Category Archives: Lung Cancer

End-of-Life Care in Patients With Lung Cancer: Patient management

8. In making end-of-life decisions for patients with lung cancer, ethics consultation by HECs should be requested when assistance is needed in clarifying applicable law and policy related to patient autonomy and competence, informed consent, withholding life-prolonging treatments, surrogate preferences, decision making for patients without family, and resource allocation, as well as determining how ethical norms should be interpreted, or negotiating interpersonal conflicts among patients, families, and physicians. Evidence: poor; benefit: substantial; grade of recommendation: C
9. In end-of-life care for patients with lung cancer, given the potential variations in ethics consultations, the requesting party and the consultant should clarify beforehand the specific objectives of the consultation, the selection of the participants, the process to be used in deliberation or negotiation, and the manner in which results will be disclosed and recorded. Evidence: poor; benefit: substantial; grade of recommendation: C

End-of-Life Care in Patients With Lung Cancer: Summary of Recommendations

End-of-Life Care in Patients With Lung Cancer: Summary of Recommendations1. For patients with lung cancer at the end of life, it is recommended that clinicians increase their focus on the patient’s experience of illness to improve congruence of treatment with patient goals and preferences: (a) be realistic, practical, sensitive, and compassionate; (b) listen; (c) allow/invite the patient to express his or her reaction to the situation; (d) provide a contact person; (e) and continually reassess the patient’s goals of therapy as part of treatment planning. Evidence: poor; benefit: substantial; grade of recommendation: C natural inhalers for asthma

2. For all patients with lung cancer, end-of-life planning should be integrated as a component of assessment of goals of treatment and treatment planning. Evidence: poor; benefit: substantial; grade of recommendation: C
3. For patients with lung cancer, an experienced clinician should inform the patient of the diagnosis and its meaning. The day-to-day contact person should also be present at this meeting and should coordinate care. Evidence: poor; benefit: substantial; grade of recommendation: C

End-of-Life Care in Patients With Lung Cancer: Conclusion

Recommendations
For patients with lung cancer at the end of life, the goal of palliative care should be to achieve the best quality of life for the patients and their families. Evidence: poor; benefit: substantial; grade of recommendation: C
In patients with lung cancer receiving hospice care, end-of-life management needs to be considered part of the longitudinal care of these patients. Evidence: fair; benefit: Substantial; grade of recommendation: B
At the end of life in patients with lung cancer, multimodality palliative care teams should be developed and encouraged to participate in their management. Evidence: fair; benefit: substantial; grade of recommendation: B

End-of-Life Care in Patients With Lung Cancer: Undertreatment with narcotics

End-of-Life Care in Patients With Lung Cancer: Undertreatment with narcoticsThere are a number of clinical barriers that exist that interfere with this optimal level of end-of-life care. Physicians are reluctant to talk about death at the end of life, and they may consider progression of disease to be a therapeutic failure. Fear of opioid addiction by the physician and patient may lead to underreporting of pain and undertreatment with narcotics. Further barriers to optimal care include the lack of available multimodality palliative care teams, fragmentation of care by multiple physicians, and no designated team leader directing the overall care. It is important for the primary care provider to be well versed in palliative care programs incorporating pharmacists, psychologists, nurses, social workers, pastoral care providers, pain specialists, and ethicists.

End-of-Life Care in Patients With Lung Cancer: Hospice

A very common complication of lung cancer is nausea and vomiting. Prevalence of this symptom is 40 to 46% in the last 6 weeks of life Causes for nausea and vomiting should be worked up and treated aggressively. Fear, anxiety, and pain can cause nausea and vomiting, and should be treated. Gastric irritation should be treated with acid-blocking agents. Overfeeding should be avoided because it can cause nausea and vomiting, and hepatic metastases can be treated with nonsteroidal anti-inflammatory drugs and corticosteroids with cy-toprotectants. Other symptoms that may occur in lung cancer such as weight loss, insomnia, and anorexia may become irrelevant at the end of life, but troublesome oral and respiratory secretions, myoclonus, and drowsiness may be important end-of-life symptoms that require careful management.

