Lung Cancer

[monicalee]

I have a friend who is diagnosed with stage 4 lung cancer .non small cell...it has progressed into his brain. He has 2 large tumors and 3 small ones. They are giving him 5 doses of radiation. Can anyone please tell me how long the side effects of nausea and memory loss is? How can I help my friend cope with the nausea and headaches associated with radiation? This came as a total surprise for everyone. This whole cancer it seems they have been a stage behind and it is frustrating. I am trying to help my friend in every way possible. Sometimes he feels on top of the world and says he isnt going to die. Sometimes he is sad to die. I am helping him try to cope with the emotions as well as trying to maintain my own emotions. It has been very difficult not to cry in front of him.

[Davy9]

I am sorry to say that you and your friend share a very difficult conundrum with many thousands of others. Any lung cancer staged at level 4 has a very poor prognosis. The treatments have to be aggressive if they stand any chance of success. There is no magic bullet in dealing with either the psychological or physical consequences of the disease or its treatment. Some turn to their religion, others to humor. It is a personal sort of situation.

The drugs available to counteract side effects are known to the physicians. All you can do is make certain they are kept advised about the need for these drugs and that they are given as prescribed. But no drug will completely control the discomforts of these treatments.

I will also advise you to become familiar with hospice care. If the juncture arrives where treatments are not succeeding or seem worse than the disease itself hospice and palliative care medicine offers a whole new set of comfort measures which can alleviate pains, anxiety and other sufferings. Hospice is no longer curative medicine but end of life comfort medicine. It does not quicken the event and unrelated diseases still get treated. If he were diabetic they would still administer his daily insulin needs. A person can enter into and come off of hospice care as they decide. Hospice care can be delivered at home or in certain care settings. At this point just learn what it is about and perhaps become familiar with hospice services available in your area.

This will be a tough row to hoe for everyone involved. Keep in mind that we are all mortal and will face our own fate in time. We all want to remain healthy and live long lives. But we all also want to pass with dignity intact. Your friend needs to get his arms around these timeless certainties and make his own adjustments.

[monicalee]

Thank You very much. I have been thinking of hospice and will talk to him about it. My friend lives alone. He does not want to stay with anyone. The meaning of "Quality of life" to him is one thing...independence. Im afraid if he goes to a nursing facility...he will give up. Im trying to get him to stay with me or another close mutual friend. I have been a caretaker and would love to have him...but he wont leave his house. On one hand I dont want to take his independence away...and on the other...I want him to be loved and cared for. The doctor told him he had a year maximum to live but most in his condition dont make it. Im torn up inside. I know everytime I think of my pain...I step back and think about how he must feel. Im scared.

[Davy9]

In my experience there will come the time that your friend will need a care provider. It might even be during his treatments where he may find himself too ill to tend to even his minor needs. If your relationship allows it would be ideal if your could place yourself in a caregiver role as needed. Even then just a single caregiver can as well get overwhelmed. Part of hospice care is respite care where they can bring into the home a person for several hours at a time to give the primary caregivers a break. You too could benefit from hospice care. They also provide grief management fro family and friends.

Advise your friend that there is no reason to be the lone valiant sufferer. He is at the point in life where he will need some real help and you are correct that it will come far better from a friend delivered in the home setting.

I do not know if you are clearly aware of what will likely happen. The final stages of most cancers is usually pretty devastating. You need to be prepared for this should you choose to volunteer for duty. Be honest with yourself and your friend and let him know that if it becomes too much for you to handle that other arrangements may be necessary.

[monicalee]

As far as side effects go on the radiation, is breathing difficulty or swollen ankles any part of this? What are some danger signs that I need to be aware of? I have an oxygen meter that I am going to use to take Jim's vitals with. He expressed a bit of difficulty breathing yesterday. He has emphysema also but has not been ordered to use oxygen...Im not sure why not. Will his temperature be a bit high due to the radiation? At what point does it become abnormal?

[Davy9]

You have what is called a 'pulse oximeter'. It will measure heart rate and the amount of blood oxygen saturation. When you use the device make note of his level of exercise just prior and during the measurement. His O2 saturation levels may be acceptable while he is resting but not so when he is doing even light work like easy walking. His O2 saturation levels may also change with just a changes i position. Another thing to note is how quickly he recuperates O2 levels.

I call an acceptable level above 90%. If he can sustain levels above 90% at all times then his saturation is okay. But if it drops into the 80's or below with exercise and takes a while to return to normal then they should consider putting him on supplemental O2.

But, there is a limitation to the tool. He could have normal O2 saturation levels and still be short of breath if he is anemic. You need normal levels of red blood cells in order to carry O2.

As to the complications of treatments I cannot advise. They are case specific and without being there and knowing about everything going on I would be just plain guessing. The ankle swelling needs to be addressed. At least they should be elevated. They could also be wrapped in a certain fashion. But, let the docs know about them. They could be a consequence of a number of things the need evaluation.

I suggest that you look into home nursing. The man needs to be homebound in order to qualify for these services (usually). If you can get it you will have an RN case manager that will regularly visit the home who will be able to help you better understand what is happening. They will also interface with the MDs to enhance the care. If on hospice you would also have this advantage.

[monicalee]

Im very upset right now...we went and talked to the doctor...and somehow he accumilated false hopes. The doctor was talking about someone else and mentioned 3-4 years. Jim has taken it that he has 4 years to live. I was there. Nothing of the kind was mentioned. He already told Jim that he has about a year because of his condition. I dont know what to do. If Jim asks me what the doctor says...I cannot lie. On the other note I will be tearing down his hopes. I dont know what to do. Jim thinks his tumors will be gone...they are huge. The doctor didnt say that at all. He said they will hopefully stabilize.

I asked about hospice and he said it isnt necessary right now...until Jims doctor tells him that there is no more he can do.

[Davy9]

Yes, people tend to pick and choose the news they hear. If a doctor is too blunt with bad news they often get criticized for their bedside manner. There is no need for you to step in and correct the situation. I'd suggest that you go with the flow. Let him believe what he wants. He'll get it figured out soon.

As for hospice care if the MD thinks there is less than 6 months to go hospice is warranted. Some docs are less inclined to bring hospice care on board as it is somewhat contrary to curative medical care. The main problem now is that he is in a solo care situation. If there is any reason to bring in home nursing support it will help you and him. You can ask his doctors about that.

[monicalee]

Jim had his last radiation therapy today...I am monitoring his steroids...the doctor wants him to begin decreasing them. Will he have depression as an effect? I want to prepare for this too. His follow up apointment is supposed to be for next week and I am going to ask about home nurse care. Can home nurse care force him into nursing home? In 2003, I had a friend die of lung cancer and he loved hospice...he thought they were the most gentle loving people and I do believe in them.
Jim has a friend who checks in on him twice a day. I cannot physically check in on him everyday but I can every other day. I do call him 2-3 times a day. I know later on, this wont be sufficient but I am still trying to talk him into getting his ends and odds squared away and staying with me or his friend. If he has primary lung cancer and it spread to his brain...can it spread anywhere else in his body?

[Davy9]

No, home nursing cannot force him into any level of care. Yes, lung cancer can spread to areas other than the brain.