Managing symptoms of lung cancer

Many people with lung cancer have difficulty breathing before or after diagnosis. This shortness of breath is also called breathlessness or dyspnoea.

It can occur for several reasons, including:

• the cancer itself and lungs not working as well
• drop in fitness level due to less physical activity
• build-up of fluid (pleural effusion) in the pleural cavity, the space between the 2 layers of thin tissue covering the lung
• lung tissue changes after radiation therapy (radiation pneumonitis)
• other respiratory conditions, such as COPD.

If the cancer is blocking a main airway, a laser, stent (a metal or plastic tube) or radiation therapy may help open the airway and make breathing easier. You may also be referred to a pulmonary rehabilitation program to learn how to manage breathlessness. This program will include exercise, breathing techniques, ways to clear the airways, and tips for conserving energy. Some people also use supplemental oxygen at home.

If you smoke or vape, your doctor will recommend you quit and suggest ideas for how to do this. Learn ways to manage breathlessness at home.

Ways to control fluid around the lungs

If breathlessness is caused by pleural effusion, you may need to have surgery.

Types of procedures include:

• pleural tap to drain the fluid
• pleurodesis to stop fluid building up again 
• an indwelling pleural catheter.

Having a pleural tap

For some people, fluid may build up in the pleural cavity, the space between the 2 layers of thin tissue covering the lung. The build-up of fluid is called pleural effusion. This can put pressure on the lung, making it hard to breathe. Having a pleural tap can relieve this symptom. This procedure is also known as pleurocentesis or thoracentesis.

To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity. It then takes about 30–60 minutes to drain the fluid. You usually don’t have to stay overnight in hospital after a pleural tap. A sample of the fluid is sent to a laboratory for testing.

Pleurodesis

Pleurodesis is a way to close the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of two ways, depending on how well you are and what you would prefer.

VATS pleurodesis – This method uses a keyhole approach called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then the surgeon will make one or more small cuts in the chest and pass a tiny video camera and operating instruments through.

After all fluid has been drained, the surgeon then injects some sterile talcum powder into the pleural cavity. This causes inflammation that helps stick the 2 layers of the pleura together and prevents fluid from building up again. You will stay in hospital for a few days.

Bedside talc slurry pleurodesis – If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic. A small cut is made in the chest, then a tube is inserted into the pleural cavity. Fluid can be drained through the tube into a bottle.

Next, sterile talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity. Nurses will help you move into various positions every 10 minutes to get the talc slurry to spread throughout the pleural cavity. The process takes about an hour.

A talc slurry pleurodesis usually requires a stay in hospital of 2–3 days. After the procedure, some people feel a burning pain in the chest for 1–2 days, but this can be eased with medicines.

Indwelling pleural catheter

An indwelling pleural catheter is a small soft tube used to drain fluid from around the lungs. It may be offered if fluid keeps building up in the pleural cavity making it hard to breathe, or if you are unable or do not want to have a pleurodesis. The catheter can be in place permanently, or until it is no longer needed.

You will be given a local anaesthetic, then the doctor makes 2 small cuts in the chest wall and inserts the catheter into the pleural cavity. One end of the tube is inside the chest, and the other is coiled and fixed outside your skin with a small dressing.

The fluid can be drained at home. When fluid builds up and needs to be drained (usually once or twice a week), the catheter is connected to a small bottle. A community nurse can drain the fluid for you or they can teach you, a family member or friend how to drain the catheter.

Improving breathlessness at home

It can be distressing to feel short of breath, but several simple strategies can help provide some relief from breathlessness at home.

Treat other conditions

Let your doctor know if you feel breathless. Conditions such as anaemia, a lung infection or COPD may also make you feel short of breath, and these can often be treated.

Sleep more upright

Use a recliner chair or prop yourself up in bed to help you sleep in a more upright position. An occupational therapist may be able to recommend a special pillow for sleeping.

Check if equipment could help

Ask your healthcare team about equipment to manage breathlessness, such as:

• nebulisers
• incentive spirometers
• oxygen concentrator to use at home
• portable oxygen cylinders for outings.

Relax on a pillow

While seated at a table, rest your head and upper chest on a pillow. Bend from your hips and keep your back straight. This helps to relax your breathing muscles.

Ask about medicines

Talk to your doctor about medicines, such as a low dose of morphine, to ease breathlessness. It is important to keep any chest pain well controlled because pain may prevent you from breathing deeply.

Modify your movement

Do gentle exercise to help you avoid losing strength and muscle. An exercise physiologist, physiotherapist or occupational therapist from your treatment centre can explain how to adjust your activities to improve breathlessness.

Create a breeze

Use a portable or handheld fan to direct a cool stream of air across your face if you feel short of breath when you are not active. Sitting by an open window can also help.

Find ways to relax

Listen to a relaxation recording or learn other ways to relax. This can help you to control anxiety and breathe more easily. Some people find breathing exercises, acupuncture and meditation helpful.

