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Managing the symptoms of lung cancer
For many people, lung cancer is diagnosed at an advanced stage. The main goal of treatment is to manage symptoms and keep them under control for as long as possible. The procedures and strategies below are for managing the most common symptoms of lung cancer. As you may have a number of symptoms, you may be given a combination of treatments. Keep in mind that you won’t necessarily experience every symptom listed here.
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 decrease in fitness level due to reduced physical activity or a build-up of fluid between the linings of the lung (pleural effusion).
If breathlessness is caused by fluid build-up in the pleural cavity (the space between the linings of the lung), you may need to have surgery:
- 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 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 space between the two layers of thin tissue covering the lung. This is called pleural effusion and it can put pressure on the lung, making it hard to breathe.
Having a pleural tap can relieve this symptom. The 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. The fluid can then be drained, which will take about 30–60 minutes. 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.
Pleurodesis means closing 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 two ways, depending on how well you are and what you would prefer:
VATS pleurodesis – This method uses a type of keyhole surgery called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then a tiny video camera and operating instruments will be inserted through one or more small cuts in the chest. After all fluid has been drained, the surgeon then puffs some sterile talcum powder into the pleural cavity. This causes inflammation that helps fuse the two 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’re 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. To help move the talc slurry throughout the pleural cavity, nurses will help you move into various positions for about 10 minutes at a time. The entire process takes about an hour.
A slurry pleurodesis usually requires a hospital stay of two or three days. After the procedure, some people experience a burning pain in the chest for 24–48 hours, 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 experience 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 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 or friend can also be taught how to clear the drain.
Improving breathlessness at home
Treat other conditions – Let your doctor know if you feel breathless. Other conditions, such as anaemia or a lung infection, 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.
Ask about medicines – Talk to your doctor about medicines, such as a low dose of morphine, to ease breathlessness. Make sure your chest pain is well controlled, as pain may stop you breathing deeply.
Check if equipment could help – Ask your health care team about equipment to manage breathlessness. To improve the capacity of your lungs, you can blow into a 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 into your lungs.
Modify your movement – Some types of gentle exercise can help but check with your doctor first. A physiotherapist, exercise physiologist or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.
Relax on a pillow – Lean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax.
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. Sitting by an open window may also help.
Find ways to relax – Listen to a relaxation recording or learn other ways to relax. This can allow you to control anxiety and breathe more easily. Listen to Cancer Council’s free relaxation and meditation recordings or call 13 11 20 for a free copy of the CDs. Some people find breathing exercises, acupuncture and meditation helpful.
Pain can be a symptom of lung cancer and a side effect of treatment. Tell your treatment team if you are in pain. If pain is not controlled, it can affect your wellbeing and how you cope with treatments.
There are different ways to control pain. Aside from medicines, various procedures can manage fluid build-up 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). If pain is hard to manage, a palliative care or pain specialist can help find the right pain control for you.
Coping with pain
- Keep track of your pain in a symptom 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.
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.
Eating well will help you cope better with day-to-day living, treatment and side effects, and improve your quality of life. Consider talking to a dietitian who is experienced in treating people with cancer. A dietitian can help you make small dietary changes to keep you well nourished and recommend protein drinks and other nutritional supplements if needed. You can ask your treatment team to refer you to a dietitian.
Eating when you have little appetite
- Choose high-kilojoule and high-protein foods (e.g. add cheese or cream to meals).
- Eat smaller portions more often (5–6 meals per day), instead of three larger meals.
- Avoid drinking fluids at mealtimes, which can fill you up too quickly.
- Eat moist food such as scrambled eggs. Moister food tends to be easier to eat and will cause less irritation if you have a sore mouth.
- Try eating 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.
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, or be a side effect of drugs or a sign of depression, which can all be treated. There are also many hospital and other programs available to help you manage 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.
- Say no to things you really don’t feel like doing.
- Leave plenty of time to get to appointments.
- Ask your doctor about what sort of exercise would be suitable. A physiotherapist or exercise physiologist 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.
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. Seeing a counsellor may help if you feel anxious or depressed. The box below gives some strategies that people with cancer have found helpful.
Getting a better night’s sleep
- Try to do some gentle physical activity every day. This will help you sleep better. A physiotherapist or exercise physiologist 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.
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This information is reviewed by
This information was last reviewed in October 2020 by the following expert content reviewers: A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Private Hospital Melbourne, VIC; Prof Kwun Fong, Thoracic and Sleep Physician and Director, UQ Thoracic Research Centre, The Prince Charles Hospital, and Professor of Medicine, The University of Queensland, QLD; Renae Grundy, Clinical Nurse Consultant – Lung, Royal Hobart Hospital, TAS; A/Prof Brian Le, Director, Palliative Care, Victorian Comprehensive Cancer Centre – Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, and The University Of Melbourne, VIC; A/Prof Margot Lehman, Senior Radiation Oncologist and Director, Radiation Oncology, Princess Alexandra Hospital, QLD; Susana Lloyd, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Nicole Parkinson, Lung Cancer Support Nurse, Lung Foundation Australia.