PURPOSE: Care of advance lung cancer remains a clinical challenge. Most patients treated with high dose opiods for pain control, have adverse effect on their underlying COPD causing increasing dyspnea, fatigue and mental confusion. Alternative adjunctive medical therapy with better symptom control serves an important role in the palliative care of patients with advance end stage lung cancer.
METHODS: Patients with diagnosis of end stage primary lung cancer who failed to conventional treatment of chemotherapy and radiation therapy were considered in our study. For treatment of severe cancer related fatigue, American ginseng was given as 600mg twice daily. Morphine sulfate 2mg was used as nebulizer for control of severe dyspnea and pain. Licorice root powder 600 mg was used 2–3 times for control of severe coughing spells. BIPAP was required for respiratory depression related to IV morphine. Two patients were taking oldenlandia 600mg twice daily, a Chinese herb for lung cancer.
RESULTS: BIPAP was well tolerated in 11/15 patients, while 4 refused. Licorice was an effective therapy in 9/15 patients for severe coughing spells and bronchospasm. It helped control recurrent hemoptysis in one patient. Morphine used as nebulizer in two patients was effective in control of marked dyspnea and pain. Ginseng improved symptoms of fatigue in 8/15. Oldenlandia used in two patients , one reported decrease use of opiods. One patient lived 4 months on supportive therapy, others 6–12 weeks.
CONCLUSION: Morphine sulfate given as nebulizer is effective in the control of dyspnea due to presence of presumed opiods bronchial receptors with less depressing of central respiratory drive and without mental confusion. American ginseng improves symptoms of fatigue in severe COPD with better exercise tolerance and ambulation. Licorice is an effective cough suppresant and helpful in cases of hemoptysis. Oldenlandia decreased the need for opiods use.
CLINICAL IMPLICATIONS: A combined modality treatment consisting of BIPAP, use of herbal medicines and morphine sulfate as nebulizer resulted in better symptom control thus improving general quality of life in patients with advanced lung cancer.
DISCLOSURE: Hassan Amjad, No Financial Disclosure Information; No Product/Research Disclosure Information