Symptom Management In Patients With Lung Cancer: Diagnosis And Management Of Lung Cancer
Publication Date: November 1, 2013
Last Updated: March 14, 2022
Recommendations
Pain Control
In patients with lung cancer who experience chronic pain, it is suggested that thorough assessment of the patient and his or her pain should be performed. (2, C)
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In patients with lung cancer who experience chronic pain, the use of the WHO analgesic ladder to plan treatment is suggested. (2, C)
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In patients with lung cancer who are being treated at all stages of the WHO analgesic ladder, it is recommended that acetaminophen and/or a NSAID be prescribed unless contraindicated. (1, A)
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In lung cancer patients with chronic pain who are taking NSAIDs and who are at high risk of gastrointestinal bleeding it is recommended that they take either misoprostol 800 mcg/day, standard dose proton pump inhibitors, or doubledose histamine H2 antagonists. (1, A)
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In patients with chronic neuropathic pain due to cancer, treatment with an anticonvulsant (eg, pregabalin, gabapentin or carbamazepine) or a tricyclic antidepressant (eg, amitriptyline or imipramine) is recommended. (1, A)
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In patients with chronic pain due to lung cancer, the use of ketamine, lidocaine 5% plasters, and cannabinoids is not recommended. (1, A)
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In lung cancer patients with mild to moderate chronic pain (score 3-6 on a VAS or NRS), it is recommended that codeine or dihydrocodeine be added to acetaminophen and/or NSAID. (1, C)
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In lung cancer patients with severe chronic pain, oral morphine is recommended as first-line treatment. (1, C)
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In lung cancer patients with severe chronic pain, oxycodone or hydromorphone are recommended as alternatives when there are significant side effects or lack of efficacy with oral morphine. (1, A)
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In lung cancer patients with severe chronic pain due who are able to swallow, transdermal fentanyl is not recommended for firstline use. (1, C)
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In lung cancer patients with stable, severe, chronic cancer pain who have difficulty swallowing, nausea and vomiting, or other adverse effect from oral medications, transdermal fentanyl is recommended as an alternative to oral morphine. (1, B)
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In lung cancer patients with severe chronic pain, it is suggested that the prescription of methadone as an alternative to oral morphine be confined to a specialist in palliative care units with experience in methadone prescription, because of difficulties with dose prediction, adjustment, and drug accumulation. (2, C)
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In lung cancer patients with severe chronic cancer pain, treatment with systemic strong opioids is recommended. (1, C)
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In lung cancer patients with severe chronic cancer pain treated with systemic strong opioids who cannot swallow or who suffer excessive nausea and vomiting, the parenteral, transcutaneous or transmucosal route of administration is recommended.
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In the management of pain in lung cancer patients unable to take oral opioids, it is suggested that the subcutaneous route to administer continuous infusion of strong opioids, is equally effective as the intravenous route. (2, C)
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In lung cancer patients with severe chronic cancer pain treated with systemic strong opioids, dose titration using either immediate release or sustained release oral morphine is suggested. (2, B)
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In lung cancer patients with severe chronic cancer pain treated with systemic strong opioids who experience breakthrough pain, parenteral morphine or transmucosal fentanyl citrate are recommended. (1, B)
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Overview
Title
Symptom Management In Patients With Lung Cancer: Diagnosis And Management Of Lung Cancer
Authoring Organization
American College of Chest Physicians