Ask CancerCare

A. A pneumonectomy is the surgical removal of one lung in which a lung cancer tumor involves all the lobes of that lung and is confined to only that area. A person with two normal lungs would be able to tolerate the impact of the reduced pulmonary capacity on their breathing in such a situation. However, people who have a history of smoking activity, emphysema or bronchitis may not be candidates for this treatment due to their diminished lung capactiy. Age may also play a role as people over age 70 have a higher risk of complications from this procedure.

Be proactive with your doctor about what your recovery plan will be. A patient who has completed a pneumonectomy will be expected to undergo a course of pulmonary rehabilitation with a respiratory therapist, who will guide the patient through regular exercises and techniques designed to help maximize breathing capacity and cope with breathlessness.

Learn more about the professionals who might be part of your recovery team in our fact sheet, "Your Health Care Team: Your Doctor is Only the Beginning" .

Listen to our podcast, The Sixth Annual Cancer Survivorship Series: Living With, Through and Beyond Cancer, Part I: The Importance of Communicating with Your Doctor About Follow-Up Care.

To help you organize your medical care after treatment, the Lance Armstrong Foundation offers "The Cancer Survivor's Medical Treatment Summary" .

A. Stage 4 Non Small Lung Cancer is characterized by the spread (or metastasis, the medical term for this process) of lung cancer cells via the bloodstream to organs outside the lungs such as the liver, brain, adrenal glands or bones. These cells attach to the new site (or sites) and begin to grow new tumors. The cells of the new tumor site, however, are lung cancer cells rather than liver cancer cells. So the chemotherapy your sister's oncologist has chosen to treat the primary tumor site in the lungs would also be considered the most appropriate treatment for the lung cancer tumors that have grown outside the lungs.

One of the benefits of chemotherapy used for Stage 4 lung cancer is not only that it's treating tumors at the locations known to exist, but it is also working on outside tumors that may be too small to be detected yet. That's why chemotherapy is considered a systemic therapy, in that it treats cancer tumors throughout the body.

Find more information about treatments for lung cancer in our Connect^® booklet, Lung Cancer: Your Guide to the Latest Research and Treatments - Highlights from the 2008 Annual Meeting of the American Society of Clinical Oncology .

CancerCare also offers a full range of free support services for people facing lung cancer.

A. This is a common question that comes up for folks diagnosed with and in treatment for lung cancer. Some lung cancer patients continue to use tobacco products either because the chemical addiction to nicotine is so strong that they are unable to quit; or, because over the course of their smoking history, they have found that smoking provides them with a soothing or calming effect in stressful situations.

A study featured at the 2006 Annual meeting of the American Association for Cancer Research (AACR) reported that nicotine stopped chemotherapy drugs such as gemcitabine, cisplatin and taxol—all of which figure prominently in first-line treatment of lung cancer—from killing cancer cells and significantly reduced the effectiveness of the treatment, according to the researchers.

In contrast, another 2006 research study, conducted by the M.D. Anderson Cancer Center, focused on the overall survival of late-stage, non-small-cell lung cancer (NSCLC) patients who quit smoking or continued to smoke during treatment. The study, which followed the survival experiences of 1,370 NSCLC patients from 1993 through 2002, found no significant difference in overall survival between these two groups of patients. Among those patients who did survive, however, and who had quit smoking at the onset of their treatment, the risk of developing a second lung cancer was significantly lower.

Your best friend's husband's smoking is affecting their relationship. CancerCare's professional oncology social workers often work with couples in situations like this and are able to help them develop new communications skills which can reduce stress and repair strained relationships. All of CancerCare's services, including counseling, education and practical assistance, are provided free of charge. Please urge your friend to contact us at 1-800-813-HOPE (4673) or email info@cancercare.org for more information about CancerCare's lung cancer program and support groups for people dealing with a lung cancer diagnosis.

For more information and resources about smoking cessation, read the American Cancer Society's Guide to Quitting Smoking.

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.

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.

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 .

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.