Advanced lung cancer (stage IIIB-IV NSCLC and extensive-stage SCLC) is associated with high symptom burden, with dyspnea, cough, fatigue, pain, anorexia/cachexia, and depression being most common. Landmark trials (Temel et al., NEJM 2010) demonstrated that early integration of palliative care improves quality of life, mood, and may extend survival in metastatic NSCLC.
Dyspnea management combines treatment of underlying causes (effusion drainage, airway stenting, radiation for endobronchial obstruction) with symptomatic measures: low-dose opioids (oral morphine 2.5-5 mg PRN, demonstrated efficacy without significant respiratory depression), oxygen for hypoxic patients, fan therapy, breathing techniques, and benzodiazepines for anxiety component. Pain management follows WHO ladder: NSAIDs/acetaminophen, weak opioids (codeine, tramadol), strong opioids (morphine, oxycodone, fentanyl), with adjuvants (gabapentinoids, antidepressants, corticosteroids for bone pain or radiculopathy, bisphosphonates/denosumab for bone metastases) and interventional procedures (radiotherapy, intercostal nerve blocks, epidural analgesia, vertebroplasty).
Hemoptysis management ranges from antitussives and tranexamic acid for mild bleeding to bronchoscopic interventions (cautery, argon plasma coagulation, stent), bronchial artery embolization, and palliative radiotherapy for major hemoptysis. Cachexia and anorexia respond to nutritional counseling, mirtazapine, megestrol acetate, and corticosteroids in select cases. Pleural effusions often require indwelling pleural catheters or pleurodesis. Psychosocial care addresses depression (SSRIs, counseling), anxiety, and family support, integrated with advance care planning and hospice transition when appropriate.