Ask CancerCare
November 2007 This Month's Topic: Coping with Lung Cancer Featured Expert: Win Boerckel, LCSW-R |
Q. I have Stage 4 non-small-cell lung cancer, and have undergone an upper left lobotomy, chemotherapy and concurrent radiation therapy, and now am receiving Tarceva. My husband has been through so much with me that I hope with the help of hospice, he will be spared from some of the emotional difficulties that may confront a spouse when the other is facing the end of life. What kind of pain can I expect, so that both of us can be better prepared for what lies ahead? Is there anything my medical team can do to make it easier on both of us? Please give me an honest answer. Everyone seems to want to avoid this one.
A. There is no easy means of determining the course of late-stage lung cancer in terms of its metastatic progression or what bodily functions it may eventually interrupt or damage that will lead to the end of life. Thus, at times, the process can be relatively benign and pain free; at other times, it may cause the person with cancer to deal with significant discomfort and pain. You have already identified one of the most appropriate resources for dealing with your situation; that is, hospice care. Hospices provide some of the best palliative care available including the patient’s physical, emotional and spiritual comfort. While admission to hospice requires that one's physician provides a "life limiting" prognosis (which is defined as less than six months of life), we encourage patients and family members dealing with late-stage cancer to check out local hospices well before admission. This gives all involved the opportunity to develop a relationship with hospice staff and ask such questions as those you posed, concerning pain and symptom management, as well as the support resources available for family members. Most often, doing so can result in peace of mind for both patient and family members, as important next steps have been identified.
For more information about hospice and end-of-life care, please consult the National Hospice and Palliative Care Organization's consumer website, Caring Connections.
We've also developed a fact sheet, "Caregiving at the End of Life" 
that might be helpful to you. And remember that CancerCare's professionally trained social workers assist lung cancer patients and family members in situations similar to yours and can help them navigate their way through end of life care.
Q. My husband has been diagnosed with Stage IIIA non-small-cell lung cancer that had spread to the mediastinal nodes. Surgery is not an option. He will begin radiation and chemotherapy treatments next week. I have heard that the five-year survival rate for this type of cancer is 15% or approximately two years. Is this correct?
A. The American Society of Chest Physicians indicates that the five-year survival rate for Stage IIIA non-small-cell lung cancer (NSCLC) ranges from less than 10% to 40% and is dependent on the extent of mediastinal lymph node involvement. NSCLC type (squamous cell, adenocarcinoma or large cell carcinoma) may also influence survival rates.
It is important to keep in mind that the primary purpose of staging a cancer is to ensure that the correct treatment protocols are utilized, rather than to predict post-diagnosis longevity. Survival rates do not represent the experience of any individual lung cancer patient. They are statistical figures which are comprised of data collected on the experience of thousands of cancer patients and then calculated to develop the average or median computation for that very large group.
Many factors influence lung cancer survival, including a patient's age, overall state of health prior to diagnosis, healthy lifestyle, compliance to treatment regimens and response to treatment. Very often, newly diagnosed patients who join CancerCare's lung cancer patient support groups have poor survival prognoses, yet survive for significantly longer periods than anticipated.
One valuable coping strategy we have learned from these group members over the years is "staying in moment." Using our physical and emotional strengths on today's issues, rather than trying to solve the unknowns of the future, appears to be one of the most effective ways of living each day with lung cancer. For more information, listen to CancerCare's Telephone Education Workshop podcast, Living Each Day With Lung Cancer. You can also find comprehensive information about lung cancer on CancerCare's up-to-date companion website, www.lungcancer.org.
Q. I was diagnosed with non-small-cell lung cancer and started chemotherapy as my doctor said surgery was not an option at this time. At first, I lost a lot of weight but by the third session I recovered. But now I've had two colds within a three-week period. Is there something you can recommend? A second concern I have involves the low level of hemoglobin in my blood, for which the doctor has recommended some erythropoietin treatments. Might this also be diet related?
A. You ask an especially important set of questions for lung cancer patients who are diagnosed with their cancer at a stage where chemotherapy is found to be the most effective treatment. You can find out more about lung cancer staging in CancerCare's Connect® Booklet, Lung Cancer Treatment Update.
