Lung cancer


Managing lung cancer symptoms

For many people, lung cancer is diagnosed at an advanced stage. The main goal of treatment will be to manage your symptoms and keep them under control for as long as possible. Treatment can help you feel better and improve quality of life. This is called palliative treatment.

This section describes treatments and strategies for managing the most common symptoms of lung cancer. As you may be experiencing a number of symptoms, you may have a combination of treatments. Keep in mind, however, that you won't necessarily experience every symptom listed here.

Breathlessness

Many people with lung cancer have difficulty breathing and shortness of breath (dyspnoea). This can be challenging and may cause distress.

Types of surgery that can help improve this symptom include a pleural tap to drain the fluid (see below), pleurodesis to stop fluid building up again and an indwelling pleural catheter. You may have one or more of these procedures to ease symptoms even before lung cancer is diagnosed, and they could be suggested at any time to improve breathlessness.

You may also be referred to a pulmonary rehabilitation course to learn about how to manage breathlessness, which will include exercise training, breathing techniques and tips for pacing yourself. See ideas about how to manage breathlessness at home.

Having a pleural tap

For some people, fluid may build up in the space between the two layers of thin tissue covering the lung (pleural cavity). This is called pleural effusion and can put pressure on the lung, making it hard to breathe. A pleural tap can relieve this symptom. The procedure is also known as pleurocentesis or thoracentesis.

To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity. The fluid can then be drained, which will take about 30–60 minutes. You don't usually have to stay overnight after a pleural tap. A sample of the fluid is sent to a laboratory for testing.

Lung Foundation Australia can provide more information about living with lung cancer. Visit Lung Foundation Australia's lung cancer overview to find written information and videos. You can also contact their Lung Cancer Support Nurse by calling 1800 654 301.

Pleurodesis

Pleurodesis means closing the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of two ways, depending on how well you are and your preferences:

VATS pleurodesis

This method uses a type of keyhole surgery called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then a tiny video camera and operating instruments will be inserted through small cuts in the chest. After all fluid has been drained, the surgeon then puffs some sterile talcum powder into the pleural cavity. This causes inflammation that helps fuse the two layers of the pleura together and prevents fluid from building up again.

Bedside talc slurry pleurodesis

If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic while you're in bed. A small cut is made in the chest, then a tube is inserted into the pleural cavity. Fluid can be drained through the tube into a bottle. Next, talcum powder mixed with salt water (a "slurry") is injected through the tube into the pleural cavity. To help distribute the talc slurry throughout the pleural cavity, nurses will help you move into various positions for about 10 minutes at a time. The entire process takes about an hour.

Pleurodesis usually requires a hospital stay of two or three days. After the procedure, some people experience a burning pain in the chest for 24-48 hours, but this can be eased with medicines.

Indwelling pleural catheter

An indwelling pleural catheter is a small tube used to drain fluid from around the lungs. It may be offered to people who repeatedly experience a build-up of fluid in the pleural cavity that makes it hard to breathe and who are unable to or prefer not to have pleurodesis.

Using local anaesthetic, the doctor inserts the catheter through the chest wall into the pleural cavity. One end of the tube remains inside the chest, and a small length remains outside the body for drainage. This end is coiled and tucked under a small dressing.

When fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a small bottle. You can manage the catheter at home with the help of a community nurse. Your family or a friend can also be taught how to clear the drain.

"Now I have good and bad days. I do breathing exercises during rehabilitation. Sometimes I feel so good that I overdo it. I forget that I have one lung and I tire easily. I'm learning to pace myself." – Lois

Improving breathlessness at home

It can be distressing to feel short of breath, but a range of simple strategies and treatments can provide some relief at home.

Treat other conditions

Let your doctor know if you feel breathless. Other conditions, such as anaemia or a lung infection, may also make you feel short of breath, and these can often be treated.

Sleep in a chair

Use a recliner chair to help you sleep in a more upright position.

Ask about medicines

Talk to your doctor about medicines, such as a low dose of morphine, to manage feelings of distress. Make sure your chest pain is well controlled, as pain may stop you breathing deeply.

Check if equipment could help

Ask your health care team about equipment to manage breathlessness. To improve the capacity of your lungs, you can blow into a device called an incentive spirometer. You may be able to use an oxygen concentrator at home to deliver oxygen to your lungs, or a portable oxygen cylinder for outings. If you have a cough or wheeze, you may benefit from a nebuliser, a device that delivers medicine into your lungs.

Modify your movement

Some types of gentle exercise can help, but check with your doctor first. A physiotherapist, exercise physiologist and/or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.

Relax on a pillow

Lean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax.

Create a breeze

Use a fan to direct a stream of air across your face if you feel short of breath. Sitting by an open window may also help.

Find ways to relax

Listen to a relaxation recording or learn other ways to relax. This can allow you to control anxiety and breathe more easily. Cancer Council has free relaxation and meditation recordings available as CDs or online. Some people find breathing exercises, acupuncture and meditation helpful. See Understanding Complementary Therapies.

Pain

Pain can be a symptom of lung cancer, but can also be a side effect of treatment such as surgery or chemotherapy. Medicines to control pain may be mild, like paracetamol; moderate, like codeine; or strong and opioid-based, like morphine. Various procedures can manage fluid build-up that is causing pain. Radiation therapy and chemotherapy can shrink a lung tumour that is causing pain or can relieve pain from cancer that has spread to the bones.

Tell your team if you are in pain. If pain is hard to manage, a palliative care or pain specialist can help find the right pain control for you.

