Abstract
BackgroundCough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice.MethodsTwo systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions.ResultsA pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches.ConclusionThe clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations.
Highlights
Cough is a common symptom in about 23-37% of general cancer patients and 47-86% of lung cancer patients [1]
The first author’s data on 100 cancer patients assessed using the Memorial Symptom Assessment Scale from the beginning of cancer treatment to 3, 6 and 12 months showed a prevalence of 42.9%, 39.2%, 35.1% and 36.1% respectively, to the experience of breathlessness, less distressing than breathlessness [2]; these numbers almost doubled in the lung cancer subgroup analysis
Our own work with lung cancer patient interviews over time [10] has shown the distressing nature of cough and its significant impact on patients’ quality of life as well as the difficulty in obtaining relief from offered treatments
Summary
Cough is a common symptom in about 23-37% of general cancer patients and 47-86% of lung cancer patients [1]. The first author’s data on 100 cancer patients assessed using the Memorial Symptom Assessment Scale from the beginning of cancer treatment to 3, 6 and 12 months showed a prevalence of 42.9%, 39.2%, 35.1% and 36.1% respectively, to the experience of breathlessness, less distressing than breathlessness [2]; these numbers almost doubled in the lung cancer subgroup analysis. Despite such high prevalence, the management of cough remains suboptimal, with. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice
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