Terminal Lung Cancer Research Articles

Effective Symptomatic Relief of Hypertrophic Pulmonary Osteoarthropathy by Video-Assisted Thoracic Surgery Truncal Vagotomy

Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy (HPOA) associated with lung cancer have been suggested since 1958. Although the etiology remains speculative, unilateral vagotomy on the side of the lung cancer achieves symptomatic relief. We report a case of a 50-year-old woman with disabling HPOA and inoperable lung cancer who experienced effective pain relief and regained full mobility after video-assisted thoracoscopic surgery was used to perform truncal vagotomy. This relatively safe and simple procedure should be considered for terminal lung cancer patients with intractable HPOA.

Placement of Two Types of Spiral Z-Stents at the Bronchial Carina for the Treatment of Terminal Lung Cancer – a New Method

Dumon Y-stents and Dynamic stents are used to treat carinal stenosis, but their placement severely impairs the expectoration of secretions, making frequent bronchoscopic aspiration necessary. We report here five patients with terminal lung cancer who had stenosis of the lower trachea and main bronchi treated using spiral Z-stents. A long tapered spiral Z-stent was placed in the lower trachea and one main bronchus, and a short straight spiral Z-stent in the contralateral main bronchus. No patients required bronchoscopic aspiration of secretions after stenting. Before stenting, all of the patients were severely dyspnoeic, requiring oxygen and having to sit in the orthopnoeic position. After stenting, the patients' dyspnoea improved, with one patient becoming ambulant without the need for oxygen support. These results suggest that the use of spiral Z-stents in stenosis of the tracheal carina in advanced lung cancer is effective in reducing the need for bronchoscopic aspiration and enhancing quality of life.

An analysis about long term results of terminal non-cell lung cancer through chemotherapy and rediotherapy

目的 研究化学疗法、放射疗法治疗不能手术的ⅢB期非小细胞肺癌的远期疗效.方法所有病例均给CAP或MVP方案化疗,80例行根治性放疗.结果全组病例1年生存率53.3%(48/90),3年生存率18.8%(17/90),5年生存率8.8%(8/90).鳞癌3年及5年生存率高于腺癌(P＜0.05).T4T0M03年及5年生存率高于T3N3M0、T4N1～2M0、T4T0M0(P＜0.05～0.01).结论化疗联合放疗治疗非小细胞肺癌有一定的临床疗效,CAP、MVP两种化疗的3年及5年生存率之间差异无统计学意义。

Morphine prescription to terminally ill patients with lung cancer and dyspnea: French physicians’ attitudes

This study aimed to investigate factors associated with analgesic use of morphine in end-of-life care. French general practitioners (GPs) and oncologists (N = 719) were asked whether they would prescribe morphine as first-line therapy to patients with terminal lung cancer suffering from dyspnea associated with cough and great anxiety. Overall, 54 percent of oncologists and 40 percent of GPs stated that they would prescribe morphine in the presented case. This prescriptive attitude correlated with physicians' age, professional background, communication skills, and attitude toward terminally ill patients. The findings of this study indicate that improving analgesic use of opioids in end-of-life care is not only a matter of enhancing technical skills acquired through training or experience but also a matter of improving communication and empathy between physicians and patients.

Second primary cancer of the larynx in patients with lung cancer.

Synchronous or metachronous second primary malignancies of the lung are sometimes encountered in patients with laryngeal cancer while the occurrence of a laryngeal second primary following cancer of the lung is rare. A two-armed study was conducted. A prospective arm in which the larynges of 56 terminal lung cancer patients were examined, and a retrospective arm incorporating both a chart study of 126 terminal head and neck cancer patients (HNCP) and a computerized search of all hospital records of patients with laryngeal and lung cancers. No laryngeal malignancy was found in the lung cancer patients' group and no antedating pulmonary malignancy was recorded in the terminal HNCP. The computerized search of 1778 lung cancer patients and 213 laryngeal cancer patients also failed to demonstrate cases where the former preceded the latter. In conclusion. No second primary of the larynx was found in lung cancer patients. These results compare with reports of large databases where cancer of the larynx was found in a negligible percentage of lung cancer survivors and theories explaining this are discussed.

