Frankly Speaking About Lung Cancer

1. Frankly Speaking About Lung Cancer Living Well with Lung Cancer: Take Control of Symptoms & Side Effects

2. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects • Effective symptom management • Requires early identification or prevention • Improves quality of life • Optimizes treatment potential • Should be a factor when deciding which treatment is best

3. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects Common Lung Cancer Signs & Symptoms: • Pain • Confusion • Depression • Swelling of neck/face • Blood clots • Cough or Coughing up blood (Hemoptysis) • Trouble breathing • Loss of appetite/weight loss • Fatigue/anemia

4. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects Common Side Effects of Treatment: • Fatigue • Trouble breathing • Pain • Nausea & Vomiting • Peripheral neuropathy • Low blood counts • Infection • Alopecia (hair loss) • Diarrhea/constipation • Loss of appetite • Mouth sores • Skin changes • Sexual/reproductive changes

5. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects “Is it the cancer or something else?” • No easy answer. GOAL: Take control of the symptoms of the disease & the side-effects of treatment! • Be aware • Be Patient Active

6. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects FATIGUE Sustained and overwhelming sense of exhaustion & decreased energy for both mental & physical work This most common & debilitating symptom may be related to: • The lung cancer itself • Effects of treatment (low red blood cells,etc) • Emotional distress

7. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects FATIGUE To manage fatigue: • Conserve energy- avoid emotional drains • Get uninterrupted relaxation: music, reading, meditation, prayer… • Do regular physical activity • Minimize unnecessary bed rest • Talk with your health care team about medications that treat anemia Inactivity leads to muscle loss…muscle loss leads to fatigue!

8. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects TROUBLE BREATHING Air hunger that causes difficulty breathing May be caused by: • the tumor itself • anxiety • anemia (low rbcs) • infection • radiation therapy • chemotherapy drugs • chest surgery

9. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects TROUBLE BREATHING To manage breathing • First-determine underlying cause! • Relaxation exercises/controlled breathing • Practice “abdominal breathing” • Exhale slowly through pursed lips, squeezing abdominal muscles upward and inward. Inhale through nose, abdomen will rise as diaphragm lowers • Oxygen use • Bronchodilators/ steroids/ inhalers • Adjust posture or body position

10. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects • PAIN • Cancer pain may steadily get worse & will not go away without treatment • Short or long term: can rob you of your quality of life! • May be caused by: • post-operative state • chemotherapy • radiation • the cancer itself

11. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects PAIN Take control of pain: • Tell somebody about it! • Pain can be controlled • You have the RIGHT to be pain-free • Find a physician/pain specialist who will help you control pain • Patients in pain do not get addicted to pain medications

12. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects PAIN • Pain Management Tools: • Medications (short & long acting, tablets, liquid, patch, injection) • Behavior modification • Pain control devices (TENS unit) • Heating pad, ice, internal pump • Relaxation, meditation, massage…

13. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects NAUSEA & VOMITING • Can be effectively controlled. Three types of chemo-induced nausea & vomiting: • Acute- Occurs within 24 hrs. of chemo. • Delayed- Occurs 24 hrs. after chemo and can last 6-7 days • Anticipatory- A learned response to n/v in previous treatments. • May be caused by: • treatments such as chemotherapy, radiation, surgery • anesthesia • constipation, etc.

14. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects NAUSEA & VOMITING Take control of N/V with medication: • Premedicate for chemo/radiation with an antiemetic regimen + steroid= improved QOL • Antiemetic medications (given orally and/or IV) such as Zofran,Kytril, Anzemet • Zofran: only antiemetic FDA-approved for prevention of N/V day 1 & 2 after chemo/xrt

15. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects NAUSEA & VOMITING Take control of N/V through diet: • Small, frequent, bland meals • Avoid fried, fatty, & sweet foods • Eat & drink slowly, chew food well • Suck on ice cubes, mints, or tart candies • Eat foods served at room temperature • Relax, breath deeply • Drink peppermint or ginger tea

16. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects PERIPHERAL NEUROPATHY Burning, tingling, weakness, pain, or numbness in hands or feet that can make it difficult to walk, hold objects, use your fingers… • May be caused by: • nerve changes as result of certain types of chemo. • tumor pressing on nerves

17. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects PERIPHERAL NEUROPATHY Take control of PN: • Notify your MD of the first indication! • Be aware of limitations Muscle weakness, decreased sensitivity to hot/cold & sharp objects • Prevent falls • use handrails • always wear shoes or hard-sole slippers • remove throw rugs • Avoid extreme hot/cold

18. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects THROMBOCYTOPENIA Known as “Low Platelet Count”: Results in tendency to bleed and bruise easily • May be caused by: • chemotherapy destroying healthy cells and/or platelets

19. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects THROMBOCYTOPENIA Take control of low platelet counts: • Keep track of CBC results • Ask MD or nurse if low platelets may occur with your type of treatment • Report unusual bleeding/bruising • Use soft bristle toothbrush • Avoid contact sports • Use electric razor for shaving • Avoid enemas, rectal suppositories

20. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects INFECTION The presence and growth of a microorganism that damages tissue. Potentially life threatening complication! • May be caused by: • chemotherapy destroying white blood cells/ Neutrophils • exposure to bacteria • complication with surgery or radiation • bronchoscopy

21. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects INFECTION Take control of infection: • Talk with your doctor about treatment to reduce the duration of low wbc counts • Wash hands regularly • Avoid people with cold and flu • Check blood counts • Avoid tobacco smoke Prevention and close monitoring is critical!

22. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects INFECTION Immediately notify your MD if symptoms arise: • Fever, 100.5 or higher • Burning with urination • Severe chills • Redness, pain, swelling or pus at central line site or an incision line • Trouble breathing or productive cough • Mental confusion

23. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects ALOPECIA Hair loss -usually begins 3-4 weeks after chemo starts. Can be extremely traumatic • May be caused by: • Chemotherapy --Death of rapidly dividing cells hair follicles): Will grow back. (Not all chemotherapy causes hair loss) • Radiation to head --Permanent damage to hair follicles: Usually does not grow back

24. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects ALOPECIA Take control of hair loss: • Cut hair or shave head before hair loss starts • Buy a wig or hairpiece before hair loss starts • Use mild shampoos & soft hairbrushes • Avoid hair dyes & permanent waves • Use sunscreen on scalp

25. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects DIARRHEA Increase in the liquidity & frequency of stool resulting from irritation of the intestines May be caused by: • certain chemotherapy drugs • infection • drug reactions • diet alterations

26. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects DIARRHEA Take control of diarrhea: • Call your MD immediately if: • diarrhea is severe for 24 hours or more • it is combined with fever, blood in stool, or severe pain • Call your MD before using OTC drugs

27. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects DIARRHEA Manage diet: • Eat small frequent meals • Eat potassium-rich foods (banana, apricot) • Drink plenty of fluids (enough to replace loss) • Avoid the following: • High-fiber foods • Fried, greasy, or spicy foods • Caffeinated products: coffee, tea, soda • Milk and milk products

28. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects CONSTIPATION Decrease in frequency and/or passage of hard, dry stools • May be caused by: • pain medications • certain chemotherapy drugs • inactivity & fatigue • diet alterations

29. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects CONSTIPATION Take control of constipation (especially if on pain medicine): • Drink plenty of fluids (warm/hot) • Eat high-fiber foods (bran, whole wheat breads, cereals, veggies, popcorn) • Increase your physical activity (walk, stretching exercises, yoga, Tai Chi, etc.) • Stool softeners & laxatives only with MD ok

30. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects WEIGHT LOSS Unexpected loss of, or diminished appetite. Can lead to anorexia May be caused by: • the lung cancer disease process • chemotherapy • radiation therapy • constipation • nausea • depression & anxiety

31. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects WEIGHT LOSS Take control of food intake: • Eat small, frequent meals/snacks • Try new foods or high protein/calorie nutritional supplements (Boost/ Power Bars/ etc..) • Light exercise may make you hungry • Arrange nice surroundings for eating • Eat whatever sounds & tastes good to you! • Eat whatever & whenever you want! Adequate nutrition is essential to recovery!

32. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects MOUTH SORES Can occur 2-5 days after chemo, and 1-2 weeks after radiation starts. Can last for up to 2 weeks. Can range from mild to severe (open bleeding) sores in mouth & throat

33. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects MOUTH SORES Take control of mouth sores: • Have an oral exam, cleaning, etc. before treatment • Brush teeth gently with soft bristle brush & toothpaste with mild abrasives • Rinse mouth with salt water (1t. Salt to 1qt. water) • Avoid salty, acidic, spicy foods • Drink through straw • Limit/eliminate tobacco & alcohol • Notify MD of mouth sores. Take pain meds, antibiotics, anti-fungals as prescribed

34. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects RADIATION FIBROSIS The formation of scar tissue in lung following radiation treatment. May be temporary & could develop months or years following radiation therapy. May affect your breathing & comfort Symptoms: • Dry mouth or sore throat • Difficulty breathing or swallowing

35. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects SKIN CHANGES Can include pain, redness, scaling, dryness, sun sensitivity, hives. Radiation skin changes only occur at site to which RT was delivered May be caused by: • can be from chemo drugs • radiation treatments • sun exposure

36. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects SKIN CHANGES To manage skin changes: • If receiving radiotherapy, talk to MD/nurse about special skin care • Use skin lotions containing aloe or lanolin- apply frequently • Take cool or warm baths/showers • Gently towel dry the sensitive area

37. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects CONCLUSIONS • The key to is to take control of symptoms & treatment side effects • Maintain open communication with your health care team • Take side effects into account when making decisions about which treatment to have– You do have choices!

38. Frankly Speaking About Lung CancerManaging Symptoms & Side Effects CONCLUSIONS cont. • Clinical trials are looking at more effective methods to manage side effects & symptoms • Newer treatments may offer better efficacy & fewer side effects • Treatment can make your symptoms better & improve your QOL! • Being involved in treatment decisions up front may allow you to take better control of side effects

39. Frankly Speaking About Lung Cancer Living Well With Lung Cancer: Take Control of Symptoms & Side Effects Questions & Answers