jade

Hi,

Last March, my father was diagnosed with lung cancer (non-small cell, I
think). He finished massive amounts of chemotherapy and radiation last
summer, but now has a problem he didn't have before - he has great trouble
breathing. He walks ten steps and huffs and puffs like he just got through
a marathon, and when he climbs the stairs to the second floor he has to lie
down for half an hour to recover. He's also using the oxygen all the time
now, and had never needed it before.

Both the oncologist and pulmonary doctor are citing radiation damage as the
cause of the breathing difficulty, and are dubious as to what can be done
about it. I'm having a hard time accepting that there is nothing that can
be done, because the situation has seriously impacted my father's quality of
life (not to mention causing depression, which he had not suc***bed to
previously). Does anyone know what avenues might be available to us, or
where we could go for possible answers? Thanks.

Blessings,
Jade

j

Hello Jade,
I don't know the answer so watch for perhaps other better replies.
Also try the acor mail lists under "N"
http://www.acor.org/
Best wishes,
J

daffman

Hi Jade, I'm having the same problem it's causing me to have problems
sleeping and moving around but the cause is different. if you find anything
that helps your father please post it so I can discuss it with my doctor.
thank you in advance.

j

I'm thinking of combining meds with the oxygen and tips from some of these
links.
Anything I post should be checked with your doctors, because I'm not an expert
and don't want to cause you harm.

The other considerations would be do you have esophagitis? (inflammation of the
esophagus) - don't know the treatment.
or a fungal ( infection in the esophagus) ? A liquid antifungal swished in the
mouth and swallowed might help that.

J - wishing Steph was here.

I'm only posting parts of, so I'll have to leave you read them completely.

http://www.cancernetwork.com/journals/oncnews/n9809ll.htm
Dyspnea is typically treated with medications, such as albuterol, administered
through a bronchial dilator. "Albuterol can cause agitation and irritability,
however, so patients who receive this prescription should be monitored
closely," Ms. Henke warned.

Steroids are the easiest to use and most effective drugs for relieving dyspnea,
and have been used extensively in terminal patients and patients who have
undergone radiotherapy, but there are long-term complications associated with
this family of drugs. Other drugs that may be used include cough medicines,
certain pain medications, diazepam, hydromor-phone, morphine, and oxygen.

http://www.acponline.org/public/h_care/4-short.htm

From http://www.lungcanceronline.org/effects/respcomps.html#dyspnea
which also mentions other possible reasons for shortness of breath.

http://www.lungcancer.org/health_care/focus_on_lc/symptom/dyspnea.htm
Drug Therapy

Opioids
Many studies have do***ented the efficacy of systemic opioids in the treatment
of cancer-related dyspnea; however, the optimal type, dose, and modality of
administration has not yet been determined. Most studies have tested morphine
sulfate given in oral, subcutaneous and intravenous methods both continuously
and intermittently. As with pain, cancer dyspnea changes in intensity
spontaneously and as a result of specific maneuvers. Thus, adjustments in
management may require regular and intermittent dosing.
Benzodiazepenes
Studies have not shown significant symptomatic relief of cancer dyspnea from
benzodiazepenes when compared to placebo. In some patients, benzodiazepenes may
be used when dyspnea is considered to be a somatic manifestation of a panic
disorder or when patients have a coexisting anxiety disorder. Tested drugs
include diazepam, alprazolam, promethazine and chlorpromazine.
Bronchodilators
A strong association has been found between airflow obstruction and dyspnea.
Studies have shown that untreated airflow obstruction is commonly present in
patients with bronchial carcinoma and is strongly associated with
breathlessness. Bronchodilator therapy combining nebulized adrenergic and
anticholinergic agents given four times per day relieves symptoms of cancer
dyspnea.
Corticosteroids
While corticosteroids are highly effective in treating bronchospasms associated
with asthma and COPD, there have been no clinical trials do***enting their
benefit in managing cancer dyspnea. However, since they are highly effective in
managing dyspnea associated with carcinomatous lymphangitis and a large
proportion of lung cancer patients also have a history of smoking and COPD,
many clinicians use corticosteroids for lung cancer dyspnea with success.

mike radcliffe

Sometimes the treatments cause as many problems as they solve 'damned if you
do, damned if you don't'.
Morphine is the best treatment for his symptoms or ativan if he can't
tolerate morphine. Good palliative care will help with these. MIKE

j

Thanks, wish I could remember this..
J

steph

Radiation can certainly damage the lung, but so can the tumour, and so can
chemotherapy.

It depends on the dose and even more on the volume of lung treated.