Care and mobility considerations

Early lung cancer (20-30%)

The majority of lung cancer cases will be terminally ill. This section applies to the smaller group who have had early lung cancer treated by surgery and long term survivors after chemo and radiotherapy. These are the minority of people with lung cancer (20-30%).

For lung cancer treated by surgery and chemotherapy or radiotherapy and chemotherapy; once the initial treatment is complete any residual disabling effects are permanent.

Commonly they will have reduced exercise tolerance due to breathlessness following -:

• Surgical removal of lung tissue
• Scarring of lung tissue from radiotherapy
• Associated COPD (chronic obstructive pulmonary disease)

Rarely

• Any of the general long term side effects from radio and chemotherapy

Most usually there will be non-disabling breathlessness on exertion and no long term effects from adjuvant treatment. There may be significant anxiety about recurrent disease compared to people with other cancers with better long term outcomes. Of patients with non-small cell cancer who have surgery 60-80% Stage 1 and 25-50% Stage 2 will survive 5 years.

Metastatic disease (70-80%)

The majority of people will have metastatic disease from the day of diagnosis. With either type of lung cancer survival is poor. It is common in both types to be significantly disabled by -:

• Cough
• Breathlessness – this may be due to a ‘pleural effusion’ – this is a collection of fluid around the lung
• Chest pain
• Pain from metastases
• Tiredness
• Anorexia
• Depression

Exercise tolerance may be significantly reduced due to the local effects of the tumour or by general weakness and tiredness associated with cancer related weight loss. Help may be required with all activities of daily living within a short time of diagnosis. When this is due to breathlessness or general debility then mobility is also likely to be severely impaired. Pain can be well controlled with symptomatic treatment but may cause significant drowsiness. There may also be significant disability from metastases in other organs including -:

• Liver – these may cause fatigue and in the later stages, mental confusion, abdominal swelling or pain and jaundice
• Brain – these may cause fits, personality change, confusion, difficulties with balance, walking and self care
• Bone – severe pain and pathological fractures. Hypercalcaemia (raised calcium levels in the blood) may cause confusion, coma and death.

• Psychological effects

Amended June 2008