Managing the Respiratory Complications of Cancer

Other lung conditions found in oncology patients

Cancer patients may develop different types of pneumonia, including bronchiolitis obliterans with organizing pneumonia (BOOP), an inflammation of the small airways and surrounding tissue. It’s idiopathic but results from the formation of granular tissue in the alveoli.

“We need to be aware and recognize it, because patients can rapidly progress to respiratory failure and the need for ventilation,” Ms Rummel reported, adding that symptoms are nonspecific and include cough and dyspnea. Providers will likely order corticosteroids to manage BOOP.

Pulmonary edema also may result from leakage of fluid from the pulmonary capillaries, decreased plasma oncotic pressure and increased capillary pressure brought on by cancer treatment—chemotherapy, radiation, and the biologic agent IL-2. Patients receiving a bone marrow transplant are at 2 to 3 times greater risk than other patients.

Patients present with a hacking cough, dyspnea, anxiety, and feelings of impending doom. They become hypoxic and tachypneic as the condition escalates.

“The goal is to decrease pulmonary venous and capillary pressure, improve cardiac output, and correct the underlying pathology,” Ms Epting advised. Patients may receive loop or thiazide diuretics, vasodilators, morphine, aminophylline for wheezing and dysrhyhmia control with digitalis when stable.

Pulmonary embolism is another lung complication that occurs in oncology patients. A clot occludes the pulmonary vasculature and leads to infarction of the lung tissue.

“A pulmonary embolism can appear out nowhere,” Ms Epting warned. “Watch and be alert.”

Symptoms include chest pain, breathlessness, hemoptysis, pleuritic pain, syncope, anxiety, tachycardia, and tachypnea. If the embolus is large, it can cause the lung to collapse and lead to congestive heart failure.

“Always consider pulmonary embolism in cancer patients,” Ms Epting said. “They are rapidly fatal, but treatable, if you are there and able to help the patient.”

Treatment involves anticoagulation, oxygen, volume or pressor support, a vena cava filter, and pulmonary embolectomy.

Malignant pleural effusions are very common and one of the most distressing symptoms related to advanced cancer, reported Beth McCraw, ARNP, ACNS-BC, OCN, adult clinical nurse specialist at the Jennie Stuart Medical Center in Hopkinsville, Kentucky. “They can affect life span and quality of life.”

Tumors can obstruct the lymphatic vessels or lymph nodes, perforate the thoracic duct, infiltrate the pleura or obstruct the pulmonary veins. Lung and breast cancers account for 75% of the malignant pleural effusions, followed by lymphoma.

A pleural effusion is associated with advanced disease and, when present at diagnosis, a 12-week life expectancy. Patients present with dyspnea, fatigue, chest pain, and a dry, nonproductive cough.

Management may include chemotherapy, radiation, thoracentesis, thoracoscopy with pleurodesis, a pleuroperitoneal shunt, a pleurectomy, or an indwelling Pleurx pleural catheter. Patients drain fluid from the catheter daily during the first week, every other day during the second week, and then as needed.

“The catheter comes in contact with more pleural space than stiffer catheters; therefore, it tends to find the fluid better,” Ms McCraw said. “Usually, the patient has rapid symptom relief.”

Cancer patients also may experience a pneumothorax, resulting from the treatment or the disease. Treatment depends on the size of the collapse and may include supplemental oxygen if less than 15% or chest tube if it is greater than 15%.

Patients also may develop adult respiratory distress syndrome and present with rapid, shallow breathing; respiratory alkalosis; dyspnea; and hypoxemia. Treatment is supportive and includes oxygen at the lowest possible level, intubation, and mechanical ventilation. Prone positioning, if started early, may help, reported Ms McCraw.