Inflammatory reactions and microorganisms cultured from sputum and blood in association with terminal stage infection of patients with lung cancer

We reviewed our experience with terminal stage infections in patients with lung cancer over an 11 year period at Kurume University Hospital. In patients with end-stage lung cancer, the infection is common and a mortal disease. We examined the clinical features and significance of pathogenic microbes isolated from sputum and blood in patients with lung cancer during their last month. Bacteriological examinations from blood done frequently in patients with episodes of fever revealed that bacteremia was one of the most important disease in terminal stage infection. In the blood cultures from the 22 patients various species of pathogenic microbes were recovered, and nine of which were fungi; five Candida albicans, three Candida tropicalis and one Candida parapsilosis. The major species of bacteria isolated from sputum were Staphylococcus aureus, including methicillin-resistant strain, and Gram-negative bacilli; P. aeruginasa, A. calcoaceticus, K. pneumoniae and E. cloacae, which are known to be frequently involved in hospital-acquired infections. However, S. pneumoniae and H. influenzae which were well known to be microbes of respiratory infections were rare. We concluded that we had to reveal the feature of terminal stage infection in order to reduce the fee for medical treatment and improve the QOL of patients with terminal stage lung cancer.

Studies on home oxygen therapy for patients with terminal lung cancer

Studies on home oxygen therapy for patients with terminal lung cancer

441 Second primary cancer of the larynx in patients with lung cancer

The incidence of synchronous or metachronous second primary malignancies (SPM) arising in the lungs following laryngeal cancer varies from 1.4–10.6% of cases. Conversely, to date, only 15 cases of a laryngeal SPM following lung cancer have been reported. We have conducted a prospective, preliminary study in 23 terminal lung cancer patients in a hospice setting in order to assess the incidence of a laryngeal SPM. No laryngeal tumors were observed. Even if under-diagnosed and under-reported, this entity is anecdotal in nature, even when considering the overall poor general survival rates of lung cancer. A lung SPM following laryngeal cancer may be explained by common risk factors such as smoking. However, this plausible theory of “field cancerization” does not seem to work both ways. Multimodality treatment or genetic factors may also playa role in the sequence of mucosal changes leading to neoplasia. Our results are presented in light of the general incidence of SPM in our country. Possible hypothesis for the lack of laryngeal SPM following lung cancer will be discussed.

Do-not-resuscitate orders at a teaching hospital in Japan.

The use of cardiopulmonary resuscitation (CPR) must be considered carefully, especially in the case of terminally ill and elderly patients.1–3 In Japan, most physicians (96 percent) are aware of do-not-resuscitate (DNR) orders,4 but unlike the situation in other countries,5–16 there has been comparatively little discussion here of DNR policy.4,17,18 There also seems to be inadequate use of DNR orders. We found, for example, that futile CPR is often performed at the time of death in patients with terminal lung cancer.4 We suspect that the reasons for the futile efforts at resuscitation include the lack of a . . .

Prognostic factors for survival in terminal lung cancer patients.

To determine the factors that are related to short-term survival and to develop a model that can be used to estimate prognosis in terminal lung cancer patients. Longitudinal cohort study of hospice lung cancer patients followed from date of admission to hospice until death. Community-based nonprofit home hospice service. Three hundred ten consecutive lung cancer patients admitted to hospice, with a separate validation sample of 78 consecutive hospice lung cancer patients. The relationships between survival and admission demographic characteristics, information from the history and physical examination, assessments of performance and nutrition, particular symptoms, and the presence of a living will were evaluated. Mean survival was 51 days, with a median survival of 27 days. Shorter survival was independently associated with those who had no living will on admission to hospice (p = 0.008), those who had tissue types other than squamous cell or adenocarcinoma (p = 0.008), those who had liver metastases (p = 0.04), those who were tachycardic (p < 0.001), those who required assistance or were dependent in their toileting (p < 0.001) and feeding (p = 0.001), those who had dry mouths (p = 0.01), and those who had severe or incapacitating pain (p < 0.05). A model estimating survival time based on the number of these significant variables present is reported (r = 0.53 in the original sample; r = 0.38 in the validation sample). Multiple factors, including tissue type, the presence of metastases, assessments of functional status, specific symptoms, and the presence of a living will, were related to short-term survival in terminal lung cancer patients admitted to hospice. A model utilizing these specific factors allows useful estimates of short-term survival for these patients.

