**6. Patient care and therapeutic interventions in PC services for patients with lung cancer**

Although there are benefits to applying PC as an additional or alternative approach to improve patients' QoL even if they are not receiving cancer-directed therapy, directed treatments have been developed to alleviate disease-related symptoms, and these are discussed below.

Pain is one of the most common and debilitating symptoms in advanced malignancies. Additionally, pain tends to be a multifaceted experience of suffering that is related to psychological distress. Thus, in such cases, a multidisciplinary approach is recommended. Opioids are one of the most commonly used medicines for managing cancer-related pain, and an aggressive titration is often necessary to control pain effectively. However, given the widespread opioid abuse problem, it is important that practitioners and/or caregivers remain vigilant about any abuse/misuse while also

avoiding undertreating pain. Pain caused by bone and/or liver metastases, as well as neuropathic pain, can be relieved using low-dose corticosteroids [51, 52].

Disease-related complications, including malignant effusions (pleural and pericardial) and airway obstruction, can cause dyspnea and cough in those with locallyadvanced NSCLC or lung cancer metastases. Thoracentesis, pleural drain placement, and pericardiocentesis with a pericardial drain/window are examples of therapeutic procedures that can be performed for palliative reasons [53, 54]. Furthermore, methods such as bronchoscopy, photodynamic treatment, laser therapy, and stent implantation (endobronchial or vascular) can be used to ease airway obstruction [53]. Hemoptysis can be treated with arterial embolization.

Patients with advanced NSCLC, as well as those with lung metastases from other advanced cancers, may experience a sensation known as air hunger. Various pharmacologic and nonpharmacologic therapies can be considered to reduce this discomfort as much as possible. Morphine has been found to alleviate the feeling of air hunger in some people. Other opioids, such as oxycodone and fentanyl, have been examined in this context, but the findings have been conflicting [55]. A motorized fan aimed toward the face can alleviate this symptom for some individuals [56]. In such cases, benzodiazepines can also be administered as an adjuvant or a replacement for opioids to alleviate dyspnea [57].

Anticholinergic medications can be administered to minimize excessive secretions, such as scopolamine, atropine, hyoscyamine, and glycopyrrolate [58, 59]. Patients with substantial appetite and weight loss may benefit from appetite stimulants and dietary counseling. Although the effectiveness of low-dose corticosteroids in stimulating appetite is unknown [52], these drugs are often used for this purpose and as an antiemetic [51].

Fatigue is also a common symptom in those suffering from advanced-stage cancer. Other symptoms, including pain, dyspnea, and depression, can also contribute to this. Endocrinopathies and electrolyte abnormalities are potential metabolic causes that must be adequately investigated and managed. Although various medications have been studied, such as steroids, stimulants, antidepressants, and erythropoietinstimulating agents, there is no compelling evidence for their efficacy in treating fatigue [60]. Physical activity and exercise have been found to be the most effective interventions for reducing fatigue [61].

Psychological distress and depression are common in patients with advanced cancers, particularly metastatic NSCLC. In a study examining the QoL of patients with advanced NSCLC, major depression was observed in 23% of patients and was also associated with lower median survival in this group compared with the group without depression [62]. Psychological distress has been shown to reduce the QoL, impair responsiveness to medicines, and increase hospitalization rates [63]. Dyspnea has also been found to be related to anxiety, which is often coupled with uncertainty about the course of the disease. The Hospital Anxiety and Depression Scale, Patient Health Questionnaire-4, or Generalized Anxiety Disorder 7-item scale can all be used to evaluate psychological symptoms. Two potential medications that can be used to alleviate symptoms are selective serotonin reuptake inhibitors and buspirone. The former are commonly administered to individuals with panic attacks [63], while breakthrough symptoms can be reduced using benzodiazepines. When it comes to treating anxiety, nonpharmacologic therapies are critical. Cognitive-behavioral therapy should be a key component of any therapeutic plan. Relaxation and panic control techniques, mindfulness training, distraction techniques, and breathing

*Palliative Care for Patients with Lung Cancer: A Review of the Current Developments… DOI: http://dx.doi.org/10.5772/intechopen.106797*

strategies may also be beneficial [63]. Additionally, patients suffering from social and financial stress are likely to benefit from social work engagement. Support groups can help patients connect with others experiencing similar symptoms. Moreover, the ENABLE II trial found that regular meetings with PC nurses to provide psychoeducation improved the patients' mood and QoL [11].

Spiritual distress is common among patients with a progressive life-threatening illness. Frequent concerns include questions about existence, the meaning of life, regret, and destiny. Spiritual issues may also be important to patients as they approach the end of their lives. The Spiritual Well-Being Scale or the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being can be employed to evaluate symptoms. In most cases, pharmacologic therapy is not required. Benzodiazepines or barbiturates can be used for sedative purposes in rare and refractory cases. It is important to listen to the patient's concerns actively and offer gentle reassurance, which are examples of nonpharmacologic therapies. Family involvement, pastoral care, and community and religious resources are all critical, as it can be incredibly distressing for individuals to watch a family member suffer from spiritual distress. It is thus critical to assess caregivers for exhaustion.

## **7. Conclusion**

Despite the significant advances in the care-providing approaches for patients with lung cancer in recent years, the morbidity and mortality remain high. Cancer and its treatments can cause incredibly debilitating symptoms. PC, an approach to care for patients with life-threatening illnesses, including those with lung cancer (or any cancer), can reduce this burden. If introduced at an early stage of a patient's illness, PC can alleviate symptoms and enhance the QoL. There is even a possibility that it will increase the chances of survival. In order to provide PC timely, the ASCO guidelines recommend that it be started within 8 weeks of an advanced lung cancer diagnosis. Ideally, the patient should be referred to PC immediately after diagnosis. However, referring all patients for early PC is challenged by understaffed PC teams. Clinicians may make referrals based on their patient's burden of symptoms or psychosocial stresses. Patients with lung cancer would benefit from clinicians with primary PC skills. Therefore, clinicians should take steps to develop these skills and, from the outset, provide routine symptom and psychosocial assessments while the patient awaits the referral. To support the patient's PC needs, advanced practice providers, nurses, and social workers can be trained to provide PC through the oncology practice. Moreover, the PC approach should involve a combination of delivery methods based on available resources. A wide range of pharmacologic and nonpharmacologic tools are available to help patients manage their illnesses. Once treatment has been initiated, the patient's response should be regularly monitored. Providing appropriate holistic care will enable patients to live as long as possible with the best QoL.

## **Acknowledgements**

This research was funded by the Institute Development Grant (IDG) of the Caritas Institute of Higher Education.