See Complementary therapies and listen to the relaxation and meditation recordings in our Finding Calm During Cancer podcast series.

Pain can be a symptom of lung cancer and a side effect of treatment. If pain is not controlled, it can affect your quality of life and how you cope with treatments.

There are different ways to control pain. Aside from pain medicines, various procedures can manage any build-up of fluid that is causing pain (see Breathlessness). Radiation therapy and chemotherapy can reduce pain by shrinking a lung tumour. Surgery may help treat pain from bones: for example, if the cancer has spread to the spine and is pressing on nerves (nerve compression).

Managing pain

• Tell your doctor when you are in pain so they can help you manage it. A palliative care or pain specialist may be able to help with hard-to-manage pain.
• Keep track of your pain in a diary – note what the pain feels like, how intense it is, where it comes from and travels to, how long it lasts and if it goes away with a specific medicine or another therapy such as a heat pack.
• Allow a few days for your body to adjust to the dose of pain medicine and for drowsiness to improve.
• Take pain medicine regularly as prescribed, even when you are not in pain. It’s better to stay on top of the pain.
• Use a laxative regularly to prevent or relieve constipation caused by pain medicines.
• Learn relaxation or meditation techniques to help you cope with pain.

See Cancer pain and listen to Cancer Council's Managing Cancer Pain podcast episode.

Some people stop feeling interested in eating and lose weight before lung cancer is diagnosed. These symptoms may be caused by the disease itself, or by feeling sick, having difficulty swallowing, being breathless, or feeling down (See Living with lung cancer).

Weight loss can affect how your body responds to cancer treatment, your risk of infection, and how quickly you recover. This can happen to anyone, no matter what size. Eating well will help you cope better with treatment and side effects, and improve your quality of life.

Eating when you have little appetite

• Choose high-kilojoule and high-protein foods (e.g. add cheese or cream to meals, use full-cream milk).
• Try eating smaller portions more often (e.g. 5–6 smaller meals per day).
• Avoid drinking fluids at mealtimes, which can fill you up too quickly.
• Eat moist food, such as scrambled eggs, because it is easier to swallow.
• Eat salads or cold foods if hot food smells make you feel sick. Avoid fatty or sugary foods if these make you feel nauseous.
• Add ice-cream or fruit to a drink to increase kilojoules.
• Eat more of your favourite foods – follow your cravings.
• See a dietitian for more tips on what to eat and drink – they can suggest small changes to your diet or what protein drinks or nutritional supplements to use that can help you stay well nourished. To find a dietitian, visit Dietitians Australia.

See Nutrition for people living with cancer for more tips on staying well nourished.

It is common to feel very tired during or after treatment, and you may not have the energy for day-to-day activities. Cancer-related fatigue is different from tiredness, as it may not go away with rest or sleep. You may also lose interest in things that you usually enjoy doing or have trouble concentrating on one thing for very long.

Let your treatment team know if you are struggling with fatigue. Sometimes fatigue can be caused by a low red blood cell count (anaemia), or be a side effect of drug therapies or a sign of depression, all of which can be treated. There are also many hospital and other programs available to help you manage fatigue.

Managing fatigue

• Set small, manageable goals for the day, and rest before you get too tired.
• Plan breaks throughout the day when you are completely still for a while. An eye pillow can help at these times.
• Accept offers of help from family and friends.
• Ask your doctor about what sort of exercise would be suitable. An exercise physiologist or physiotherapist can help with safe and appropriate exercise plans.
• Get a referral to an occupational therapist for help with relaxation techniques, breathing exercises and ways to conserve your energy.
• Consider acupuncture – some people find it helps with cancer-related fatigue.
• Say no to things you really don’t feel like doing.
• See Fatigue and cancer and listen to Cancer Council's Managing Cancer Fatigue podcast episode.

Getting a good night’s sleep is important for maintaining your energy levels, reducing fatigue and improving your mood. Pain, breathlessness, anxiety, depression and some medicines can make it hard to sleep. If you already had sleep problems before the lung cancer diagnosis, these could become worse.

Talk to your doctor about what might help improve your ability to sleep. Your medicines may need adjusting, or sleep medicines may be an option. Talking to a counsellor may help if you are feeling anxious or depressed. Some strategies that people with cancer have found helpful are listed below.

Getting a better night’s sleep

• Try to do some gentle physical activity every day. Exercising may help you to sleep better. An exercise physiologist or physiotherapist can tailor an exercise program for you. See Exercise for people living with cancer.
• Avoid alcohol, caffeine, nicotine and spicy food.
• Avoid watching television or looking at a computer, smartphone or tablet before bed, as the blue light may tell your body it’s time to wake up.
• Follow a regular routine before bed and ensure the room is dark, quiet and a comfortable temperature.
• Try soothing music, a recording of rain sounds, or a relaxation recording.
• Listen to Cancer Council's Sleep and Cancer podcast episode for more tips and our Finding Calm During Cancer podcast series for a relaxing sleep track.