Taking Care of Your Loved One

• Do not be surprised or upset if the sense of taste of the person with cancer changes from day to day and even from hour to hour. There may be days when he or she does not want a favorite food or says it tastes bad
• It is a good idea to keep food within easy reach at all times. That way, the person with cancer can have a snack when he or she is ready to eat. Depending on the preferences of the person with cancer, you could leave a snack-pack of applesauce (along with a spoon) or a favorite protein drink on the bedside
• A good rule of thumb when choosing between different foods is to focus on good sources of protein. A lung cancer patient should try to eat at least one gram of protein for every kilo (2.2 pounds) of body weight every
• You will probably want to keep urging the person with cancer to eat more than he or she feels like It is best to offer this encouragement as gentle support. That way, it seems much more helpful than pushing them to eat. When there is no appetite, you can suggest that he or she drink plenty of clear liquids.
• The person you are caring for may struggle to eat a lot of food at a time. A good option is to suggest smaller meals more often throughout the
• It is important to talk openly and frankly about ways to manage “eating problems”. Having regular conversations can help both of you feel more in control and can avoid any major issues.

Many treatment regimens for patients with lung cancer have side effects. In general, a physically fit body can better tolerate drugs and treatments. So, you can encourage the person you are caring for to think about getting more exercise. Many studies have shown that physical activity and exercise can improve fatigue, quality of life, cardiorespiratory fitness, pulmonary function, muscle mass and strength, improve sleep quality, and decrease anxiety and depression in people living with lung cancer.

A 2018 systematic review of studies found preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Cardiorespiratory endurance and muscular strength have been shown to be independent predictors of survival.

Anything that has the potential to improve health outcomes is worth exploring. The American Cancer Society and American College of Sport Medicine recommend avoiding inactivity and suggest people living with cancer should engage in regular physical activity. Consider talking about exercise with the person with cancer and encouraging him or her to speak with a medical professional about appropriate activities. You may consider adding a kinesiologist, physical therapist, or cancer exercise specialist, and an oncology dietician to your team. There are often barriers to exercise for people living with lung cancer. It is important to make a flexible program that is aligned with their needs and preferences. Start easy and make sure they are listening to their body.

All aspects of health are connected. Exercise can improve your physical health and mental health. Helping the person with cancer develop an exercise plan and sticking with it can become one of your key roles as a caregiver. Better yet, join in, it might also help you manage the physical and mental stress of being a caregiver.

Pain is a warning sign that something is not right. If muscles, bones, or organs are damaged, then the pain is usually a constant ache, throbbing, or tenderness in one spot. This type of pain responds to medicines that treat the source of the symptoms.

Nerve pain is quite different and requires different medications. Patients often describe the pain as shooting, burning, electric, and intense. Unlike muscle pain, nerve pain can come out of nowhere—the person with cancer may not have any pain one moment and seconds later be in unbearable pain. Opioid medications (those containing or based on morphine) usually do not help.

It is important for the person with cancer to keep a pain diary. This simple journal is a place for the person with lung cancer to describe his or her pain to the medical providers honestly. It is an excellent way to get them information as they manage the pain of the person with cancer. As a caregiver, you can offer to help write the pain journal, making it as easy as possible for the person with lung cancer. It does not have to be complicated. A notebook that lists times, basic descriptions of pain, and how the person responds to pain medicines will do the trick.

Pain diary: Take this to your appointments. https://www.cancer.org/content/dam/cancer-org/cancer-control/en/worksheets/pain-diary.pdf

Medicines called ‘opioids’ come from morphine (made from a type of poppy), or they are artificial forms made to have the effects of morphine. When used for a long time, a patient will become used to the effects of the drug. Medical providers skilled in the use of the opioids will monitor their use carefully, switch opioids when necessary, and taper the patient off them when they are no longer required. When the medications are taken for pain, addiction is unlikely.

However, as a caregiver, it is vital for you to know that certain patients are at high risk for opioid addiction. For example, patients who have a drinking problem or are cigarette smokers or who have a family history of alcoholism are at a higher risk for opioid addiction. Likewise, people who have mental health issues are more likely to develop an addiction to opioids. In all likelihood, people with lung cancer with these increased risk factors will still be prescribed opioids, but they should be monitored for safety more closely. As a caregiver, you can help make sure that the person you are caring for is monitored appropriately so that he or she does not become addicted.

It is also critical that we all keep the communities safe. Keep the opioids out of reach and locked away from young children, teenagers, and visitors to the home. Do not store them in the medicine cabinet in the bathroom. Unfortunately, people with cancers are often targets for people with addiction.

If the person you are caring for will be taking any opioid pain medication, it is essential for them to take a laxative at the same time to counteract the constipating effects. Products containing senna and bisacodyl are common, but there are others, too. Polyethylene glycol, sold under the brand name Miralax, is another one. Others, including docusate and Colace, are not usually effective, so encourage the person with cancer to explore other options.

Laxatives are not necessary if the person with cancer has a feeding tube delivering their nutrition.

Managing constipation can seem embarrassing for many lung cancer patients to discuss. Depending on your relationship, he or she may be hesitant to talk about it. However, ignoring this issue can lead to emergency room visits.

Many people with lung cancer have shortness of breath, whether or not they have had surgery as part of their treatment. Be alert for any sudden shortness of breath they have and report it to their health care team as soon as possible. Sudden shortness of breath may be a sign of something else that needs treatment right away, such as a blood clot or fluid in the lining around the lungs. You can make sure that the person with lung cancer is aware that sudden shortness of breath might be a significant change and that they need to take it seriously.

