Editing Lung cancer (section)

===Palliative care===
[[File:Diagram showing how you have internal radiotherapy for lung cancer CRUK 160.svg|thumb|alt=A machine attached to a tube that goes into a person's mouth and into a bronchus. At the end, an object emits radiation at a lung tumor.|right|[[Brachytherapy]] (internal radiotherapy) for lung cancer given via the airway]]
Integrating palliative care (medical care focused on improving symptoms and lessening discomfort) into lung cancer treatment from the time of diagnosis improves the survival time and quality of life of those with lung cancer.{{sfn|Aragon|2020|loc="Integrating palliative care into lung cancer care"}} Particularly common symptoms of lung cancer are shortness of breath and pain. Supplemental oxygen, improved airflow, re-orienting an affected person in bed, and low-dose [[morphine]] can all improve shortness of breath.{{sfn|Aragon|2020|loc="Dyspnea"}} In around 20 to 30% of those with lung cancer – particularly those with late-stage disease – growth of the tumor can [[airway obstruction|narrow or block the airway]], causing coughing and difficulty breathing.{{sfn|Obeng|Folch|Fernando Santacruz|2018|loc="Introduction", "Prevalence", and "Clinical presentation"}} Obstructing tumors can be surgically removed where possible, though typically those with airway obstruction are not well enough for surgery. In such cases the American College of Chest Physicians recommends opening the airway by inserting a [[stent]], attempting to shrink the tumor with localized radiation ([[brachytherapy]]), or physically removing the blocking tissue by bronchoscopy, sometimes aided by thermal or [[Laser ablation#Medicine|laser ablation]].{{sfn|Obeng|Folch|Fernando Santacruz|2018|loc="Management"}} Other causes of lung cancer-associated shortness of breath can be treated directly, such as [[antibiotic]]s for a lung infection, [[diuretic]]s for [[pulmonary edema]], [[benzodiazepine]]s for anxiety, and [[steroid]]s for airway obstruction.{{sfn|Aragon|2020|loc="Dyspnea"}}

Up to 92% of those with lung cancer report pain, either from tissue damage at the tumor site(s) or nerve damage.{{sfn|Aragon|2020|loc="Cancer-related pain"}} The [[World Health Organization]] (WHO) has developed a three-tiered system for managing cancer pain. For those with mild pain (tier one), the WHO recommends [[acetominophen]] or a [[nonsteroidal anti-inflammatory drug]].{{sfn|Aragon|2020|loc="Cancer-related pain"}} Around a third of people experience moderate (tier two) or severe (tier three) pain, for which the WHO recommends opioid painkillers.{{sfn|Aragon|2020|loc="Cancer-related pain"}} Opioids are typically effective at easing [[nociceptive pain]] (pain caused by damage to various body tissues). Opioids are occasionally effective at easing [[neuropathic pain]] (pain caused by nerve damage). Neuropathic agents such as [[anticonvulsant]]s, [[tricyclic antidepressant]]s, and [[serotonin–norepinephrine reuptake inhibitor]]s, are often used to ease neuropathic pain, either alone or in combination with opioids.{{sfn|Aragon|2020|loc="Cancer-related pain"}} In many cases, targeted radiotherapy can be used to shrink tumors, reducing pain and other symptoms caused by tumor growth.{{sfn|Spencer|Parrish|Barton|Henry|2018|loc="What are the indications for using palliative radiotherapy?"}}

Individuals who have advanced disease and are approaching end-of-life can benefit from dedicated [[end-of-life care]] to manage symptoms and ease suffering. As in earlier disease, pain and difficulty breathing are common, and can be managed with opioid pain medications, transitioning from oral medication to injected medication if the affected individual loses the ability to swallow.{{sfn|Lim|2016|loc="Key area three: providing symptom management in the last days"}} Coughing is also common, and can be managed with opioids or [[cough suppressant]]s. Some experience terminal delirium – confused behavior, unexplained movements, or a reversal of the sleep-wake cycle – which can be managed by antipsychotic drugs, low-dose sedatives, and investigating other causes of discomfort such as [[hypoglycemia|low blood sugar]], [[constipation]], and [[sepsis]].{{sfn|Lim|2016|loc="Key area three: providing symptom management in the last days"}} In the last few days of life, many develop [[terminal secretions]] – pooled fluid in the airways that can cause a rattling sound while breathing. This is thought not to cause respiratory problems, but can distress family members and caregivers. Terminal secretions can be reduced by [[anticholinergic medication]]s.{{sfn|Lim|2016|loc="Key area three: providing symptom management in the last days"}} Even those who are non-communicative or have reduced consciousness may be able to experience cancer-related pain, so pain medications are typically continued until the time of death.{{sfn|Lim|2016|loc="Key area three: providing symptom management in the last days"}}