70. Morice AH, Menon MS, Mulrennan SA et al (2007) Opiate therapy in chronic cough. Am J Respir Crit Care Med 175:312-315

    Article  PubMed  CAS  Google Scholar 

  71. Tscheikuna J, Chvaychoo B, Naruman C, Maranetra N (2002) Tranexamic acid in patients with hemoptysis. J Med Assoc Thai 85:399-404

    PubMed  Google Scholar 

  72. MacDonald N (2007) Cancer cachexia and targeting chronic inflammation: a unified approach to cancer treatment and palliative/supportive care. J Support Oncol 5:157-162 discussion 164-166, 183

    PubMed  CAS  Google Scholar 

  73. Del Fabbro E, Dalal S, Bruera E (2006) Symptom control in palliative care - Part II: cachexia/anorexia and fatigue. J Palliat Med 9:409-421

    Article  PubMed  Google Scholar 

  74. Berenstein EG, Ortiz Z (2005) Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev (2):CD004310

    Google Scholar 

  75. Jatoi A, Windschitl HE, Loprinzi CL et al (2002) Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol 20:567-573

    Article  PubMed  CAS  Google Scholar 

  76. Chochinov HM (2001) Depression in cancer patients. Lancet Oncol 2:499-505

    Article  PubMed  CAS  Google Scholar 

  77. Fulcher CD, Badger T, Gunter AK, Marrs JA, Reese JM (2008) Putting evidence into practice: interventions for depression. Clin J Oncol Nurs 12:131-140

    Article  PubMed  Google Scholar 

  78. Candy M, Jones L, Williams R, Tookman A, King M (2008) Psychostimulants for depression. Cochrane Database Syst Rev (2):CD006722

    Google Scholar 

  79. Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA (2008) Psychotherapy for depression among incurable cancer patients. Cochrane Database Syst Rev (2):CD005537

    Google Scholar 

  80. Jackson KC, Lipman AG (2004) Drug therapy for anxiety in palliative care. Cochrane Database Syst Rev (1):CD004596

    Google Scholar 

  81. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5:302-311

    Article  PubMed  CAS  Google Scholar 

  82. Clayton JM, Hancock KM, Butow PN, et al (2007) Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust 186:S77, S79, S83-S108

    PubMed  Google Scholar 

  83. M.D. Anderson Cancer Pain Guideline for Adults (2008) http://utm-ext01a.mdacc.tmc.edu/mda/cm/cwtguide.nsf/LuHTML/SideBar1

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Hui, D., Bruera, E. (2010). Palliative Care for Patients with Lung Cancer. In: Stewart, D. (eds) Lung Cancer. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-524-8_19

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