Recommended for all patients with lung cancer are safe and effective pain relief; individualized drug therapy can be used to control pain; palliative radiotherapy in patients with advanced lung cancer can control the pain and palliative chemotherapy also recommended to control pain and other symptoms of bone metastases obvious pain of lung cancer Patients, bisphosphonates joint recommendation of radiotherapy to relieve the pain; stenting can be used as the superior vena cava obstruction, tracheo-esophageal fistula or bronchial fistula palliative treatment.
Palliative treatment of lung cancer is an important component of treatment can improve the quality of life and even survival, “Guide” for lung cancer common symptoms (such as pain, coughing and breathing difficulties, etc.) for the palliative treatment of the evidence-based assessment and recommendations:
1. Imperative that all lung cancer patients and their families be assured that their pain can be safe and effective mitigation, should the law to all inquiries in patients with pain, pain in patients with a simple self-report and assessment of the scale as the main source of (evidence level: 1A).
2. For all patients, the use of individual control of pain medication, there should be laws and administration in an appropriate treatment for pain, pain during treatment regularly assess the effectiveness of treatment (level of evidence: 1 A).
3. For all patients with mild to moderate pain, to ensure that no contraindications to use the circumstances, the initial use of acetaminophen or non-steroid anti-inflammatory drugs control pain, or more serious when the pain intensified, the use of opiates ( Level of evidence: 1 B).
4. To any patients, is expected to continue the use of opioids, not recommended pethidine, which is due to its role in a short time, and metabolites of pethidine to a toxic, can cause central nervous system excitement, irritability result Anxiety, irritability and seizures (level of evidence: 1 B).
5. The pain is not through simple analgesics to control, auxiliary drugs such as tricyclic antidepressants, anticonvulsant drugs and stability of drugs often increase the effectiveness of simple analgesics (level of evidence: 1 C).
6. Recommended for all patients with oral administration, because of their convenience and economy, not on oral analgesics, recommended by the rectum or transdermal delivery, do not recommend the use of intramuscular injection is due to its analgesic drug can cause pain, inconvenience Absorption and unreliable (level of evidence: 1 C).
7. Constipation due to opioids in the treatment of common and deal with its forecast, given preventive treatment and regular check (level of evidence: 1 B).
8. Activities to encourage all patients to maintain and, where possible, to self-censorship, not as much as possible to avoid prolonged activity (level of evidence: 1 B).
9. The pain and muscle tension and convulsion related, recommended measures to stimulate the skin (fomentation and Cold Compress), acupuncture and psychological treatment, and other ways to relieve the pain, mental pain care can be incorporated into the treatment plan, but not a substitute for analgesics ( Level of evidence: 1 C).
10. For patients with advanced lung cancer, palliative radiotherapy can control the pain and palliative chemotherapy recommended to alleviate pain and other symptoms, even if its survival is not significantly improve the (level of evidence: 1 B).
11. Analgesia does not work on the standards of patients with lung cancer, the recommendation of its professional go to the pain clinic or palliative care related to the diagnosis and treatment (level of evidence: 1 C).
12. All complained of breathing difficulties in patients with lung cancer, recommended assessment of all its possible causes, such as the atmosphere, partial obstruction, a large number of pleural effusion, pulmonary embolism or merger of COPD or congestive heart failure increased, if the above causes clear, to recommend Appropriate treatment (level of evidence: 1 C).
13. For all patients with lung cancer, breathing difficulties if their treatment can not be the cause, recommended to opiates, while the other recommended methods such as oxygen therapy pharmacology, bronchiectasis agents and corticosteroids (level of evidence: 1 C).
14. With breathing difficulties on all the patients with lung cancer, the recommendation to consider non-pharmacological and non-invasive therapy, such as the patients and their families education, respiratory control, walking exercise, relaxation therapy and psychological support (level of evidence: 2 C).
15. Cough for all the problems of patients with lung cancer, the recommendation of its treatable causes of the assessment (level of evidence: 1 B); if not treatable causes, recommend the use of opioids antitussive (level of evidence: 1 B).
16. The pain is caused by bone metastases patients with lung cancer, radiation therapy, recommended to alleviate the pain, the immediate pain relief, the dose of 8 Gy single radiotherapy and the effect of radiation on many occasions the same division (level of evidence: 1 A); but Compared with the single radiotherapy, radiotherapy split many times the pain relief for longer, the number of treatment need to fewer and fewer bone-related events (level of evidence: 1 A).
17. For obvious pain bone metastases patients with lung cancer, bisphosphonates joint recommendation of radiotherapy to alleviate the pain (level of evidence: 1 A); if patients on analgesics, radiotherapy and tolerance bisphosphonates, to recommend to radioactive substances Relieve the pain (level of evidence: 1 B); if transferred to the long bones and (or) load-bearing bone, and there is isolated, clearly limits the osteolytic changes (to hit more than 50 percent of the cortex), and satisfaction and health status is expected to survive more than four weeks , To recommend surgery fixed so that the possibility of fracture to a minimum, recommended priority intramedullary nailing, especially on the femur or humerus (level of evidence: 1 C).
