END STAGE LUNG CANCER AND CORRECT AMOUNT OF OXYGEN???

Portal Forums Cancer Treatments / Symptom Management Palliative Care and Hospice END STAGE LUNG CANCER AND CORRECT AMOUNT OF OXYGEN???

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January 26, 2013 at 1:43 pm  #1253048    

pamela77

Can the cancer in one’s lungs eat up the lung tissue that even the highest amount of oxygen will not give any relief to someone in distress? How can a doctor really measure how much oxygen is needed to make someone more comfortable?. What is the highest amount of oxygen have you ever ordered for someone with lung cancer?
Can someone be put in harm’s way with too much oxyxgen? I have read where some people with pulmonary fibrosis increase their o2 up to 18 liters when moving around, is this possible for someone with end stage lung cancer?

January 26, 2013 at 4:12 pm  #1253055    

Dr West

It’s possible that cancer and/or other lung disease can leave so little functioning lung that adding oxygen even at high levels won’t give adequate relief of the sensation of air hunger, also known as dyspnea (pronounced DISP-nee-ah). We usually look at a person’s “oxygen saturation”, measured by an oximeter placed on a person’s fingertip or earlobe, to determine whether their lungs are getting enough oxygen. If the number is over about 88%, that should be a pretty good amount, though sometimes people will feel short of breath despite having a very good “O2 sat” of 95%, for instance. If so, adding more oxygen won’t help — people can be short of breath even if their lungs are getting enough oxygen.

It is possible for people to get too much oxygen. People with COPD can have a decrease in their respiratory drive from more supplemental oxygen than needed.

Four to 6 liters of oxygen/minute is the most that is readily given in a home setting. There are some “high-flow” oxygen set-ups in hospitals that can give 30-40 liters/minute, but those aren’t portable and can only be done in the hospital, often only in an ICU setting.

Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

January 27, 2013 at 1:32 am  #1253067    

pamela77

Dr. West,

If someone with end stage iv nsclc has a saturation rate that drops to 82 every once in awhile is that a good time to increase their oxygen intake? Presently the patient requires 10 liters of oxygen 24/7. It seems at this point of the disease the saturation rates move all over the place. I would like to increase the oyxgen in hopes of bringing more comfort to the patient. I am just a caretaker of a family member. In your professional opinion who do you recommend guiding the patient and caretakers with the overall management of oxygen, the oncologist or the pulmonologist? In the mean time morphine and ativan helps but not enough. Can a doctor order morphine thru a pain pump that is controlled so a patient can push the button if their SOB gets too overwhelming? I have been giving liquid morphine under the tongue, I heard a nurse say I could give the morphine too fast which could put extra stress on the lungs, is this true? I am a walking piece of free advertising for your website, I love it!!!!!!!!!! I hope I am using this format of questioning my concerns to you correctly.

January 27, 2013 at 2:27 pm  #1253074    

catdander forum moderator

Hi Pamela, I’m so sorry about this. I have asked a palliative care doctor to respond with any input she may have. I hope you have gotten your person comfortable.

Janine


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

January 27, 2013 at 2:59 pm  #1253078    

Dr West

Thank you for your very kind words about GRACE. I’m very gratified that we could provide helpful information and support for you.

The pulmonologist is really the person best equipped to oversee the oxygen administration for a person, and I really can’t make specific suggestions for your situation — it is far more appropriate to speak to one or more of the individual doctors involved.

It is absolutely feasible to have a patient self-administer morphine through a patient-controlled analgesia (PCA) pump to help with shortness of breath, potentially to be combined with a fixed “basal” rate of morphine given per hour to a person for pain and/or air hunger. It’s true that the opioids can decrease the “respiratory drive”, but that doesn’t mean it isn’t appropriate to give them. Morphine can be extremely helpful in alleviating the symptom of air hunger, and even if it does decrease the respiratory drive some, I think that if a person is at a point where they are really suffering with shortness of breath and they can’t be readily relieved with other measures, it’s very unfortunate to withhold something that can relieve suffering. Withholding medications that can relieve pain and suffering may be done as a misguided effort to prolong survival, but usually at that point the main thing this achieves is prolonging the process of dying, and less comfortably than we could otherwise do.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

January 27, 2013 at 4:13 pm  #1253087    

cards7up

Is this patient on hospice? If you have someone coming in to help with meds, they can also help with oxygen. As a family member, if you’re trying to do this on your own, it can be very hard and hospice not only helps the patient, but also the family. Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011. Local recurrence, surgery to remove LRL 8/29/13. Chemo carbo/alimta x3.

January 28, 2013 at 5:28 pm  #1253118    

Dr Harman

I’m so sorry for what you and this patient is going through. It is difficult to put an absolute number for a patient’s oxygen, as this will depend on what the focus of care is. If care is focused on comfort, sometimes the number is not as helpful and it is more important to adjust treatment–oxygen, morphine or other opioids, lorazepam (ativan)–based on whether it makes the patient more comfortable. More oxygen does not always mean more comfort, as a patient may have a high oxygen number (the O2 saturation), but still feel quite short of breath.

Judy mentioned hospice, and I would just add that hospice has expertise in the management of a person’s comfort and shortness of breath at this stage. They can help with real-time decisions on oxygen and medications to help with this.

-Dr. Harman


Stephanie Harman, MD
Medical Director, Palliative Care Program
Stanford University Medical Center

Views expressed here represent my opinion, not those of GRACE or Stanford University Medical Center. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

July 9, 2014 at 6:40 pm  #1264833    

poorav

Dr Harman.. (Stephanie Harman, MD
Medical Director, Palliative Care Program) and any other doctors in related fields PLZ help me fastttt i want to ask it be found END STAGE LUNG CANCER AND CORRECT AMOUNT OF OXYGEN??? with ABG report of blood sample taken just after 5 min of patient removed from the artificial oxygen supply… if u can tell me how much LPM of oxygen patient need aprox that will be so kind of u.. dear .. latest ABG report i am mentioning now …

Baro 717.1mm hg

pH 7.392
P02 49.0mm Hg
PCO2 44.7mm Hg
cHCO3 26.6 mmol/L
BE 1.2 mmol/L
SO2 (c) 84.1%
Hct 22.2%

July 9, 2014 at 7:07 pm  #1264834    

JimC Forum Moderator

Hi poorav,

I’m sorry, but for practical as well as legal reasons that kind of specific recommendation cannot be made by the GRACE faculty. Only the doctors directly involved in a patient’s care can determine this.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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