Managing symptoms

Many people with lung cancer have difficulty breathing and shortness of breath (dyspnoea) before or after diagnosis. These can occur for several reasons, such as the cancer itself and a reduction in lung function, a drop in fitness level due to less physical activity, or a build-up of fluid between the linings of the lung (pleural effusion).

If breathlessness is caused by pleural effusion, you may need to have surgery. Types of surgery include:

• pleural tap to drain the fluid
• pleurodesis to stop fluid building up again
• an indwelling pleural catheter.

If the cancer is blocking one of the main airways, a doctor may be able to use a laser, stent (a metal or plastic tube) or radiation therapy to open up the airway and improve breathing. You may also be referred to a pulmonary rehabilitation course to learn how to manage breathlessness. This will include exercise training, breathing techniques, ways to clear the airways, and tips for pacing yourself.

Having a pleural tap

For some people, fluid may build up in the pleural cavity, the space between the 2 layers of thin tissue covering the lung. The build-up of fluid is called pleural effusion. This can put pressure on the lung, making it hard to breathe. Having a pleural tap can relieve this symptom. This procedure is also known as pleurocentesis or thoracentesis. To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity. It then takes about 30–60 minutes to drain the fluid. You usually don’t have to stay overnight in hospital after a pleural tap. A sample of the fluid is sent to a laboratory for testing.

If you smoke, your doctor will advise you to quit and suggest ways to do this.

Pleurodesis

Pleurodesis is a way to close the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of 2 ways, depending on how well you are and what you would prefer.

VATS pleurodesis – This method uses a keyhole approach called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then a tiny video camera and operating instruments will be passed through one or more small cuts in the chest. After all fluid has been drained, the surgeon then injects some sterile talcum powder into the pleural cavity. This causes inflammation that helps fuse the 2 layers of the pleura together and prevents fluid from building up again. You will stay in hospital for a few days.

Bedside talc slurry pleurodesis – If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic while you are in bed. A small cut is made in the chest, then a tube is inserted into the pleural cavity. Fluid can be drained through the tube into a bottle.

Next, sterile talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity. Nurses will help you move into various positions every 10 minutes to get the talc slurry to spread throughout the pleural cavity. The process takes about an hour.

A slurry pleurodesis usually requires a hospital stay of 2–3 days. After the procedure, some people experience a burning pain in the chest for a day or two, but this can be eased with medicines.

Indwelling pleural catheter

An indwelling pleural catheter is a small tube used to drain fluid from around the lungs. It may be offered to people who repeatedly have a build-up of fluid in the pleural cavity that makes it hard to breathe and who are unable to or prefer not to have a pleurodesis.

You will be given a local anaesthetic, then the doctor inserts the catheter through the chest wall into the pleural cavity. One end of the tube is inside the chest, and the other stays outside the body for drainage. This end is coiled and tucked under a small dressing.

When fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a small bottle. You can manage the catheter at home with the help of a community nurse. A family member or friend can also be taught how to clear the catheter, which may be more convenient.

Improving breathlessness at home

Treat other conditions – Let your doctor know if you feel breathless. Conditions such as anaemia, a lung infection or chronic obstructive pulmonary  disease may also make you feel short of breath and these can often be treated.

Sleep more upright – Use a recliner chair or prop yourself up in bed to help you sleep in a more upright position. An occupational therapist may be able to recommend a special pillow for sleeping.

Check if equipment could help – Ask your health care team about equipment to manage breathlessness. To improve your lung capacity, you can blow into a lightweight device called an incentive spirometer. You may be able to use an oxygen concentrator at home to deliver oxygen to your lungs, or a portable oxygen cylinder for outings. If you have a cough or wheeze, you may benefit from a nebuliser, a device that delivers medicine to your lungs

Relax on a pillow – Rest your head and upper chest on a table with a pillow. Bend from your hips and keep your back straight. This helps to relax your breathing muscles.

Ask about medicines – Talk to your doctor about medicines, such as a low dose of morphine, to ease breathlessness. It is important to keep any chest pain well controlled because pain may prevent you from breathing deeply.

Modify your movement – Some types of gentle exercise can help but check with your doctor first. An exercise physiologist, physiotherapist or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.

Create a breeze – Use a handheld fan to direct a cool stream of air across your face if you feel short of breath when not exerting yourself. You may also find it helpful to sit by an open window.

Find ways to relax – Listen to a relaxation recording or learn other ways to relax. This can help you to control anxiety and breathe more easily.

Pain can be a symptom of lung cancer and a side effect of treatment. If pain is not controlled, it can affect your quality of life and how you cope with treatments.