Patient and physician characteristics affecting the choice of home based hospice, acute care inpatient hospice facility, or hospitals as last site of care for patients with cancer of the lung.

In this exploratory study we found that in 1986, in Clark County, Nevada, home based hospice services were utilized at a very limited level for lung cancer patients. A nontraditional acute care hospice facility, however, was heavily utilized; but only slightly less so than community hospitals. Using death certificate and state cancer registry data, we explored several factors affecting these choices of sites of treatment of the last episode of illness. Among them were sociodemographic characteristics of patients, physicians' specialty, and volume of patients with terminal cancer of the lung. The findings and hypotheses lend support to further studies of the most cost effective last site of care for terminal lung cancer. The need for an ongoing examination of the impact of public policy on the definition of hospice and careful consideration of nontraditional models is indicated.

NURSING CARE OF THE TERMINAL LUNG CANCER PATIENT

Care of the terminal lung cancer patient will be more effective when a multidisciplinary approach is used. Planning for terminal care should not be delayed until the last few hours or days of life. Hospice care offers the terminal lung cancer patient an alternative to dying in a hospital or nursing home. Caring support to alleviate pain and prevent suffering is the goal of nursing care for the terminal cancer patient. Nursing interventions should be directed toward allowing the patient to retain decision-making authority in care for as long as possible.

Continuous Intravenous Infusion of Morphine for Severe Dyspnea

We describe eight patients who had terminal lung cancer causing severe dyspnea unrelieved by oxygen, nonnarcotic drugs, or intermittent bolus narcotics. We treated these patients with continuous intravenous infusion of morphine, beginning with bolus IV injections of 1 or 2 mg of morphine every 5 to 10 minutes until the patient reported relief. A continuous morphine infusion was then started, with the hourly dose equal to 50% of the cumulative bolus dose. Vital signs, degree of sedation, and blood gases were serially followed. Six patients achieved good dyspnea relief, one had moderate relief, and one had a poor response. Variable changes were noted in the PaO2, whereas PaCO2 steadily increased in five of seven patients, and pH decreased in six. There was little change in systolic blood pressure or pulse, and only one individual had less than 10 respirations per minute. The major side effect of treatment was sedation, treated by temporarily discontinuing morphine until the patients' mental status improved and then restarting the infusion at a 50% lower hourly morphine dose. Mean time of study was 30 hours (range 16 to 87 hours). Seven of the eight study patients died during treatment. Whether morphine therapy shortened survival is uncertain. We conclude that continuous morphine infusion is effective therapy for severe dyspnea. The treatment is ethically justified. Relief of suffering is the primary goal of therapy, and less risky treatments are unavailable.

The Relationship Between Lung Cancer and Asbestos Exposure

This study supports the theory that asbestos exposure may be implicated in a recent upsurge of terminal lung cancer cases in Kure, Japan. The number of asbestos bodies found in the lung during autopsy of 158 subjects from 1984 to 1986 suggests that 70.4 percent of the 51 diagnosed lung cancer cases could be attributed to asbestos exposure. Of the 107 subjects in whom death was not caused by cancer, 38.4 percent had significant asbestos exposure. Types of asbestos bodies found in diagnosed lung cancer cases were analyzed using scanning electron microscopy and x-ray analyzer. Chrysotile was the most widely found component, but amphiboles such as crocidolite and amosite also were detected. Residents of Kure had high exposure to the inhalation of asbestos bodies, possibly related to the upsurge in lung cancer deaths. In our earlier report, asbestos exposure was implicated in the increased incidence of malignant mesothelioma in Kure, an active Japanese ship-building port since the 1920s. Our current findings indicate that asbestos exposure may be a pathogenic factor in lung cancer in world seaports where asbestos exposure has been prevalent.

The terminal care of patients with lung cancer.

Summary Lung cancer is the commonest form of malignant disease seen at St Christopher's Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher's Hospice are listed in Table 1.