Coping with pain

  • Keep track of your pain in a symptom diary – note what the pain feels like, how intense it is, where it comes from and travels to, how long it lasts, and if it goes away with a specific medicine or another therapy such as a heat pack.
  • Allow a few days for your body to adjust to the dose of pain medicine/morphine and for the drowsiness to improve.
  • Take pain medicine regularly as prescribed, even when you are not in pain. It's better to stay on top of the pain.
  • Use a laxative regularly to prevent or relieve constipation from pain medicines.
  • Try learning relaxation or meditation techniques to help you cope with pain. Cancer Council has recordings available as CDs or online.
  • See Overcoming Cancer Pain and listen to our podcast episode on pain.

Poor appetite and weight loss

Some people stop feeling interested in eating and lose weight even before lung cancer is diagnosed. These symptoms may be caused by the disease itself, or by nausea, difficulty swallowing, breathlessness, or feeling down.

Eating well will help you cope better with day-to-day living, treatment and side effects, and improve your quality of life. You may find it useful to talk to a dietitian who is experienced in treating people with cancer. A dietitian can help you find foods that you can manage, and can recommend protein drinks and other supplements if needed. You can ask your treatment team to refer you to a dietitian.

Eating when you have little appetite

  • Have small meals and snacks regularly. A large, full plate may put you off eating – try using a smaller plate with moderate portions instead. Likewise, drink from a half-full glass.
  • Eat moist food such as scrambled eggs. Moister food tends to be easier to eat and will cause less irritation if you have a sore mouth.
  • Try eating fresh salads or cold foods if hot food smells make you nauseous.
  • Avoid fatty or sugary foods if these make you feel sick.
  • Use lemon juice and herbs to add flavour to bland food.
  • Add ice-cream or fruit to a drink to increase kilojoules and nutrients.
  • Eat more of your favourite foods – follow your cravings.
  • See Nutrition and Cancer and listen to our " Appetite Loss and Nausea" podcast episode.

Fatigue

It is common to feel very tired during or after treatment, and you may lack the energy to carry out day-to-day activities. Fatigue for people with cancer is different from tiredness, as it may not go away with rest or sleep. You may lose interest in things that you usually enjoy doing or feel unable to concentrate on one thing for very long.

Let your treatment team know if you are struggling with fatigue. Sometimes fatigue can be caused by a low red blood cell count or the side effects of drugs, and can be treated. There are also many hospital and other programs available to help you manage fatigue.

Managing fatigue

  • Set small, manageable goals for the day, and rest before you get too tired.
  • Plan breaks throughout the day when you are completely still for a while. An eye pillow can help at these times.
  • Say no to things you really don't feel like doing.
  • Leave plenty of time to get to appointments.
  • Ask your doctor about what sort of exercise would be suitable. Even a gentle walk around the garden or block can boost your energy levels.
  • Ask for and accept offers of help with tasks such as shopping, cleaning and gardening.
  • Eat nutritious food to keep your energy levels up.
  • Consider acupuncture – some find it helps with fatigue.
  • Listen to the " Managing Cancer Fatigue" episode of our podcast.

Difficulty sleeping

Getting a good night's sleep is important for maintaining your energy levels, reducing fatigue, and improving mood. Difficulty sleeping may be caused by pain, breathlessness, anxiety or depression. Some medicines can also disrupt sleep. If you already had sleep problems before the lung cancer diagnosis, these can become worse.

Talk to your doctor about what might be helpful for you. Your medicines may need adjusting or sleep medicines may be an option. There are also a number of strategies that other people with cancer have found helpful (see below).

Getting a better night's sleep

  • Try to do some gentle physical activity every day. This will help you sleep better. Talk to a physiotherapist or exercise physiologist, who can tailor an exercise program, and an occupational therapist, who can suggest equipment to help you move safely. You can also read Exercise for People Living with Cancer or call 13 11 20 to find out about exercise programs.
  • Limit or cut out the use of alcohol, caffeine, nicotine and spicy food.
  • Avoid using technology, such as television, computers or smartphones, before bed, as the light tells your body it's time to wake up.
  • Follow a regular routine before bed and set up a calm sleeping environment. Ensure the room is dark, quiet and a comfortable temperature.
  • Try listening to gentle music, a recording of rain sounds, or a relaxation recording.
  • Listen to our " Sleep and Cancer" podcast episode.

Key points about managing symptoms

Shortness of breath

Breathlessness can be managed with:

  • surgical procedures – including pleural tap to drain fluid, pleurodesis to stop fluid building up, and an indwelling pleural catheter to drain fluid
  • pulmonary rehabilitation – including exercise training, breathing techniques and pacing tips
  • self-management – such as sleeping upright, gentle exercise, using a fan, positioning pillows and relaxation techniques.

Pain

Pain can be managed with:

  • pain medicines - mild (e.g. paracetamol), moderate (e.g. codeine) or strong (e.g. morphine)
  • surgical procedures that drain fluid or reduce the size of the cancer
  • radiation therapy or chemotherapy
  • self-management – such as keeping a symptom diary, relaxation and meditation.

Other symptoms

Many people with lung cancer also experience:

  • poor appetite and weight loss – see a dietitian for ways to make food nutritious and appealing
  • fatigue – pace yourself, accept help and find ways to exercise
  • difficulty sleeping – try to do some gentle physical activity every day and set up a regular bedtime routine.

Expert content reviewers:

Dr Henry Marshall, Thoracic Physician, The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, QLD; Dr Naveed Alam, Thoracic Surgeon, St Vincent's Melbourne and Epworth Richmond Hospitals, VIC; A/Prof Martin Borg, Radiation Oncologist, GenesisCare, SA; Dr Lisa Briggs, Consumer; Kirsten Mooney, Thoracic Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; Claire Mulvihill, Lung Cancer Support Nurse, Lung Foundation Australia; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President Elect, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW.

Download PDF Order FREE booklet

Talking bubbles icon

Questions about cancer?

Call or email our experienced cancer nurses for information and support.

Contact a cancer nurse