The emerging role of palliative medicine in the treatment of lung cancer patients

Abstract

The symptom burden of patients with lung cancer is extensive and includes loss of appetite, dyspnea, and other symptoms that lead to decreased quality of life. Randomized controlled trial data indicate that early palliative care improves quality of life and depressive symptoms and may extend survival in advanced non-small cell lung cancer compared with standard care. Combining an appetite stimulant (megestrol acetate) with an atypical antipsychotic (olanzapine) leads to greater weight gain and appetite improvement compared with an appetite stimulant alone. Cancer-related dyspnea appears to be a "central" effect that stems from altered afferent inputs in the setting of ventilatory muscle weakness; various treatment options that have shown success in treating cancer-related dyspnea are opioids, tunneled pleural catheters, bilevel positive airway pressure, and nebulized furosemide. Buprenorphine is a unique opioid with activity at mu and nociceptin receptors (also called opioid-receptor-like receptors); it improves pain states dominated by central sensitization.