There are different ways to control pain. Aside from medicines, various procedures can manage any build-up of fluid that is causing pain. Radiation therapy and chemotherapy can reduce pain by shrinking a lung tumour. Surgery may help treat pain from bones: for example, if the cancer has spread to the spine and is pressing on nerves (nerve compression).

Coping with pain

• Tell your doctor when you are in pain so they can help you find a way to control it. A palliative care or pain specialist may be able to help hard-to-manage pain.
• Keep track of your pain in a diary – note what the pain feels like, how intense it is, where it comes from and travels to, how long it lasts and if it goes away with a specific medicine or another therapy such as a heat pack.
• Allow a few days for your body to adjust to the dose of pain medicine and for drowsiness to improve.
• Take pain medicine regularly as prescribed, even when you are not in pain. It’s better to stay on top of the pain.
• Use a laxative regularly to prevent or relieve constipation from pain medicines.
• Try learning relaxation or meditation techniques to help you cope with pain.

Download our booklet ‘Understanding Cancer Pain’

Listen to our podcast ‘Managing Cancer Pain’

Some people stop feeling interested in eating and lose weight before lung cancer is diagnosed. These symptoms may be caused by the disease itself, or by feeling sick, having difficulty swallowing, being breathless, or feeling down.

Weight loss can affect how your body responds to cancer treatment, chances of infection, and recovery. This can happen to anyone, no matter what size or shape. Eating well will help you cope better with day-to-day living, treatment and side effects, and improve your quality of life.

Eating when you have little appetite

• Choose high-kilojoule and high-protein foods (e.g. add cheese or cream to meals).
• Try eating smaller portions more often (e.g. 5–6 smaller meals per day).
• Avoid drinking fluids at mealtimes, which can fill you up too quickly.
• Eat moist food such as scrambled eggs. If you have a sore mouth, moist foods tend to cause less irritation.
• Eat fresh salads or cold foods if hot food smells make you feel sick. Avoid fatty or sugary foods if these make you feel sick.
• Add ice-cream or fruit to a drink to increase kilojoules.
• Eat more of your favourite foods – follow your cravings.
• Talk to a dietitian for more tips on what to eat – they can suggest small changes to your diet that can help you stay well nourished.
• Ask your dietitian if you need to use protein drinks or nutritional supplements and which ones to buy.

Download our booklet ‘Nutrition for People Living with Cancer’

Listen to our podcast ‘Appetite Loss and Nausea’

It is common to feel very tired during or after treatment, and you may lack the energy to carry out day-to-day activities. Fatigue for people with cancer is different from tiredness, as it may not go away with rest or sleep. You may lose interest in things that you usually enjoy doing or feel unable to concentrate on one thing for very long.

Let your treatment team know if you are struggling with fatigue. Sometimes fatigue can be caused by a low red blood cell count (anaemia), or be a side effect of drugs or a sign of depression, all of which can be treated. There are also many hospital and other programs available to help you manage fatigue.

Managing fatigue

• Set small, manageable goals for the day, and rest before you get too tired.
• Plan breaks throughout the day when you are completely still for a while. An eye pillow can help at these times.
• Leave plenty of time to get to appointments.
• Ask your doctor about what sort of exercise would be suitable. An exercise physiologist or physiotherapist can help with safe and appropriate exercise plans.
• An occupational therapist can show you relaxation techniques, breathing exercises and ways to conserve your energy.
• Consider acupuncture – some people find it helps with fatigue.
• Say no to things you really don’t feel like doing.

Download our fact sheet ‘Fatigue and Cancer’

Listen to our podcast ‘Managing Cancer Fatigue’

Getting a good night’s sleep is important for maintaining your energy levels, reducing fatigue and improving mood. Pain, breathlessness, anxiety or depression can make it hard to sleep. Some medicines can also disrupt sleep. If you already had sleep problems before the lung cancer diagnosis, these could become worse.

Talk to your doctor about what might help improve your ability to sleep. Your medicines may need adjusting or sleep medicines may be an option. Talking to a counsellor may help if you feel anxious or depressed. Some strategies that people with cancer have found helpful are listed below.

Getting a better night’s sleep

• Try to do some gentle physical activity every day. Exercising may help you to sleep better. An exercise physiologist or physiotherapist can tailor an  exercise program for you.
• Limit or cut out alcohol, caffeinated drinks, nicotine and spicy food.
• Avoid watching television or using a computer, smartphone or tablet before bed, as their light tells your body it’s time to wake up.
• Follow a regular routine before bed and set up a calm sleeping environment. Ensure the room is dark, quiet and a comfortable temperature.
• Practise mindfulness, such as listening to a meditation recording. Or listen to gentle relaxation music.

Listen to our podcast ‘Sleep and Cancer’