18. To have the symptoms of brain metastases, recommended the completion of six weeks a specific treatment (surgery or radiotherapy) for the period of dexamethasone (16 mg / d) treatment during this period can quickly reduction or withdrawal (level of evidence: 1 B) .
19. Isolation of a brain transfer of non-small cell lung cancer (NSCLC), double-check if the exclusion of other distant metastasis or lymph node metastasis, consideration should be given to primary tumors of the lung radical resection (evidence level: 1C); No transfer to other parts of the same period resectable N0 ~ 1期primary NSCLC, in addition to the removal of the tumor, but also deal with isolated brain metastases to surgical resection or radiotherapy surgical excision, the removal of isolated brain metastases, should be followed To whole brain radiation therapy (level of evidence: 1 B).
20. On the back of new patients with lung cancer, recommended the entire spinal sagittal T1-weighted MRI examination to help diagnosis, but not recommended simple X-ray, bone scan or CT myelography, and other diagnostic inspection (level of evidence: 1 C) .
21. Epidural spinal cord of a transfer, if they are not able to move around and Qingtan, recommended immediate large dose of dexamethasone and radiotherapy (level of evidence: 1 B).
22. When the X-ray examination confirmed that patients with signs of a spinal cord compression, should be considered neurosurgery consultation, if possible, to have metastatic epidural spinal cord compression but the physical state (PS) can still score, should immediately surgery, following Radiotherapy to the (level of evidence: 1 A).
23. Hemoptysis for all of the large number of patients with lung cancer, recommended bronchoscopy to clear source of bleeding, followed by bronchial treatment, such as argon plasma coagulation, Nd-YAG laser and fulguration of (evidence level: 1 C).
24. Malignant pleural effusion to have symptoms of patients with lung cancer, recommended as the preferred wear chest drainage measures to alleviate the symptoms (evidence level: 1 C).
25. Wear on the chest after the recurrence of pleural effusion symptoms of patients with lung cancer, chest tube drainage retention recommendation and pleural fixation (level of evidence: 1 B).
26. Suspected of having lung cancer caused by the superior vena cava (SVC) obstructive symptoms, treatment recommended by the organization before the start of school or cytological diagnosis methods (level of evidence: 1 C); small cell lung cancer (SCLC) led to the SVC obstruction, Recommended to chemotherapy (level of evidence: 1 C); NSCLC led to the SVC obstruction, recommend stenting and (or) radiotherapy. Similarly recommend stenting for the non-response to chemotherapy or radiotherapy, with symptoms of SCLC SVC obstruction or NSCLC (level of evidence: 1 C).
27. Malignant diseases of the tracheo-esophageal fistula or bronchial fistula patients, consideration should be given esophagus, trachea or esophagus + tracheal stenting to alleviate the symptoms. It is not recommended to attempt involvement trachea and (or) esophageal radical resection of esophageal or shunt (level of evidence: 1 C).
28. Recommend evaluation of all lung cancer patients whether there is depression, if it exists, should be given the appropriate treatment (level of evidence: 1 C).
Lung cancer palliative care consultation and evaluation of the quality of life hospice care
For all patients with advanced lung cancer, recommended as a treatment for palliative care as part of the charge of the health care team members regularly use of standardized assessment methods and simple symptoms of disease-specific health-related quality of life survey conducted its assessment of that spirit and humanistic care The importance.
Palliative care consultation, evaluation of the quality of life of patients with lung cancer should be run through the entire course of treatment until the patient died, “Guide” recommendations:
1. For all patients with advanced lung cancer (and their families), recommended palliative care into their treatment, including those to cure or prolong life for the purpose of treatment (level of evidence: 1 C).
2. Advanced lung cancer patients, if possible, recommend a palliative care consultation team to participate in palliative care and hospice care in the past (level of evidence: 1 C).
3. Advanced lung cancer patients, recommended by the charge of the health care team members regularly use of standardized assessment methods and simple symptoms of disease-specific health-related quality of life survey to assess their (level of evidence: 1 B).
4. Clinicians recommended in patients died of lung cancer, their families and friends stay in touch (level of evidence: 1 C).
5. Of patients with lung cancer, recommended the following active intervention measures to reduce its sad consequences, including patients and their families understand the foreseeable died within a few weeks, in advance of the upcoming will inform the families of the dead and to give effective in patients with hospice care, focusing on Is the elimination of their spirit, the value of physical and practical aspects of the concerns (level of evidence: 1 C).
6. Recommend dying of lung cancer patients to their doctors and nurses in care during the funeral to maintain a healthy lifestyle (level of evidence: 1 C).
7. Recommend patients with terminal lung cancer patients with respect for the family physician may be used in mourning ceremonies (level of evidence: 1 C).