Questions about lung cancer- your experiences?

  1. Hello, all.

    I was wondering if anyone here had had family members who suffered from lung cancer, and how it progressed at the late stage? I'd be interested to hear your personal experiences with it (I posted here rather than Oncology because I really figured I'd have a better chance at getting a response in this forum, ie, you had a grandmother with it, father, etc.), but I was also wondering about something specifically: here's a scenario for you. Please let me know what you think/know. ;>)

    92 year old female with cancerous lymph nodes approximately four years ago begins to have neuro problems (shaky, can't remember anything, repetitive speech, etc.). Suffers from extreme loss of appetite x3 weeks at least, lots of nausea and vomiting. Fighting pneumonia x1 year, tx'd with antibiotics (2) but no further tx. Admitted to telemetry d/t N/V, etc. MRI shows large tumor in highest portion of lung that is pressing on spinal cord. MD says that tumor is causing circulation problems (???) and pressing on the aorta (?- unconfirmed). Pneumonia and weakness are causing difficulty breathing, currently on more abx and breathing tx's, and using postural drainage to improve breathing. Female is a DNR. No TPN started, only fluids to hydrate (ie, glucose, saline, etc.).

    This...crap. This is a personal question, a real scenario, and I'd really like to hear what you think. How quickly does this progress? Anything. Tell me something. Thanks.

    Kristi
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  2. 26 Comments

  3. by   aimeee
    Oh, Kristi. I'm sorry. It sounds like things could progress very quickly from this point. Are they doing some radiation to try and reduce the tumor pressure?
  4. by   Hellllllo Nurse
    I do not have any relatives who've had lung CA. But, I worked inpt acute-care hospice for 4 years. I took care of a lot of lung CA pts.
    It is a pretty rough way to go, but having good pain and sx mgmt really makes a difference. Is the lady on palliative care?
    Nebulized MSO4 elixir helps alot w/ dyspnea.
  5. by   cactus wren
    Have they done any scans to look for mets? Sounds like maybe she could have brain mets...Sorry, outlook isn`t good..Agree that pallitive care is needed, now...
  6. by   casperbjs
    We found out my Dad who was 72 years old had lung cancer in October 1991, he was in the hospital with pneumonia. When the Dr. came to him to talk to him about it, the Dr. mentioned chemotherapy and radiation. We ask about how much longer it would give him if he opted for this. He told us maybe 6-9 months. I looked at my Dad and ask what he thought, he said no to treatment. I agreed with him, I hated thinking about him being miserable with chemotherapy. You could watch him getting weaker and weaker. He ended up in the hospital 4 days before Christmas with pneumonia again, and CHF. He had ascites, the cancer had spread to his liver, kidneys. He couldn't urinate the day before Christmas. They were giving him pain shots every 4 hours. Finally I ask the Dr. about IV pain medicine. I was really surprised the Dr. didn't do that sooner.
    The Dr. was planning on sending him home to die. Was no one's choice. I knew I didn't want him to die at home with my Mother there. He was very uncomfortable, and very with it mentally until he died. I had a funny feeling at change of shift that night while I was with him. I called the nurse in that was taking care of him and ask her about his breathing. I told her I thought it was different. She listened to his lungs and tried to reassure me. She told me there was no difference. Then I ask about him being a "no code" she told me he was a no code.
    I said ok, I needed to know what the dr. had put on the chart. About 2 a.m. that morning Dad wanted to sit in the chair with his legs elevated. About 4:30 a.m. I realized he was having Cheyne- Stokes. He died shortly after that.
    I hope this is what you're looking for, sorry about rambling on about this.
  7. by   renerian
    I lost dad and his mom to cancer. I agree palliative care is what it sounds like she needs. ARe you thinking of inpatient care (palliative) or hospice at home? I did the later with both family members.