End-of-Life Care in Patients With Lung Cancer: Dyspnea

End-of-Life Care in Patients With Lung Cancer: DyspneaPatients often fear a lonely, painful death with technologies that are out of their control and only delay the natural process of dying. Cancer care should be a longitudinal involvement from diagnosis, treatment of the cancer and its symptoms, managing recurrences, and end-of-life supportive care. The physician must recognize a turning point in the patient’s condition when anticancer treatments fail to work and physical and emotional support become the primary mode of treatment.
The physician should be aware that symptoms of weakness, pain, fatigue, and nausea and vomiting are continuing clinical problems throughout the course of a terminal illness.’ In a study evaluating end-of-life care in 939 patients in five teaching hospitals between 1989 and 1994, severe dyspnea occurred in 32% of patients and severe pain in 28% of patients.> These and other symptoms are the focus of end-of-life care in the patient with lung cancer.

End-of-Life Care in Patients With Lung Cancer: End-of-Life Care of Patients

Recommendations
For the patient with lung cancer, decision making about ICU treatment should incorporate available knowledge about prognosis, including the use of a cancer-specific outcome prediction model to complement clinical judgment, and weigh reasonably expected benefits of critical care against potential burdens, including distressing physical and psychological symptoms. Evidence: poor; benefit: substantial; grade of recommendation: C health and care mall

In the inoperable or unresectable patient with lung cancer, prolonged mechanical ventilation is discouraged in view of dismal reported outcomes. Evidence: fair; benefit: small; grade of recommendation: D

End-of-Life Care in Patients With Lung Cancer: Provision of Palliative Care by the Critical Care Specialist

End-of-Life Care in Patients With Lung Cancer: Provision of Palliative Care by the Critical Care SpecialistFor patients with lung cancer treated in ICUs, as for other patients at substantial risk of hospital death, it is not appropriate to postpone palliative care until death is imminent. Death may come suddenly and unexpectedly, as it did for many patients with cancer and other serious illnesses in SUPPORT, whose median predicted 2-month survival was 20% on the day before they died. In addition, accumulating evidence from critical care and other settings suggests that patient suffering is associated with unfavorable outcomes including higher mortality, whereas relief of distressing symptoms and improved communication about treatment goals may promote favorable clinical and utilization outcomes.

End-of-Life Care in Patients With Lung Cancer: Average hospital’s operating

End-of-Life Care in Patients With Lung Cancer: Average hospital’s operatingSymptom burden is relevant in ICU decision making, although expert palliative care can be expected to improve patient and family comfort and should be integrated into treatment plans for all critically ill patients— especially those, such as patients with lung cancer, who remain at high risk for hospital death. Financial and other burdens for families of such patients may be significant.

End-of-Life Care in Patients With Lung Cancer: Burdens of ICU Treatment

A retrospective study documented hospital mortality of 75% among 57 patients with primary lung cancer who were admitted to a medical ICUs, identifying acute pulmonary disease (such as infection or ARDS) and Karnofsky performance status prior to hospital admission as factors predictive of ICU and hospital death; among hospital survivors (n = 14), median postdischarge survival was 32 weeks for patients with stage I or II disease, and 16 weeks for stage III or IV. Among 44 lung cancer patients included in a retrospective study of critically ill cancer patients, approximately one half of whom received mechanical ventilation, hospital mortality was 48%. An earlier retrospective study, involving lung cancer patients without prior surgical resection who required mechanical ventilation for respiratory failure, found that 39 of 46 patients died receiving mechanical ventilation and < 10% survived the hospitalization; no patient was liberated from mechanical ventilation after 6 days, a finding consistent with other data associating prolonged mechanical ventilation with dismal outcomes for cancer patients. canadian drug mall

At the present time, no data exist with respect to functional status or quality of life of patients with lung cancer surviving ICU treatment.

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