Managing lung cancer symptoms

Ways of managing lung cancer symptoms

Lung cancer can affect the tissue around the lung, and cause symptoms like coughing, bloodstained sputum (phlegm), breathlessness and chest pain. The cancer can also make you less hungry, cause weight loss, leave you feeling tired and, sometimes, you may not be able to sleep at night. Most of the time, the best way to improve lung cancer-related symptoms is to have treatment to treat or shrink the cancer.

Speak to your doctor or nurse about any symptoms you have. As well as cancer treatments, your doctor may be able to refer you to a palliative care service to help you manage your cancer symptoms.

Breathlessness (being short of breath)

Ways of managing breathlessness include:

  • medication
  • breathing techniques
  • relaxation exercises
  • other treatments for breathlessness—chemotherapy or radiation to shrink a cancer, and oxygen therapy
  • pleural effusion
    • thoracentesis (plural tap)
    • pleurodesis
    • indwelling pleural drains.

If you're feeling breathless, try the Action Plan for Breathlessness. (You may like to print it and stick this Action Plan on your refrigerator or somewhere you can find it easily.)

Managing lung cancer-related breathlessness will depend on the cause of your shortness of breath. There are several ways to ease your discomfort. Your doctor may do some tests to investigate your breathlessness, including a chest X-ray or measuring how much oxygen is making it into your bloodstream. It is important to work out what is causing your breathlessness and to help you manage this.

Medication

Your doctor may give you medication (drugs) to help with breathlessness caused by lung cancer. These may treat pneumonia (chest infection), wheezing, fluid build-up in the lungs or anxiety.

Breathing techniques

Although breathlessness can be a difficult symptom to live with, there are things you can do to prevent or reduce its impact on your life. In this section, we explain some breathing techniques that can help.

Get into a comfortable position.

When you feel breathless, it helps being in a comfortable position that supports your upper chest muscles and allows your diaphragm and tummy to expand. In the following pages, we describe four comfortable positions.

Position 1

Sit in a chair in an upright position, with your back supported, legs uncrossed and feet resting comfortably on the floor. Let your shoulders drop and feel heavy, with your arms resting softly in your lap. Keep your head upright.


Position 2

Sit in a chair and lean forward with your upper body. Have your legs uncrossed, feet on the floor and shoulders relaxed. Slowly move forward a little so that your elbows and lower arms are resting on your thighs, supporting your upper body. Keep your knees shoulder-width apart and let your chest relax when you lean forward.


Position 3

Stand and lean forward onto a secure surface. Let your arms and elbows rest on the surface so that you're supporting the weight of your upper body. Keep your shoulders and chest relaxed by letting your forearms remain shoulder-width apart.


Position 4

Stand in an upright position and lean back against a secure surface. Let your arms drop to your sides and make your shoulders heavy and relaxed.

Source: Macmillan Cancer Support UK accessed on the internet 30/10/2013: http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Breathlessness/Breathingmoreeasily.aspx


Relaxation exercises

There are relaxation exercises you can do to help when feeling short of breath. A member of your Multidisciplinary Care Team will teach you and your family exercises so that you can practise them at home.

Other treatments for breathlessness

Your doctor may suggest more treatment to improve your breathing. This could include:

  • chemotherapy or radiation to shrink a cancer
  • oxygen therapy (in hospital and/or at home).

Pleural effusion

Sometimes, fluid builds up in the chest because the cancer has spread. Lung cancer can spread to the pleura. The cancer irritates the pleura and they then make too much fluid which is called a pleural effusion.

You may be treated with:

  • thoracentesis (pleural tap)
  • pleurodesis
  • indwelling pleural drains.

Thoracentesis (pleural tap)

When fluid builds up in the area between the lung and the chest wall (pleural cavity) you may experience shortness of breath, tiredness or pain. Your doctor can try to relieve the symptoms by removing the fluid, performing a procedure called thoracentesis (pleural tap). Fluid is sucked out or drained out from around the lungs through a plastic tube inserted under local anaesthetic.

Pleurodesis

If the fluid returns after you have had a pleural tap, your doctor may consider doing a procedure called pleurodesis which involves draining fluid and inserting talcum powder into the pleural cavity (between the lung and the chest wall). The powder inflames the membranes and makes them stick together, which reduces the risk of the fluid coming back. This can be done at the patient's bedside.

Indwelling pleural drains

Some patients cannot have surgery, or built-up fluid isn't controlled with pleurodesis. They're offered a long-term (permanent) indwelling pleural catheter, which is a drainage tube that is put into the pleural cavity to drain fluid when the fluid returns and causes symptoms like shortness of breath.

The tube remains in the space around the lung and is fixed to the skin under a dressing. The tube is connected to a small bottle that collects the fluid. The drain can be managed by the patient, a confident carer or the community nurse service.