    Hugs,

    renerian
  8. by   NICU_Nurse
    Thank you, all of you, for your responses. I was at work last night and realy a mess. This is about my grandmother, and I feel...well, I'm going between crying uncontrollably to total shock and feeling numb. It looks like I'm going to visit her (she lives out of state) this weekend. I took care of a lung CA pt in nursing school, and this is bringing back very vivid memories- coincidentally, he also had the same type of CA with a tumor that was pressing on his spine (his was AIDS related, though, not that that makes a lick of difference). He became paralyzed from the nipples down, and on my first clinical with him, he was coherent and conscious, but within a week he was completely out of it, and had begun mimicking memories from his childhood (ie, eating an ice cream cone with his father, etc.). He died shortly after that, and I'm just trying to make sense of all of this now, you know? Apparantly she's known for about four years, but didn't want treatment of any kind because of her age, which I totally understand and respect, but I wish I had known because I would have made more of an effort to see her sooner. I don't know...she just sounded so happy in her letters and on the phone...I had no idea. I spoke to her on Christmas day and she was telling me how she had decided she wanted to live to be 100 and then, bam, I get a call that she's been hospitalized. I called her hospital room and she thought I was my father. Anyway. I feel wierd talking about this on here, because I'm not one to spill personal stories (unless they're good for a laugh...ha...), but I really needed to know some valid information. The doctor told my aunt that she won't have to go back to the nursing home, so I'm assuming he meant that she'll be going into hospice, which I don't know anything about. All I know is at the nursing home (despite her telling me they treat her great) she wasn't getting great care, and hopefully at the hospice she'll get better care (I mean, isn't that what hospice is for? Damn, all my nursing education has just gone out of my head.) She's on telemetry right now, but with the pneumonia and the phlegm (the MD said it's hardening in her lungs right now and she can barely breathe) I'm worried she's going to be put on a ventilator. Do they vent patients who've signed a DNR? Also I'm wondering about the nutrition- I mean, obviously the idea is to just let her die peacefully and pain free (my aunt is non-medical, and had no idea if she's getting pain medication, but if she's not, you can bet I'm going to throw a hissy fit that the entire state of North Carolina will be privy to), but does that mean they won't feed her? I have no idea how this works. She hasn't eaten but a few bites in weeks, at least two to three weeks, and vomits up everything she puts in her mouth, including OJ and milk. I have to go lie down and sleep now- just got home from work. Thank you again. I appreciate it, I really really do.

    Kristi
  9. by   BadBird
    I am so sorry that you are going through this, I know how difficult it is. My Dad died in 1998 after a year long battle with lung CA, he suffered terribly from the effects of radiation and chemo. I truly believe in his case that the treatment is what killed him. I watched my Dad drop from 220 lbs down to less that 100 lbs. He suffered every day and it broke my heart. I am so glad I was there to take care of him at the end. Hospice was wonderful and I can say he did not die in pain.

    In my opinion, pallative care is what is best for your Grandmother, she will be painfree and at her age why put her through invasive tests and treatments that probably will only hurt her anyway. {{{{{{{{{{HUGS}}}}}}}}}}}}} to you, I know this is a difficult time for your family.
  10. by   finallyRN
    kristi-
    First off I am so sorry to hear about your grandmother. My aunt just died on Christmas eve from non-small cell lung cancer. She was diagnosed at stage 4 in May. She was in the hospital for a pleural effusion when the cancer was discovered. She opted on chemo in an attempt to prolong the inevitable. The chemo made her so weak and so sick. She lost so much weight because she had no appetite with the chemo. She started an experimental chemo drug called IRESSA. That last a couple of weeks until she got so week. In October she stopped all treatments and went on Home Hospice. She was on continuous oxygen at this point. Several days before Christmas she took a turn for the worse. She was so lethargic couldn't even get out of bed. We finally put her in InPatient Hospice with PO Morphine and PO Ativan. She lasted about 36 hours after that and died early Christmas Eve.
    There were no documented mets (other than the chest wall at initial diagnosis). Because of her altered metal status at times and extreme weakness we believe she probably had brain mets. The last several days she wasn't getting anything as far as fluids because she was so end stage at that point.
    She went so fast from diagnosis to death. I guess lung cancer can be like that sometimes.
    Kristi please feel free to PM me if you want to talk since my experience is still so fresh for me.
    You and your family are in my prayers.