If the person with cancer was a smoker or exposed to secondhand smoke, he or she may have chronic obstructive pulmonary disease (COPD). In such cases, patients with lung cancer often need to use an inhaler to reduce the inflammation and narrowing of the airways in their lungs.

If the shortness of breath is not changing much over time, there are some effective therapies to manage the symptoms:

• Pulmonary rehabilitation is an exercise designed to strengthen breathing muscles and other muscles. It can be very effective, though many people with lung cancer find it hard to tolerate.
• Low dose opioids can help reduce the disturbing feeling of not being able to catch a breath. When used for this, drugs are given at very low doses compared to treating pain.
• One simple method for relieving shortness of breath is a fan. Direct the air toward the person’s face if that is comfortable. There are receptors on the human face that sense air movement and send signals to the brain to reduce the sensation of ‘air hunger’.
• Some people with lung cancer will need to use oxygen to manage their shortness of breath. Suggest that the person with cancer talk over this option with the health care team. If oxygen is required, encourage the person with cancer to use the oxygen.  If oxygen saturation measurements remain below 88% for prolonged periods, other complications can result.

As a caregiver, it can help to understand the basics of when the person you are caring for may become nauseated (have an upset stomach). There are four main causes of nausea in patients with lung cancer:

• Many drugs, including pain medicines, especially those used in chemotherapy, can cause nausea.
• Many patients with lung cancer experience some stomach or upper intestinal irritation, which can cause them to feel nauseated.
• The mind of a person with lung cancer can influence the body to feel nauseous. Anxiety about upcoming chemotherapy treatments, called anticipatory nausea, commonly occurs in lung cancer patients. Also, the brain can sometimes perceive pain as nausea.
• Some lung cancer patients will feel vertigo or motion sickness, which can lead to feelings of nausea.

Each type of nausea is treated differently. You can help the person with cancer recognize the cause and provide his or her health care team with the information they need to give effective treatment.

To one degree or another, everyone with lung cancer feels fatigue (tiredness). You can help the person with cancer deal with fatigue in several ways. Encouraging the person with cancer to keep moving and helping with sleep are basic things that can reduce fatigue. Preventing weight loss and making sure they know it is good to ask for help are also worthwhile.

Even if the person with cancer takes all these steps, fatigue may still become an issue caused by a variety of things. The body creates cytokines in response to inflammation, and these cytokines cause fatigue, weight loss, and loss of appetite. Cancer that is increasing in size needs nutrients for its rapidly growing cells and can “steal” energy from the rest of the body.

When helping figure out how best to handle fatigue, there are some basic questions that you can bring up for discussion with his or her support team and health care providers:

• • Sleep problems: is the patient’s sleep disturbed because of pain, shortness of breath, treatment side effects, or anxiety?
  • Mood: is the person with cancer worried, depressed, or blue?
  • Treatment: is the person with cancer more fatigued after radiation or chemotherapy? Are there any medications causing the person with cancer to feel more tired?
  • Could anemia be causing the fatigue?
  • What type of exercise can the person with cancer safely do?
  • Is the person with cancer a candidate for pulmonary rehabilitation?
  • Could low oxygen in the blood be the problem?

A palliative consultation can be beneficial for patients with advanced lung cancer. Especially if diagnosed with late-stage disease, you should encourage him or her to seek out a palliative care consultation. There is evidence that patients who receive a palliative care consultation within eight weeks of diagnosis have a higher quality of life, report fewer depressive symptoms, and live slightly longer. This study was a surprise to many in the medical community, who had thought that palliative care was the step leading quickly to hospice.

At its best, palliative care eases symptoms and helps patients with lung cancer choose their personal treatment goals at crucial decision points. These decisions are made with their entire health care team—surgeons, radiation oncologists, and medical (chemotherapy) oncologists. As a caregiver, you may find a palliative care consultation especially helpful in defining your role and making sure that you are doing everything possible to support the person with cancer. At first, the person with cancer may not want to explore palliative care, but they can ask for a palliative care referral at any time.

Encourage the person with cancer to investigate palliative care when he or she feels ready. See Lung Cancer Choices, 6^th Edition, Chapter 8: Supportive Care

Integrative medicine is a total approach to care that involves the patient’s mind, body, and spirit. If the person with cancer is at all open to pursuing various health care approaches, we suggest that you encourage him or her to explore how integrative medicine can be used to treat lung cancer. Integrative medicine combines conventional western medicine with complementary and alternative medicine (CAM) practices that have shown the most promise. CAM is an umbrella term used to describe a group of diverse medical and healthcare systems, practices, and products that are not generally considered to be part of western medicine. CAM therapies can often help improve the quality of life for individuals living with diseases such as lung cancer and have even been shown to improve health outcomes.

Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.

The person with cancer may be interested in exploring the different healthcare systems from around the world. As you help him or her search for qualified practitioners of CAM therapies, do your homework, just as you should with any health care provider. Encourage the person with cancer to ask questions about the provider’s experiences treating people with lung cancer and to ask about what resulted from the methods.

There are many different CAM therapies that the person with cancer might pursue as part of an integrative medical approach to lung cancer treatment. For example, some cancer patients learn to use relaxation techniques to reduce stress during chemotherapy. Others find that acupuncture helps relieve nausea. Many people with various ailments have found that yoga helps them manage pain. Regardless of the CAM therapies that the person with cancer explores, it is important to keep the primary health care team, including all western medical practitioners (the doctors, nurses, and social workers) in the loop. Openness and communication among everyone involved in the care of someone with lung cancer are critical. You can help see that everyone on the health care team stays on the same page. See: Lung Cancer Choices, 6^th Edition, Chapter 11: Integrative Medicine, Complementary Therapies, and Chinese Medicine in Lung Cancer