When treatment for lung cancer has failed to stop advancement of the disease, a few main symptoms are of most concern. Pain at the primary cancer site and in any place where it has spread is the first symptom that needs the attention of the treating health care providers and family members. Adequate pain management can usually be achieved with most kinds of cancer, and this becomes more important as death approaches. The second symptom of primary concern is shortness of breath, or “dyspnea.” Dyspnea occurs as lung function further deteriorates due to the effects of cancer. Feelings of breathlessness and the coughing that happens with it can be helped with opioid pain medications and supplemental oxygen, and these are often provided in hospice care.
In the early stages, increased time spent in bed sleeping, the development of delirium (a kind of acute confusion) and the inability or loss of interest in eating or drinking are common features. As the process continues, consciousness decreases and the dying person becomes increasingly hard to wake up or may appear to be in a stupor. During this time, it is still important to treat pain and anxiety in the dying person as he or she may have moments of wakefulness and be aware of imminent death.