    Meg
  11. by   caroladybelle
    I am sorry for the situation that you are going through at this time.

    My father died of end stage emphysema at age 57, after 45 years of smoking ( between 2-3 packs of unfiltered pall malls). About two years prior his death, the pulmonologist found "shadows" on a chest xray. The pulmonologist wanted to do a bronchoscopy, but Daddy refused - MD wanted me talk him into it. Daddy, a stubborn Vietnam/Korean war vet, weighed 90 lbs at taller than 6 foot. As an Onco nurse, I know that the only definitive cure for lung ca is extensive resection - chemo/rad by themselves are generally only palliative - and knew that he did not have adequate lung function to be resected. I told the MD, if Daddy refused, he refused - that what difference would knowing that he had cancer make, when there was nothing that we could do about that wouldn't be contraindicated by his overall condition and/or make his remaining time miserable. Besides, if he wished to be in denial about the illness, at that point what difference would it make (he was already on O2 at 6Lt/NC despite being COPD). To this day, I do not know whether he had lung ca or lymphoma. When he died, he weighed 75 lbs, and his nodes were swollen, the chest xray was fairly whited out and he had nodules all over.

    As a vet, he had always said he was allergic to MSO4 - many vets will say that, as they had buddies that became addicted to opiates in Asia - but he wasn't really. We also utilized ativan and xanax - he came home - to be with his rottweilers, Snake & Gator and his cat, TC. They slept on the bed with him, while he snuck cigerettes (yes, while on O2, but what are you going to do with your parents, huh). When he became unable to swallow, the ativan/ms can be dissolved in a drop of water and will absorb buccally. He died with his pets around him.

    Do not worry about lack of intake - as lung ca progresses, the body lacks O2 to process nutrients - it quite frankly lacks the energy as it is using all its energy to breathe - pushing the pt to eat frequently just makes them feel bloated and uncomfortable. Also, know that as cancer progresses, the tumor tends to suck up all the nutrients, so you just end up feeding the tumor and not helping the pt. TPN creates an infection vector as well as strenghtens the tumor. Also, the fluids flood the lungs frequently, creating effusions. Some studies show that the natural dehydration tends to create an analgesic effect. If we try to correct, we frequently cause the pt more discomfort.

    Please encourage her to take MSO4 - I tell people that it is a naturally occurring opiate - that G-d/nature/Yahweh/Allah gave us all things on this Earth for good, and we should using them for their good uses, and that it is no sin/weakness. MSO4 can actually relieve stress on the heart and lungs, by reducing anxiety and O2 use, and thereby lengthen life.

    Sorry to be so clinical - will keep you in my prayers.

    PM me if you wish.

    Carolina of the South
  12. by   2banurse
    ((((Kristi)))) I just wanted to you to know that my thoughts and prayers are for you and your grandmother. My dear grandmother died of lung CA when I was 18 and in nursing school the first time. I was totally unprepared for both. I just remember the relief I felt when she did pass on, because I knew she was no longer in pain. I still miss her greatly and I feel that it is now her spirit that is pushing me to go back to nursing school.

    Again my thoughts and prayers are there for you and your grandmother.

    Warmly,
    Kris
  13. by   prmenrs
    I'm so sorry, Kristi. I know it just HURTS.

    My dad died in 1983 of lung cancer [oat cell]. Not a day goes by that I don't miss him, and wish he could know his grandsons.

    All I can say is just to be there with her, and for yourself.
  14. by   RNonsense
    I lost my Grandmother to lung ca in 1989, and my dad 2 years ago. He was 60. I'm so very sorry that you're going thru all this. My thoughts and prayers are with you.

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