Cough

Coughing is a common symptom of lung cancer which can be upsetting if you find it hard to stop.

Usually, the best way to treat coughing is to treat the lung cancer. If it's not possible to remove the cancer with surgery, using chemotherapy or radiation treatment to try to shrink the cancer can help.

Some medications can be very helpful to reduce the effects of your cough. They may be given in tablet or liquid form. Sometimes breathing in steam or having saline through a nebuliser (a fine spray) is helpful.

If you're coughing up green or dark yellow sputum (phlegm) you may have an infection and need to see your doctor about antibiotics.

Pain

There is a range of prescription medications and complementary therapies to help with pain caused by lung cancer.

Radiation treatment or chemotherapy, medications and other medical treatments are also used to treat cancer pain. Many people find a combination of more than one treatment helps, but everyone is different, so it might take time to find the right pain relief for you.

Sometimes, it is not possible to control all pain. You may still feel some discomfort. However, your health professionals, particularly your palliative care nurse and GP, will help make you feel as pain-free as possible.

Morphine is a medication very commonly prescribed to reduce pain. It has the added advantage of reducing breathlessness and cough.

Pain cannot be seen or tested for by your doctor or nurse so it's important to tell them if you are in pain.

Fatigue (no energy)

Fatigue can be described in many ways, including feeling exhausted, extremely tired, sleepy, drowsy or finding it difficult to concentrate. Fatigue can appear suddenly and rest may not help. Here are some ideas to help cope with fatigue:

  • Let people help you. Family, friends and neighbours may offer to help with tasks, such as shopping, childcare, housework and driving.
  • Take a few weeks off work during or after having treatment or work fewer hours. You may be able to work from home.
  • Do light exercise, such as walking, and keep up your normal exercise routine if approved by your doctor. Don't start any new exercise routine until you feel better after treatment.
  • Try to eat a healthy, well-balanced diet. Some people find small, frequent snacks more appealing than trying to eat a meal. If you have nausea, have your meals when you feel like eating.
  • Fatigue may be caused by some specific things that can be found in blood tests and may be improved by treatment.

Trouble sleeping

Some people with lung cancer have trouble sleeping or have a problem falling asleep with long periods where they lie awake or don't get enough sleep which can affect how well they feel during the day. If you are in pain this may affect your sleep.

Ways to cope with not being able to sleep (insomnia) are:

  • Unless you are very unwell, try to wake up at the same time each day.
  • Try to go to bed at the same time each night.
  • Try to spend time in bright light during the day.
  • Create a quiet, dark and restful place for sleeping.
  • Be careful with caffeine—caffeinated drinks like tea, coffee and soft drinks. These may give you energy but may leave you feeling anxious.
  • If you're not sleeping well, talk with your health care team.
  • Take your pain medication.

You may like to read our information sheet "Cancer-related fatigue" on our website.

Nausea (feeling sick)

Nausea (feeling sick) is a common symptom of lung cancer. Even if you do not feel sick (nauseous) you may not feel hungry or enjoy foods you used to like.

For more information, contact your local Cancer Society for a copy of the information sheet "Coping with the Side Effects of Chemotherapy and Radiation Treatment: Fever, Nausea (feeling sick) and Vomiting", read it on the Society's website or phone the nurses on the Cancer Information Helpline 0800 CANCER (226 237).

Weight loss

Weight loss is a common symptom of lung cancer. If you're underweight or losing weight, try to eat good sources of protein and include foods high in calories in your diet.

For extra protein, eat meat, fish or poultry at least once a day; preferably more.

Good sources of protein and energy include:

  • meat, fish or poultry
  • milk and dairy products
  • legumes (for example, baked beans, kidney beans, chick peas, lentils) and nuts.

If weight loss is a problem for you, talk to a dietitian for more information. They may recommend adding supplements to your diet.

The Cancer Society has a booklet titled Eating Well During Cancer Treatment to read or listen to on our website. You can also get a copy from your local Cancer Society or by phoning the nurses on the Cancer Information Helpline 0800 CANCER (226 237)

Key points: Managing lung cancer symptoms

  • You can get a variety of symptoms caused by lung cancer, from pain and breathlessness (being short of breath) to weight loss and trouble sleeping. Your doctor can help with pain relief.
  • Manage your fatigue (extreme tiredness) with the help of family/whānau and friends as well as through exercise and diet.
  • If you are underweight or losing weight you will need to have more protein and energy in your diet. Your doctor, nurse or dietitian can provide advice on your diet.
  • Talk to your doctor if you have any breathing problems, if you are coughing up any green, yellow or blood stained sputum (phlegm) or your breathlessness is getting worse.

We suggest you also read our booklet Coping with Cancer: Your guide to support and practical help