Cancer patients often have comorbid medical problems in addition to their underlying malignant disorders. In fact, patients older than 65 years bear a disproportionate burden of cancer as well as increased prevalence of medical problems such as chronic obstructive pulmonary disease, heart disease, diabetes, and hypertension. Whether patients are seen in primary care or cancer care settings, unexplained symptoms often frustrate physicians and patients. Because many advanced cancers spread to the thorax, symptoms such as dyspnea, cough, chest pain, or palpitations often present a challenge in sorting out the likely cause of the problem and developing appropriate interventions. Evidence-based recommendations have been published describing various approaches to the problems of cancer-related fatigue, anorexia, depression, and dyspnea. Cancer patients are often also at higher risk for pulmonary infections.
Clinicians caring for cancer patients should be familiar with the assessment and treatment of common conditions that manifest as chest symptoms. In addition, these clinicians need to be familiar with some cancer-specific aspects of chest symptoms and syndromes. Dyspnea is a common symptom of certain cancers such as lung cancer and is also common in patients with numerous advanced cancers. It is often multifactorial. Optimal treatment requires an understanding of contributing etiologies and pathophysiologies to direct therapeutic interventions as clinically appropriate. Important cardiopulmonary syndromes include malignant pleural effusion, malignant pericardial effusion, superior vena cava syndrome, and lymphangitic carcinomatosis.
In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.References
- Yancik R, Ganz PA, Varricchio CG, et al.: Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. J Clin Oncol 19 (4): 1147-51, 2001. [PUBMED Abstract]
- Komaroff AL: Symptoms: in the head or in the brain? Ann Intern Med 134 (9 Pt 1): 783-5, 2001. [PUBMED Abstract]
- Dy SM, Lorenz KA, Naeim A, et al.: Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol 26 (23): 3886-95, 2008. [PUBMED Abstract]