Having treatment for non-small-cell lung cancer (NSCLC), the most common type of lung cancer, can be complicated. While the treatment may address the cancer itself, it may leave out other physical, emotional, and spiritual needs. That's why people with NSCLC at all stages may benefit from palliative care.
Palliative care is a broad range of services aimed at relieving pain, easing stress, and other services that can improve your quality of life. It can be delivered during cancer treatment or at any stage of the disease. Research shows it can improve outcomes such as health care delivery, quality of life, and use of hospice.
The services can include medical care such as nutritional counseling and procedures to open airways. It can go beyond caring for your body to include mental health counseling or massage.
Palliative care is used at any phase of your illness. It's not the same as hospice care, which is only for the end of life.
"If patients think about palliative care, they might think about death and dying. But, really, palliative care is for living," says Toby Campbell, MD, a thoracic medical oncologist at the University of Wisconsin School of Medicine and Public Health in Madison. "Our job is to help people find ways to live well. Our whole focus is on the living part of the equation, not the dying part, so people might be surprised that we ask so many questions about living."
Understanding Late-Stage Lung Cancer
Late-stage NSCLC is cancer that has spread to certain lymph nodes or to other parts of your body. It includes stages III and IV cancers – specifically stage IIIB to stage IVB. From 2018 to 2022, about 44% of all lung cancers were diagnosed in the late stage, according to the CDC.
During late-stage cancers, it's usually not possible to remove all of the cancer. Instead, you'll likely focus on managing symptoms. The latter stages may present different challenges than earlier stages of the disease.
"Symptoms in late-stage cancer are more burdensome," Campbell said, adding that there may be more symptoms at the same time, or they may be more severe.
Whether you or a loved one has adenocarcinoma, large-cell carcinoma, or squamous cell carcinoma – all are the main types of NSCLC – palliative care may be able to improve quality of life.
How Can Palliative Care Help With Late-Stage NSCLC?
Palliative care can be especially helpful during late-stage NSCLC. Your palliative care team will partner with your existing care team including your doctor. These support services can manage symptoms, help you communicate, help you navigate the health system, and so much more.
The palliative care health professional may ask about what's important to you, what you hope for in the future, or what you're worried about, Campbell explains. "It is in the exploration of hopes and worries that we identify goals and objectives and crucial information about values that lets us help them navigate other big decisions," he says.
The goal is to meet people where they are, so visits may be with a wide range of health professionals, Campbell notes.
"We try to provide just what the patient needs, when they need it, rather than a one-sized approach. It is personalized medicine but for the patient, their family, and their life, rather than for the cancer in a molecular way," says Campbell.
Types of Palliative Care for Lung Cancer
Palliative care services often used among those with NSCLC include:
- Medical procedures to open airways
- Medications to treat pain
- Medications to suppress a cough, open closed airways, and improve breathing
- Extra oxygen in portable tanks
- Medications to increase appetite
- Emotional support and mental health counseling
- Nutritional supplements to reduce weight loss
- Medications to lower nausea
- Massage and mindfulness
- Help with insurance, workplace challenges, and financial hardship
Who Provides Palliative Care?
Palliative care can be delivered by a wide range of health care professionals, including:
- Doctors
- Nurses
- Social workers
- Primary care teams
- Occupational therapists
- Physical therapists
- Spiritual counselors
- Psychologists and therapists
- Nutritionists and dietitians
- Speech-language pathologists
- Pharmacists
Customizing Palliative Care for You
Palliative care needs may depend on the type of treatment you have. Those using newer therapies, like immunotherapy or targeted therapies, may have different needs. For instance, issues with mental skills can affect people on immunotherapies. Some people on the newer therapies may have a better response rate and fewer side effects, compared with people on traditional chemotherapy, and as a result have other needs, according to a 2022 report in Journal of Clinical Oncology.
It can be difficult for doctors to give a prognosis, especially for those using newer therapeutics such as immunotherapy, as people may live longer. Because people are living longer, palliative care can also be used for survivorship needs, which widens the breadth and length of services that may be used, according to authors of the report.
Another challenge of palliative care is that resources can be limited and people with lung cancer are living longer, so more people may use it and stress the system. That said, palliative care is linked with longer survival in people with NSCLC.
Palliative Care: Access and Timing
Some barriers to palliative care exist. According to a 2020 report in Annals of Palliative Medicine, some people with lung cancer may not understand the role of palliative care. On the flip side, doctors may not refer them for palliative care services because they have concerns about the services interrupting medical care, the authors wrote.
Many people with lung cancer aren't referred for palliative care until later in their disease, or not at all, even though the benefits of using palliative care early on are well documented, authors of a 2024 study in Journal of Pain and Symptom Management reported.
When people were referred soon after their diagnosis, they had longer times in hospice, less frequent aggressive care at the end of their lives, and lower rates of dying in a hospital, the study showed.
Palliative care should be started within eight weeks of diagnosis, according to a report in the ASCO Educational Book.
Palliative care may be more accessible when it can be delivered remotely, if needed. When researchers compared results from people seeking palliative care remotely and in-person, both forms were effective, a 2024 study in The Journal of the American Medical Association found.
There's a lot to deal with physically, emotionally, and spiritually if you or a loved one is facing late-stage NSCLC. At the same time that the patient is getting treatment, they (and those around them) may be coming to terms with concepts of life and death, which can be difficult.
Palliative care can ease the burden on patients and their loved ones, offering the support needed to address everything they need.
Show Sources
Photo Credit: Pornpak Khunatorn/Getty Images
SOURCES:
Toby Campbell, MD, thoracic medical oncologist, University of Wisconsin School of Medicine and Public Health.
American Thoracic Society: "Treatment of Advanced-Stage Non-Small Cell Lung Cancer."
Cleveland Clinic: "Non-Small Cell Lung Cancer."
National Cancer Institute: "Late-stage cancer."
CDC: "U.S. Cancer Statistics Lung Cancer Stat Bite."
American Lung Association: "Supportive (Palliative) Care for Lung Cancer," "Palliative Care and Lung Cancer: Getting the Support You Need."
Yale Medicine: "Dyspnea with Advanced Cancers."
LUNGevity: "Palliative Care 101 – Improving Quality of Life While in Treatment," "What to Ask Your Doctor."
Lung Cancer Research Foundation: "What is palliative care?"
Journal of Clinical Oncology: "Patient-Centered Palliative Care for Patients With Advanced Lung Cancer."
Journal of Pain and Symptom Management: "Timing of Palliative Care Consultation Impacts End of Life Care Outcomes in Metastatic Non-Small Cell Lung Cancer."
Annals of Palliative Medicine: "Medical oncologist perspectives on palliative care reveal physician-centered barriers to early integration."
Cancer Medicine: "Psychosocial Issues and Experiences of Advanced Stage Lung Cancer Patients Receiving Palliative Care: A Qualitative Study."
ASCO Educational Book: "Supportive Care in Lung Cancer: Improving Value in the Era of Modern Therapies."
JAMA Oncology: "Association of Early Palliative Care Use With Survival and Place of Death Among Patients With Advanced Lung Cancer Receiving Care in the Veterans Health Administration."
JAMA Network: "Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer."
