My 69 yr. old wife has stage 3b small cell lung cancer. In the past year, she's had chemo ( cisplatin and carboplatin), lung resection (lower 2 lobes removed) and 6 weeks of radiation (no concurrent chemo).
Radiation ended last week...several continuing problems :
1. off and on severe fatigue
2. shortness of breath
3. persistent dry cough
4. level 5 pain...in the area of the remaining lung lobe, in the area below her breast where the drainage tubes were placed. Pain meds (hydrocodone, lidocaine patches ) provide some relief.
5. she wakes each morning in pain, but as the day progresses, the pain eases somewhat.
Two questions:
1. Is all of this "normal" , given what's occurred so far?
2. given her cough, lung pain is pneumonitis a likelihood?
Thanks for any help .
Reply # - March 9, 2015, 12:34 PM
Patrick, I’m so sorry your
Patrick, I’m so sorry your wife is having such bad problems.
Radiation pneumonitis usually happens 6-24 weeks after radiation is completed. Though as Dr. Mehta stated below cough and shortness of breath usually resolve a week or so after radiation treatment is over.
Since there are other reasons for these symptoms and she doesn’t have her pain under control a call into her oncologist is in order to let them know what’s happening. If you wife is in pain with the current pain management regime then it’s safe to say she should be reevaluated for an updated plan.
Dr. Mehta had this to say about pneumonitis, “Pneumonitis is one of the risk factors associated with radiation treatment to the lung. Radiation pneumonitis is an inflammatory reaction that resembles a pneumonia that typically occurs in patients 6-24 weeks after they have completed radiation treatment. The symptoms of radiation pneumonitis are often similar to the symptoms one experiences when one has a pneumonia or the bad flu. Patients can complain of a cough, shortness of breath, or even chest fullness. Most patients who develop these symptoms after radiation report that the symptoms resolve by themselves in 7-10 days. A few of the patients have really severe symptoms and come in to be evaluated by a physician. If the diagnosis of radiation pneumonitis is made, then patients can be treated quite effectively with a short course of steroids.” http://cancergrace.org/radiation/2008/08/11/pneumonitis/
I hope this helps,
Janine
Reply # - March 9, 2015, 12:45 PM
I wanted to add a couple of
I wanted to add a couple of links on the pain management. It's important to stay ahead of the pain and nerve specific pain can be difficult to treat. My husband still has nerve pain that travels from incision site to chest tubes site. Drugs like lyrica can be very helpful.
http://cancergrace.org/cancer-treatments/2012/07/28/dr-harman-on-cancer…
and this discussion thread, http://cancergrace.org/forums/index.php?topic=8202.0
Reply # - March 10, 2015, 03:13 PM
Thanks for your replies and
Thanks for your replies and the links.
So, we went to the hospital yesterday because of my wife's very severe pain in several sites. A CT was done and it showed no indication of pneumonitis. However, fluid was present in that remaining upper lobe (or in the chest region...I don't know which). Recommended treatment was to draw off some of the fluid by needle. The procedure failed to produce any fluid and also caused a pneumothorax.
Next recommended procedure was to re-inflate that lobe and also to try again to draw fluid. 150 ml. of fluid were drawn (that's not much, is it?) and my wife was admitted to the hospital.
Now, we're almost back to where we were 72 hours ago...pain continues, although less severe and shortness of breath continues.
Finally, here are my questions/comments...
1. from what I've read, shortness of breath is a "normal' consequence of lobectomy and radiation. However, is it "permanent" and/or is it likely to improve at all?
2. again, from your links and others, I understand that pain in these cases is very complicated. However, is this good day/terrible day effect "normal"? And, is the pain likely to be permanent?
Complicating all of this is the fact that my wife had been a very active, healthy 69 y/o woman. She's never been seriously ill and never experienced serious pain. So, all of this is new territory for her. she's never experienced any of it and is having difficulty adjusting to it and accepting it.
thanks very much.
Reply # - March 11, 2015, 10:56 AM
Patrick,
Patrick,
An MD will comment within a day.
Until then I can give you a caregiver/expert layman’s :) understanding. Yes the shortness of breath can definitely improve. With everything she's gone through it's very reasonable for her to be in a lot of discomfort and nothing she’s feeling should be discounted. Whether the pain and anxiety are new to her or not this is an awful disease. A thoracotomy is considered by many surgeons to be one if not the most difficult surgery from which to recover. I hope that doesn't sound too harsh. It's just a lot of new, complicated and important info for you both.
Too a pleural effusion causes chest pain and shortness of breath, and so does a collapsed lung (pneumothorax). But you should both expect a lot if not all but complete recovery from all this (preparing for the worst is implied by your questions and hoping for the best seems to be innate in us all). Of course the exception is she won't get back complete lung function. There’s both physiotherapy and even CF type therapies if needed. For now she's probably got a spirometer in her room. It's a good exercise that a nurse or respiratory therapist can help with a schedule best for her individual needs. Many get nebulizer treatments while in the hospital that are helpful.
Most of what you've described could be my husband over 5 years ago. The exception being his thoracotomy was for a biopsy not resection. All these setbacks are an awful strain on the body. One of his saving graces was the fact that he was in excellent condition before the cancer wrecked his shoulder, plus everything else. Surprisingly it's very common for people who are diagnosed with late stage lung cancer to be very healthy. It’s a big step ahead to be in excellent shape without co-complications (comorbidities).
I'm really thankful for hope, there seems to be no getting around it, Simon implied.
You're a good mate,
Janine
Reply # - March 11, 2015, 11:01 AM
Patrick1945,
Patrick1945,
The treatment that you describe is not the typical course for limited stage SCLC. Therre are likely good reasons for that, but you might also consider getting a second opinion from a surgeon and medical oncologist specialized in lung cancer.
There are MANY reasons for chest pain after sugery and radiation. Postoperative pain is perhaps most likely, but the tyipcal workup will also make sure that there is no heart attack, blood clot in the lungs (pulmonary embolus) or other severe problems.
The typical treatment of pneumothorax is a chest tube.
There are many medicines that can help quel cough. Guaifenasin, dextomethorphan and codeine are the most commonly used and I defer to your wife's doctors on which (or others) are best for her.
Shortness of breath is very, very common after lung surgery and after lung radiation. After all, in addition to cutting out/killing cancer, the treatments also remove/damage normal lung. For most patients, there is some improvement with time and re-conditioning (getting in shape, to the extent possible) but typically not recovery to the same breathing status as prior to treatment.