By M. Ellen Mahoney, M.D., F.A.C.S.

A diagnosis of lung cancer is a devastating challenge for family and friends as well as for the person diagnosed. An estimated 200,000 persons per year in the U.S. are told that they have lung cancer.  If your loved one has recently been diagnosed with lung cancer, you’re facing many questions about his/her upcoming personal battle. 

As the caregiver, you can begin getting answers by learning more about lung cancer from the many resources available to help you. As you learn more, you will be better able to formulate the questions to ask your loved one’s physicians so that you can plan the best medical strategy and the best methods for support of your family and friends.

Dealing with the News               

Early lung cancer may not cause symptoms, and even when symptoms occur they may be attributed to more common respiratory conditions. When the diagnosis of lung cancer is made, your loved one will likely be shocked and then overwhelmed with feelings of anger, depression, and confusion, among others. He/she will worry about the future from a physical, emotional, and financial standpoint—both personally and in regard to his/her family.

As the caregiver, you can provide needed love and support in several ways starting with learning as much as possible about the disease.  The National Cancer Institute has a comprehensive set of information services available at and through their Cancer Information Service.  They can send you printed material and are also available by phone at 1-800-4-CANCER (800-422-6237). In addition, their Website has a link to an instant messaging system so you can ask questions. This resource can give you information about the disease in general, as well as helping with individualizing it so you know what applies to your own situation. It has examples of questions you may want to ask your doctor at each stage of diagnosis and treatment.

Websites such as National Institutes of Health and the American Cancer Society, also provide useful information to better prepare you and your loved one to ask the doctor about prognosis and treatment.

Here are some facts to help you understand Lung Cancer:

• There are two major types of lung cancer: small cell and non-small-cell. Non-small cell lung cancer grows more slowly than small cell cancer, and represents about 85% of all lung cancer.
• These two types are thought to have different causes and treatments.
• Besides the type of cell involved, your doctor needs to know the extent of the disease, also known as “staging.” Staging involves testing to investigate whether the cancer has spread outside the lung.
• Unless the cancer is confined to the lung, and can be surgically removed, lung cancer is hard to control with current treatments.  It is sometimes possible to shrink the cancer with chemotherapy and radiation to make it accessible to surgery for cure.
• If the cancer cannot be removed surgically, ask your doctor about clinical trials that offer hope of new therapies against this disease. Clinical trials are the way progress is made in medicine.

Speaking to the Doctor about Caring for Someone with Lung Cancer

Talk to your loved one’s doctor to get as many answers about his/her condition as possible. You’ll find the prognosis depends on several key factors including the type of lung cancer, how early it’s detected, his/her overall health status and age, as well as the treatment plan.

Your doctor will plan the course of treatment based on the type and stage of the cancer. Surgery, chemotherapy and radiation each have different side effects you will learn about. Throughout treatment your loved one may experience a loss of appetite, fatigue, weakness, and a compromised immune system at various times, depending on the type of therapy being used. As his/her caregiver, it’s important to:

• Prevent exposure to other family members suffering from colds or the flu
• Keep water at his/her bedside to encourage fluid intake
• Encourage a healthy diet and serve small meals
• Avoid serving uncooked foods such as seafood, fish, and “rare” meat

Maintaining a Healthy Environment

Your loved one may experience wheezing or other breathing difficulties related to the lung cancer. If you’re caring for your loved one at home, maintain a healthy living environment by:

• Not permitting smoking in the house
• Deferring indoor household projects that cause excessive dust
• Changing air filters in your heating and cooling system on a regular basis
• Minimizing the need to climb stairs—if possible, create a first floor “bedroom” for your loved one

A healthy environment also means providing emotional support. Encourage your doctors to maintain open and honest communication about the proposed treatment, the pros and cons of the choices, the alternatives and the chances of success. Your loved one may need help assessing the value of the proposed treatments, making decisions that are right for him/her, and communicating their values and wishes to the doctor.

Depression, Guilt, Remorse: Managing Feelings

As a person with lung cancer, your loved one may experience depression and a strong sense of loss. At times your loved one may not appreciate your support. He/she may get angry and say inappropriate, uncaring words. If he/she was a smoker, guilt and remorse may also be experienced. Remember your loved one needs time to come to terms with the disease and to fight for recovery.  Here are some ways you can assist:

• Encourage discussion about his/her feelings—don’t keep emotions bottled-up
• Be honest about his/her condition—be sensitive, yet forthright so not to create false optimism
• Promote the idea of keeping a journal about his/her experience—consider doing this together 
• Maintain a day planner to track doctor appointments, therapy treatments, medications—share this information with the doctor during each visit 
• Help your loved one prepare a document called a “Medical Power of Attorney” so that it is clear who makes decisions if he or she is temporarily unable to do so. And while you’re at it, prepare one for yourself! The document itself is important, but so is the discussion about values, wishes and preferences for care.

Getting Support

Cancer affects the entire family.  You and your family will need help coming to terms with the fact that your loved one has lung cancer. Depending on where you and your family derive strength, you can reach out to support groups and faith-based organizations—both for you and your loved one. If the cancer has spread outside the lungs, ask your doctor about referral to palliative care specialists so that symptoms can be controlled most effectively. These organizations also often have education and support services for family and friends.

And, don’t forget to take care of yourself and ask for help.  Acknowledge your feelings. Give yourself time to accept the diagnosis. Ask others for help in understanding and assisting, when possible, with any new responsibilities.  Try not to do everything at once. As difficult as it may seem, try to live day by day and not be overwhelmed by the future. These difficult situations seem unbearable at times, but they also hold the promise of healing and nurturing families and individuals who face this challenge together.