Lung Cancer Care

Coping with the diagnosis of cancer is only the beginning of the journey. The entire process of diagnosis, treatment and changes in lifestyle are day by day hurdles for both caregiver and loved one.

Lung cancer’s association with smoking, second hand smoke and environmental irritants such as asbestos are factors that modify how one handles the diagnosis. The feelings of guilt about smoking or job choices (in the case of asbestos handling) are important to address with caring professionals and your loved one.

Lung Cancer Variations

Small and large cell lung cancers can be “mixed,” creating three categories of lung cancer which can affect the lungs. Generally, cancers are designated “small cell” or “non-small cell.” These cancers are further subdivided into adenocarcinoma, histopathologic and other designations that pertain to the shape of the cancer cells and/or their location.

The outlook for patients with various cancers is improving and changing with each clinical study and each individual diagnosed with cancer.

Diagnostics, Staging and Classification

Stage 1 and Stage 2 tumors of the lung are treated by cutting the tumor out and in some cases, following with radiation therapy to inhibit re-growth. If the individual cannot undergo surgery, radiation alone is used to destroy the tumor. In some cases, tumors can be “lasered,” which literally burns the tumor away. The laser can be used via a flexible scope which is inserted into the lung while the person is mildly sedated.

More complicated is the Stage 3 lung cancer division, where patients may have lymph nodes with cancer cells, or cancer cells in another area such as the mediastinum, the area separating the right and left sides of the chest. The affected sections of the lung indicate which “type” of Stage 3 process is going on and treatment selection is presented accordingly.

Stage 4 and some Stage 3 cancer patients are given the options of “comfort care” or chemotherapy. Individuals with Stage 4 or “recurrent” cancer may have measurable benefits from chemotherapy, more so than being made comfortable.

Targeting Drug Therapy

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs," "molecularly targeted therapies," "precision medicines," or similar names.

Targeted therapies differ from standard chemotherapy in several ways:

Targeted therapies act on specific molecular targets that are associated with cancer, whereas most standard chemotherapies act on all rapidly dividing normal and cancerous cells. Targeted therapies are deliberately chosen or designed to interact with their target, whereas many standard chemotherapies were identified because they kill cells. Targeted therapies are often cytostatic (that is, they block tumor cell proliferation), whereas standard chemotherapy agents are cytotoxic (that is, they kill tumor cells). Targeted therapies are currently the focus of much anticancer drug development. They are a cornerstone of precision medicine, a form of medicine that uses information about a person’s genes and proteins to prevent, diagnose, and treat disease.

Many targeted cancer therapies have been approved by the Food and Drug Administration (FDA) to treat specific types of cancer. Others are being studied in clinical trials (research studies with people), and many more are in preclinical testing (research studies with animals).

Caregiver Coping

Depression and anxiety over the diagnosis affect caregivers, sometimes more drastically than the loved one. The dynamic of the personal relationship can influence whether caregiver or loved one “shows” the anxiety and depression more profoundly.

With help from medical professionals involved in your loved one’s care, caregivers can be guided to other professionals and groups that focus on coping with the diagnosis. Today’s cancer centers focus on the healing approach for everyone involved, not just the patient.

Loved ones and caregivers benefit by initiating a discussion on how to handle the diagnosis and treatment. Your loved one may want the option of having a single visit alone with their primary care doctor or oncologist to be able to ask questions they are not ready to discuss with you, or the entire family. You can offer this option to your loved one to help both of you cope with “raw” questions that need a physician’s answer.

Doctors may not be able to accommodate an extended private consultation with a caregiver, but it may help at crisis points (initial diagnosis or change in treatment and prognosis). There may be staff trained to fill this need, so it is better to ask and plan any discussion that would be otherwise difficult with your loved one present.

Coping skills are learned and sometimes transitory. What works during a given stage of treatment may need some help as time passes. For example, caregivers may find a release of stress by hiring staff to help with personal care, or to have a few hours outside the home. However, caregivers might find that the time outside the home is most productive for relieving stress when it involves a specific activity, such as exercise or perhaps counseling.

Dual counseling is another option for caregiver and loved one, regardless of the prognosis or stage of the cancer journey. The cancer center overseeing your loved one’s care can recommend a competent therapist. Clinical trial managers can advise you on any types of therapy offered to caregiver and/or loved one for the duration of the trial. Be open to a change of therapists if you have reached a plateau or would like an additional perspective.

It’s important to monitor’s one’s own sleep, eating habits and moods as it is to look after a loved one’s. Any changes that occur should be noted and discussed with your own doctor. Depending on your loved one’s state of processing and understanding their diagnosis, you may open up the discussion about how both of you have changed health and wellness behaviors.

End-of-life planning can be done with assistance from hospice or with family members. Remove the focus from the “end” idea, which insinuates the outcome of the cancer treatment will be negative. Hospice has a number of stories where patients have lived vibrant lives well beyond any expectations the doctors had. Often, getting “details” out of the way is a step away from the idea of “death,” because the topic is what is most painful. Caregivers and loved ones may have different reasons for fearing the discussion, but if both individuals converse about their mutual visions for their own end-of-life care, it becomes almost “another family discussion.”

Whether the discussion involves the possibility of assisted living outside the home, or bringing in more caregiving help for various stages of treatment, caregivers may find the hardest part is taking the leap of faith to begin talking. As a caregiver, you must also be willing to examine the possibility that you may need more help than you predict. Let go of the limiting thoughts that say you must do everything for your loved one. Being present and loving are “everything,” and with them, you can make the decisions that will serve your loved one best.

Is Clinical Trial Right for us?

Connecting with the appropriate trial that allows the individual to receive cutting edge treatment is not as hard as it once was. There are sites online that allow for “matching” to the appropriate trial. These sources offer detailed processing to ensure the person is in the correct trial. The National Cancer Institute has an online help form to locate clinical trials and the results of some trials are available.

Aside from the altruistic benefits of participating in a trial, there are many personal advantages. Caregiver and loved one can take part in counseling and advanced cancer management strategies, the benefits of which continue after the trial has concluded.

Information from the clinical trial will help your loved one’s doctor in enhancing their care. If the trial medication or therapy does not provide a significantly positive outcome, it can help doctors redirect their therapy in a direction to enhance treatment. Many clinical trials provide information for physicians that could not be obtained with traditional therapy. The amount of monitoring, cross-referencing and documentation provide useful details about the “concentrated care” a clinical trial offers.

A clinical trial is not a “last resort,” although it can provide help for some individuals where current therapy is at a transition point. Bright alternatives and new frontiers are available for any who participate in a trial, especially in the age of “ideal” matching of patient to clinical trial.

Understanding your own expectations (and especially your loved one’s) will help you as the study progresses. Don’t be afraid to discuss your hopes with the staff so you can begin the experience feeling at ease.

Cancer, a devastating word to hear in conjunction with your loved one’s health and future, can be a health crisis that bonds everyone involved, helping to create the healing “cure” that balances not only the cells, but the soul.

Information on Targeted Drug Therapy was originally published by the National Cancer Institute.