MTE26 - New Paradigms in Symptom Management in Lung Cancer (Ticketed Session) (ID 836)
- Event: WCLC 2018
- Type: Meet the Expert Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 2
- Coordinates: 9/26/2018, 07:00 - 08:00, Room 206 AC
MTE26.01 - Treatment of Cancer Related Symptoms (ID 11592)
07:00 - 07:30 | Presenting Author(s): Patricia Rivera
The majority of patients with lung cancer are diagnosed with advanced disease where the 5-year survival rate remains low. Improving survival, quality of life (QOL) and control of symptoms are pivotal goals for health care professionals caring for patients with lung cancer. Several studies have shown that symptom burden and distress are higher among patients with lung cancer 1,2. Despite advances in treatment of advanced lung cancer including targeted oral therapies which have resulted in improved survival and QOL3, and early palliative care intervention which results in improvement in symptom control and quality of life4, a recent study showed persistent significant symptom burden, distress and unmet needs in patients with advanced lung cancer5. The most common symptom in lung cancer is fatigue, reported in about 40% of patients, followed by pain (30%)5. Organ specific symptoms and complications include cough and dyspnea (20%), airway obstruction, hemoptysis, pleural effusions and tracheoesophageal fistula5,6. Providers caring for lung cancer patients need to be aware of common symptoms and interventions available, particularly non-drug interventions, and work together in multidisciplinary teams to ensure lung cancer patients are receiving the best therapeutic and non-therapeutic interventions in their cancer care in order to improve survival and QOL.
Cancer-related fatigue, sometimes referred as cancer fatigue syndrome may be related to both the disease process and treatments, including surgery, chemotherapy and radiation therapy. Other factors that may contribute to fatigue include anemia, dyspnea, decreased nutrition, decreased exercise, pain, depression, and insomnia.Pulmonary rehabilitation (PH)/physiotherapy, shown to be very effective in patients with COPD, is an underappreciated intervention in patients with lung cancer due to lack of randomized data and low rates of referral (<25%). Although limited, existing, evidence supports PH/physiotherapy in lung cancer patients before and after surgery and that in patients receiving therapy other than surgery, may result in both ability to maintain and improve physical function, muscle strength and quality of life 7,8.
Acute and chronic pain in the lung cancer patient may be multifactorial and influenced by physical, psychosocial and spiritual factors6. Pain-assessment tools and targeted imaging as required are as first essential steps in evaluating a patient’s pain symptom6. Healthcare providers should understand the WHO analgesic ladder which recommends use of analgesics (acetaminophen and NSAIDs) for mild pain, addition of weaker opioids (codeine or dihydrocodeine) for mild to moderate pain and stronger opioids (morphine, hydromorphone, oxycodone)for severe pain6. Psychologic factors contribute to increased pain and suffering among cancer patients and non-drug interventions including hypnosis, cognitive behavioral coping mechanisms, meditation and relaxation exercises have been shown to reduce pain in patients and long term survivors9.
The symptom of dyspnea is complex , often multifactorial and results in worsening QOL in patients with lung cancer. Dyspnea may be due underlying COPD or cardiac disease, complications of the tumor such as airway obstruction or pleural effusion, and side effects of treatment such as anemia, muscle fatigue, infection, pneumonitis and decreased nutrition. Careful and thorough assessment is paramount in order to manage dyspnea effectively.
Patients with symptomatic endobronchial and extrinsic airway obstruction can benefit significantly from therapeutic bronchoscopy. Therapeutic bronchoscopic interventions, often used in combination, include debulking of airway tumors mechanically, using laser, electrocautery, cryotherapy, argon plasma coagulation. Balloon dilatation and insertion of silicone or metallic airway stents may be performed to treat extrinsic stenosis or endobronchial strictures due to radiation and covered metallic airway stents are effective in the management of tracheoesophageal fistulas6.
Hemoptysis, occurring in about 7-10% of lung cancer patients, is most commonly due to endobronchial tumor involvement. Rare causes include airway-vascular fistula formation, tumor necrosis with cavity formation, and complications from treatment (bevacizumab). Hemoptysis can be minor or severe/massive, the later defined as more than 200 mL of blood in a 24-hour period and commonly requires intervention. Securing the airway with a single-lumen endotracheal tube is paramount. Bronchoscopy is an excellent tool for both diagnosis and therapeutic intervention when endobronchial disease is found as the cause of the hemoptysis and includes laser, electrocautery, and argon plasma coagulation. External beam radiation therapy may also be used for endobronchial tumors causing hemoptysis6. When hemoptysis is due to parenchymal lesion such cavitary lung lesions due to cancer or due to complications of therapy, external bean radiation therapy or bronchial artery embolization is recommended.
1. Cooley ME. Symptoms in adults with lung cancer. A systematic research review. J Pain Symptom Manage 2000;19:137-53
2. Graves KD, Arnold SM, Love CL, et al. Distress screening in a multidisciplinary lung cancer clinic : prevalence and predictors of clinically significant distress. Lung Cancer 2007; 55:215-24
3. Rolfo C, Passiglia F, Ostrowski M, et al. Improvement in Lung Cancer Outcomes With Targeted Therapies: An Update for Family Physicians. J Am Board Int Med 2015;28:123-33
4. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small cell lung cancer. N Engl J Med 2010;363:733-42
5. Sung MR, Patel MV, Djalalov S, et al. Evolution of Symptom Burden of Advanced Lung Cancer Over a Decade. Clinical Lung Cancer 2017;3:264-80
6. Simoff MJ, Lally B, Slade MG, et al. Symptom Management in Patients With Lung Cancer. Diagnosis and management of Lung Cancer, 3rded: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013; 143(5) (Suppl):e455S-e497S
7. Granger CL. Physiotherapy management of lung cancer. Journal of Physiotherapy 2016; 62:60-67
8. Holland AE, Wadell K, Spruit MA. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD. Eur Respir Rev 2013; 22:405-13
9.Ayrjla KL, Jensen MP, Mendoza ME, et al. Psychological and Behavioral Approaches to Cancer Pain Management. J Clin Oncol 2014; 32:1703-11
MTE26.02 - Symptoms and IO Toxicity Management (ID 11593)
07:30 - 08:00 | Presenting Author(s): Jarushka Naidoo
Abstract not provided