Chemotherapy for either small cell on non-small-cell lung cancer tends to be fairly aggressive and can produce some difficult side effects. While chemotherapy is focused on destroying lung cancer cells it can also interfere with normal body functions, such as the production of the three types of blood cells: red blood cells, white blood cells, and platelets. Normally, just before you start a chemotherapy treatment session, your doctor arranges for you to have blood tests to determine the effect the treatment is having on your blood cells. Low counts of any of these cells may prompt either a change in dosage or frequency of treatment, or a need to take medication that can stimulate bone marrow production of the blood cells.
Your colds may be due to the chemotherapy's suppression of the bone marrow's production of white blood cells, which are the body's infection fighters. If your doctor feels that your white cell count has significantly decreased, he or she may consider putting you on a medication for this condition. Talk again with your oncologist about whether this might be a possibility.
Similarly, the low levels of hemoglobin you mention may be due to low red blood cell counts induced by chemotherapy. Red blood cells carry oxygen and iron to provide the body with components necessary for energy. Red blood cells are an important factor in maintaining energy levels in our bodies and too few of them can result in fatigue and anemia. It sounds like your oncologist believes anerythropoietin-type drug might be helpful in boosting your red blood cell count. While extreme low red blood cell counts are not normally related to diet, you might also want to ask your oncologist for a referral to a dietitian who works with cancer patients to develop a meal plan that would increase your dietary intake of iron and help you maintain a healthy weight.
CancerCare offers Connect® booklets that provide more detailed information on chemotherapy side effects: Finding New Ways to Cope With Fatigue , Understanding and Managing Chemotherapy Side Effects and Coping With Nausea and Vomiting From Chemotherapy .
Q. I was diagnosed with Stage IB non-small-cell lung cancer in late spring. My doctor said that all I’d need was surgery and she referred me to a surgeon. I had a lobe resection and he said that they had gotten all the cancer. When I went to see him last week he gave me a referral to an oncologist for what he said was "adjuvant treatment," meaning chemotherapy. Why do I need to do this? My aunt had chemo 10 years ago and it was really hard on her.
A. Your question is one we are hearing more frequently these days from lung cancer survivors who have been diagnosed with early-stage disease and have had surgery as their primary treatment.
For a long time, it was believed that only surgery was necessary to achieve a successful outcome for lung cancer patients diagnosed with Stage IB to IIIA non-small-cell lung cancer. However, a number of recent investigational research studies provided evidence that patients who received both surgery as a primary treatment and chemotherapy as an "adjuvant," or secondary, treatment, reduced their risk of the cancer recurring. Unlike chemotherapy used as a primary therapy, an adjuvant chemotherapy protocol is a relatively short-term intervention with a fixed duration of treatment.
You should discuss any of your concerns about the side effects of chemotherapy with your oncologist before treatment starts. I do want to note that there are significantly fewer, less severe side effects in current-day chemotherapy than when your aunt had her treatment. We hope this information helps you to make an informed decision on adjuvant treatment.
For more information on lung cancer staging and adjuvant treatment, see the CancerCare Connect® booklet, Lung Cancer Treatment Update .
For information on coping with the side effects of chemotherapy, you may find helpful our CancerCare Connect® booklets, Finding New Ways to Cope with Fatigue , Coping With Nausea and Vomiting From Chemotherapy , and Managing Diarrhea. For additional information, see the National Cancer Institute’s Coping with Cancer.
Win Boerckel, LCSW-R, is Lung Cancer Program Coordinator and Program Director of LIVESTRONG & National Relations Program. Win provides supportive services for lung cancer patients and their loved ones, facilitates face to face and telephone support groups, and serves on several professional advisory boards, including those for the websites lungcancer.org and plwc.org.
The questions and answers listed above are from the November 2007 Ask CancerCare feature. New Ask CancerCare topics are introduced every month.
If you have additional questions about coping with lung cancer, please contact CancerCare directly for information and guidance. CancerCare provides free professional support services, including counseling, education, financial assistance and practical help. These services are provided by professional oncology social workers. If you have a specific concern or question and would like to speak with an oncology social worker, please contact us at info@cancercare.org or 1-800-813-HOPE (4673).
For questions about medical issues, please visit Cancer.net, the patient information website of the American Society of Clinical Oncology (ASCO).
